[Closed] Mental health and police cells

It's a pretty bad situation for MH patients as there's still such a lack of awareness of the conditions.

When the ambulance service do the telephone triage of MH patients they're always asked questions about whether they're violent or whether they're armed and other such nonsense. All it serves to do is put the patient on the offensive before we even arrive as they often feel like they're being labelled as being mad and dangerous when they're most likely not.
Once the ambulances arrive, the lack of any training in dealing with MH patients is normally pretty clear by the way many people treat the patients. The same goes for the police.

My experience of dealing with MH patients is that 9 times out of 10 no-one really knows how to deal with them, what's the best way to treat them and where is the best place to refer or transport them to. Due to this no-one wants to get involved and no-one wants to take responsibility for the patient.

If you ever manage to get to a hospital with the patient, the nursing staff often have the same issues and the psych teams that are supposed to assess the patients either never bother turning up or come up with great excuses to not properly assess them.

It's shit but I can't see it changing any time soon.

the flipside of this being that hospitals are for physically ill people. in hospital we regularly look after people with mental health problems because the local mental health service and the police won't take them. the mental health services because they're physically impaired somehow - overdosed, drunk or that beautiful catchall - you can't exclude an organic cause. the police in part, and esp if any sedation's been given, won't take them as, they say, the person hasn't done anything wrong.

which is true unless they've been threatening other patients, destroying property or attacking the staff thus enabling that get out of jail free card that says you can do whatever you like in hospital and get away with it (which it has to be said is employed a lot more by the general public than people with mental health problems). the only exception I've seen with this is nutting a police officer and that multidisciplinary team exchange finished real quick.

sometimes, just when you're thinking what sort of folk must they have in the psychiatric services that they never have any beds, those very staff will come down and tell you. and it's then you realise then extent of the cracks into which vulnerable people can disappear.

it's a problem that encompasses all the services these people (and a range of other at risk groups) are like to come into contact with. suffice to say I've never seen all those groups sat down at a table and, even if they were and able to overcome their various perspectives (which sounds a but far fetched but I did a child protection thing not so long ago where this actually did happen) then any sensible suggestions are right up against management and that's where they'll end.

like everything else, follow the money. or lack of it.

I spend a deal of time with the police in connection with this sort of stuff and in the main they're great, realising for the most part that they're in no less an iniquitous position than we are. not only that we all know we'll be doing the same next week, the week after and the week after that and nothing changes.

It's buck passing from other services that are either understaffed, underfunded, both, or CBA...
Whichever way its shit..

Not in any way a dig at A&E etc. by the way, in case it read that way.

It's buck passing from other services that are either understaffed, underfunded, both, or CBA...
Whichever way its shit..

I think that your post sums it up perfectly 🙁

After understandable criticism of people with mental health problems being held for hours on end in police cells until someone can deal with them, we are explicitly instructed that a police station is not a place of safety as far as the MHA goes (this came out some years ago). So when we are turned away by A&E who can't take them or the Psychiatric Unit refuse to attend until 24 hours later, we have no choice but to break our own instructions.

Err but picking someone up on a 136 means taking them to a place of safety. Doesn't have to be the cells. The problem is, coppers don't want to spend the shift sitting in A&E with a psych patient all night. Which is fair enough. But be honest about it, eh?

Psych hospitals and police stations are places of safety (under the act). Not all A&E's are.

Most psych hospitals won't take someone off the street - needs to be a planned admission with community teams / police or via A&E. Do people think they can just rock up at a psych hospital and drop someone off? You'll usually find that most psych wards are full and any admissions are expected and planned.

1 in 4 people have some kind of mental health problem. You nick 4 people, chances are one of them will have some issues. It's not all about catching the robbers. It's about looking after people and keeping them as safe as you can.

We have one 136 bed for the entire county. When it's gone it's gone. Even if it's empty they wont take anyone who has drunk anything, taken anything, or is in anyway shouty or upset.

Neither custody or A&E are a suitable place to go with someone in crisis. There needs to be more resources. It would save money in the long term, because I am sure having two police officers sit with someone taking up an A&E bed or police cell isn't the cheap option.

Edit - in reply to the above. Officers will need to sit with the person even if they are in custody. And yes I do think there should be a facility to drop off someone who is ill to an appropriate hospital rather than lock them up.

Practically, in many places, it does mean the cells. Depends how many cops you've got on and what else is going on. They can't just be left to sit in the kitchen or the waiting room.

While the Act includes a police station in it's definition of a place of safety, subsequent Codes of Practice state that it should be used only on an exceptional basis. I would estimate that we have such a situation at least once a week, which is not exceptional by anyone's reckoning.

Yeah but it won't be the arresting officers that do that it will be up to the custody serg and, more than likely a civvie.

We're not talking about locking someone up, but keeping them safe for a period of time until they can get properly assessed, and a suitable plan for them formulated.

You nick 4 people, chances are one of them will have some issues.

Maybe statistically so, but not every person with some sort of mental health issue needs to be detained for their own or someone else's safety.

It's about looking after people and keeping them as safe as you can.

Quite, which is why neither cells or other parts of police stations are an appropriate place for them. Especially the ones who cannot take on board that they are not in any trouble despite being at the police station, and end up in an even worse emotional state than they were to start with.

As I said, busy Friday night is the inspector gonna let 2 bobbies sit in A&E all night babysitting, or lock them up and await a visit from the duty doc or AMHP? I'm not saying it's right... It's just the way it is.

I know. It's pretty crap though.

Yeah but it won't be the arresting officers that do that it will be up to the custody serg and, more than likely a civvie.

This is not the case in my force.

We're not talking about locking someone up, but keeping them safe for a period of time until they can get properly assessed, and a suitable plan for them formulated.

It takes hours to even get the crisis team to answer the phone.

But that's what the topic is about - people with MH issues in crisis that DO get locked up.

Maybe a cell isn't an appropriate place in your eyes, but they should sure as hell be safe? Regular checks, CCTV, food/water/warmth etc?

If not then where? (Anywhere but your station? 😉 )

If not then where? (Anywhere but your station?  )

An appropriate mental health facility?

Most A&E depts are fine with mental health patients and have on-call (and sometimes on-site) mental health professionals....

....the problems start when said mentally unwell person is either drunk or violent.

I've been working the police custody suites since 2005 determining whether people are fit to detain, fit for interview and screening for mental illness....no mental health practitioner i've ever spoken to has been willing to carry out a mental health assessment on someone who is drunk....and rightly so, the potential for misdiagnosis is huge.

This is why the bizarrely acting (and likely mentally ill person) is taken into custody, because they are steaming drunk and need to cool off before a proper assessment can be carried out....A&E would take them (and often do) but when someone is drunk, acting bizarrely and becoming unmanageable should they be in A&E disrupting everybody else's treatment?....this is when they end up in a cell, its not perfect but who is going to pay for a holding facility for people who are suspected of having some kind of acute mental illness episode until they are sober and can be assessed?....whose budget will that come out of?

Of course alcohol isnt always a factor, sometimes the mentally unwell person is sober but incredibly antisocial and a danger to other people....where do you place these guys and girls until they can be assessed?....in a bed next to your nearest and dearest, good luck with that.

Then there are those with no insight into their condition who resist help, again they are a problem in A&E where they can create havoc because they dont believe there is anything wrong with themselves....to stop them absconding and to get them in front of a mental health professional the custody suite comes into use again....not ideal but it does the job.

Mental health isnt glamorous so doesnt get the budget it needs, my university lecturer at St Georges in London said that 25% of those coming through A&E have mental health problems but the A&E budget for mental health is only 5%.

Timidwheeler....most mental health facilities wont take anyone who is intoxicated and sadly a huge percentage of those picked up by the police and sectioned for mental health reasons are also drunk.
I've pitched up at the local acute unit with a known patient who had a mental health history as long as your arm....the staff refused to even come outside and see him because he'd been drinking, it was all done through an intercom which was shameful it itself and their response was that he needed to go to A&E until he was sober....of course A&E arent happy to see said patient, he starts kicking off and ends up in custody....and so it goes on and on.

Okay, so if more money were available, what would be the answer? Some sort of secure custody/place of safety facility inside hospitals? A kind of mental health A&E? From my limited civilian understanding, it does seem weird that mental health issues are kind of a tag-on to both the criminal justice system and emergency health system when both would see a massive disproportionate number of people with mental health conditions. (And that's not a criticism of anyone working within those systems).

1 in 4 people have some kind of mental health problem

Its an odd patchwork service
I remeber having to take someone in off the streets at work who came in crying and asking for help
he had just been discharged and not given enough money to get the bus home and then sent on the free bus to town

NO amount of calls to the Mental health team - including one from the council adult protection officer got them to GAS or claim he was anything other than fit to be released.

Its a mess and we only moan when one of you **** up rather than sympathise with you for the shit you have to deal with

On that note thanks

The view from the other side of the cell door is that when I was arrested for my own safety I was detained at the police station rather than any medical facility. The police (who I usually detest) were brilliant, I have never eaten so many McDonald's and there were a changing guard outside to always chat to. Was a very very bizarre time but it was much better in the cells than in the hospital ward I ended up in.

The police treated me as an ill person and made sure I knew I wasn't in trouble, the hospital staff treated me like a criminal and a complete inconvenience.

Having worked in mental health for 6 happy years, there where 3 types, mad, sad or dangerous.

Mad ones where usually mixed up and could sometimes be talked to and problems explained, sad where just depressed or lonley,lost their jobs, money problems ,relationship problems etc, and dangerous, likely to go off like a dropped bottle of tizer, but usually just talking to them brought them down as did drugs legally prescribed.

The thing is mental health is always someone elses problem, where as if people are listened to and offered support they usually respond.

oh and use any communal shop or restraunt, any road or public transport, and youll see people obviously in need in mental health care,some get help and some dont until they just implode or explode.

But then where do they go for immediate help,only 2 places police or a and e.

Pik n Mix....good to hear that side of it, the police and the custody medics know that a cell isnt the best place when someone is having a mental health crisis and every effort is made to make the stay pleasant and we all go to great lengths to ensure the affected person doesnt feel like a criminal.

I know what you are saying about A&E, the reception the patient gets when i bring a mental health case into A&E would make me want to kick off too...far too many hospital staff see mental health cases as an inconvenience and dont make any kind of effort to hide their disdain for this type of illness.

konabunny - Member

Okay, so if more money were available, what would be the answer? Some sort of secure custody/place of safety facility inside hospitals? A kind of mental health A&E?

[professional hat on] Absolutely this. But at/on same site as the mental health unit rather than A&E. ^^

I have a good friend who is a police custody nurse and we often discuss this as TBF I think he gets dumped on with patients that are seen as too dangerous or drunk for the local mental health unit's Section 136/Place of Safety suite and go to custody instead.

Barriers to improvments are 1) money, 2) economies of scale and 3) the institutional intolerance, in fact horror on the part of middle managers that there might be some times of the day where people run out of things to do and just sit there waiting for a call/admission.

1) [i][b]Money[/b][/i]: space, setup costs and ease/guarantee of access. The care quality commission and mental health act commission's standards for that sort of place, and the impact it (or rather its patients, the chaos/disturbance than can come with them and the needs they pace on the staff) have on the other patients already properly admitted to mental health units are understandably high. Given the size and layout of mental health units it is often a huge undertaking to provide a Place Of Safety Suite. There is also an ongoing debate about how to staff it and with what type/grade of staff. In an ideal world I would say Band 6 Mental health nurse plus helpers of some description but realistically you are talking £120k just for a b6 nurse 24/7. Unless they are shared with another service in the same building, which brings me to...

2) [i][b]Economies of scale[/b][/i]. Most mental health units are reducing their bed numbers and consequently their overall staffing numbers, and going, going gone are the days of massive hospitals or units with loads of wards all of whom could send a pager-equipped member of staff to assist with emergencies and so when the alarms went off on a general adult mental health unit, you would have 6 extra people to help. (secure units and hospitals have far better responses to emergencies but are also not often on same site or indeed run by same hospital trusts/companies as general adult acute units where 136 suites are the most usefully placed) Obviously if you had one switched on member of staff at all times in your POS suite who had access (reasonably within 30 seconds of pressing alarm) to a few extra staff who were [i]guaranteed[/i] to be available (much like you do in a police custody suite but for diferent resaons!). But to be abe to guarantee this, you need to have a large enough body of staff to draw from (if your response team is 4 people but there are only 8 on duty in the whole 2-ward unit then you are pretty much bound to get a situation where everyone has their hands full with one crisis or another and one person turns up to help when the alarms go off. But this brings me to:

3) [b][i]Middle management are horrified by the notion that you might not always be busy or indeed just be sat on your arse waiting for something to happen[/b][/i]. I order to guarantee a timely response to any emergency you need to accept that your expert staff may at times run out of things to do, and have to sit around just waiting for the call. Middle managment (and some posters on here, given some of the comments I read on fire/ambulance service threads) cannot cope with this sacrifice of overall productivity versus the ability to respond properly, expertly and immediately when needed ...but the more you spread your staff between different roles at the same time (general ward staff, unit co-ordinator, emergency response person, Place Of Safety/Sec 136 Person) the greater the chance of something terrible happening because everyone was too tied up in their other role to be able to deal with the emergency. In our local POS suite the permanent member of staff (not a qualified mental health nurse BTW) is usually called to help out on the wards if there is no one in on a 136 because the wards are so horrendously busy. That being so, what happens when it all kicks off in the POS suite: what chance have the wards of helping out there and what compromises do they make to the care and safety of the inpatients on the ward in order to attend an emergency elsewhere in the unit?

Julianwilson: thank you for that informative and slightly sad post.

Are there countries that get it right?

No real point to make other than I think awareness of this problem needs to be raised, this has been a problem for years.

Thanks for raising awareness. Now what?