A new map developed by the Care Quality Commission highlights worrying restrictions in access to health-based places of safety for young people experiencing a mental health crisis.
People who have been detained by the police under Section 136 of the Mental Health Act must be taken immediately to a safe place where a mental health assessment can be undertaken. This should be a ‘health-based place of safety’, located in a mental health hospital or an emergency department at a general hospital. They should only be taken to a police station in exceptional circumstances.
In the financial year 2012/13, there were 21,814 reported uses of Section 136, of which 7,761 involved the use of a police cell. CQC’s work with HM Inspectorate of Constabulary, HM Inspectorate of Prisons and Healthcare Inspectorate Wales in May and June 2012 found that some of the most common reasons for the use of police custody related to the unavailability of health-based places of safety because there were not enough staff or beds.
The map – which draws on a CQC survey of mental health providers earlier this year – shows the locations of all 161 health-based places of safety in England and gives details of opening times, the areas they serve, their capacity, and the age groups they accept. It can be found here: www.cqc.org.uk/hbposmap.
CQC’s survey found that, while all but one upper tier local authority (county or municipal borough) area is served by a health-based place of safety, over 20% of these areas are not served by a place of safety which accepts young people under the age of 16.
CQC found that 56 (35%) of the 161 health-based places of safety do not accept young people under the age of 16. This results in a lack of access for under 16s in 33 of 152 upper tier local authority areas (22%). 13 NHS mental health trusts (of 56 surveyed) and two community interest companies restrict access for young people under the age of 16 at all of their places of safety.
CQC also found that 28 of the health-based places of safety which do not accept under 16s also do not accept young people aged 16-17 (17% of all health-based places of safety). This results in a lack of access for 16-17 year olds in 17 of 152 upper tier local authorities (11%). Seven NHS mental health trusts and two community interest companies restrict access for young people aged 16-17 at all of their places of safety.
Figures from the Association of Chief Police Officers estimate that, in 2012/13, 580 children and young people under the age of 18 were detained under Section 136. Of those, it is estimated that 263 (45%) were taken to police custody. CQC believes that the restrictions on access for young people to health-based places of safety in some areas are a key reason for this.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health) said:
“We undertook this work because the Home Secretary expressed concern in May last year about the number of people who found themselves inappropriately taken to police stations during a mental health crisis. We too are worried about what appears to be the routine use of police custody as a place of safety. We are particularly worried about the number of young people affected by this and the fact that so many areas are not served by a health based place of safety that will accept a young person who is experiencing a mental health crisis.
“The Mental Health Crisis Care Concordat states that a local health-based place of safety should be available for young people who are in crisis. Young people should be able to use this facility even if it is attached to an adult ward. They should certainly not be taken to police stations routinely.
“We are calling on those providers that restrict access to health-based places of safety for young people to review their local protocols and to ensure that appropriate arrangements are in place.
“This map can help the police to identify the nearest health-based place of safety – where a suitable one is available – to avoid people being taken to a police station when what they so badly need is to be assessed in a therapeutic environment.
“We will use this map to inform our inspections of mental health service providers – helping them to improve crisis care – and our monitoring of police powers under the Mental Health Act.”
Care and Support Minister, Norman Lamb, said:
“When someone is in mental health crisis, it is very important that a health-based place of safety is available. That is why we set out plans for this map in our Crisis Care Concordat.
“It is unacceptable for a child in a mental health crisis to be taken to a police cell because there is no health-based place of safety. Our Crisis Care Concordat reinforces the duty on the NHS to make sure that people under 18 are treated in an environment suitable for their age, according to their needs.
“Whilst there has been a welcome decline in the use of police settings as places of safety over the past couple of years, this is still not as rapid a fall as we would like.
“It is imperative that all areas implement the principles of the Concordat as quickly as possible to make sure good crisis care is available, no matter what your age or where you live.”
Home Secretary Theresa May said:
“The CQC’s findings are significant. It is not acceptable for any local area to lack a health-based place of safety. As I have made clear, people detained under the Mental Health Act should not be held in police cells. The best place for people suffering a mental health crisis is a proper healthcare setting.
“I have made it a priority to improve the way people with mental health issues – including under-18s – are treated when they come into contact with the police. The Secretary of State for Health and I expect the findings of this report to be acted upon quickly.
“I have also asked HMIC to investigate how vulnerable people are treated in police custody and the Government has launched a review of sections 135 and 136 of the Mental Health Act.
“I look forward to the publication of the CQC’s full report in the summer.”
Other findings from the survey include:
• 151 out of 152 upper tier local authorities are served by at least one health-based place of safety. The exception is the Isles of Scilly.
• The majority (106) of upper tier local authorities are served by one health-based place of safety. 19 local authorities are served by two, 17 local authorities are served by three, six local authorities are served by four. Essex is served by six, Hampshire is served by seven, and Lancashire is served by 12.
• 131 (81%) of the 161 health-based places of safety are located on a mental health hospital site. 23 (14%) are based in an emergency department in a general hospital and 7 (4%) are part of a mental health service on an acute hospital site. Of the 151 upper tier local authorities served by a health-based place of safety, 129 are served by places of safety located in mental health units only, 12 are served by places of safety located in both mental health units and A&E departments, and 10 are served by places of safety in A&E departments only.
• One health-based place of safety is specifically for young people only, and does not accept people who are 18 and over (the Aubyn Centre, provided by North Essex Partnership University NHS Trust).
A full report on the findings of the survey will be published in the summer once full analysis of the results is complete.
This will include CQC’s findings on how health-based places of safety are being used, whether exclusion criteria are in place, how they are staffed, and also how mental health providers are working with other agencies, including the police, in this area.
The survey is one of CQC’s commitments under the Mental Health Crisis Care Concordat. It is also a key component of a wider themed programme of work which CQC is undertaking on the care and support that people experience during a mental health crisis.