Oral evidence: Policing and mental health, HC 202Tuesday 28 October 2014
Oral evidence, 28 October 2014.
Witnesses
Chief Constable Simon Cole, Leicestershire Police, Former ACPO lead on mental health, and Mark Smith, Head of Suicide Prevention and Mental Health, British Transport Police, gave evidence.
Chair
Mr Cole and Mr Smith, thank you very much for coming. I am going to open the questioning and then I am going to hand over the chair to Dr Huppert. I hope you will excuse me, but I wanted to start with Mr Cole because obviously we do not see enough of each other.
Chief Constable Cole
No, Chairman.
Chair
Can I start with you? This is a very sad story that has been told. We have had so many reports. We have had the Adebowale report. Ministers are obviously concerned about what is happening. There is clearly an economic case for getting it right in this time of heightened austerity. Why are we still failing to do the early intervention that Mr Shaw and Mr Kressinger talked about? Where have we gone wrong?
Chief Constable Cole
Well, firstly, I agree this is a really serious issue, and the two sergeants who have given evidence, I was nodding vigorously throughout because I agree with their description of what is happening. My sense is now that there have been lots of reports. There now needs to be consequent action on the ground. I do believe genuinely that the Crisis Care Concordat offers that opportunity, but I also agree absolutely with what has just been said by my colleagues, which is at the moment that is a strategic document. There are only 10 of them been signed off nationally. This is something that was agreed in theory in February and it is not making a difference on the ground to the level that it could. But there are examples, Chairman. Very quickly, there are things happening that I think are positive. The general trend is towards less people being in police cells for 136, but it is still far too high. I absolutely share the view expressed by your two previous witnesses that police custody should not be in the Mental Health Act as a place of safety. It is just plain wrong. Street triage and liaison and diversion are things that I think are taking the debate forward.
Chair
We know you have a good story to tell and we are coming on to that slightly later. My concern is the number of people with mental health problems and concerns who have died in custody. I think the figure is two-thirds of people who commit suicide shortly after contact with the police have mental health problems. Why is it that inquest after inquest is coming up with evidence and verdicts that suggest if the police had handled it differently, had better training, these people would not have died?
Chief Constable Cole
Well, I think the first thing I want to make abundantly clear is that “prevent all deaths” is part of what our role should be. If a death can be prevented, we should be absolutely engaged and committed. You have highlighted and I know you have heard stories of dreadful personal tragedy and I would want to acknowledge that as a start point. In terms of numbers, deaths in contact with police, the last set of figures, deaths in custody there were 11, which is the lowest figure for a decade; around a million, 1.1—
Chair
Yes, but if I stop you there before you go on, of the 11, four had been detained due to mental health concerns?
Chief Constable Cole
Yes.
Chair
That is a very high proportion, isn’t it?
Chief Constable Cole
Absolutely it is and it perhaps indicates some of the complexities and some of the realities. Of course, the fact that they were in a police cell is because two of those, I believe, were 136 detentions and two of them were arrests for other matters. Certainly, those two would not have been in a cell if that was not an option. The other point I think you made, Chairman, was around subsequent suicides, of which there were 68 in the most recent IPCC report recorded. My colleague Mr Smith is doing some work nationally on that that I think the Committee might find useful. Can I ask him—
Chair
No, thank you. I will invite him, thank you.
Chief Constable Cole
Could I ask you to invite him, Chairman?
Chair
I will. That is why he is sitting next to you, Mr Cole. Mr Smith, just as an overview, we have specific questions to you. When we originally decided to have you, people wanted to know why and, of course, it is because of the number of people who commit suicide and are ill in those circumstances when on transport and, therefore, you are on the front-line. Are these on the increase or is it stabilising? Please give us some figures.
Mark Smith
Okay. I think it is stabilising at the moment. We did have a period in 2013 where we were very concerned about the growing numbers. I think we got to about August of 2013 and we had a 34% increase.
Chair
But in terms of sheer numbers?
Mark Smith
In sheer numbers, 325 people took their own lives on the railways in 2013-14. A further 91 attempted and survived with injury. On top of that—
Chair
But those are huge figures, aren’t they, 300 people?
Mark Smith
They are. To extend the scope of it, there were over 4,000 suicidal incidents in 2013 on the transport network. It is not just the people that unfortunately take their own lives; there is that whole raft of other incidents that involve people threatening to take their own life, attempting and surviving with injury, attempting with no injury, 999 calls from concerned people who are missing. It does create a huge demand.
Chair
How are your members equipped to deal with this? This is extremely difficult to deal with someone who is about to throw themselves under a train or on a track. How on earth do you include that in training? It sounds to me some of the most sophisticated and esoteric methods of training that one could imagine.
Mark Smith
We have different layers of training. At the recruit stage, we give them an input on suicide prevention, not only the force policy and approach but also some of the softer skills that might help give officers confidence in dealing with somebody that is obviously in crisis and distressed. We also try to get as many people through the Samaritans’ Managing Suicidal Contacts course. We have about 1,000 of our officers trained in that course. We also have trained our control room operators to know about our response policies and the other aspects that they can help front-line officers in terms of direction. We also have a course that uses police hydra technology. I do not know if you have heard of that before, but it is a computer immersive training where you get feeds of audio and written tasks. We give that to sergeants and inspectors to test decision making around vulnerable people. Part of that is suicide.
Chair
In terms of your officers, how much training do they receive in terms of hours?
Mark Smith
In hours? We attempt to give all of our officers at least one day’s training on mental health and suicide prevention. The inductions at recruit level are quite short, only two hours. The Managing Suicidal Contacts course is another full day.
Chair
It is not a huge amount of time?
Mark Smith
It is not huge, but one of the things I have been talking to our—
Chair
Would you like them to have longer training?
Mark Smith
I think always longer training in these issues; they are very important. What we have done is increase the confidence of our officers to go and proactively look for people who are in distress on the railway. In the last 12 months—
Chair
Sure. Have you ever had to do that?
Mark Smith
I have. I was a serving officer for 31 years and I have been involved in many incidents involving death and attempted suicides on the railway. I have done the Managing Suicidal Contacts course with the Samaritans.
Chair
Do you ever keep track? Once you have found someone who was about to commit suicide and you have intervened to stop this happening—I do not know how many times this has happened—
Mark Smith
140 in the last 12 months.
Chair
For you?
Mark Smith
Not for me personally, no, British Transport Police, the local police, members of the public and rail staff.
Chair
Who keeps track of these 140 after they have been, in effect, saved?
Mark Smith
We do. British Transport Police has two joint police and health teams. We have one in London, one in Birmingham. The London one is funded by NHS England, London Underground, BTP, and the one in Birmingham is funded as part of the DOH street triage programme. Basically, everybody that comes to our notice, all of those 4,000 people, will have a risk assessment approach applied, which was designed for us by the Oxford Centre for Suicide Research. Then we basically look to our health colleagues to help place those people into care pathways.
Chair
Yes. Do you have any joint training with other organisations, for example, paramedics, or training with mental health charities like Mind?
Mark Smith
We have at a local level, but not a nationally agreed programme at this time.
Chair
Would you like to see a nationally agreed programme?
Mark Smith
I think that would be very good, yes.
Chair
Mr Cole, it is quite different. What Mark Smith is doing with his team is quite different to what your officers are doing. By the time they get into the custody suite—and I know you are the chief constable, but you must go to custody suites very, very often in Leicester and Leicestershire. It is a busy place, isn’t it?
Chief Constable Cole
Yes. I think British Transport Police have a real specific need because of the volume that you have highlighted. The national training package that was alluded to by the sergeants earlier, there is a national e-learning package, which won awards and 88,000 officers and staff have done. I think that is a good start point. I would like to see more face-to-face training. I think that that is of value. You have highlighted already yourself, Chair, it has to be interagency training. This is about shared risk, about people who are ill, and it may be they are a repeat caller. It may be they are an offender going through the cell block. It may be they are detained under section 136. There is a whole set of issues that play around policing and mental health. It is not just around 136.
Chair
Thank you. We have other questions.
Michael Ellis
I would like to ask you, Chief Constable, about two things briefly. The first is the street triage situation. I understand Leicestershire works well and closely with Northamptonshire, my own local police force, and work together, which is good. I would like to ask you about street triage inasmuch as this is a new diversion type service, is it not, which is being piloted in Leicestershire?
Chief Constable Cole
Yes.
Michael Ellis
How does it work and is it working well?
Chief Constable Cole
Broadly, there are nine Home Office-funded street triage pilots in nine different forces and then there are another 16 forces who have now, with their local health partners, created triage. They are all slightly different, but the broad basis of them is in the Leicestershire model, from 7.00 in the morning until 3.00 in the morning there is a crewed police officer with a trained mental health nurse who will be deployed and is available to advise any incident involving mental health. What are the advantages of that? Shared information. Straight away you have what is on the police computers. You have just asked a series of questions around how sergeants would know. One of the ways people would know is on the Police National Computer. It may be indicated that somebody has a tendency to self-harm or be violent. Also, then, health data as well, so the health practitioner can talk about the health records and that means better decisions are made. What does it mean? We have been going since January 2013 in Leicester. About a 30% to 40% reduction in the use of section 136 powers. The numbers your predecessor as Chairman has alluded to around detentions going to police cells, we are at around about 30 in a typical year.
Michael Ellis
This is a system whereby it is like a utility that you can use. Is it county wide?
Chief Constable Cole
Yes, absolutely.
Michael Ellis
You have one mental health nurse attached to a police officer?
Chief Constable Cole
In effect, yes.
Michael Ellis
That you can call to anywhere in the county if you think it is necessary?
Chief Constable Cole
Yes.
Michael Ellis
It is like deploying a specialist unit?
Chief Constable Cole
Yes, and they are based in our central custody hub so they can also provide advice there. They can provide advice over the phone. It is a combination.
Michael Ellis
It has reduced by 40% your admissions under the Mental Health Act?
Chief Constable Cole
Our use of the 136 detention power.
Michael Ellis
The other point I wanted to ask you was about this. There has been a report today by one of the committees of this House about children feeling alienated by their contact with the police and this causing a lasting negative impression, which can be passed down the generations. Those children grow up and end up with a negative impression of the police. What can you do to ameliorate this situation?
Chief Constable Cole
That is a more general issue. It is not specifically around mental health.
Michael Ellis
No, it is not. It can relate to mental health as well, but it is a more general issue.
Chief Constable Cole
Yes, and, indeed, the Office for National Statistics’ most recent survey said 90% of young people trusted the police. I have not seen the report; I have just seen the reporting of the report, if that makes some sense. What can we do? We can make sure that we have coherent engagement strategies, we are engaged in schools, places of education, cubs, youth groups, all of those kinds of things. In relation to mental health, a really key issue has been highlighted by those that have just given evidence before us, which is the significant lack of provision for young people. If you are a young person suffering from mental illness, we are detaining you in a cell. You are more likely to be detained in a cell than an adult and there are literally no places. I could give you from my own force examples where it has taken us over 60 hours to place a mentally ill 15-year-old girl. She spent those 60 hours in a police cell in Leicester, the nearest bed being Manchester at one point. There is a profound issue.
Michael Ellis
I take your point, but isn’t it also the case that if young people have a negative view of the police it may often be because on the few occasions that they come into contact with the police, the police are in a position where they are seeking to reprimand them or they are in trouble for something? Perhaps if the police engaged more with young people in a non-suspect type scenario that might encourage more people to have positive impressions of the police.
Chief Constable Cole
It would, although other data suggests 90% of young people trust us. I guess the bottom line for us is we are an enforcement agency and young people are most likely to be victims and most likely to be offenders. That age group between 14 and 25 is the age group that is likely to be inside that line.
Michael Ellis
I accept that. Thank you very much.
Dr Huppert
Thank you for that. Can I move back to the idea of places of safety, which we have talked about? It touches on the rather horrific example you just gave, Chief Constable. The Police Federation in their evidence to us talked about hospitals operating informal exclusion criteria around drugs, alcohol, aggression, children and learning disabilities, so a fairly extensive list. Is there any progress being made on breaking down those barriers?
Chief Constable Cole
The barriers you have described are specifically not barriers according to the guidance from the Royal College of Psychiatrists, whose evidence to this Committee I would really commend to you and I think nails a lot of the issues. Is there progress being made? Well, hopefully, the concordat will force that progress: the production of more meaningful data; the production of the challenge that you talked about in terms of why people have been refused. But even as recently as last week the Care Quality Commission report, “A Safer Place To Be”, highlights an example of a 16 year-old who had been going to kill themselves on the railway, it taking four and a half hours to get to a place of safety that might vaguely accept them, and when they got there being asked to be breathalysed before the 16-year-old, who was vulnerable and about to commit suicide, would be allowed in. These things are still going on. Has there been progress? I think there has been significant progress and you can see that in the numbers of 136s and where they are now going, but the variation is stark. Mr Vaz has highlighted that variation; from the West Midlands where there is virtually nobody going to a cell, my colleague from Devon and Cornwall has described nearly 800 people going to cells.
Dr Huppert
Again, on the issue about refusals—I will come to you in a second, Mr Smith—HMIC suggested that data should be collected on any time somebody is brought to a health-based place of safety by police and is not accepted and why. Do you think that would help to break through this?
Chief Constable Cole
Yes. Being candid, until three or four years ago the data collection around the whole piece was pretty inadequate. I was involved in some work with Inspector Siobhan Barber, who is behind me here, who did a lot of the hard work around trying to get some data together. I think some of the data that you have been quoting yourself during this session has helped draw it together. We need to understand what routes people go after 136 is used. What is then always quoted is how many were sectioned. Well, I do not think that is a dreadfully legitimate test. The test is did that person receive care that supported them at that point of crisis. That might have been a care plan. It might have been working with friends. It might have been a referral to another agency for another day. The data set is getting more coherent. There is work going on nationally. I think one of the reasons that 136s are believed to be going up might just be about better data collection.
Dr Huppert
Interesting. Mr Smith, BTP must have particular challenges with places of safety because there are so many around that you cannot know them all. Do you experience the same sort of problems?
Mark Smith
We do, and one of those cases that Mr Cole referred to there was one of our cases. We find exactly what has been described, which is a very ad hoc, patchy situation across the country. There are areas where there are few problems involved in the whole arrangements around section 136, particularly in London. We have been working and seeing great improvements in the arrangements there. The actual number of people going into police cells in London has been reduced to—I will ask colleagues behind me—but I think it is under 20 this year, down from about 80 last year. We also need to go in and take some action sometimes. In the cases that are quoted in the Care Quality Commission report, members of my team will go and see managers within health at the location to try to resolve the issues, which are often due to different interpretations of local policies. One thing BTP does struggle with is the mental health codes of practice say there should be local policies to govern how section 136 is managed locally. Of course, BTP would struggle very much with 43 different policies.
Dr Huppert
Do you get help from the local forces in each area?
Mark Smith
Yes, undoubtedly. BTP have a policy that we do not ever take any section 136 detainees into our own custody, but they are in London where there is a good provision. BTP officers outside London will take people to local police stations if that is the only alternative and then will be working under the local arrangements. Yes, we have seen opportunities to improve things where you can build relationships with health and understand each other’s position. If you do not do that, then there are problems.
Dr Huppert
One last question from me and then I will bring in Lorraine Fullbrook. You have this interesting role of head of suicide prevention and mental health in BTP. Do other police forces have equivalent roles?
Mark Smith
Other police forces often have heads of mental health, heads of safeguarding, which covers a breadth of issues around adult and child issues, so in most forces there is a senior lead for mental health issues.
Lorraine Fullbrook
The Home Secretary in her speech to the Police Federation in May held up Leicestershire and, I understand, Cleveland and Scarborough as best practice on the street triage project that you have set up. The initial results show outcomes are better for vulnerable people, show quicker solutions for police—
Chief Constable Cole
Definitely.
Lorraine Fullbrook
—and reductions of the section 136 in the initial results. She would like to see this rolled out across the country. She stated that additional money would be made available this year for four new pilots to be identified by the police. Do you know where those areas are? Are you involved in sharing the best practice that you have found throughout your project in the four areas?
Chief Constable Cole
The answer to do I know where those four areas are, no, I do not off the top of my head, I am sorry. There are now nine Home Office-funded triage pilots and, as I think I said, another 16. The point about triage, Her Majesty’s Inspectorate of Constabulary has picked up in their report issued about three or four weeks ago on core policing where there was a recommendation that every force should look at the business case and the business benefits of street triage and, depending on the outcome of that assessment, every force should then make a decision about progressing with health partners street triage. The spreading of that has come from the HMIC report around 136 and custody. The other thing that I would make the Committee aware of, which is just starting, is the Care Quality Commission are doing inspections of crisis care mental health. They have just done a couple of test inspections. One of the test inspections was my own force area with health partners. They have announced this morning another 15 areas where they are going to inspect the crisis care response, so looking at availability of places of safety, provision for young people, transport, which is a key issue. The data—I think we probably both have the same data pack, which is good—suggests that individuals should be transported by ambulance and medical staff and that is not happening in 75% of cases. I think there are a lot of positive things that are going on in terms of that spread. There is a proper assessment being done by the Home Office of the nine projects, but the other thing that we have done nationally is share the criteria of that assessment with the 16 self-starters so that there is an assessment done on the same basis. I think you have nailed it. The outcome is there are lots of organisational benefits. There are cost benefits. It is more efficient. I think the Chairman started off by talking about the time. This is about an individual’s life and the police laying hands on them because they are ill and taking them to a cell is not the best option for those individuals. It is just not.
Lorraine Fullbrook
As you are the expert, if you like, on street triage—
Chief Constable Cole
I have never been called that before.
Lorraine Fullbrook
—how can you insert yourself right in the middle of that to spread your best practice that you have built up over the time that you have been doing this?
Chief Constable Cole
To be fair, you have mentioned the Home Secretary.
Lorraine Fullbrook
How can you be pushy and get in there?
Chief Constable Cole
To be fair, the Home Secretary and Norman Lamb have both been hugely supportive of this agenda with their different responsibilities. I think they both get the issue that is at the heart that individuals are getting a service that we should not all be proud of between us. That has been spread. The HMI has used us as an inspection test bed as a force on a number of things. We are cited in that recent HMI report as best practice. I would want to stress there are other versions of that. I think in Devon and Cornwall the triage is within the control room access to mental health expertise, mental health nurses and the data. Because of the geographic spread, physically setting off to get from Exeter to Land’s End is apparently a long way, so they have had to find a different solution. I think that more than half the forces in the country now have a triage scheme of some sort. Liaison and diversion offers similar opportunities. There are currently 10 of those schemes centrally funded, about £25 million worth of funding. They are being empirically assessed and then there is another nine to be announced in the new year. That will be again half the country has liaison and diversion in cell blocks.
Dr Huppert
Would you say the issue about street triage is not about whether it helps, whether it works, but whether it is affordable?
Chief Constable Cole
No. That is a really interesting question. I think it pays for itself really quickly because it is much cheaper to give someone the right option straight up than it is to take them, wait for six hours at a place of safety, wait another six hours for an assessment and detain them. The other thing I would think—and I know you had Michael Brown here, mental health cop, who I would say has done a fantastic job and I would want that put on the record. There is an element of street triage that it is a plaster to fix a current problem. The optimum system probably does not have triage because it has shared information. It has accessible care plans. It has got upstream of the problem. Where we are at the moment we need something to get us there and street triage I think is that tool.
Dr Huppert
Thank you, and I am sure Inspector Brown will be pleased to hear the comments.
Mr Winnick
Just one or two questions. Chief Constable, I was rather interested in what you said about the West Midlands, which is my part of the world. Is there any particular reason why the situation is so much better? I think that is a good way of putting it.
Chief Constable Cole
Because I left about 10 years ago could be the answer.
Mr Winnick
Which would be perhaps challenged by your successors, but carry on.
Chief Constable Cole
I think there has been a mature partnership discussion. Michael Brown was personally involved in it because he was doing some of the work for the chief officers there who took some particular leadership. I think there were a couple of specific issues involving deaths involving the police that forced a real hard look at what was happening and why things were happening. As a consequence, there is a mature partnership that is delivering what I believe the Act and the guidance to the Act and the nationally agreed guidance, which is here, say. That is being delivered and the Crisis Care Concordat in the West Midlands is broadly being delivered already, so there is something about leadership, the will to deliver, having accountability structures, and making it happen on the ground.
Mr Winnick
Good. Mr Smith, if I understand the position, you are, in fact, currently in your very responsible position within the British Transport Police a civilian, but you were a former senior police officer?
Mark Smith
I was, that is correct. That is correct. I was a detective chief superintendent. I was an area commander and I served a short period, about a year, as an acting assistant chief constable for crime.
Mr Winnick
Your period in total with the police service?
Mark Smith
With my current service it is now 34 years.
Mr Winnick
In your present position?
Mark Smith
Eighteen months.
Mr Winnick
Basically, as I see it—and for both of you, in fact, the question—is the lack of sufficient co-ordination between the National Health Service and the police force. I get the feeling that while nationally the situation is satisfactory, that is not necessarily on the ground locally with the concordat. Would that be the position, Mr Smith?
Mark Smith
My thoughts are that locally you need very good relationships, conversations and opportunities to exchange information and data about risk with health to make things work more effectively. Locally, we do suffer some areas where that is difficult to get the traction that we require. In other areas, you have pockets of excellence where we have had really good reception. In fact, BTP’s scheme in Birmingham is funded as a part of the street triage pilot schemes. I was very impressed with the cross-city CCG there for accepting the challenge of hosting a service that runs from the Scottish border to Land’s End in terms of the coverage. We work with the Birmingham and Solihull Mental Health Trust, who obviously also supply to the West Midlands street triage. The relationship there is excellent and I think wherever we can build effective relationships with health locally we can break down the sorts of issues that would hamper co-ordination. When you get that right and you share data about people and risk—and our street triage is not about reduction of section 136 per se, it is about reduction of inappropriate use of section 136. Our whole scheme is about outcome. It is about getting people from crisis to care, and that is what that is about.
Mr Winnick
Chief Constable, anything you wanted to add?
Chief Constable Cole
I would endorse all of that. I would add two things. I think it would be really helpful if the police service was able to be a member of the health and wellbeing boards that are created in every area. In many areas, we have been invited to be but we are not a statutory requirement, and that seems to me to be something of a gap. The other thing is in the new health model the relationship and understanding of those commissioning services is as important as any of the operational relationships that you have just described. The commissioning of the shape of those services—and clearly health has gone through enormous change in recent years with CCGs being created and the like—what that commissioning model looks like and the commissioning guidance given is really important. I would want to stress the nature of these committees is always that we talk about what is wrong; there are lots of places where things are going really right and you have just highlighted the West Midlands, your area. There is lots going really right there. Our relationship, our triage, is because of a good relationship with the Leicester NHS Partnership Trust who have committed to it people and money.
Mr Winnick
You gave alarming figures to the Chair at the beginning of the evidence that the two of you have given regarding suicide incidents or what could be potential suicide. One could make the frivolous comment on a very, very serious and tragic situation the attraction of “Anna Karenina”, the episode at the conclusion of the novel, but is there something about trains that attracts people unfortunately in that state of mind, which one wishes with all the will in the world that their lives will be preserved?
Mark Smith
This problem has confounded us for a while. We have worked very closely with Network Rail, Transport for London, Samaritans and academics on the question why people come to the railway because then we can do more to prevent it. One thing we do know is that people who try to take their own life or do take their own life on the railway live very near to it. Even in rural areas, the people will live near railway lines, so it is an available means within their daily life. Other research suggests—and this is from academic journals—that there is something around people’s thought that it might be lethal, a sure means, which is not, in fact, completely the case. The likelihood of a fatal injury if you jump in front of a tube train is about 55%. The reality is 45% of people will have life-changing injuries. We work with Network Rail and with Samaritans and the train operators. We have a joint research programme going on at the moment, which has been funded by Network Rail and commissioned by the Samaritans to look at those wider issues to see what we can do to stop it. The issue around, I suppose, showing railway deaths on films or in books or in media reporting, we do seem to see a connection. When you get media reporting around suicide, then we have spikes of events. We try to work with the media. There are media guidelines, as you know, for editors to try to do that responsibly, otherwise we do see an effect in what happens on the ground.
Mr Winnick
Very interesting.
Dr Huppert
That is very interesting indeed, Mr Smith. A few final questions, if I can. Before I come on to a few factual things about the Mental Health Act, do you have particular problems with people who are at risk or suicidal and a long way from home? Is that a particular challenge?
Mark Smith
Yes.
Dr Huppert
Particularly, do you ever have problems with getting local health services to take somebody who is from somewhere a long way away?
Mark Smith
Yes, we do. We do, and although it should not happen—I have had discussions just yesterday about this—we do have regular events where because the person is presenting with an issue outside their home area there is a reluctance to do an assessment in that area. I had a case where I had to personally intervene not so long back where an individual was taken off the railway lines trying to kill themselves. They had a physical injury so we went to A and E nearby. We then walked next door to the mental health unit, who assembled all of the staff that were required to do the assessment and then discovered the person was out of their home area. Then we got into difficulty and we had to intervene at a senior level to get that done.
Dr Huppert
It seems very strange given this is clearly an emergency situation. It is not as though you can wait a few months.
Mark Smith
I know, but it does happen. I think issues around funding unfortunately come into this.
Chief Constable Cole
The example I quoted earlier from the CQC report about the 16- year-old, if you read that report one of the places of safety refuses to accept the 16-year-old because they do not live in that area. You mentioned I think, Chairman, Sussex along the way. Sussex has been mentioned. Sussex and Beachy Head is a particular and unique issue. That is why their numbers are as they are. People head from all over the country to Beachy Head and it presents a particular demand. Sussex’s use of 136, a lot of the numbers relate to that geographic location.
Dr Huppert
We should perhaps try to find if there are ways of disaggregating those numbers, at least to understand what is happening in the rest of Sussex. Can I finally ask you both a few specific questions about changes to the Mental Health Act? Can you give relatively brief answers, if possible? I am not trying to truncate your answers. Firstly, to be clear on the point that was raised by the custody sergeants about changing the Mental Health Act to allow the police to access private property to detain people who are in need of care, are you supportive, not supportive?
Mark Smith
We have a specific issue with this inasmuch that the power applies to people who are in a place to which the public have access. Railway lines are a place to which the public do not have access, so our officers need to remove somebody from a place of danger, get them to a public place, and then make that judgment as to whether they need care and control for the power to be made out and executed. Now, albeit there is some legal precedent that would support us doing that because we do have powers to remove people as trespassers from the network, it is a clunky way of doing things. It is not dissimilar to perhaps colleagues that need to find a route around the problem in private premises.
Dr Huppert
You would like to find some sort of arrangement for that?
Mark Smith
Yes.
Dr Huppert
Chief Constable Cole?
Chief Constable Cole
I do not support the extension into a private place for the reasons expressed very eloquently by my predecessor from Devon and Cornwall in terms of giving evidence. I understand absolutely why a lot of operational cops would wish for it because at the moment they are sitting and waiting and waiting and waiting for warrants to be sworn for people to get to private premises, but I just do not support it. I believe if the system operated as the law currently describes—and I do think there is a pretty profound issue for Parliament, which is: does Parliament want to enact something that means that the response to mental illness is the police have a power to enter a place?
Dr Huppert
You have been helpfully clear. Again, a few other quick things, and hopefully quick answers. Do you think there would be any problems in reducing the detention clock under section 136 from 72 hours to 24 hours?
Chief Constable Cole
It is absolutely outrageous that you can be detained for 72 hours for being ill and 24 hours for murdering somebody.
Dr Huppert
You would support 24 hours?
Chief Constable Cole
Yes.
Dr Huppert
Okay.
Chief Constable Cole
The PACE reviews should be done with a medical practitioner there. At the moment, if you are in custody, the inspector has to do it. It should be a review done with a medical practitioner.
Dr Huppert
I have two more questions that will be very helpful for our report. There have been suggestions to extend police powers under the Mental Health Act, such as the power to detain, to other professionals; paramedics, for example. Would you support that or not?
Chief Constable Cole
I would.
Mark Smith
I think in a setting where there is no need for police support, then that is a good option.
Dr Huppert
Thank you. That is very helpful. Last question: have you, as an organisation, formally asked the Government to change the law relating to section 135 or section 136?
Chief Constable Cole
I have been involved in the consultation process that is ongoing. I believe the review intends to report later this year, early next year.
Dr Huppert
You have fed in all of these lines?
Chief Constable Cole
I have met with the review, Dr Mason.
Mark Smith
We have, and the distinction is that we have asked for the power to extend to places where people are trespassing, not to extend to people entering private premises. If the individual is there as a trespasser, either on the railway or on the top of a high building, then the power can be used. That is what we have asked for.
Dr Huppert
Okay, thank you. Mr Smith, Chief Constable Cole, thank you very much for coming to give evidence.
Chief Constable Cole
Chairman, could I indulge three one-sentence points?
Dr Huppert
Yes, why not?
Chief Constable Cole
Thank you. Firstly, I think there is an implication to consider about police detaining mentally ill people and taking them to cells in relation to CRB checks, because the question we are then asked is: has this person been detained in a police cell? We say, “Yes, they have”. The postcode lottery alluded to by Mr Vaz then applies to your subsequent CRB check where if you have been taken to a health-based place of safety you might have a different CRB check than you do if you have been taken to a cell.
Dr Huppert
That was a long sentence, but very helpful.
Chief Constable Cole
I know, but it had some commas in it. The point made by the sergeants around the law does not say a place of safety has to either be a place of safety or a police station, it says it can be anywhere. It can be a doctor’s surgery. It could be a community nurse. It could be anywhere appropriate and we should not lose that. Lastly, your point, Chairman, around the suicide prevention role, every area is required or used to be required to have a suicide prevention strategy, which was a partnership suicide prevention strategy. There is still a national suicide prevention strategy, which suggests areas should have a local strategy. The answer is forces should be feeding into that strategy, which is a multiagency partnership strategy.
Mark Smith
Could I just say one thing? Is that possibly allowed?
Dr Huppert
One and only one.
Mark Smith
One and only, I promise.
Dr Huppert
The Members of the Committee are supposed to be elsewhere.
Mark Smith
One of the things that we have also contributed to discussion on is the Care Act. We were hoping that it would allow us to refer people at risk of self-harm and suicide into the multiagency arrangements for the care of vulnerable adults. The current legislation at the moment does not include that class of people in the at-risk category.
Dr Huppert
With those very brief sentences, Mr Smith, Chief Constable Cole, thank you very much.
Chief Constable Cole
Thank you.
Mark Smith
Thank you.
Dr Huppert
That concludes the session for today. Oral evidence: Policing and mental health, HC 202 24