Patients may get to the Police station on a charge, or from a Mental health Act section 136 Order - detention for three days [ but to be dealt with in one ] to a place of safety ... for behaviour that looks like mental illness needing help and not able to want or to find it.
Police And Criminal Evidence [ PACE ] rules of practice
...... see also Prosecution guidelines for late alternatives after 'charging'
Arrest - charges - prosecution - court appearance - verdict, sentence or maybe remand for Reports ( probation, social work, psychiatry ) - and re-appearance for sentencing.
It is the Station custody Officer who is the gatekeeper for whatever happens next after someone who might be mentally ill is taken into custody after Arrest.
So it is important he does not get too far ahead on the wrong track.
Detention may be because of a 3 day Section 136 Place of Safety Order ... i.e.a police power when somebody in a public place is thought to be mentally unwell :- [ sectiion 136 Place of safety Order :- The Code can be misleading because it implies that the Custody Sgt has the power to discharge the detainee at any time.
What it must mean is that the Custody Sgt can discharge the detainee from s.136
if he or she can determine that the purpose of the detention has been completed
because after that point detention is "no longer appropriate".
The Police do not have the power to override the requirements of s.136(2).
But Jones ... the authority to detain under this section ends immediately
if the doctor’s assessment leads him or her to conclude that the person is not mentally disordered”...
That could be the local police doctor ...ooops .. forensic examiner ... and what do they know !!! ??? the usual ...' not ill as I saw them' ... fit to be deatined ..nothing about 'best interests' or 'least restrictive' ...
a view from a custody officer
A person is ‘detained’ for the purpose of 136 and as such must be treated in accordance with Police and Criminal Evidence Act and its Codes of Conduct. Code C Annex E states .
If an officer has any suspicion, that a person of any age may be mentally disordered, that person shall be treated as mentally disordered
The Custody Officer must contact an FME to conduct an appropriate examination of that person.
If that FME considers that this person is Fit for interview or charge then the grounds for detention no longer apply
(se s. 34 PACE below)If the FME feels that further assessment is required then a multi disciplinary team is called out.
the custody officer must as soon as practicable inform the appropriate adult of the grounds for detention and the person’s whereabouts
.
Until an appropriate examination either by an FME or multidisciplinary team
is conducted then the custody sergeant cannot release within the 72 hour time scale.
s34(1) PACE states;
if at any time a custody officer becomes aware that the grounds for the detention of that person have ceased to apply;
AND is not aware of any other grounds on which the continued detention of that person could be justified
… it shall be the duty of the custody officer to order his immediate release from custody”
The issues for custody Sergeants (Certainly in large Metropolitan Forces ) is not attempting to release as soon as possible
but either:
Having to detain whilst waiting for a bed and subsequently keeping that individual safe
If deemed not to be mentally disturbed trying to ensure follow up visits by health practitioners (Duty of care)
a more personal response
..."You do make a valid comment about the competence or ability of the FME,
In my experience most were not s 12,
irrespective of this most did not have the inclination to make the decision that this person was fit for release etc.
There was reliance on the assessment teams to make that decision.
I have, during my time as a custody sergeant asked for a second opinion
when I felt that the person detained was mentally ill and the FME was not so inclined to say so.
Disagreeing with an FME is not done lightly but most custody sergeants would rather argue the point with an internal inquiry
rather than be asked difficult questions by the coroner.
A custody Sergeant cannot be told what to do by an Inspector, it must be an officer of the rank of Superintendent in charge of the station.
Custody Officers are unique beasts, very much like AHMP's
whereby their decision can be held accountable not only internally but through the criminal and civil law.
Whilst I am sure you could give me anecdotal instances to disprove my statement,
my experience of custody sergeants is whilst they would rather not have to look after someone
who is mentally disordered for up to 72 hours without any help,
once they have the problem they will not discard their responsibility lightly." ]
"
Working within PACE time clock (24 hours) when the person is detained for a criminal matter.
The station Officer must be told, and must be asked to record in the custody documents, that they have been made aware there might be mental illness present,
and that might be behind any disturbance that has taken the person into the police station.
That should lead to greater care - the Appropriate Adult or Approved Social Worker, being called in, and maybe the next step to 'charges' dropped, the matter being taken over by the local mental health team.
Where the custody officer is aware he/she may call in the police surgeon who may just decide about 'fit to be examined' and 'fit to be detained' at the police station. If that is all they do then 'charges' may go ahead, and get too far on for diversion to be possible .
If charges do go ahead there is still the opportunity to divert before a Court appearance, because the prosecution service, if told of mental health problems, may well not proceed toproswecutioin, but instead divert to ...say,the local mental health team care, or have the charges changed or dropped.
Mentally ill people when recognised as such can be diverted by the prosecution people, if theyknow about the mental health concerns, going instead to the mental health service , or have a charge reduced,or dropped.
Anybody mentally ill - or who might be - should have an appropriate adult helping them.
Families who go to the police station should know that they can be the appropriate adult, or if the Social worker is the appropriate adult that they should ask to speak with them.
Finally at Court appearance it may be made clear by the defending solicitor that there is a mental health problem, and then the Court may ask for psychiatric, probation, and social worker reports before sentencing,leading to probation order with conditions of treatment, rather than prison.
Vulnerable groups in
detention
Detainees who required assistance while in custody due to their age or health ( physical or mental ).
Here the focus is upon the use of 'appropriate adults' to safe-guard the interests of juveniles and mentally disordered or mentally handicapped people while in detention.
The Codes of Practice state that if a detainee
appears to be suffering from physical illness or injury or mental health
problems the custody officer should immediately call for the police surgeon [ Forensic Medicl Examiner - FME ]
(C 9.2).
Here the extent to which detainees received medical attention is
examined, along with the reasons for such attention and the
recommendations resulting from it.
Appropriate adults
Under PACE the police must provide an 'appropriate adult' for juvenile and
mentally disordered or mentally handicapped detainees (C 3.9). The role of
the appropriate adult is to provide support to a vulnerable person in custody
which may involve:
• giving advice
• ensuring police interviews are conducted properly
• facilitating communication between officers and the detainee.
A person, including a parent or guardian, should not be an appropriate adult
if he or she is involved in the offence, for example as a suspect, witness or victim
Otherwise they can be most suitable. Often social workers are preferred.
(C 1C). People acting as solicitors or lay visitors should also not be
appropriate adults (C 1F).
Furthermore, admissions made by a suspect to an
appropriate adult do not have the same status as those made to a legal
adviser, and therefore can be disclosed to the police.
In cases where the detainee appears to be suffering from a mental disorder [ ed.appears to whom - a custody officer may choose not to see, or not to recognise, or may not appreciate the presence of mental disorder ]
PACE states that in addition to an appropriate adult being contacted the police must call in a registered medical practitioner and an approved social worker to assess the detainee at the police station. (C 3.10).
Mentally disordered or mentally handicapped people
Compared to juveniles, mentally disordered or mentally handicapped detainees made up a much smaller group of those in detention.
Just two percent of all those in the custody record sample were treated as being mentallydisordered or mentally handicapped.
Other research has suggested that the
proportion who are actually mentally disordered might be higher and that
detainees with mental health problems are not always identified by custody
officers.
These studies, using independent medical assessments and various
definitions of mental problems, have estimated that those suffering from
mental disorder or mental handicap make up between 10 per cent and 26
per cent of detainees.
Compared to other detainees, those classified as having mental problems tended to be older and were more likely to be women.
Forty-three per cent
were over 30 years of age, compared to 27 per cent of other detainees, while
24 per cent were women compared to 15 per cent of the whole sample.
There was little variation across stations in the proportions of detaineestreated as having mental problems.
Four out of ten of these detainees were in custody under s.136 of the Mental Health Act 1983 (MHA), with the police station providing 'a place of safety'.
The remainder had been arrested for a wide range of crimes, with theft, criminal damage and public order
offences the most common.
Appropriate adults attended the police station in two-thirds of cases (66%)
involving mentally disordered detainees, a much lower proportion than that
for juveniles.
Custody records provided a number of explanations for why in
the remaining one-third of cases an adult was not called.
In a very small
number of cases a parent or social worker refused to attend the station.
In
the majority of cases a doctor attended the station and recommended that an
appropriate adult was not required or that the detainee was fit to be kept in
custody and interviewed.
It should be noted however, that the requirement
for an appropriate adult is independent from that for a doctor and the police
should not wait for a doctor's recommendation where they suspect a
detainee has mental problems. [ well what should they do ? - in practice they call in theri police surgeon who doesn't always get it right ]
In other cases custody officers appeared to
have viewed the detainee's condition as not serious enough to require an
appropriate adult, or their initial concerns receded.
Confirming previous studies, social workers were far more likely to act as
appropriate adults in cases involving mentally disordered or mentally
handicapped detainees than in those involving juveniles.
Six out of ten cases
involved a social worker, these being equally divided between duty social
workers, specialist social workers and social workers whose status was unknown.
Friends or neighbours 16 %, and parents or guardians 15%,
other relatives 7%, acted as appropriate adults in most of the remaining cases.
Just 2% were from an approved Panel.
In addition to securing an appropriate adult, PACE requires the attendance of
a doctor in cases where a detainee appears to be suffering from mental
problems or has been detained under the MHA (Sec 136). In the custody
record sample a doctor attended in just over three quarters of such cases
(76%), a higher proportion than that found by Brown et al. (1992).
While
such medical attention focused on the nature and extent of any mental
problem, in a small number of cases it also concerned other medical matters,
including physical injuries, drunkenness, drug addiction and medical
conditions.
The recommendations resulting from a doctor attending the
station are :- In over a third of cases an appropriate adult was recommended, while in just under a third one was thought not to
be required.
An equally common recommendation was that the detainee was
fit to be kept in custody, while less frequent recommendations were that the
detained person was fit for interview 1/10, required hospital attention 1/11, should be allowed medication, or should be given regular checks while held in
custody.
Comment.
There is no suggestion here that the police doctor get involved in giving
custody officers any advice about who else they might get in touch with ; ask detainee family doctor, local community mental health team for opinion or to come and see, or police surgeon do something to be able to record level of community care of mental illness.
so that charge might change be downgraded, and prosecutor to review charge, or divert, or mental state be further looked into, so that it can be taken into account
when before magistrates - say - for bail reports which might tell magistrates
of extenuating illness, and point to line of sentencing; nothing.
Surely, police surgeons should be directed to take these further steps,
or they must at least simply ask police custody officer
to contact the mental health team representative
with clinical notes for a better briefing. And let any solicitor know there is a mental health disorder issue here.
There are fault lines in these PACE guidelines.
Who decides who to call in as appropriate adult?
How is it the custody officer can decide one is not needed?
How expert are they about that ?
In practice, the custody officer tends to leave things about mental disorder to be decided by the advice of the police surgeon - who often just decides 'fit to be interviewed' .... 'fit to be detained' maybe offers an oral sedative and goes away - the next morning nothing else is done.
It's a different shift.
Where the police notice 'weird behaviour', then it should be incumbent on them, and the custody officer to record this, to try to find out more - it should be made easy for them to have the local mental health team tel.number, just to ask the local mental health team duty contact 'are they on your books - record that in custody notes, and make sure - at least the next morning before any magistrates appearance that the solicitor and then the Court know ' there is mental disorder here'.
What can the family carer do? Well, they can offer to be the appropriate adult and get the page of advice about their duties and powers.
They can make sure the fact of the mental condition is mentioned and that they are recording that was done.
They can ask the custody officer that they speak to the duty social worker, and give the custody officer the tel.no.
They should tell the custody that the local community mental health team is involved, and give the tel.no. for that contact.
And the outcome.
Maybe diversion, maybe the prosecutor accepts, a lesser charge
Maybe a bail offer and a Bail Report if they go before magistrates so that disposal has a health basis - maybe Probation plus conditon of accepting mental health care - and treatment.
When presenting a Report for the Court - which may be done some time after the event that led to a charge - it can be crucial that the Court knows what the person was like in behaviour at the start of custody - make sure the comments on behaviour whilst in custody are made known to the solicitor acting in defence. ...i.e. near to the time of the event , so that 'he was ill at the time' has some backing and weighty credence from observation recorded in the custody notes.
Prosecution service has it's own guidelines
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