Worldwide, someone dies by suicide every 40 seconds. More than 6,000 people ended their own lives in the UK last year and it is estimated that for every completed suicide, there are many more attempts.
So perhaps it is unsurprising that around 80% of police detentions under Section 136 of the Mental Health Act relate to suicide prevention. This is the police power that allows an officer to remove someone from a public place to a place of safety for a mental health assessment if that person’s mental state appears to be placing them or others at risk.
The use of police cells as a “place of safety” has generated much of the ongoing controversy this power has attracted. Last year over 2,000 of the 28,271 police mental health detentions were taken to custody. But as of December 11, the Policing and Crime Act 2017 has banned the use of police custody as a place of safety for anyone aged under 18, and for adults in most circumstances. The length of detention has also reduced from 72 to 24 hours and the police are now encouraged to contact a health professional before detaining someone.
Changes to emergency mental health provision are needed, but sadly these amendments may not greatly improve the care of those detained under Section 136, or lower the number of detentions.
From police cells to hospitals
One of the biggest reasons for the use of police cells has been a shortage of available health-based place of safety suites, which are generally specialised units attached to mental health hospitals. A&E, also a place of safety, has traditionally only been used when a detained person has required immediate medical attention. Now though, despite vigorous opposition from some health professionals, more patients detained under Section 136 may be taken to emergency departments.
While agreement has long been near universal that police custody is never an acceptable place for a vulnerable person experiencing a mental health crisis, A&E can also be a noisy and distressing environment, especially out of hours when most detentions occur. Here too, hospital staff may feel as ill-equipped as most other people to address suicide. With many patients already facing lengthy waiting times in A&E departments, this is unlikely to manifest as a great improvement in care.
The BBC documentary series Ambulance recently showed paramedics waiting an hour for a patient detained under Section 136 who had taken an overdose to be allocated a cubicle. No additional place of safety capacity is likely to be created, so unless detentions are further reduced police cars could be set to join ambulances queuing outside hospitals.
The police cannot solve the problem alone
High rates of detention have contributed to suggestions that too many people were being detained because the police were using the power unnecessarily. But the reality is that Section 136 has long been used to plug the gap in mental health provision. Often detaining someone has been an officers’ only option to fulfil their duty to protect life.
Solely focusing on the number of detentions does not offer a solution and the police cannot bring down detention rates without support from other services.
From 2012 street triage schemes, where a mental health professional joins the police in responding to calls to vulnerable people, began to emerge. These teams have broadly been welcomed for improving the care of people in need and making fewer Section 136 detentions.
A recent University of Brighton study into Section 136 interviewed people who had been detained before street triage was introduced. Almost all felt that the police’s decision had been appropriate but wished there had been another option. Another key finding was that several people had been detained repeatedly, some over ten times in a year, which greatly increased the total number of detentions recorded in Sussex.
No single solution
The issues are more complex than how appropriate a detention may be.
My further research is indicating that around 30% of Section 136 detentions in several parts of the south-east involve a person who has been detained before and that this is a widely recognised issue elsewhere in the country. Interviewees have given accounts of multiple traumas and ongoing hopelessness punctuated by life-saving interventions by the police, which stop a suicide but cannot address the underlying problems that have driven their desperation in the first place.
Dealing with the causes of extreme distress before someone reaches crisis point offers an urgently needed alternative. One programme succeeding in breaking the cycle of high frequency repeat detention is the Serenity Integrated Mentoring project. This police-led scheme builds on the foundations of one of the first street triage models. Involving a patient, officer and mental health nurse working together, the project is demonstrating the stability that can be achieved when patients and professionals are enabled to step back from firefighting long enough to focus their efforts at pre-crisis intervention.
Of course, not everyone who experiences suicidal thoughts or acts on those thoughts has a mental illness. But unless more robust methods to avert suicidal crises are developed, detention rates will continue to be unacceptably high, regardless of where those detentions are located.
Anyone who would like someone to talk to in confidence can contact the Samaritans by calling 116 123.