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People with Mental Health Problems: Detainment

Volume 635: debated on Wednesday 31 January 2018

I beg to move,

That this House has considered procedures regarding the detention of people with mental health problems.

It is a pleasure to serve under your chairmanship, Mr Hosie, and I am very pleased to have obtained the opportunity to—[Interruption.]

Thank you, Mr Hosie; I am grateful for your chairmanship.

I am delighted to have obtained the opportunity to bring this matter before the House. It strikes me that there may be a large cross-over between many of the people whom we are about to discuss and those with whom the House has just concerned itself.

In recent years, as a community and a society, we have made remarkable progress on our attitudes to mental health. To talk about mental illness is no longer the taboo that it was when I was growing up, and as a consequence we have seen remarkable progress in recent years in relation to the treatment of people, especially in our national health service.

Today, I will focus attention on a slightly different aspect of this issue—one that does not get the same attention as the treatment of people with mental health problems in the NHS. I will talk about the experience of people who come into contact with the criminal justice system—initially, of course, with the police, then with the prosecution services and, possibly, the prison authorities. The purpose of this debate is to make it clear to the Minister that within those agencies of the state, we need a change of attitude and culture similar to those we have seen in other aspects of our daily life.

It is surprising that this issue does not get more attention. Many of the people about whom we are speaking often exhibit in public or private what might euphemistically be called “challenging behaviour”, which is a symptom or consequence of their mental illness. It seems to me that at all levels—in the police, the prosecution services, the courts and the prisons—we need a greater level of understanding of their life experience and, as a consequence, better implementation of procedures. In fact, many procedures are pretty good but, as I will come on to explain, they are not followed in a way that is appropriate or that was intended when they were put in place.

I confess that I had rather thought that, within the criminal justice system, we had got beyond that point. Almost a quarter of a century ago, both as a trainee solicitor in Aberdeen and as a prosecutor, I railed against some police officers who, at that stage, still reported people who had attempted suicide, alleging that they had breached the peace. That attitude belonged in the 19th century, not the 20th, and I hope that such things would not happen today. However, it illustrates the underlying attitude that requires exposure.

My interest in this issue was first engaged as a result of a constituent—a lady resident in Orkney—who came to see me because she was concerned about the treatment of her son. This is not an isolated case. From discussions that I have had with people in the police, the criminal justice system and social work, I believe that it illustrates pretty well many of the ways in which the criminal justice system fails to meet the needs of people in our community, especially those who suffer from mental health problems.

I will not name these people; my constituent and her son want to retain their privacy, which is perfectly legitimate. However, the Minister should be acquainted with this case; last week, I forwarded him my correspondence file, which is fairly substantial, so that he would be aware of the background.

My constituent’s son is resident in Romford. He has a history of mental illness problems, but prior to the episode that I will discuss he had taken himself off some of the medication that he had been prescribed, because it had side effects that disagreed with him. He was reported missing by his partner on 27 April 2014. She contacted the police because she was concerned that he might kill himself. Eventually, he was traced by two police constables to a shopping centre in Romford. Questioned by the constables on the street, he told them that he was in possession of two kitchen knives, and at that stage he said that he did not intend to harm others; later in an interview, he said that he was considering harming some of those he loved.

The detaining officers—the two police constables on the street—proceeded, quite rightly in my view, to detain my constituent’s son under section 136 of the Mental Health Act 1983. Given the information that his partner had provided the police and what he himself had said to them in the street, that seems to have been an entirely sensible step to take. Afterwards, as a standard procedure, the constables contacted their station sergeant. The sergeant instructed them to take him—let us just call him “M” for the purposes of today—not to a place of safety, that is the hospital, but back to Romford police station, where he would be interviewed under caution. That was done and the interview was conducted. There was no legal representation for M when he was in the police station and there was no appropriate adult present either.

I congratulate the right hon. Gentleman on the speech he is making. Does he agree that, at that point in the police station, it should be a requirement of the system for investigating officers to inquire as to whether the individual is already under treatment by a mental health team and, if so, for them to seek information from that team about the individual’s psychological condition?

I am almost certain that if the medical condition being experienced by the person in custody was physical rather than mental, that course of action would be routine—simply what was expected. That is what I mean when I talk about a culture change being necessary. We need to treat people with mental illness in exactly the same way as we would treat people with a physical illness.

In fact, M disclosed in the course of his interview under caution, which unfortunately was not tape-recorded, that he was hearing voices and that he had been on medication, but had stopped taking it because of its various side effects. At the conclusion of the interview, he was charged with possession of a bladed article under section 139 of the Criminal Justice Act 1988. He was seen by medical professionals at some point in the course of his detention. I eventually had to submit on behalf of my constituent a data subject access request to get the custody records to find out the names of those medical practitioners. I still do not know their qualifications or whether they had, as the hon. Member for Stretford and Urmston (Kate Green) mentioned, access to the records that would have disclosed his full treatment history.

My constituent’s son eventually appeared the next day, 28 April 2014, at Barkingside magistrates court. He pleaded guilty and was remanded in custody until 12 May for psychiatric reports. Those were not available on 12 May or 14 May—a familiar story for anyone who deals with the summary courts—and he eventually appeared on 21 May, when those medical reports were available. Unfortunately, at that point it was apparent that the probation service reports were not available. It was 11 June before his case was finally disposed of. He was admitted to bail on 21 May and sentenced on 11 June. He was placed on a community order for six months on the condition that he remained under the supervision of the police service. In the meantime, he spent something in excess of three weeks in Pentonville prison, on remand and in custody, and 24 hours in police custody over a case that ultimately resulted in a community disposal.

I have enormous regard for those who staff and manage our prisons, but I do not know of any body of work that suggests that people suffering from a mental health problem are ever helped by being locked up in prison. That is essentially the point here. If my constituent’s son had been taken not to the police station, but to a hospital where he could have been treated and stabilised at the earliest possible stage, an inappropriate use of resource would have been avoided and he would have got the treatment he required.

Following the community order, I became involved with my constituent and a lengthy correspondence ensued. Fast-forwarding to 12 February 2015, I eventually received a letter from a deputy assistant commissioner at the directorate of professionalism within the Metropolitan police—she is a fairly senior officer—that concluded that my constituent’s son’s

“welfare and mental health was correctly managed during his time in police detention and that he was assessed as being of sufficient mental capacity to understand his actions on the day in question.”

She concurred that the officers had “acted correctly.” Unsurprisingly, my constituent was disinclined to let matters rest at that point. There was further correspondence, including with somebody with the glorious title of “professional standards champion”. That was not particularly fruitful, and it led eventually to a complaint to the Independent Police Complaints Commission.

On 25 January 2016—this is getting on for two years after the initial incident—the IPCC upheld the complaint. It observed in passing that the constable who had been the original arresting officer had received management action in relation to the Metropolitan police’s mental health policy; I pause here to say in parentheses that the only person in this whole sorry saga who acted correctly was the original arresting officer. At every stage in the process, he seems to be the one who gets the training, the management interventions and the counselling. If this poor constable is sitting somewhere in a police station in London sticking pins into an effigy of me, I would not blame him, but he was never the object of our concern. It was the failure of those above him to implement their own procedures properly that has probably brought us to this point today.

Thereafter, the correspondence between the Metropolitan police and me discloses a culture that requires change. The concept of professionalism, a directorate of professionalism and professionalism champions seem to exist for the purpose of protecting police officers, rather than admitting fault, learning from the experience and moving on. Those things exist for the protection of colleagues, rather than the investigation of complaints. To this day, I still do not know the qualifications of the force medical examiner who saw my constituent’s son in custody. I suspect that having made a data subject access request, I will get that information if I go to the Information Commissioner, but the fact that I have to anticipate that tells us everything we need to know about how such complaints are handled.

In many ways, my constituent’s son is fortunate. The episode was not perhaps as acute as it might have been. He is particularly fortunate to have a mother who is an intelligent, strong-willed, determined and articulate woman. She was never going to be fobbed off with excuses or half-answers. Without the support of his mother in Orkney or the support my office has been able to give him through her being my constituent, I am pretty certain that these questions would have gone unanswered. I am pretty sure that the original arresting officer will be inclined in the future simply to do what he has been told by his superiors. In that way, the culture and the mistakes continue.

The Metropolitan Police Service could probably have dealt with this issue in April, May or June 2014 had they simply accepted that they made a mistake and apologised. They did not do so because of the culture that exists. I suspect and have good reason to believe—I speak often to police officers and others within the criminal justice system in London and other parts of the country—that that culture continues to exist. That requires change if we are to give people who suffer mental health illnesses and who come into contact with the criminal justice system the treatment and respect they deserve.

It is a great pleasure to serve under your chairmanship, Mr Hosie. I congratulate the right hon. Member for Orkney and Shetland (Mr Carmichael) on securing this debate and the way in which he presented it. Perhaps coincidentally, it follows a debate I was here for yesterday on perceived failings in the way in which the criminal justice system deals with people on the autism spectrum.

The underlying challenge is the same: it is about awareness, understanding and ensuring not just that the right protocols are in place, but that they are implemented by human beings. That is a challenge, and I wholly endorse what the right hon. Gentleman said about the progress we have made as a society and a Parliament in our understanding of mental health and the consequential priority that we need to attach to it. I pay tribute to his work on that in the Cabinet of the coalition Government, and to the work of many of his colleagues, not least the right hon. Member for North Norfolk (Norman Lamb), who is tireless on this subject.

We have made progress, but the right hon. Member for Orkney and Shetland is entirely right to raise tough questions about implementation and culture inside the criminal justice system and the police system. I do not think anyone would argue that the police are the agency best suited to dealing with people who are solely or primarily unwell by virtue of mental ill health, but the reality is that the police spend a lot of their time dealing with, supporting and safeguarding people on the mental health spectrum.

I have just completed a tour of our police system in which I talked to every single police force in England and Wales. One of the most consistent themes in all those conversations was concern about the increasing amount of time that our police officers spend with people who have a spectrum of mental health concerns. In some of those cases, that is entirely right and appropriate, because those people may be pursuing criminal activity or there may be a public safety issue. Increasingly, however, the police are being called into situations to which those two criteria do not apply. That is increasingly uncomfortable territory for them, because they are not necessarily the most appropriately qualified people to deal with such situations.

Let me address the right hon. Gentleman’s fundamental point about culture. I must put on record some of the improvements and the good things that are happening, but I need to acknowledge that there remains a stubborn cultural issue around how the police, and other bits of the public sector system, respond to complaints. I have been very explicit with the new chief executive of the Independent Office for Police Conduct, which is the new body that is taking over from the Independent Police Complaints Commission, that the Government, the IOPC and the police need to work together to try to change the culture. That is much easier to say than to do.

Too often when something goes wrong, as it inevitably will, there is a tendency to circle the wagons, blow smoke and protect the police family. We need to move away from that, and towards a culture of learning from mistakes. That is how the police improve. I argue strongly that doing so is very much in the interests of the police family, because we police by consent. That is built on a foundation of trust in our police system. Incidents such as that which the right hon. Gentleman recounted chip away at confidence and trust in our police. Therefore, it is in the interests of the police system to embrace the need for a new culture. When I speak to the superintendents conference, they volunteer that that is what we need to do.

It is a cultural change. I do not think the problem is necessarily with the frameworks, the procedures, the standards or the rights of prisoners in custody. We have made considerable progress on that, but I acknowledge that there remains a stubborn problem with its implementation in practice.

I accept what the Minister says about culture, but I wonder whether he could look at one systems issue, namely the matter of obtaining medical information from a person’s own mental health practitioner where an individual in detention is already under the care of mental health services. I understand that is not part of routine procedure at the moment. Will the Minister go and look at that, and see whether it should be?

I certainly give an undertaking to the hon. Lady that I will look into that. Prisoner rights in custody are pretty clear in terms of the duties on a custody officer—a custody officer is required to determine whether a detainee is, or might be, in need of medical treatment or attention, and to make sure that he or she receives appropriate treatment or attention if he or she appears to be suffering from an illness or injury or a mental disorder—but I give the hon. Lady that undertaking and will write to her.

Having acknowledged the point made by the right hon. Member for Orkney and Shetland, I want to place on record some of the genuine improvements that have been made. He raises a real concern, which has weight in the police system because of the amount of time police officers spend, in the modern age, dealing with people on the mental health spectrum.

A considerable effort has been made in recent years to improve local responses. Crisis care concordat partnerships have been successful in pushing people together at a local level to address long-standing issues such as the overuse of police cells as places of safety. As I have gone around the system, I have been very impressed to hear about the various triage schemes in many areas. Those schemes encourage closer working and exchange of real-time information between the police and health professionals. There are different models. Some have health staff embedded in police control centres. Others have health professionals working alongside police on the ground, and sometimes in the custody suites. The common feature of those models is that they enable the police to deal more confidently with people in crisis, informed by professional advice about the best solution.

Many areas are developing community-based voluntary sector or partnership drop-in centres—sometimes called crisis cafes or places of calm—to which those who feel themselves nearing a crisis may be referred, or may self-refer, for support and advice. Such co-operation mechanisms have resulted in a significant and, I hope, welcome reduction in the use of police stations for those who have committed no offence. In 2016-17, a little more than 1,000 such uses were recorded, compared with just under 8,500 in 2012-13, so there is progress on that front.

We are changing the powers available to the police under the Mental Health Act 1983. In particular, the use of police stations as places of safety has been completely banned for under-18s. For adults, regulations now set out very specific criteria on when a police station can be used. Police officers are required, if practicable, to consult a mental health practitioner before detaining a person under section 136, but I will come back to the hon. Member for Stretford and Urmston (Kate Green) with a more refined position on requirements to consult the individual’s own medical practitioner.

The period for which a person may be detained for the purposes of a mental health assessment under section 135 or section 136 is now reduced to 24 hours to ensure such assessments and arrangements for further care are completed as swiftly as possible and that people are not unnecessarily delayed. Police powers to detain a person under section 136 have been extended to any place other than a private dwelling, enabling the police to act promptly in places such as workplaces.

Better community partnership and changes to the 1983 Act have clearly made a difference.

The point on which the IPCC upheld the complaint of my constituent’s son was that he should have been detained under section 136 as well as the Criminal Justice Act 1988 provisions, and that did not happen. That was a fairly narrow point, in many ways, but anecdotal evidence suggests that it is fairly widespread. What is the Home Office doing to establish an objective picture and find out what is happening on the ground? I suspect the procedures are not that bad, but the implementation requires some attention.

I accept the point that the IPCC found that guidance to detain under both section 136 and for any accepted offence had been breached in that case. I am not quite sure how long it took between 2014 and that judgment—probably too long. I accept that, but I come back to my earlier point. The right hon. Gentleman will know from experience that from the specific, we learn and probe general application. That is why our complaints process must work better than it does at the moment, not just for his constituent’s son and others in that position, but for the police officers concerned.

A lot of police officers are, in their words, being left out to dry for long periods of time, while the processes take too long. We want a swift process of finding the truth; we want accountability—accountability matters—but then we want a culture of learning and thinking, “What have we learned, and what are we doing about it?” We are not there yet, but everyone is talking about it in the right way. Part of my responsibility as Policing Minister is to continue pushing on that.

I am running out of time, but I should mention that if a person who has been detained for an offence is identified as having possible mental health or substance misuse issues, they may be referred to liaison and diversion workers for advice and onward referral to support services. Such schemes now provide support across 80% of police custody suites and courts in England, with the expectation that 100% coverage will be achieved by 2021.

On police use of force, a new memorandum of understanding between police forces and mental health and disability settings was finalised in 2017. At the extreme end of that is the response that we have to make to the report on deaths in custody. Some of the issues that the right hon. Gentleman has picked away at—the human testimonies, and the attitudes of the police when they feel defensive—come through very clearly in that report, and we have to break those down.

As I hope I have made clear, across a range of the avenues available to the Government, we are making some progress. I repeat my undertaking to come back to the hon. Member for Stretford and Urmston on her question.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.