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Mental Health Act: Section 136

Volume 670: debated on Tuesday 28 January 2020

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

The subject of this debate is section 136 of the Mental Health Act 1983, but I am discussing only a tiny aspect of it. As a Minister from the Home Office, my hon. Friend the Member for North West Hampshire (Kit Malthouse), is responding, I am dodging all leaflets, letters and things that I have received from Mind and all the rest of it, and just narrowly looking at one little thing.

This evening, there is a dinner for the parliamentary police graduates; those of us who have been on the course with the police are going. The great advantage of the course, as with similar courses, is that people on it learn what it is like to be a police officer, both on and behind the frontline. Many of us come back from it wishing to make legal changes, because we have seen what it is like to face the problems that police officers face day in, day out. I have often used this route to address issues to do with child protection cases—I think I have 12 or 13 of them. There is one that I have nagged on for some considerable time. It comes from an experience that I had when out in a patrol car with a couple of uniformed cops in Wandsworth. I have raised this matter several times, but some of the answers that I have received—I hesitate to say this to Minister—were not very clever.

Section 136 gives the police the power to remove a person from a public place to a place of safety when that person appears to be suffering from mental disorder. The person will need to be deemed by the police to be in immediate need of care and control as their behaviour is of concern. They are detained, not arrested. From 2018 to 2019, some 50,000 people were detained under the Mental Health Act; about 18,000 or 19,000 people were detained under section 136. It is a little piece of a big Act that has a big effect, and most of it is positive—including, ultimately, for the people detained.

As I say, a person will be deemed by the police to be in immediate need of care and control because their behaviour is of concern. Frequently, this is when the police are trying to stop the individual committing suicide. There have been tragic misinterpretations, and because of a civil quirk I will touch on, the police have had to release the person detained without taking them into a place of care. Ultimately, that person has gone home, or to a relative, and committed suicide. I want this tiny change so that that cannot happen.

As I have said, it is important to point out that the person is not under arrest. When a decision is made to remove them, they are being removed for their own care to a place of safety. The police power is to facilitate the assessment of their health and wellbeing, as well as to provide safety for the people around them. That is excellent, as far as it goes. My primary focus is on the fact that this applies fully only if the individual is in what is deemed to be a public place.

My interest comes from my personal involvement in one case, as I have said, plus from considerable discussions with frontline police officers over the years—predominantly from the Metropolitan police and the Surrey police—and with Professor Rix, who has just retired as a psychiatric consultant, and who was so upset about what was happening that he has been campaigning with the police. There are also a few senior police officers up and down the country who are so concerned that they are campaigning on this as well.

A few years ago, I joined two young uniformed police officers in their response car in Wandsworth. We attended a call with the blues and twos on. It was quite spectacular for me, sitting in the back seat. The officers were excellent drivers; how we missed hitting people on the way there was quite remarkable. We dashed to a residential council tower block, of which Wandsworth has quite a number, and went up to the 14th floor, where a very nervous lady—the mother of the household—let us in.

When we walked in, we saw the woman’s 22-year-old daughter standing on the windowsill of the open window, about to jump. The moment she saw us, she moved further towards the edge, so we moved back out and tried as best we could to persuade her to come down from that precarious position. We quickly established that she had a history of genuine suicide attempts, so this was for real. We pulled back to some degree because she clearly did not like the sight of uniformed police, but fortunately we were joined by two plain clothes officers. One was a very quick and clever lady officer, who entered the flat and managed to persuade the girl to come down from the windowsill and sit on the bed. She saw the pills that the girl planned to take for the suicide if she was not able to jump out of the window, pushed them to one side, gradually removed them and calmed the girl down. The girl clearly needed to go to a place of safety for psychiatric and medical help, but she vehemently refused and became very agitated the moment that was mentioned. She made a number of attempts to go back to the window, and had to be caught and brought back to the bed.

In the meantime, we made contact with the nearby St George’s Hospital psychiatric unit, seeking urgent assistance and someone of professional standing, as required under section 136, effectively to commit her so that she could be taken away to safety. The unit was busy, and it was some considerable time before a healthcare official finally turned up, with an ambulance and a crew. Many healthcare professionals say that it is better to have an ambulance than a police car in such circumstances, but it had completely the opposite effect for that young lady. When she saw the ambulance coming, she was off for the window again, and we had to get her back. The healthcare professional asked her to come quietly into care. That made matters even worse, and we had a tremendous struggle, but in due course the sad young lady was transported to the unit at St George’s, which is designed to be a place of safety. A life was saved—eventually.

The whole pantomime in that 14th-floor flat had occupied five officers and three NHS staff for about four hours. I am not counting myself, as a bystander. I warn any Members who go on such trips that it is par for the course that the police do not like us to get involved. I was trying to help in another case when there was a bit of a fight, and a very large police sergeant told me to keep out of the way, because “We don’t want a” dot-dot-dot “by-election”; that was really caring of him.

It was obvious from the beginning that the police themselves could quite simply have taken care of the young lady quickly and gently. They were very competent, and could have sorted it out and taken her to care. Admittedly, they would have taken her in a police car, but it could have been a plain police car—not an ambulance. Immediate action would have meant that she was transferred to safe care and would have met the required time limit for assessment, which I think is 24 hours. It would have been very quick, and would have reduced the continuing risk over the period in which we saw her attempts to leap out of the window. It was a huge waste of time, except for the end result, for the police and the national health service professional; that is aside from the up-and-down agitation for the young lady.

Under section 136 of the Mental Health Act, if this pantomime had taken place in a public place—if we had managed to persuade the young lady to go outside the flat’s front door and place herself on the landing—the police would have been able to take her into detention and take her to the hospital. We would not have had to wait for a mental health professional, and she would have gone into the care of St George’s.

When I raised this in a debate in 2017, the then Under-Secretary of State for the Home Department assured me that there was a triage system under a new, innovative policy, so that

“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.”—[Official Report, 11 July 2017; Vol. 627, c. 269.]

I liked the Minister. She was very earnest, and she clearly believed everything she was saying to me. I was polite, and I did not look for pigs flying around the Chamber, as I could have done. On hearing her remarks, Professor Rix and police officers who were campaigning on the issue—Professor Rix was here this evening—were absolutely astonished. The politer comments were, “Get real”, and, “Yeah, right.”

There are throughout the United Kingdom large numbers of frontline police officers who respond to all sorts of emergencies, including events like this one. There are not the same number of mental health professionals waiting around, driving around, going out with the police or waiting for a call, so that they can meet the police when they are on patrol to deal with a situation like this.

The hon. Gentleman raises a really important point. When I speak to the police service in Greater Manchester, they tell me what an enormous proportion of their time is spent dealing with people in mental health crisis. There are a number of aspects to this; I will not comment on his individual case. This surely points to the need for much greater investment in mental health crisis care and mental health community services. I hope that he will go on to mention that, and that the Minister will respond. While I am on my feet, perhaps I can ask the Minister when the Government plan to bring forward the White Paper in response to the Wessely review.

I suspected that I might get that question. That is why, as I very carefully explained, I asked for a Home Office Minister, not a Department of Health Minister. I suspect it would be better if the hon. Gentleman asked a written question, rather than asking my poor hon. Friend on the Front Bench something that he cannot possibly answer because he is not expecting it.

I found the reality of going out with the police to be completely different from what my very lovely Under-Secretary of State lady told me. The system just does not work. I am therefore suggesting a change that has been requested by the police. When I have put this to the police, the enthusiasm has been emphatic. They have been quite clear about it. One of them, who has had to deal with a lot of these cases, again in central London, commented, “Whoever puts this through will be a hero as far as we’re concerned.” But also, unwittingly, they will be a hero for those mentally ill people who are in distress, who need help and who may well commit suicide.

I am requesting a simple change, effectively removing the restrictive reference to a public place. It is quite simple to do. I have a small ten-minute rule Bill that would have fitted the purpose, but I pulled it because the Department of Health said that it had a review, as the hon. Member for Manchester, Withington (Jeff Smith) suggested. It does have a review, and there is a lot to be reviewed. This is a simple change to make life just that little bit easier for our battered policemen when they are dealing sympathetically—I have always found them sympathetic in these cases—with people who are mentally ill, and who are threatening to damage other people or themselves.

As I said, it has been enthusiastically supported by police officers and by Professor Rix, who has almost made it his psychiatric gift to the nation to undertake this campaign for a number of years.

Experience tells me that the Minister will, in the nicest possible way, probably say, “Thank you, but no thank you,” or, “We’re reviewing this”; I can see by his smile that the temptation is there. Having been a Minister in similar debates, I can assure him that it is possible—I have done it myself—to see the words that you have been given to read out and deviate from them. If the answer that I got before is the answer that he is going to give me, can he stall it? Instead, will he genuinely look at this and meet me, Professor Rix and one or two of the police officers who are deeply into this, to see whether we can do something positive to make it much easier for police officers in these circumstances to deal with individuals, particularly those who are either going to hurt somebody else or hurt themselves? I have a string of cases from the police and Professor Rix that I could go through with him.

As I said, something like 19,000 people were detained under section 136 in 2018-19. That is not known by most people, but it is certainly known by the police officers who are helping people in desperate circumstances to keep themselves alive or not hurt other people. This is a plea to the Minister to be positive this time.

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing the debate. His long-standing interest in these matters is well known. I am grateful to him for raising this important issue, and I congratulate him on his persistence in repeatedly raising it. I have learned in my relatively short time in this place that persistence often pays. I am not sure whether it necessarily will on this particular occasion, but perhaps we could meet in the future to discuss where things may go.

I also congratulate my hon. Friend on spending time with his local police officers. I am encouraging as many Members as possible to do so, because a lot can be learned on the frontline, as the hon. Member for Manchester, Withington (Jeff Smith) said. I have met quite a few police officers over the last few months, and one thing that the response teams in particular have persistently raised with me is the amount of time they spend dealing with people who have mental health issues. It is a tribute to them that for many people they are the automatic first port of call for help in a wide range of situations.

Notwithstanding that, it is not acceptable that the police should be asked to cover the roles of other agencies out of normal hours simply because they are a 24/7 service, or because of staff or facilities shortages elsewhere. The police are not trained social workers, paramedics or mental health professionals, and assisting people who need these services also prevents the police from carrying out their own core tasks. Sometimes police involvement will be necessary in mental health cases, because either criminality or a threat to safety is involved. In such cases, it is vital that people in police custody have access to the support and medical care they need. However, it is clear that the best place for people suffering a mental health crisis is a healthcare setting, because the police cannot provide the specialist care they need.

There has been good progress through a number of initiatives to improve the way that the police and their partners respond to vulnerable people experiencing mental health crisis, but we acknowledge that there is still more to do. Provisions contained in the Policing and Crime Act 2017 designed to improve outcomes for people in mental health crisis came into effect on 11 December 2017. Those include removing the use of police cells as places of safety for under-18s detained under sections 135 or 136, cutting the use of police cells for adults and reducing the maximum period of detention to 24 hours. We have seen a continued decrease in the use of police cells as a place of safety since 2012-13. There were only 136 instances last year, compared with some 9,000 cases in 2011-12. The Department of Health and Social Care has already made £30 million available for health-based places of safety since 2015, and I will mention some of the other investments that it is making in a moment.

I know that my hon. Friend, as he has this evening, has previously raised concerns—sometimes echoed within the police service—that police officers do not have sufficient powers to act quickly in relation to people in private homes who are mentally distressed. In the NHS, home treatment teams serve to support people in acute mental crisis in their homes, so that they do not need to be admitted to hospital. But, of course, when a person does not allow services to help them, the burden often falls on police officers. They can often find themselves among the first to be called to assist a person in their home, as my hon. Friend has experienced, only to find that they have limited legal options to resolve the situation on their own.

Police officers do have the powers to act to prevent crime and to protect people and property from serious harm, but at the moment the Government do not believe they should be given the responsibility for removing people from their homes without due process. The police are not mental health practitioners, and it is essential that a professional assessment is made so that people get the support they need. At present, officers can support mental health professionals who have obtained a section 135 warrant to remove a person from a private address, and we believe that is the right and proportionate approach to those in their own homes.

Health and Home Office Ministers considered legislating for additional powers following their 2014 review of sections 135 and 136, but decided on balance that such new powers were not appropriate, a position that this Government continue to hold. Rather than circumvent the need for a warrant, I am clear that a more satisfactory response is to ensure that the necessary mental health crisis care services are in place throughout the country to provide the responses that people need. We wish, where possible, to reduce the frequency of detentions under the Act and to prevent people from reaching a crisis state. We will keep this issue under review and continue to work with the police, in conjunction with other partners, to better understand the precise scope and nature of mental health demand, and distinguish where the police may need to continue to engage and ensure that other services need to play a bigger role.

As my hon. Friend will know, there has been a huge rise in the demand for mental health services both within and outside the health service. Given what I have said about the amount of police time spent in engaging with mental health crises, missing persons or whatever it might be, this is definitely something on which we need to work. If he believes this—and he has allies, such as his friend Professor Rix, who may be able to sway minds—I would be more than willing to meet him in the Home Office to discuss what more we can do. It is certainly the case that, on top of the enormous investment in mental health provision through the national health service that we will be seeing over the next few months and years, we all need to look at and think about the legislation in this area, and I would be more than happy to do so in the future.

Question put and agreed to.

House adjourned.