Section 136 and police custody—an unacceptable situation

Abstract

“What have I done to deserve this? I was ill; I was locked up because I was ill.” These are the words of someone detained in police custody under section 136 of the 1983 Mental Health Act, which authorises police officers in England and Wales to take people having acute mental illness episodes to places of safety (eg, hospitals, mental health facilities, police stations) for assessment. Guidelines state that police stations should be used only in exceptional—and undefined—circumstances. But a new report shows that 9378 people were detained in police stations under section 136 between April, 2011, and March, 2012, often because suitable facilities were unavailable or detainees were deemed intoxicated or violent. They can be held without review for 72 h (average 10·5 h), compared with 24 h for criminal offences.Detention in police cells conflates mental illness with criminality, increasing stigma, and could be particularly problematic in people having their first episode of psychosis, for whom initial negative experiences of mental health care could have lifelong ramifications. Cells are small and unpleasant, visibility is poor (of concern in those at risk of self-harm), and often sectioned people are not separated from those arrested for criminal offences, allowing for potential harassment.To avoid police-cell detention, 136 suites—dedicated environments for acute psychiatric assessments—should be more widespread; protocols should be standardised and rigorous; police officers and mental health professionals should receive more training and be better integrated; and mental health care overall should be made more accessible and patient-friendly, thereby reducing acute crises and section 136 admissions.The report recommends declassifying police stations as places of safety and remanding patients in custody only in truly exceptional circumstances and for a maximum of 24 h. Such actions would be a strong first step but do not go far enough. Mental illness is not a crime, and should never be treated as such. Policy changes are needed to ensure that no one is remanded in custody solely for being ill. “What have I done to deserve this? I was ill; I was locked up because I was ill.” These are the words of someone detained in police custody under section 136 of the 1983 Mental Health Act, which authorises police officers in England and Wales to take people having acute mental illness episodes to places of safety (eg, hospitals, mental health facilities, police stations) for assessment. Guidelines state that police stations should be used only in exceptional—and undefined—circumstances. But a new report shows that 9378 people were detained in police stations under section 136 between April, 2011, and March, 2012, often because suitable facilities were unavailable or detainees were deemed intoxicated or violent. They can be held without review for 72 h (average 10·5 h), compared with 24 h for criminal offences. Detention in police cells conflates mental illness with criminality, increasing stigma, and could be particularly problematic in people having their first episode of psychosis, for whom initial negative experiences of mental health care could have lifelong ramifications. Cells are small and unpleasant, visibility is poor (of concern in those at risk of self-harm), and often sectioned people are not separated from those arrested for criminal offences, allowing for potential harassment. To avoid police-cell detention, 136 suites—dedicated environments for acute psychiatric assessments—should be more widespread; protocols should be standardised and rigorous; police officers and mental health professionals should receive more training and be better integrated; and mental health care overall should be made more accessible and patient-friendly, thereby reducing acute crises and section 136 admissions. The report recommends declassifying police stations as places of safety and remanding patients in custody only in truly exceptional circumstances and for a maximum of 24 h. Such actions would be a strong first step but do not go far enough. Mental illness is not a crime, and should never be treated as such. Policy changes are needed to ensure that no one is remanded in custody solely for being ill. Section 136 and police custodyA Lancet Editorial (June 29, p 2224)1 advocated policy changes so that no-one is remanded in police custody solely for being ill. Section 136 of the 1983 Mental Health Act authorises police officers in England and Wales to take people suffering from a mental disorder to a place of safety for assessment. Detention in police stations under Section 136 is still common, despite guidance of the Code of Practice.2 The most frequent reason for detention (57 of 70, 81%) was the perception of a risk of suicide or self-harm. Full-Text PDF