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Mental Health (Police Procedures)

Volume 571: debated on Thursday 28 November 2013

Motion made, and Question proposed, That the sitting be now adjourned.—(Anne Milton.)

I look forward to this debate under your excellent chairmanship, Mr Brady. I thank the Backbench Business Committee for finding the time for this debate on a most important subject and I am pleased to see the interest, that the turnout here today shows.

The poor quality of life and of the services available to people struggling to live with mental ill health has been the subject of previous debates in the House. This debate relates to police involvement with people with mental ill health, particularly during times of mental health crisis. Mental health crisis, as defined by the Royal College of Psychiatrists, is

“when the mind is at melting point”.

It may involve an immediate risk of self-harm or suicide, extreme anxiety, panic attacks or a psychotic episode. How we treat the most vulnerable in society lies at the heart of our values. We made a decision not to hide away the sick and disabled, as we had hidden them away in the past in asylums and institutions, but we still have a long way to go in granting them equal status in society and equal access to justice.

The Mind report “At risk, yet dismissed” shows that those who suffer from mental ill health are three times more likely to be victims of crime. Shockingly, 50% of people with some form of mental ill health have experienced a crime in the past year, and severely ill women with mental ill health are 10 times more likely to have been assaulted. Crimes are less likely to be reported and prosecuted, because people with mental ill health fear being dismissed or disbelieved. Sadly, the evidence shows that more often than not they are. How does the Minister plan to improve police understanding of mental ill health and ensure more accurate recording of such crimes, and will he give a commitment to greater investigation and prosecution for such offences?

Another reason for not reporting is fear of police powers in relation to mental ill health. Too often, between 5 pm and 9 am during the week, at weekends and on bank holidays, police officers are the only first responders available in a mental health crisis, despite the fact that they lack the medical knowledge, skills and training to resolve and manage the crisis. They respond not because there is a real and immediate threat to members of the public, but because mental health services are understaffed, under-resourced and overstretched, and lack facilities.

For example, Miss P, who is 23 and a size 8, is a sweet, loving young girl who has suffered mental ill health for most of her life. She finds it difficult to build relationships and she is lousy at keeping appointments. She does not drink alcohol, except when she is in mental health crisis, and when she does, she turns into a violent and abusive person. Local mental health services concede that she needs a specialist placement, but they cannot find one. In the past five years, police have been called to 130 incidents and attended court to give evidence for 81 offences, resulting in 18 terms of imprisonment. The gaps between her prison sentences are becoming briefer—days, not weeks—and her self-harming and suicide attempts are escalating. The cost to that young girl, her family, the police, the courts, the probation service and the Prison Service is huge. I am told that it approaches £1 million, all for one young girl.

When the Minister sums up, I hope he will address this critical question: how much longer will we expect our police services to process vulnerable people through the criminal justice system due to mental health, underfunding and failures?

I congratulate my hon. Friend, the hon. Member for Halesowen and Rowley Regis (James Morris) and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate. My hon. Friend will be pleased to know that, as a result of the work done by her and others, the Select Committee on Home Affairs will be looking into this issue, with a possible report next summer.

Will my hon. Friend comment on the study by Nottingham university, published in May this year, which shows that 56% of custody officers suffer from depression and anxiety? It is not just the victims of crime, but the officers themselves. Is it not right that the new College of Policing should carefully consider the issue of training?

As always, my right hon. Friend makes excellent information available to the House. I am delighted to hear of the study to be made next year by his Committee, which is highly regarded across the House. He is right to focus on mental ill health among police. It is little surprise, given the amount and range of incidents with which we require them to deal. That is why we must ensure that the police are called to attend only incidents that they can deal with and that they have the skills and capability to manage, so they do not go home at the end of their shift feeling guilty and bereft about an incident that they may perceive they dealt with badly. My right hon. Friend made a most helpful intervention, and I thank him.

The Centre for Mental Health states that police are the first point of contact for a person in mental health crisis and that up to 15% of police incidents have a mental health dimension. Other people have told me that mental health interventions occupy up to 30% of police time. The Royal College of Psychiatrists recognises that in some areas police cells are the routine place of safety, under section 136 of the Mental Health Act 1983, when a mental health crisis requires urgent assessment and management. Many of those detained come from socially deprived backgrounds, and some black and minority ethnic groups are over-represented.

The Royal College reports considerable geographic variation in the use of police cells. During 2012-13, five police areas recorded more than 500 uses of police-based section 136 places of safety, while four areas recorded 10 or fewer uses, and one had zero. The difference was that the latter areas had better health-based services and facilities. Will the Minister undertake to talk with the Department of Health about the urgent need for commissioning boards to provide an adequate number of staffed health-based places of safety in every part of the country? At present, 36% of all places of safety under section 136 are thought to involve police custody. In 2011-12, an estimated 8,000 to 11,000 orders were made, with 347 involving under-18s. Will the Minister ensure that accurate figures on how often and in what circumstances police officers are called to deal with mental health crises are available, so that we can get a clear picture of the problem?

People held by police under section 136 are, as I have said, the most acutely vulnerable. One study found that in 81% of cases involving police-based places of safety, the person was self-harming or suicidal. The Independent Police Complaints Commission found that 35% of deaths in police custody involve people with mental ill health. Alarming reports from Inquest show that a number of those deaths are linked to police restraint techniques, and that 65 people took their lives within two days of leaving a police place of safety. Between 20% and 30% of people held on section 136 detentions in police cells were subsequently sectioned.

The impact on time and costs associated with police engagement in mental ill health has never been calculated accurately, but it is clear that, in a variety of ways, health service costs are being passed to the police services. It is common for police officers taking people in mental health crisis to accident and emergency or medical-based places of safety for an assessment to be told, “There’s no bed available”, “The person is too drunk”, “They are under the influence of drugs”, “They are aggressive”, “They are a child”, or, “They have a learning disability”, all of which condemn that person in crisis to a night in police custody. How much longer can we allow these informal exclusion criteria around drugs, alcohol, aggression, children and learning disabilities to continue?

My hon. Friend is making all the points that are in my notes—although I was intending not to speak in the debate, but merely to intervene. That is exactly what local police officers have said to me. They feel uncomfortable about the police having to perform that role and becoming the place of safety of last resort. Several parents of adult sons who can be difficult and dangerous have come to me. They are reluctant to call for help when they feel that they are under threat or that their son may threaten other people, because they do not want them to be in the police system—they do not want to criminalise them— but they know that there is nowhere else they can refer them to.

I thank my hon. Friend for her intervention. She makes an excellent case for ensuring that crisis intervention teams are available with the skills and capability to understand and manage mental health problems. These are not the skills that we provide our police officers with; this is the skills base that we provide our mental health nursing professionals with, which is why specialist crisis teams in mental health services must be expanded and made generally available.

Places of safety in bridewells remove police staff from the front line, as they supervise and monitor vulnerable, at-risk individuals and arrange mental health assessments. The Health and Social Care Information Centre found that, even where a place of safety was health based, in 74% of cases transportation was provided by police, not the ambulance service. The police were providing an ambulance/taxi service.

More than 40,500 patients absconded from mental health units in the past five years. Again, police officers are expected to find and return these individuals, even when they pose no risk to wider society. Then there are calls to respond to understaffed mental health units where a patient’s behaviour is deemed to be unmanageable. These are not tasks for police officers. To quote the Police Federation:

“Police officers should not be called to mental health premises to assist in the restraint of aggressive/violent patients. Mental health professionals are trained in the control and restraint of mentally ill patients and have powers to sedate them, whereas police officers are trained to subdue, restrain and arrest violent people.”

Inquest, Mind and others have highlighted the risks of police restraint, as opposed to mental health restraint techniques. I welcome the Royal College of Nursing study into restraint techniques. I also welcome the nine pilot street triage schemes operating across the 43 police forces where mental health nurses are either available with police officers responding or available to consult. The schemes are making a huge difference, but we cannot wait until 2015 for them to be assessed and reviewed before we put them in place across the public sphere.

We need suitably staffed hospital places of safety in all areas, catering for all age groups and available 24 hours a day, so that police stations are used only in exceptional circumstances. We also need section 136 to be used less by better, improved mental health services generally—however, I want to focus on removing the police from the equation. We need accurate data—a point I have already raised with the Minister—on the use of section 136 in the police service. The report from the independent commission on mental health and policing states:

“We need to ensure the culture within policing is one that recognises their role in supporting people in crisis and their responsibilities under the Mental Health Act.”

There needs to be a higher level of training and awareness for police officers. The online training that is currently available is just not good enough. Some forces have teamed up with community groups, local health trusts and universities, working with mental health patients, to improve their operation. Best practice from these groups needs to be shared and expanded.

The Association of Chief Police Officers lead on mental health says:

“There should be a reduction from 72 to 24 hour detention time…for a”

section 136

“assessment to take place when a police place of safety is utilised… 72 hours should remain for health based”

assessment. The 24-hour period would

“reflect the detention time limits in the Police and Criminal Evidence Act 1984…To support this, a statutory time limit for assessments to be undertaken by all health professionals”

for those

“in police custody should be put in place. The Pace clock should be stopped for 4 hours while assessments are carried out where there are criminal offences to be faced”,

so that police are not restricted in the time that they have to cross-examine someone. I am confident that I reflect the feeling in this Chamber and the wider House today. No one would be turned away from an A and E department if they had had a stroke or broken a limb, if they had had alcohol or were aggressive. We cannot let mental health services operate to different criteria.

I want briefly to focus on what is a growing area. We need to be sure that we have clear guidance and responses in place for the 800,000 people in the UK diagnosed with dementia. A 91-year-old man suffering with psychotic dementia was living at home with the support of his family and the mental health team. One evening, a neighbour called the family to say he was wandering the street looking for his wife, who had died six years previously. His son went immediately to his father and at around 9 pm called the out-of-hours health service for advice. The doctor took the details and asked whether the son wanted to bring his father to the hospital or whether he wanted the doctor to visit the house, but the son said, “No, it’s okay. I’m on top of things. Dad’s okay. I’ve given him a cup of tea and he’s heading for bed.” By 11.30 pm the gentleman was in bed, fast asleep and his son went home.

At 2.30 am, the family had another call from the neighbour, saying, “The police are breaking into your dad’s house.” Why? Because the out-of-hours doctor decided to watch his back and had sent an ambulance, but it did not arrive till three hours after he called it. The man was fast asleep and the ambulance crew felt they had to get a response, so they called out the police. The police climbed on to the ledge over the front door, looked in and saw the man in bed, fast asleep and said, “He’s fast asleep”. The ambulance crew said, “No, we must see him.” The police broke in, terrifying the man, who was greatly distressed—as can be imagined—so they took him to A and E, because they could not handle the situation. That is an appalling situation. The family tried ringing the ambulance service and the police, saying, “Leave him alone. He’s fine,” but they carried on. He was highly distressed when he got to the hospital, and thought he had done something wrong and felt that he was the criminal. This was an appalling case.

There are good ideas and good practice for when people are missing, for example, or have wandered, including using taxi drivers, Citizens Advice and neighbourhood watch to look out for individuals. Police officers need clear guidance on how not to exacerbate a situation by going in, in uniform, and frightening people who are wandering.

We have lost 15,000 police officers in the last three years. The police must prioritise tackling crime, ensuring public safety and upholding the law. It is not the task of police services to fill gaps in an overstretched mental health service. We need to consider how to respond to the most vulnerable in society. The police must build their partnerships with agencies and organisations best equipped to provide appropriate help and support. I look forward to colleagues’ contributions to the debate, to the Minister’s and the shadow Minister’s responses, and to improved quality of services for those in mental health crisis.

It is a great pleasure to speak in this important debate under your chairmanship, Mr Brady.

I thank the Backbench Business Committee, the hon. Member for Bridgend (Mrs Moon) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). The three of us came together to secure this debate. I also speak in my capacity as chairman of the all-party group on mental health.

As the hon. Member for Bridgend said, the police are often on the front line in dealing with people who are suffering a mental health crisis. As she mentioned, it is estimated that up to 40% of police activity is related to mental health issues. In my region of the west midlands, West Midlands police estimates that 20% of all incidents that it deals with involve individuals with mental health problems.

Police officers are often asked to deal with complex and challenging situations on the ground. As the hon. Lady pointed out, they have specific powers under section 136 of the Mental Health Act 1983, and it might be worth dwelling on that section’s specific wording:

“If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.”

The latest figures show that some 21,814 people were detained using section 136 powers last year. As the Royal College of Psychiatrists has pointed out—the hon. Lady mentioned this—far too many of those individuals are still detained in police custody suites. The Royal College of Psychiatrists talks about 36% of those people being detained in police cells, which are essentially a proxy for a health care place of safety.

There were 15 deaths in police custody last year, of which seven could be attributed to, or were related to, specific mental health concerns. A number of the deaths followed the use of the police’s section 136 powers. A number of the deaths are currently being investigated.

Section 136 is part of the 1983 Act, which built on the Mental Health Act 1959. In 1959, there were still a considerable number of asylums in Britain; the whole complexion of our approach to mental health care was completely different from today’s. Thankfully, we do not have asylums and we are making huge efforts to treat people in appropriate settings and in the community.

The reason for section 136 is essentially to give the police powers when someone has absconded from an asylum-based setting. There is a strong argument, which I put to the Minister, that we should consider reviewing the section 136 power in the context of how we approach the treatment of crisis care in mental-health settings in the 21st century. I am not saying that the police should not have the power, in certain circumstances, to detain people, but we should have a full review of how that power is used.

The relationship raises a number of important issues, not just about how the police are using the power but about how they interact with the health service when dealing with people detained under section 136. As the hon. Lady said, we should work towards ensuring that places of safety are located in appropriate health care settings.

As the hon. Lady also said, we must ensure that the police have adequate training to deal with the often difficult and challenging situations that they face. However we reform the system, there will always be circumstances in which the police have to deal with people suffering from severe mental anguish and difficulty. The police need the appropriate intensive training necessary to deal with such difficult and challenging circumstances, but it is also true that other agencies and public bodies, such as the national health service and the ambulance service, have a responsibility to work with the police. We must ensure that all those agencies are working in alignment.

In the west midlands, for example, West Midlands police has developed a good working relationship with the West Midlands ambulance service such that, when West Midlands police is dealing with people suffering from severe mental issues under section 136, an ambulance, rather than a police car, should take that person to a place of safety, thereby not creating the context of criminalisation. There is a good working relationship in my area, but I know there are many examples across the country of where that is not the case and of where there are barriers that prevent such important co-ordinated working, which supports people who are suffering from severe mental health crisis.

Michael Brown is a particularly interesting police inspector in the west midlands; he tweets under the name MentalHealthCop. He has been writing on his award-winning blog about some of the police’s difficulties when interacting with the national health service and about some of the blockages in the system. As the hon. Lady pointed out, one of those difficulties is often the reluctance of local NHS staff, particularly in A and E, to play a role in the section 136 pathway, if I may use that phrase. Staff are reluctant to take responsibility, and there are often confused lines of responsibility between the police and the NHS about who will take responsibility for the care of an individual.

The hon. Lady alluded to the assumption in certain parts of the NHS that the most clinically complex patients, who are often suffering from a mental health problem related to the overuse of drugs and alcohol, should somehow be left in a police cell until they sober up or recover. That situation is not acceptable in any circumstances—no one suffering from a complex mental health condition should normally be placed in police cells.

Police cells are simply not the right environment for such people to end up in. I am not saying that there are no circumstances in which such a person should be held in police cells—there may be particular circumstances in which they should—but we should move to a situation in which we do not, in a civilised and compassionate society, house people in police cells when they are suffering some of the most desperate moments in their life.

Like the hon. Lady, I welcome the street triage pilots that the Government have been running across the country. Police and community psychiatric nurses are working together to resolve issues on the ground, and I look forward to the Minister’s view on how those pilots have been working and when we can expect a coherent evaluation of their success. We need to move quickly to roll out those pilots across the country.

There is a broader point on our approach to mental health crisis care in general. This is ongoing work about which many Members are concerned, but we must ensure that there is better integration between the health service, the police and local crisis care teams, often with the involvement of social services. I understand that the Government are working on a crisis care concordat, which will outline the roles and responsibilities of all agencies in relation to crisis care. One way of reducing the police’s use of section 136 is to ensure that we have a coherent and integrated approach to dealing with mental health crisis care in Britain. We need to tackle the problem head on. The Royal College of Psychiatrists has said that we

“need to focus on reducing the need for section 136 by ensuring that patients, their families have ready access to appropriate and timely crisis care.”

I want to dwell for a moment on the role of police and crime commissioners. Although they have come in for some criticism, some incredibly good work has been done on this issue by PCCs over the past few months. In Staffordshire, the PCC has been able to take a strategic view of the relationship between the police and local health services and has put in place processes to start tackling the problems.

We need suitably staffed hospital-based places of safety. That is an absolutely critical and crucial part of the picture. A police station should be used in exceptional circumstances only. I ask the Minister to consider reviewing the section 136 powers and updating the definition of an appropriate place of safety, which is set out in the 1983 Act.

I want to mention a particular case that is tangentially related to today’s debate and illustrates the importance of all agencies—police, probation, social services and prisons—in dealing with mental health. Members may remember the tragic case of Christina Edkins, who was brutally killed on her way to school from Birmingham to Halesowen earlier this year. It was a particularly tragic and brutal killing, which shocked the whole community in my constituency.

It turns out that the killer, Phillip Simelane, who had been in prison several times and had a history of disturbed and violent behaviour, had been given a psychiatric assessment in prison. That assessment had raised some serious issues about his mental condition, but, following a breakdown in the process, when Simelane was released from prison he somehow got lost in the system. The relationship between mental health services—I think it was the Birmingham and Solihull Mental Health NHS Foundation Trust—police, probation and social services was not close enough and Simelane was lost to the system. That loss resulted in an absolute tragedy for a totally innocent young girl on her way to school.

I raise that case in the context of this debate only because the importance of all those who deal with people with severe mental heath issues can be seen in the story. The consequences of failure can be devastating for individuals and families. Each agency has an absolute responsibility to ensure that we avoid such tragedies, which can have a devastating impact on communities.

Does my hon. Friend recognise that this is about not only the police and the national health service, but the courts? Better training must be available to the courts, so that they are better able to deal with such issues.

My hon. Friend makes a good point. Mental health training and awareness need to exist throughout the criminal justice system, because, although I am not going to discuss this in my speech, I think that victims of crime have disproportionate levels of mental health problems and other issues.

In a compassionate and civilised society, we owe it to the most vulnerable and those suffering from acute mental distress, anguish and confusion, who get picked up by the police and are subject to section 136, to treat them with the dignity they deserve at a time when they may be experiencing some of the most difficult situations of their lives. It is incumbent on the police, mental health services, social workers and the Government to be responsible for ensuring that we achieve that goal of health-based places of safety where people can be treated in a compassionate and civilised way and can get back on a path to recovery. It is incumbent on us all to work together, both in government and in local communities, to ensure that that happens.

Order. I want to move to the winding-up speeches at about 25 minutes to 3. I am not putting a time limit on speeches, but I am flagging that up.

I will keep that in mind, Mr Brady. I thank the Backbench Business Committee for enabling us to have this debate and for rescheduling it so quickly. I congratulate both the hon. Member for Bridgend (Mrs Moon) on starting the debate and setting out many of the issues so well and my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on outlining so much of the important ground in this area.

My hon. Friend referred to the blogger Michael Brown, who tweets under the name MentalHealthCop and rightly won the Mind digital media award last year. He probably deserved to win it again this year as he continues through his blog to inform and educate not only the public, but many of his fellow officers. More power to his elbow for that.

When I was preparing for this debate, the stand-out fact that jarred with me was that 36% of all people subject to place-of-safety orders find themselves in a police cell rather than a hospital. On the most recent figures, that is 7,761 place-of-safety orders. According to Her Majesty’s inspectorate of constabulary, the average length of stay in a police cell is over 10 hours and 32 minutes —more than 10 hours!

Such people have not committed any crime, but have been judged under section 136 of the Mental Health Act 1983. They are not criminals; they are experiencing a mental health emergency and are being let down by a health service that institutionally discriminates against those with mental health problems. There are many ways of measuring whether we have achieved parity of esteem between physical and mental health, and the numbers we lock up in police cells must be among the starkest measures of progress. Today’s debate is about the role of the police service in addressing the needs of people with mental health problems. The police cannot completely be removed from the equation and do have a role to play.

One in four of us will experience a mental health problem at any one time. We are talking about something commonplace, but often hidden in plain sight in our society. That is why Victor Adebowale, in his report for the Metropolitan Police Commissioner, Sir Bernard Hogan-Howe, was right to say that mental health issues are a part of the core business of policing. The current situation is not properly serving that purpose.

The issue is not peripheral. Rates of mental health conditions among offenders range from 50% to 90%. There is no escaping the fact that the police, often as first responders, are and will continue to deal with people suffering from mental health problems. In London, according to estimates by the mental health unit of the Metropolitan police, 15% to 25% of police activity is related to mental health issues. Some estimates put the level much higher—40% has been cited in the debate already. Either way, that amounts, in London alone, to more than 600,000 calls a year related to mental health difficulties.

It is important to stress that people with mental health problems are much more likely to be the victims, rather than the perpetrators, of crime. That fact all too often gets glossed over in how our media report such things. The impact of crime on people with mental health problems can be far more profound, with deeper consequences, than for those with greater resilience. That is often not reflected fairly or appropriately in how such matters are reported.

In October, Victim Support and the mental health charity Mind published their study of the victimisation of people with mental health problems—“At risk, yet dismissed”—and it challenges many of the popular misconceptions. Some of the facts from that report have already been referred to, but the ones that stand out for me are that women with severe mental illness are 10 times more likely to be assaulted and that almost half of people suffering from a severe mental illness were victims of a crime in the past year. The impact of such crimes on the victim is huge.

As the Chair of the Select Committee on Home Affairs, the right hon. Member for Leicester East (Keith Vaz), pointed out in his intervention on the hon. Member for Bridgend, it is also right to recognise that the police themselves are in a stressful occupation, which is often distressing and a cause of real difficulties for them. Estimates suggest that in London alone the mental illness costs to the Metropolitan Police Service are equivalent to £1,000 per employee—a huge, unmanaged cost.

The nature and role of police work, however, also require the police to be in control and psychologically robust. All police services, and the MPS especially, are therefore in a unique situation, in which the mental health and well-being of staff require particular attention. The statistic we were given earlier—the 56% of staff working in custody suites who are themselves reporting anxiety and depression—is a stark reminder that our debate is not only about them out there, but about all of us experiencing mental health problems in our lives.

Lord Adebowale’s report included 12 recommendations. Incidentally, although the report was commissioned by the Metropolitan Police Commissioner, my understanding is that he has not yet responded to it. When is he likely to do so?

I will pick up six stand-out common themes from the report: first, the lack of mental health awareness, touched on in earlier contributions; secondly, the lack of guidance and training on suicide prevention, which is an important element; thirdly, the lack of adequate care for vulnerable people in custody, which goes to the heart of the debate; fourthly, poor inter-agency working—without doubt one of the keys to unlocking so much of what does not work; fifthly, the disproportionate use of force and restraint; and finally, the failure to communicate with families, which all too often sits at the heart of failure on these issues.

Much of that is echoed in the report “A Criminal Use of Police Cells?” by Her Majesty’s inspectorate of constabulary, which found that the use of police custody as a place of safety varies from 6% to 76% of the total number of people detained under section 136. As a result of a shortage of the right staff in the right places at the right times, people who have not committed a crime are often treated as if they were criminals. HMIC put it this way in its report:

“those detained under section 136 who were taken to a police station were generally treated like any other person in respect of the booking-in procedure; risk assessment; and, ultimately, being locked in a cell (rather than being taken to another part of the station).”

The report also found multi-agency working to be patchy, as was awareness of training resources and activity—they are clearly the areas where relatively small changes could lead to big differences in operation.

The recently published experimental analysis of police data offers some important insights. It bears out the HMIC finding that there is huge variation in the use of police cells as a place of safety. The Sussex, Devon and Cornwall, West Yorkshire, Avon and Somerset, and Hampshire forces all recorded more than 500 uses of section 136, while Lancashire, Merseyside, Hertfordshire and City of London recorded 10 or fewer uses.

Drilling down into those figures and using them to understand why things are so different and what best practice might look like, and to ensure its better spread, we can see why the Government should be commended for having the statistics collected and such analysis done. Buried a little deeper in the experimental data, however, is something else. For the first time, there are estimates for the number of under-18s held in police cells under section 136.

In the past year, according to the most recently published statistics, 263 children and young people were held in police custody. The report urges caution about that figure, because of the experimental nature of the data, and I can understand that caution. It should still be a source of shame and a spur to act, however, that we are locking up children at a time of deep and acute mental health crisis. The hon. Member for Totnes (Dr Wollaston) has rightly challenged on that issue—she raised it in Health questions—and I hope that she will be speaking in the debate.

I hope that the soon-to-be-published concordat on emergency mental health care will do something—more than something—to stop the barbaric practice of children being held in police cells when they are having a mental health crisis. Indeed, next year the Care Quality Commission will be conducting a themed inspection, looking at the whole pathway of crisis care—the role of the police service and of various aspects of the health service—and I hope that it will also cast light on this issue.

I have some questions for the Minister. There has been good progress on rolling out the liaison and diversion services in custody suites. That early identification, assessment and referral can result in much better outcomes. Will the Minister give some indication of when the Treasury will sign off the outline business case for national roll-out of the service? Given the numbers of young people in the criminal justice system with mental health needs, does the liaison and diversion service cover them as well? Will it ensure that they are always included?

Street triage is being piloted by the Home Office and the Department of Health, and we have heard how that can make a significant difference by bringing health professionals into the equation. How will the street triage model fit with liaison and diversion? Also, to repeat a rightly put question, how is that model being evaluated, and what are the time scales for a rapid roll-out should the evaluation show that street triage is working well, which I understand it is showing? How quickly therefore can we get it out throughout the country?

In the report on police custody as a place of safety, HMIC recommends that if there is not significant reduction in the inappropriate use of police custody by April 2016, the Mental Health Act should be amended to remove police stations as a place of safety, except on an exceptional basis. HMIC goes on to state that “exceptional basis” should be written into the law and defined. Will the Minister set out the Government view of that recommendation? If that was signalled as an intention of the Government, would it serve as a further spur to action throughout government, the NHS, social care and police services?

Finally, sitting at the heart of the disparity between mental and physical health and of the institutional bias and discrimination that people with mental illness suffer is deep-seated stigma. The Government deserve much credit for funding the Time to Change anti-stigma campaign—a global leader in such campaigning that is making a real difference in this country. So far, a number of Departments have signed up to play their own part in the Time to Change campaign. I understand that there are discussions with the Home Office, and it would be good to know from the Minister today when the Home Office will be signing up to Time to Change. Furthermore, the attitude to and awareness of mental health problems remain an issue in the police service. One way in which forces could address that is by working together to sign up to Time to Change. Will the Minister use his good offices to promote Time to Change to chief constables and police and crime commissioners?

In conclusion, I want to cite the HMIC report and give two quotes from it from people detained under section 136. The first is:

“I was discharged by the mental health crisis team as a low risk to myself and others and not requiring follow-up. I am concerned that my section 136 detention [in police custody] will show up on…enhanced criminal record checks…in the future.”

Perhaps the Minister will say whether we can ensure that that does not happen.

The second is:

“What have I done to deserve this? I was ill; I was locked up because I was ill.”

Surely that is not what the police service is there for; that is what the health service is there for.

I welcome the opportunity to serve under your chairmanship in this debate, Mr Brady, and I congratulate the hon. Member for Bridgend (Mrs Moon), who I am delighted to count as a friend, although she is unfortunately an Opposition Member, and my hon. Friend the Member for Halesowen and Rowley Regis (James Morris). I am delighted to have the opportunity to speak. I also congratulate my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), and I pay tribute to him for his work as a Health Minister.

Let me put what I want to talk about in a little context. As I think most Members know, I am Member of Parliament for Plymouth, Sutton and Devonport. My constituency contains a naval garrison that is the base for 3 Commando Brigade, Royal Marines, as well as a base for the Royal Navy. Members may be interested to know that Charles Cross police station, in Plymouth city centre, is the busiest police station in the whole of England, so I do quite a bit of work with the police station and go to talk to the police there.

The reason for how busy the station is may well be the size of its catchment area—it goes over to Tavistock and also to Torpoint and Saltash—or it may be because Plymouth is a military garrison city, as there are certainly significant cultural issues that go with that. We also have more licensed premises in Plymouth than there are in the whole of Liverpool—in fact, it is nearly double the number. There are several really big issues crowding in on the police in Plymouth. I pay real tribute to the police officers who work at the custody suite in the Charles Cross police station, who find themselves under a fair amount of pressure.

My right hon. Friend the Minister will find a number of themes going through the debate today, reflecting the great concerns we have across the House on this issue. Since the previous time we discussed this matter, real progress has been made and I pay tribute to him and his colleagues, including those in the Department of Health, for that progress.

The last time I talked in a debate on a similar subject, I told the story of a 17-year-old girl who was highly autistic, and who had kicked off, for reasons of mental ill health, in one of the retail centres in my constituency. She was taken to Charles Cross police station. I have to say that the police found the situation very difficult, and were rather challenged by what happened. I want to talk a little about what we can try to do about that sort of situation. When the girl’s mother arrived to pick up her child and help her, she found that the girl was banging her head against a wall and having real difficulty with the situation she was in. To my mind, that shows that we need to make sure not only that there is better training for our police but, much more importantly, that community health nurses are located in our police stations, to help the police identify situations such as that one.

Since I last spoke on the issue, Glenbourne unit, up at Derriford hospital in my constituency, has been refitted and reopened. I am delighted that that work has happened and that there is now much better co-ordination across the divide. However, the story I have told is not unique. I suspect that it happens in every single town and city up and down the country. Local progress has been made, but we have further to go.

I want to make another brief point. Plymouth is a naval military city, so we need to ensure that we have a much better understanding of how military veterans are treated. They have been through some pretty difficult times in Afghanistan and Iraq. My right hon. Friend the Minister will know that I have been pressing him to consider the use of military courts, not to put veterans in front of a court martial or anything like that—they have of course retired from the military—but because we need to act with much more sympathy when dealing with veterans who find themselves in the justice system.

I learned about that matter when I went to the United States of America with the Northern Ireland Affairs Committee. There we saw at first hand how the US deals with veterans. There is a specific Department of Veterans Affairs, which is able to assess people and keep in much closer touch with them. The Department gives all veterans a mobile telephone, so it can ring them up at least two or three times during the course of the year to make sure that they are getting on well. The US also has specific courts for veterans that are staffed by people who have military experience. I urge my right hon. Friend to consider whether, in a similar way, we could use those of our magistrates who have experience in the military and will have much better understanding of what can happen to veterans. We visited a court in Little Rock, Arkansas, that has been highly successful and has found that veterans do not reoffend once they have been through that process. There are mechanisms in place in the US to ensure that veterans are looked after.

My final point is that we need places of refuge and safety. In my constituency, there is a brilliant organisation called Twelves Company—if my right hon. Friend is interested, I would be very willing to bring up members of that organisation to have a conversation with him—that deals with sexual health. One of my constituents was raped by her husband and had real mental health problems; I hope that I played a small role for her by taking her to see Twelves Company. Since then I have not noticed her tweeting quite so much on the issue, so I hope some balance has been found for her and that we have helped her.

I call for a more joined-up approach to this matter. We need to ensure that the police have alternatives signposted to them, and that the health services and the courts and justice system recognise that mental health is an issue to consider. Frankly, it is not rocket science, it is mental health.

I congratulate all the previous speakers in this debate, and start by declaring an interest: I am married to a full-time consultant psychiatrist who chairs the Westminster parliamentary liaison committee on behalf of the Royal College of Psychiatrists.

Perhaps more relevantly to today’s debate, I should point out that I have been in a police cell in the middle of the night. I hasten to add that it was in a medical capacity, but I congratulate the Secretary of State for Health on advocating work experience for MPs. I would advocate more MPs spending a night in the cells. If they did, they would realise that that is absolutely the last place someone should be if they are acutely distressed by a mental illness.

That is particularly the case for an acutely distressed 12-year-old. Can we imagine a situation in which a 12-year-old child with a broken leg would be taken to a casualty department because there was no specialist orthopaedic surgeon or facility to assess them? That would be utterly unthinkable, yet in Devon and Cornwall alone, on three occasions since the start of this year 12 and 13-year-olds who have been acutely distressed with mental health issues have been held in police cells. That is utterly unacceptable for anyone, but it is particularly unacceptable that on 25 occasions—I would point out to the Minister that this is in Devon and Cornwall alone—children of 17 or under have been in that situation.

If we look at the situation for adults, we see that, shockingly, there have been 674 occasions on which people have been assessed in cells. As we have heard, the average time detained in that situation is 10 hours. On only 277 occasions have those assessments taken place in an appropriate place of safety. Devon and Cornwall is second behind Sussex in that terrible league of shame.

The situation is not the police’s fault. I want to stress that, and I pay tribute to the members of the police alongside whom I have worked in the past, as a forensic medical examiner, for their professionalism. Many police officers have sent me really heartfelt e-mails describing the difficulties they face. The situation is putting huge pressure on the police. It is a totally inappropriate use of resources. As Lord Adebowale has pointed out, it represents very poor inter-agency working, but there is no financial incentive for the NHS to change because the burden of resourcing falls on the police services.

The situation is totally unacceptable on any clinical level. I am disappointed that there is no Health Minister sitting alongside the Minister today, because ultimately the situation requires a total refocusing of services. If we look at the statistics, we see that 82% of those who are detained under section 136 do not go on to compulsory admission to hospital. That highlights the point that many of these situations could be avoided in the first place.

I am sorry to say that some general practitioners will not see patients unless they have registered. Someone who is acutely distressed and has paranoia as a result of mental illness might not recognise that they are unwell and therefore might not register or go to see a doctor. Consultant psychiatrists might refuse to see a patient without a GP referral. Those are all hurdles in the system. Time and again, carers may be desperate to access help for people who are really unwell, but they must fall off the cliff and become acutely unwell in a public place before the police can step in with a section 136 order that could have been avoided.

I thoroughly welcome the pilot project using triage, but street triage should not be necessary because we should pick up such situations much earlier. I would like volunteers who work with the homeless, for example, and who may be aware that someone is slipping into a distressed state, to be able to refer them directly to psychiatric services and bypass primary care. Of course, I would like all primary care doctors to ensure that they deliver the right care at the right time to all their patients, as the good ones do, and directly and actively seek out people who are homeless and vulnerable but who may not come forward to seek help.

Much of the problem is about funding—it would be wrong not to make that clear. The funding of units where people can be seen in an appropriate place of safety is crucial. It is no surprise that the local authorities that have most use of police cells are often in rural areas, where there are additional geographical challenges in providing appropriate places of safety. But if parity of esteem is to have more than just a hollow ring to it, we must ensure that within the NHS cake there is fair distribution of funding for mental health, and we must recognise in funding formulae that rural areas sometimes face extreme challenges. Sparsity must be recognised in funding if there is to be fairness.

Another problem is that mental health beds are running “too hot”. The CQC has said that in 50% of areas bed occupancy is 90%, and in 15% of areas it is 100%. That causes delays throughout the system. Ultimately, there is a problem not just with appropriate places of safety, but beyond that with having beds available when people need admission. On four occasions in Devon and Cornwall, the process of assessment has taken so long that a bed that was provisionally booked was taken by the time the assessment had been made. All those causes of delays in the system must be addressed: the availability of suitably qualified section 12 approved doctors; the availability of psychiatric beds; and, crucially, the availability of appropriate places of safety.

Will the Minister examine the effect on children when medical facilities are not suitable? There may be secure children’s homes— my preference, of course, would be to have a medical facility available, but I can say from personal experience that anything is better than a police cell. Police cells in the middle of the night are desperately frightening places. They are often full of people who are drunk and shouting. It is unthinkable that a child should be in that environment in a police cell. I hope that the Minister will say that if by next year children as young as 12 are still being put in police cells, Parliament will legislate to abolish that.

Order. I am grateful to hon. Members for keeping to time so well. If the shadow Minister and the Minister take no more than 12 minutes each, there will be a couple of minutes for the hon. Member for Bridgend (Mrs Moon), who opened the debate, to wind up.

It is an honour, Mr Brady, to serve under your chairmanship. We have all seen in our constituencies the pain suffered by those with mental health problems, the trauma that that can cause to their families and local communities, and the immense problems that may arise for the police. I welcome the debate and the initiative taken by my hon. Friend the Member for Bridgend (Mrs Moon), the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Halesowen and Rowley Regis (James Morris), and the powerful testimony about what happens at the sharp end from the hon. Member for Totnes (Dr Wollaston).

Police officers have many different roles. They maintain order, protect life, limb and property, prevent and deter offences and, when an offence has been committed, take appropriate measures to bring the offender to justice. However, as the Chief Constable of Greater Manchester police, Sir Peter Fahy, warned earlier this year, policing and mental health problems have increasingly become the main issue for his officers responding to emergency calls, and that

“the force was struggling to cope.”

He is not alone.

Indeed, as the right hon. Member for Sutton and Cheam said, such is the increasing number of calls that recent reports about the Metropolitan police’s new protocol suggest that officers have been ordered not to respond to calls from mental health units and emergency departments for help to control and restrain patients unless there is

“a significant threat to life and limb”.

Such an uneasy interface between the health service and the police does not benefit anyone, least of all those suffering from mental health issues. That is why HMIC, charities, chief constables, police and crime commissioners, the Police Federation and others have all expressed their concern for both the police and those suffering from mental health issues under the current system.

The role of police officers is to ensure the safety of the public and deal with individuals who pose a threat to others or themselves. In an emergency involving an individual with mental health issues, more often than not a bobby will be first on the scene. Too often, police officers and staff must deal with people with complex mental health needs alone, instead of with the support of experienced and trained medical professionals. They are required by the law, when appropriate, to take the individual to a place of safety. More often than not, the only option is to take them into custody. It is not right that people with mental health issues who have not committed a crime are treated as criminals. Those detained under section 136 may not have committed a crime, but are suspected of suffering a mental health disorder.

Worryingly, a joint review by HMIC, the Care Quality Commission and Healthcare Inspectorate Wales found that police custody was still being used as a primary or secondary place of safety as a result of, among other factors,

“insufficient staff at a health-based place of safety”


“the absence of available beds at the health-based place of safety”.

That is increasingly putting a great strain on our police service. Statistics show that such incidents may tie up officers for up to eight hours. That in turn adds further strain on those suffering from mental health issues, because they are treated like any other person taken into custody during the booking-in procedure and risk assessment, and ultimately when locked in a cell.

At the heart of the difficulty—several speakers referred to this, including my hon. Friend the Member for Bridgend—is the fact that 15,000 police officers will be lost by the next election, and police resources are already stretched incredibly thinly, without the unnecessary pressure of having to act as stand-in social workers and mental health nurses because those vital services have also been cut back. Police officers are clear that they are not the right people to deal with those who need complex medical intervention for serious mental illness and that the experience of being detained may add undue stress and upset for these people, making the problem worse.

In government, Labour recognised the seriousness of the problem and commissioned the Bradley report in 2009. However, after three years in government, despite taking some welcome steps, the Government have been slow to act on the report’s fundamental recommendations, leaving us with the unacceptable problem that we now face. Quite simply, we must do better—better for the police and better for those suffering with mental health issues.

As Lord Bradley’s report acknowledged, good training and support to inform police practice are vital. To that end, I welcome the police street triage team pilots, such as those operating in Newham and Birmingham, and I encourage further working between mental health professionals and the police. However, as I have said, a police officer responding to a mental health emergency will often find themselves left with no assistance. That is unacceptable for the officer, the person concerned and the general public.

Crucially, therefore, we must have a proper partnership between the police and health providers—as the hon. Member for Halesowen and Rowley Regis rightly argued and as Lord Bradley’s report also recommended—through joint training packages for mental health awareness and learning disability issues, with community support officers and police officers linking with local mental health services. Crucially, we also need to work towards moving away from the use of custody cells for those detained under section 136 to dedicated places of safety, ensuring that people suffering mental health illness are dealt with sensitively and appropriately, and are given the correct medical treatment.

Birmingham—the city I am proud to represent—is a leading example of the places of safety strategy. West Midlands police uses a mental health assessment centre at University Hospitals Birmingham, with an on-site community psychiatric nurse to carry out assessments and refer to appropriate support. Innovative local strategies such as that are welcome, leading the way with new approaches to police procedure and mental health issues. However, three years after the Bradley report, recent reports and calls from those in the police about the problem getting worse, not better, are cause for concern that not enough has been done to tackle the issue.

In conclusion, the Government need to recognise their responsibility. They urgently need to look holistically at the problem, ensuring that the right resources are available to free up the police and that people with mental health difficulties get the support they need. It is also vital that a clear, strategic framework across all Departments is put in place to help to drive and improve partnership working. I believe that policing is about more than just cutting crime, and we believe that officers should not be expected to plug the gaps in other Departments’ shortfalls—neither should those suffering from mental health issues be let down.

I echo the congratulations that have been given to the hon. Member for Bridgend (Mrs Moon) on the way in which she introduced the debate, and to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), in the latter case particularly for his energetic chairmanship of the all-party mental health group. I shall start briefly with the general subject of mental health reform and then move on to the specific policing aspects of the matter. In doing so, I hope to sweep up a lot of the specific questions that have been asked during the course of this very good debate.

Mental health reform is clearly key to the wider programme of health reform, and the Government want to see mental health issues receiving parity of esteem with physical health issues. The mandate to NHS England has a specific objective

“to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole.”

We have shared our developing work with the Welsh Government, as health, obviously, is devolved, and I know that they, too, are considering these matters.

As a basic principle, which has been expressed by many hon. Members on both sides of the debate, it is impossible to argue that people facing mental ill health should not have their health needs met by professionals who are able to provide appropriate support and treatment. The police are not best placed to provide that, but they may have a key role to play in identifying vulnerabilities among people with whom they come into contact.

Essentially, the police come into contact with four groups of people who may have mental health problems. First, there are people who have committed a crime, or are arrested on suspicion of committing a crime. For those people, it is essential that we strike the right balance between bringing offenders to justice and helping people get access to appropriate interventions in order to tackle factors, such as mental health problems, that may be contributing to their offending behaviour. In the second group are those who come into contact with the police because a member of the public has concerns for their safety or for the safety of others, but when no crime has been committed. In the third are people who may have been reported as missing. As the hon. Member for Bridgend pointed out, they may be elderly and have a history of dementia, or they may be people known to mental health services whose families or carers have reported them as missing. The fourth category is victims of crime or witnesses who may themselves have mental health problems and need support at every stage of the criminal justice system, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) pointed out.

I will go through those groups. We have heard about the review by Lord Bradley, who highlighted that a significant proportion of prisoners have some form of mental health problem. One key recommendation was that to make that contact with the criminal justice system work, we needed to put offenders in touch with treatment and other support services that can help stop their behaviour escalating into more crime. There are currently more than 50 adult and almost 40 youth liaison and diversion services working with offenders with mental health problems, substance misuse problems or learning disabilities at the earliest point of contact with the police and courts.

To answer the questions that my right hon. Friend the Member for Sutton and Cheam asked about what is happening next, from April 2014 we will introduce an enhanced core model across a number of selected areas. The aim is to ensure that those services can lessen health inequalities and improve justice outcomes for people who come into contact with the criminal justice system and for whom a range of complex needs are identified as factors in their offending behaviour. My right hon. Friend was right to say that a business case has been submitted to the Treasury. He asked the eternal question of when we will hear back, and I can tell him that the decision is imminent.

We also know that there is a clear link between mental health problems and deaths in custody. That is a very serious issue. Obviously, every death in police custody is a tragedy, and that is a priority matter for the Government. Work in the area is overseen by the ministerial council on deaths in custody. The council’s independent advisory panel has recently awarded a two-year research contract to the university of Greenwich, which will be working on a number of projects to consider the impact of mental health problems on deaths in custody. Those projects will cover a wide range of the issues that have been brought up in individual cases in this debate and elsewhere. That is one stream of work.

Obviously, the Independent Police Complaints Commission has a vital role to play in the investigation of deaths in custody. It must be notified of any death that occurs in police custody, and it is currently carrying out a review of how deaths in or following police custody are investigated. A progress report on the review was published in September, and the final report is due to be published early next year.

Although that is one group of people affected, most of the debate has rightly involved another group with whom the police regularly come into contact: people suffering from mental ill health who have not committed and are not suspected of committing any crime. There may be concerns for their safety or for the safety of others, and they may need to be detained in a place of safety for that reason. However, all too often, those people, who are ill, find themselves in police stations. Many contributors to the debate made that point.

Her Majesty’s inspectorate of constabulary’s report on the use of police cells as a place of safety for individuals detained under section 136 of the Mental Health Act found that in a number of areas, the use of police cells remained unacceptably high. Again, my right hon. Friend the Member for Sutton and Cheam made that point. We know that during 2012-13, almost 8,000 section 136 orders were made for which a police station was the place of safety. As has been said, that is more than one third of the total number of section 136 detentions. Straightforwardly, that is unacceptable, other than in truly exceptional circumstances. Those are people who are likely to be in crisis, and they need and deserve proper care and support from people qualified to provide it.

My right hon. Friend the Home Secretary announced to the Police Federation, at its conference in May, that she was taking action, along with my right hon. Friend the Secretary of State for Health, to ensure that people with mental health problems receive the care, support and treatment that they need, and that police officers are freed up to do their job of fighting and preventing crime. That work has made significant progress. The most visible sign of it will come shortly when the concordat, which has been agreed by almost 30 national organisations, agencies and Departments, is published early in the new year. A lot of work has gone on between the Home Office and Health Ministers on this matter—that relates to a point made by my hon. Friend the Member for Totnes (Dr Wollaston). I am happy to assure her that I have been working closely with my hon. Friend the Minister of State at the Department of Health, who is responsible for care and support and has overall responsibility for mental health policy.

The concordat will be an extremely important document in taking us forward. It will provide national leadership by setting out the standard of response that people suffering mental health crises and requiring urgent care should expect, and key principles around which local health and criminal justice partners should be organised. It will leave agencies in both the criminal justice and health fields in no doubt about what is expected of them.

There has been a lot of talk about places of safety. I know that interim arrangements have been made in North Yorkshire—the only police force area without a single facility at the time of the Home Secretary’s announcement—and that health-based places of safety will open in York and Scarborough early next year.

The hon. Member for Bridgend asked about exclusion criteria. The concordat will state that people suffering a mental health crisis should be supported in a place of safety, and that there should be no automatic criteria that exclude individuals, although their safety and the safety of others is the paramount consideration. She and others, including my hon. Friend the Member for Halesowen and Rowley Regis, mentioned the street triage pilots, which have obviously been extremely beneficial. The pilot by Sussex police went live on 16 October and other forces are having their launches in December. West Midlands police is moving along with this, and so is the Metropolitan police. Rather than all the pilots coming to an end at once, and there then being an assessment and then something else happening, what seems to be happening is that other areas are picking up the benefits and expanding the system. I am conscious that it is being expanded in the east midlands as well.

The point has been made that too often, the police end up transporting people who ought to be transported by ambulance. The Association of Ambulance Chief Executives is drawing up a national protocol on the transportation of people in mental health crisis, which I hope will act as a catalyst for wider change and improvements.

My hon. Friend the Member for Halesowen and Rowley Regis made a pertinent point about the need for a review of the operation of sections 135 and 136 of the Mental Health Act 1983. Options for a review of those sections are currently being examined, and I expect that work to get under way this financial year.

There has been much mention of children in the debate. The practice of routinely holding in police custody children in a state of mental distress is, of course, unacceptable. Again, that will be dealt with in the coming concordat. Obviously, I take the point that young people and children are central among all the groups of people for whom it is inappropriate that they should find themselves in a police cell in the middle of the night during a mental health crisis. That is one of the changes that we need to see.

There was a request from the hon. Member for Bridgend for better data collection. The College of Policing, which, incidentally, will be doing much of the training work that the Chairman of the Home Affairs Committee, the right hon. Member for Leicester East (Keith Vaz), asked for, recognises the important issues surrounding mental ill health and policing. In its short period in existence, it has already held an awareness event with deputy chief constables. They have agreed on the need not just for clearer guidance about the use of restraint—again, I take the point made throughout the debate about the difference between mental health restraint and police restraint—but for better capture of data and evidence about the operational demands on police. The college now has a national group working to take that forward.

The third group that I mentioned was missing people. It is estimated that four out of every five adults who go missing are experiencing a mental health problem when they disappear. If those people have dementia, they may be frightened, be unable to find their way home or exhibit aggression. The police will often be the first port of call when someone goes missing, so in responding to such calls, the police need to work closely with health services and other agencies to ensure that people can be safely transferred to the most appropriate place.

Our missing children and adults strategy highlights the importance of local areas considering whether they need to be doing more to protect children and vulnerable adults who go missing, and provides a framework for them to do that. The move to bring together the Child Exploitation and Online Protection Centre and the UK Missing Persons Bureau in the National Crime Agency will result in improved integrated working by law enforcement across the UK, including missing persons investigations.

The last group that I mentioned was victims and witnesses. The new victims’ code, which will be implemented the week after next, will ensure enhanced support at every stage of the criminal justice system, including a new entitlement to ask that special measures be used in court and to be provided with information about the support that registered intermediaries can provide.

As the usual gateway to the criminal justice system, the police will have a duty to conduct an early needs assessment to identify victims who may be particularly vulnerable—including those with mental health issues—and therefore eligible for enhanced services. Such victims will be advised of the availability of pre-trial therapy, and access to such therapy will be facilitated if needed.

We are legislating to provide police and crime commissioners with the power to commission support services for victims of crime. We intend that, from October next year, the majority of emotional and practical support services for victims of crime will be commissioned locally by PCCs rather by than central Government. PCCs are well placed to consult, and identify the needs of, victims in their local area and to determine how best to meet those needs.

Responding to people with mental health problems is not something that any agency or organisation can do alone. In many areas, PCCs are already playing a pivotal role in encouraging agencies to come together to address the issue. The work that I have talked about highlights the importance of joint working nationally and locally in order to make a real difference.

It is obvious that the police have, and will continue to have, a key role in dealing with mental health issues as they arise. They need to be adequately trained to identify vulnerabilities and behaviours that require further intervention, but they are not and cannot replace health professionals. Both types of professionals should be left to do the job that they are best at doing and trained to do, because that, in the end, will be the best response for mental health patients themselves.

I thank you, Mr Brady, for your excellent chairmanship throughout the debate. I also thank my co-sponsors of the debate, because no one could have had better co-sponsors with greater gravitas or greater recognition on both sides of the House for the work that they do in this area. It is extremely pleasant to see in the Chamber at the end of the debate the hon. Member for Broxbourne (Mr Walker), who has also played a huge part in raising mental health issues in the House.

This is a time of consensus. There is cross-party agreement that we must move forward. We all recognise that the police, the voluntary services, the health service and, most importantly, people who suffer from mental ill health want recognition that it is time for change and for a review of the use of section 136 powers for the 21st century.

I thank the other hon. Members who have taken part in the debate. The hon. Member for Totnes (Dr Wollaston) demonstrated her insight into issues involving rural areas and children, and the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) paid particular attention to military matters. We all look forward to the concordat being published in the new year. Let us hope that between us, across the House, we can ensure that people who suffer mental ill health have the service that they desire and deserve.