Report on the Review of the Mental Health (Scotland) Act 1984

Chapter 20

POLICE POWERS AND RESPONSIBILITIES

Place of safety

1. The police are one of the agencies who may be called upon to deal with a person who is mentally disturbed. It is a task which calls for skill and sensitivity. They may have to intervene at a time of crisis, with limited or no information about the person and his or her situation. We have considered whether the legislative powers the police have to undertake this responsibility are appropriate.

2. Under s118 of the 1984 Act, a constable who finds a person in a public place who appears 'to be suffering from mental disorder and to be in immediate need of care or control' may, if he or she thinks it necessary in the interests of the person or for the protection of other people, remove the person to a place of safety. The definition of 'place of safety'³ includes a hospital or residential home or any other suitable place which is willing to admit the person. It should not include a police station unless by reason of emergency there is no other suitable place available for receiving the patient.

3. The removal to a place of safety is for the purposes of enabling the person to be examined by a medical practitioner and of making any necessary arrangements for treatment or care. The maximum duration of the power to detain is 72 hours, but the power ends once the medical examination has concluded and either arrangements have been made for the treatment or care of the person, or the decision has been made by the doctor that no such arrangements are necessary. If the person requires admission to hospital and is unwilling to be admitted, the examining doctor can detain him or her under the emergency provisions of s24 or s25.

4. Evidence given to us suggested there was a degree of inconsistency in the use of this power. This did not only depend on the attitudes of local police officers, but also the working arrangements with local health and social work services.

5. In December 1999, the Scottish Executive Health Department issued guidance on the roles of GPs and the police in dealing with mentally disordered people who may be potentially violent⁴. This recommended that there should be locally agreed procedures for obtaining health and social work information and (where appropriate) support, where an individual appears to be suffering from a mental disorder. These local arrangements should involve round the clock access to an appropriate source of such information.

6. In respect of the 'place of safety' where the person should be held to allow for examination, the guidance suggests that this might be the incident site, the person's home or, where the doctor thinks it appropriate, a hospital. It should not normally be a GP surgery or a health centre. The police and doctors are encouraged to consider whether a mental health officer (MHO) could assist in deciding on the best course of action.

7. The guidance relates specifically to potentially violent incidents. Of course, many of the situations which might involve the police in dealing with a mentally disordered person would not involve the risk of violence to others, but may involve the person acting in an inappropriate way, or putting himself or herself at risk. Nevertheless, much of the guidance would seem to be equally relevant to these situations.

8. The evidence we received would suggest that, despite this guidance, there is need for improvement in some areas of Scotland in the degree of co-ordination between the police and care agencies in responding to people with mental disorders who come to police attention.

9. We received oral evidence from the Association of Chief Police Officers (Scotland) (ACPOS). They pointed out that police officers will often come across people who appear to be behaving in a way which suggests mental disorder. Police officers generally are loath to detain a person in such a condition in a police cell, but may also be extremely concerned for the person's safety. In such circumstances, they may either seek to secure the attendance of a police surgeon (or, in some cases, the person's own GP), or take the person to local psychiatric services.

10. We also received evidence suggesting that there can be difficulty in persuading psychiatric services to admit such people, particularly where it is suspected that the person is under the influence of alcohol or illegal drugs. Police officers may then feel obliged to arrest the person on a criminal charge such as breach of the peace, partly to ensure the person is in safe custody rather than returned to the streets.

11. This attitude is understandable. Nevertheless, it was pointed out to us by, among others, the Fife Advocacy Project that detaining a person who is mentally unwell in a police cell, without input from trained mental health workers, could cause an unacceptable risk of self harm.

12. From the point of view of the health services, there may of course be good reasons for the reluctance to admit. In many services, beds are at a premium. Such patients can be extremely disruptive, and can put other vulnerable patients at risk. In some cases, a person's behaviour may be judged to be due solely to intoxication, rather than by mental disorder.

13. We are not in a position to identify whether difficulties in liaison between the police and psychiatric services in particular areas can be attributed to faults on either side. We are satisfied, however, that there is considerable variation in practice, and that it is necessary for more robust arrangements to be put in place.

14. In general, it would seem that the powers given to the police in s118 are appropriate, although we consider that the duration of the power should be reduced. The power exists in order to allow a person to be medically assessed, after which the emergency detention powers of the assessing doctor can then be brought into play if appropriate. Even in rural areas, we believe that the police ought to be able to have the person assessed by a doctor well before 72 hours have elapsed.

15. Section 118(3) requires the constable who has removed the patient, where practicable, to notify 'some responsible person residing with the patient' and the nearest relative. We believe that, with slight amendments, such a power should remain.

16. There would seem to be a need for better training and greater co-ordination between agencies. The 1999 guidance on the role of GPs and the police in dealing with potentially violent mentally disordered persons recommends that joint training involving the police and mental health services is carried out. Amongst the issues it should cover is the application of the Mental Health (Scotland) Act. (We discuss police training further in Chapter 30).

17. In their evidence to us, ACPOS pointed to the considerable improvements in child protection practice which had come about through the development of joint working arrangements, and suggested that this approach could be beneficial in relation to people with mental disorders who may be offending or at risk.

18. Many of these issues relate to practice rather than legislation. We understand that they have been considered by the review which was commissioned by the Scottish Executive of the operation of the current strategy on mentally disordered offenders. We do, however, feel that the legislation and the associated Code of Practice could do more to encourage an appropriate response to people with mental disorders who come to the attention of the police.

19. We are particularly concerned about the availability of suitable 'places of safety'. Despite the legislative requirement that this should not be a police station except in an emergency, it appears that there is no suitable alternative in some parts of Scotland, and the 'place of safety' may be in acute psychiatric in-patient facilities. This may also be inappropriate, since it can mean placing at short notice a person who may be potentially violent alongside vulnerable patients.

20. We propose that health boards should be under a duty to ensure that there are appropriate places of safety in their area, and to notify the police of their whereabouts. The Code of Practice should set out minimum standards for places of safety.

21. We also believe that the use of the powers vested in the police should be monitored by the Mental Welfare Commission. This would help to identify problems in particular areas, but also good practice, which could be more widely shared. More generally, it is important that there continues to be monitoring of the extent to which local protocols and arrangements are developed in accordance with the national strategy and guidance.

22. The Scottish Association for Mental Health (SAMH) raised concerns about the dangers of using CS spray on people with mental health problems, suggesting that there could be harmful interaction with antipsychotic medication. It was also suggested that this be reported to the Mental Welfare Commission. We agree that such incidents are potentially serious and should be so reported.

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