“‘ello ‘ello ‘ello. What’s goin’ on ‘ere then?”
The last five years have seen a steady increase in the number of people subject to the provisions of the Mental Health Act 1983 (NHS Information Centre, 2011). This is in large part due to increases in the use of section 136, the police holding power.
There was a staggering 135% increase in s.136 detentions from 6,004 in 2006-7 to 14,111 in 2010-11. But why?
This could be a result of increased mental health awareness and better training of police officers. Increased awareness of symptoms of mental distress may increase detection rates and prompt officers to use s.136 as a means of bringing people to the attention of mental health services. However, two unpublished studies by experienced mental health social workers involved in mental health training of police officers found the opposite. One of these – a controlled study – found a decrease in the use of s.136 following mental health training of police officers in one area, in contrast to a neighbouring area which did not receive similar training. (We are hoping to publish this study soon to make this finding more widely available.)
It is possible that the increase in s.136 detentions could be a result of better recording. However, I have quoted the official figures collected by NHS Trusts and collated by the NHS Information Centre. It is unlikely that recording systems have radically improved over the last five years to produce this pattern.
Unfortunately, research studies don’t help us much either. Most studies of s.136 are local, with small samples and frequently contradictory findings. However, they consistently find that only a small proportion of section 136 detentions (about 25%) subsequently result in a formal detention in hospital.
A recent study of the use of s.136 in Trafford, Manchester, for example, found threats of self-harm (35%) and aggressive behaviour (22%) to be the most common reasons for detention (Sadiq et al., 2011). Of those known to mental health services only 4% had a diagnosis of psychotic disorder, with most having a diagnosis of mood disorder (22%), personality disorder (20%), or a drug and alcohol problem (18%). However, this study included only 45 s.136 detentions.
A large study of 887 s.136 detentions over 3 years across five south London Boroughs found an over-representation of people of Black British, Black African and Black Caribbean ethnic origin in s.136 statistics and in subsequent MHA detentions in hospital (Borschmann et al., 2010). Over 40% of all s.136 detentions resulted in a discharge with no subsequent hospital admission (formal of informal).
Older papers (see the reference list of the Borschmann paper for some more reading suggestions) have found a preponderance of young men with a diagnosis of schizophrenia amongst those detained under s.136. Although young men are still commonly found in s.136 statistics, this pattern appears to be changing with fewer people with a diagnosis of psychotic disorder being detained (although Sadiq et al.’s (2011) study needs to be treated with some caution due to its small sample). This could potentially indicate that Early Intervention in Psychosis services are effectively engaging with young people with that diagnosis, but further research is required to confirm this.
The potentially changing composition of those who are detained under s.136 cannot explain the unprecedented increase in its use. It is possible that it is mirroring the decline in psychiatric beds over the same period. Rising thresholds for psychiatric inpatient care, in order to rationalise demand for a shrinking resource, may be leaving some people suffering mental distress literally on the streets waiting to be picked up by the police. Mental health crisis services are unable to cope with the rising demand and have become mostly inaccessible to people not already known to mental health services.
Whatever the reason for this pattern, though, it is clear that people find it distressing to be detained under s.136 of the Mental Health Act 1983. In one study, detainees and their carers talked about their dissatisfaction with the quality of care and treatment from both the police and mental health professionals (Riley et al. 2011). They felt criminalised and suggested that police stations should only be used in exceptional circumstances for people experiencing mental distress.
Mental health services should either accept police officers in their ranks as allied mental health professionals and provide them with full support and training, or provide mental health crisis services which genuinely meet the needs of their local population.
Borschmann, R. D., Gillard, S., Turner, K., Lovell, K., Goodrich-Purnell, N. & Chambers, M. (2010) Demographic and referral patterns of people detained under Section 136 of the Mental Health Act (1983) in a south London Mental Health Trust from 2005 to 2008. Medicine, Science and the Law, 50, 15-18.
NHS Information Centre (2011) In-patients formally detained in hospitals under the Mental Health Act 1983 – and patients subject to supervised community treatment, Annual figures, England 2010/11. London, NHS Information Centre for Health and Social Care.
Riley, G., Freeman, E., Laidlaw, J. & Pugh, D. (2011) ‘A frightening experience’: detainees’ and carers ‘experiences of being detained under Section 136 of the Mental Health Act. Medicine, Science and the Law, 51, 164-169.