Peter Moore: The system is failing the mentally ill - and expecting police to pick up the pieces

A recent headline in a national newspaper read “my son died of overdose because police won’t answer mental health calls”. The story is tragic but is she blaming the wrong organisation?

Why are the police responsible for failures in the NHS? Under the Mental Health Act Section 136 if a police officer finds a person in a public place he or she believes is suffering from a mental illness and is “in need of immediate care and control” the officer has the power to take the person to a “place of safety”.

Immediate care and control can mean suicidal or could mean a danger to themselves or others. In the past the place of safety was a police station, but this was entirely inappropriate.

As a police surgeon I was often called to the police station to see someone detained “under a 136”. Locking someone in a cell who has done nothing wrong but is suicidal was clearly wrong.

It also took up police time who had to watch them carefully to avoid further physical harm. I have no doubt that the whole process was causing further mental harm.

Once in the place of safety they would be assessed by a psychiatrist and a social worker. This might result in release with further follow up or admission to hospital. What made this even more difficult was that once someone was in the police station and the NHS staff knew they were safe so were in no hurry to attend.

Another problem arose. If the psychiatrist decided they were safe to be released the police had no choice unless they had committed an offence. Keeping them in custody would be illegal.

But if there is a tragedy after leaving the police station. Either suicide or harming others, the police will get the blame. Why were they released?

I once saw an elderly confused lady who had wandered out of a residential home in London, got on a train at Paddington and got off at Torquay. She tried to book into a hotel but, when the receptionist could not find her booking she said, “I know I’m booked in. The Queen booked me in personally”.

After trying social services the hotel was forced to call the police.

The only option for the officer was to bring her in “on a 136”. She ended up locked in a cell surrounded by drunks who were swearing. She was no risk to anyone and all the staff were upset.

After many meetings and pressure from government the NHS agreed that the place of safety should be the hospital. But even this was complicated.  A and E was not a designated place of safety. It had to be a special area in a mental health unit.

Even after this agreement we had problems. If there are any possible suggestion of violence the hospital would refuse admission. This would be understandable in cases of severe violence but they started looking for excuses. Any past history of even the most minor assault gave them a reason to refuse.

The argument over how to deal with the mentally ill in a police station is not new. I found a letter in the British Medical Journal from 1875 about the problem of a “lunatic” arrested by the police in Exeter. In Victorian times the word “lunatic” referred to today’s “mentally ill”.

There was a battle over whether the police surgeon or GP should deal with the problem. There was also a debate over who pays. Even this is an issue today. Should the police pay forcaring for the mentally ill?

When I was working, despite all sides agreeing that the police station is not the place for anyone with mental health problems, the police could not persuade the NHS to make the hospital the only place of safety. In the end the only way the police could pressurise the NHS was to refuse to answer mental health calls.

Sadly, this also meant some very ill people fall through the cracks.

Blaming the police makes better headlines than blaming the NHS. No one is suggesting that the NHS staff do not care but the police also care. After one hundred and fifty years of debate it is time we decided how to deal with the mentally ill in a public place who are “in need of immediate care and control”.

Blaming the police does not help anyone.