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Mental Health Act 1983

Volume 627: debated on Tuesday 11 July 2017

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

I am delighted to see the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), in the Chamber. I hope—she is still smiling—that she is in a benevolent and co-operative mood.

As the Minister will be aware, I am raising a small but important matter, in my opinion and that of others, by seeking a small change to section 136 of the Mental Health Act 1983. She will probably have been made aware that I have raised the matter twice before, for the first time when I presented a ten-minute rule Bill in 2014. I did not proceed with that measure because there was an ongoing Government review of the whole section. Although that review was extensive, it did not consider the specific point that I am raising this evening. The second occasion was almost exactly a year ago, when I raised the matter in an Adjournment debate.

I was initially prompted to seek the change having seen the need for it at first hand on the streets of London. I was with a couple of young officers from the Met in a response car, and our first call was a dash to a flat on the 14th floor of a council residential tower block. The mother of the household nervously let the officers in, and we saw her daughter, aged 22, standing on the window ledge threatening to jump. We quickly established that the daughter had a history of genuine suicide attempts. As the young lady was clearly put out by the uniformed police officers, we were joined very promptly by three further officers, two of them in plain clothes. Fortunately, one of those officers was female.

That officer was very astute and persuasive, and managed to get the young woman to come down off the window sill, sit down on the bed and talk matters through. The young woman made it quite clear that she needed psychiatric help. Much effort was made to persuade her to go to a place of safety for psychiatric and medical aid. The young woman vehemently refused and, when pressed, she struggled to head for the window and jump yet again.

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

The other four officers stood on tip-toes waiting to catch the young woman on each occasion when she looked as if she was going to dive through the window. Fortunately, they managed to stop any action. In the meantime, contact was made with St George’s Hospital’s psychiatric unit to seek urgent hospital psychiatric assistance. After some considerable time, the appropriate psychiatric individual arrived with an ambulance and crew. This immediately inspired further alarm, rejection and, ultimately, a huge struggle. In due course, a sad young lady was transported to the hospital as the designated place of safety, and we had prevented the suicide.

The whole pantomime had occupied five officers and three NHS staff, and took about four hours to sort out. It was obvious from the very beginning that the police themselves could have taken care of the young lady quickly, as indeed they did after instruction from the NHS staff. Immediate action by the police would have taken the lady into care quickly, thus reducing the continuing risk over those four hours, and saving the police and NHS staff a large number of man hours. Under section 136 of the Mental Health Act, the police would have been able to act promptly if this pantomime had taken place in a public place. However, the incident took place at the young lady’s mother’s home. That was deemed, correctly, to be a private place, which meant that no direct police action was legally possible. I have had discussions with officers in the Met, and I have found that this was not an unusual case.

A more tragic case was the death of Martin Middleton in 2010. He was taken to a Leeds police station by officers who had visited him at home, having been made aware, and then seeing for themselves, that Mr Middleton was making serious preparations for committing suicide. The officers incorrectly believed that they could arrest Mr Middleton and take him from his home under section 136. When they arrived at the police station, the custody sergeant refused to detain Mr Middleton as the arrest had taken place in his home. The officers were therefore required by the custody sergeant to return Mr Middleton to a relative’s home, hoping that that was some form of safety. Sadly, Mr Middleton still managed to hang himself there.

At the inquest, the coroner had no hesitation in agreeing with Professor Keith Rix, who was called to give expert evidence, that Mr Middleton fell into a category of mentally disordered persons for whom there is no provision under the 1983 Act. Subsequent to raising the issue, I have heard from many frontline police officers, including those who have campaigned on the issue, and I have also had extensive conversations with Professor Keith Rix, who is an academic psychiatrist and an expert in this area. I am reliably informed that the Garda in the Republic of Ireland have a clear operational advantage over our police because, under section 12 of the Irish Mental Health Act 2001, they can act promptly, even in a private residence.

As the all-seeing Minister will be aware, over the 10 years between 1997 and 2007, admissions to hospital as a place of safety went up from 2,237 to 7,035—those are the latest figures that I have been able to get. The Minister is quick with arithmetic, so she will be able to note that that is a threefold increase. The difficulty facing the police is that the powers on which they can act are limited to persons found by the police in a public place. There is ample anecdotal—and perhaps stronger—evidence that the police in desperation sometimes persuade a person to leave their home, or contrive to remove them to a public place so that they can use the section 136 powers of arrest. In fact, one London-based social services authority’s audited figures estimated that 30% of section 136 arrests were recorded as having been made at or just outside the detainee’s home. The police do that in sheer desperation to save the individual’s life, which would be lost unless they acted. Put bluntly, a tiny adjustment to the legislation would allow the police to act in a private home, as they can in a public place. That would save an enormous amount of time and, potentially, a considerable number of lives.

In my discussions about this, it has been suggested that the police already have sufficient powers—they do not. The second argument is that an amendment would extend the right of the police to enter private properties—yes, it would. There are many legal reasons for the police to enter a private property; perhaps the most obvious and linked one is that if the mentally ill person was threatening, or in the process of murdering, somebody in that private place, rather than killing themselves, the police could act immediately.

There is a simple solution to this: amend section 136 by simply removing the words

“in a place to which the public have access”.

When I raised this issue in the Adjournment debate about a year ago, the Minister’s predecessor gave a clear indication that change was being considered. He gave me a commitment that if the Government could not get this right using the measures they were considering, an amendment to section 136 might be exactly what was required.

My hon. Friend is making an important and thoughtful speech. Does he agree that it is possible at the moment for a mental health professional who wants to put someone under section 2 or section 3 of the Mental Health Act to gain entry to their house with the police and a locksmith? It therefore seems strange that the police do not have powers to deal with a very similar situation when they have concerns about someone’s mental health and believe they need to exercise section 136 powers.

I thank my hon. Friend, who is, of course, on his way, with a bit of luck, to being a very senior academic psychiatrist in a couple of years. He is right. In situations such as this, no one rings up St George’s Hospital in Tooting and says, “Please could I have a psychiatrist?” They ring the Met police, who then have the difficulty of dealing with the situation, and who stand there holding the detainee in the private home while the psychiatrist is brought in from the hospital.

I shall be grateful if my hon. Friend the Minister will at least be prepared to meet me and Professor Rix to discuss how this difficulty can be sorted out. If necessary, I am prepared to resort, as I have in the past, to the ten-minute rule Bill procedure to bring about this tiny change.

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) not only on securing the debate, but on the measured way he has approached it. He highlighted some of the really serious challenges faced by the police and the emergency services in dealing effectively, but also humanely, with those who are in a mental health crisis. We can all agree that this is a very important topic.

For far too long, the subject of mental ill health has not received appropriate attention. The services for those experiencing mental ill health are sometimes not what they should be, and people have been faced with long waits for the help and support they should have received.

However, the Government have made clear their utter determination to improve mental health services, and we have made considerable progress in recent years to address the serious concerns we are discussing tonight. In particular, the use of police cells as places of safety under the Mental Health Act has fallen significantly. Last year, it was down to as few as only 2,100 instances. Some forces, such as Hertfordshire and Merseyside, have achieved zero use of police stations, while others, including West Midlands, Suffolk, Nottinghamshire, Lancashire and Lincolnshire, have very low usage—right down in the single figures. We expect to see significant improvement when the numbers come out in October.

This has been brought about by a lot of good local partnership working. Only last week, I was with the police and mental health services in Kent, introducing their new strategy, which involves innovative working between the police and local health partners so that they can respond effectively and swiftly to those who are suffering mental ill health. It is also about bringing together the voluntary sector to enhance the support for local people. There are similar partnerships all over the country as part of the crisis care concordat partnership networks, which are driving forward really good improvements.

Most police forces will now have street triage schemes. This means that, although they are quite different in different parts of the country, most police officers will be deployed alongside mental health professionals, so if a call comes into the centre that somebody is experiencing a problem of the type we have heard about, mental health professionals will be sent along with the police officers as they respond. Alongside the reduction in the use of police cells, we have seen a reduction in the use of section 136 powers as these decisions are being made by health professionals to make sure that somebody in such a crisis can get the care that they need immediately. We have seen really good examples in Norfolk and in the west midlands, with dramatic falls in the number of people being sectioned. I am very happy to meet my hon. Friend to discuss this excellent work. In the meantime, I will send him examples that he could perhaps take up with his local police force to make sure that it is drawing on the best possible practice from around the country.

We have increased the availability of liaison and diversion schemes so that those entering the criminal justice system who have mental ill-health or substance misuse issues can be immediately identified and referred into suitable assessment or treatment. These schemes now cover about 75% of the population of England, and we are on track to provide national coverage by 2021. We have provided some £15 million to 88 local projects to increase the provision and capacity of health-based places of safety, focusing on the areas with particularly high use of police cells and limited places of safety. We have announced a further £15 million of funding to continue this vital work.

Just as importantly, we are also bolstering our mental health services. We are investing record levels in mental health and improving access by introducing the first-ever waiting times standards for treatment. We have invested £400 million to improve mental health crisis care in the community and £250 million to establish liaison mental health services in every emergency department by 2020. Since 2010, we have increased spending on mental health to a record £11.6 billion in 2016-17, and a further £1 billion will be invested every year by 2020-21 so that we can deliver the mental health services that people richly deserve.

In addition to this, we are making £1.4 billion available by 2020 for children and young people’s mental health services.

I do, of course, applaud the Government’s work in this field. However, I am talking about the particular emergency situation where someone is sitting in a police car, a radio call comes through, they tear up to the incident, and they are two miles away from St George’s hospital and the psychiatrist who visits it. They need to do something on the spot.

I very much appreciate my hon. Friend’s specific point. I wanted to set the scene and describe to him the scale of the investment to ensure that we do have the appropriate medical professional to accompany the police. I think we can all agree that we need those trained mental health professionals to be able to assess the person and to make the best judgment call on the best way to treat them. It is unreasonable to expect a police officer to have enough clinical experience to be able to make that call.

Like my hon. Friend, I have spent time with my local armed police officers. I have been out on the beat. I have seen the extent to which, in the course of their everyday working, they encounter people who have mental health problems, and how brilliant they are at handling the situation. We have heard vividly about how well they are able to manage it, as he has seen himself, but that is usually about containing it. They are not qualified to assess the best clinical approach for the individual in the way that a mental health professional is.

I completely agree. If section 136 is used in a public place—and if it were used in a private place—the individual goes into care in a mental hospital environment and must be assessed within 72 hours. That is an added protection. No one expects policemen to be wonders on psychiatry, but the assessment follows very quickly.

My hon. Friend makes a very good point and he will be pleased with recent legislation that has reduced that timeframe from 72 to 24 hours. That is a big step forward. Whether an incident happens in a public place or in someone’s home, we are working towards a situation where a mental health professional will be with the police when they attend. That means that there will be no delay similar to that described so vividly by my hon. Friend. I think that some of the examples he gave happened some time ago. As a result of investment, particularly in the work of the crisis care concordat, which has created the framework for police forces to work with mental health services in their community, all kinds of innovative measures have been introduced to ensure that resources, including mental health nurses routinely working with police officers on the beat and specialist back-up to deal with situations similar to those we have heard about this evening, are planned and delivered locally. That is how we want things to happen.

As I have said, we are putting the resources in place. Although these services are working in most of the country, additional investment is being provided where that is not the case. There is also support through the crisis care concordat to fill those gaps and to ensure that everyone everywhere has the same experience.

My hon. Friend is making some thoughtful and good points about the extra resources that are going in to support people with a mental illness. On section 136 powers, the mental health professional who accompanies the police is often a nurse, and they do not have powers to section people. A section 12-approved doctor who accompanies the police, however, does have powers to section people, and the same is true under sections 2 and 3 of the Mental Health Act. I think that is where my hon. Friend the Member for Mole Valley (Sir Paul Beresford) is coming from.

I thank my hon. Friend for his contribution. The point I was trying to make is that a range of health professionals are working alongside the police in different settings to make sure that their response is appropriate. Sometimes it is mental health nurses who will be on the beat with police officers. My hon. Friend the Member for Mole Valley said that the police were called because somebody was in a very aggravated and stressful situation and they might have been prepared to take their own life. A call handler at the emergency centre would triage that situation, understand its severity and send the appropriately qualified medical professional so that they can make those decisions.

I think we are largely in agreement on the progress we have made. I want to focus on my hon. Friend’s key point, which is that he does not think that the police have sufficient powers to act quickly in relation to people in private homes who are mentally distressed. I have read through his previous contributions and I am sympathetic to his point. I appreciate how utterly frustrating it must be for police officers who find themselves in a situation where they feel helpless to take action in a reasonable amount of time when they would have those powers if they were in a public place. Having read previous debates and contributions, however, I think it is right that we consider somebody’s home differently from a public place. For most people, their home is their refuge. It is a special place. We allow people to do all sorts of things in their homes that we do not allow them to do in a public place. We have to reflect carefully before taking more powers on the state to allow us to intervene in people’s private space. We seek to strike the right balance so that we can intervene to keep people safe and ensure that they get access to services without violating their privacy. We have consulted quite widely on the matter, and we considered it when we were looking at a review of the legislation. There was a lot of discussion about it, and the view was that we had struck the right balance and did not need to take the extra step that my hon. Friend wants us to take.

New powers have been introduced, as I mentioned, in the Policing and Crime Act 2017, and we are monitoring how they are working. I reassure my hon. Friend that if that monitoring suggests that we can or should do more, we will take further action. We expect to see a lot more data from the police this autumn about how sections 135 and 136 are implemented on the ground. We will be analysing the results of a new annual data return to establish whether there are any new trends or patterns that need further response. We will have the opportunity to consider the whole issue in the round as we look, as promised, at the Mental Health Act.

I am happy to meet my hon. Friend and any other colleagues who have a close interest in this policy area, along with Professor Rix and officials from the Department of Health and the Home Office, to make sure that we have this absolutely right. We want to join up mental health professionals and police professionals appropriately to prevent the sorts of situations that we have heard about this evening. I look forward to building on the good progress that we have made, and I will continue to work well with my hon. Friend to make sure that that happens.

Question put and agreed to.

House adjourned.