My Lords, we now move to issues relating to the interaction between the police and people with mental health problems. This amendment would ban the use of police cells for adults detained under Sections 135 and 136 of the Mental Health Act 1983 in the same way as this Bill now bans it for children under 18.
I am very encouraged by the 53% reduction in the use of police cells as places of safety during 2015-16. The police, mental health services, local authorities and voluntary sector partners deserve our congratulations on that. However, that still left 2,100 people taken to police cells—a situation that will have led inevitably to exacerbation of their mental health crisis. I listened very carefully to what the Minister said in response to similar amendment that we discussed in Committee. I thank the Minister for the meeting that we had at the Home Office to discuss it. I am encouraged by the clearly expressed intention of the Government eventually to reduce the use of police cells to zero, and I hope that the Minister will feel able to accept this modified amendment, which takes account of her concerns.
We got rid of discriminatory mental health legislation only a few years ago, and we are on a journey towards parity of esteem between physical and mental health. The Mental Health Act 1983 is now over 30 years old, and we need further to update how we treat people with mental health problems and enshrine that in statute. At least two police forces have now managed to reach the desirable target of zero use, which proves that use of police cells can be avoided even in exceptional circumstances, so we are not asking for something that has been shown to be impossible; we are asking for
something that has been shown to be possible. But we appreciate that it requires the provision of more health-based places of safety, more training, better regulation, better partnership working and more diversionary strategies such as street triage.
That is why subsection (4) of the new clause, which my amendment would insert into the Bill, makes provision for delayed implementation until such time as the Secretary of State is convinced that everything is in place to ensure that there is no longer any need to take people in mental health crisis to a police cell for their assessment to be done. I appreciate that this was not strictly necessary, as implementation is dealt with elsewhere in the Bill, but I included it to make clear what I am asking for. I suggest that an implementation date of April 2019 is quite achievable.
When you are in a crisis, you need compassion and understanding and, with the best will in the world, the police are not the people to give that. That is why the police themselves are keen that the objective of my amendment is achieved as soon as possible. A mental health crisis is a mental health car crash. Nobody who broke their leg in a road accident would expect to be taken to a police station for triage; they would be taken to a health-based place of safety for their needs to be assessed and treated—in other words, an A&E department in hospital. We cannot say that we have achieved parity of esteem between physical and mental health if we continue to treat mental health emergencies in a different way from the way we treat physical emergencies. People detained in this way are not criminals and yet they are treated as such and feel distressed and confused, making it even more difficult to help them get well.
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One example is Declan. At the age of 21, he had depression, anxiety and suicidal thoughts. One night, after being out with friends, he decided to walk home, experienced a dissociative episode and found himself alone on a motorway bridge. Police arrived and took him to a cell after finding several crisis suites full. Declan said:
“My laces were removed ... and my possessions were taken off me, including my phone … it made me feel alone, isolated, and hopeless. I hadn’t done anything wrong – and didn’t see why I couldn’t keep my things … No one knew I was there. I felt like a criminal”.
This should not happen—ever.
I am grateful to the noble Baroness, Lady Chisholm of Owlpen, for her letter of 25 November following our meeting at the Home Office. She accepted that the police station should be used only in exceptional circumstances, but also accepted that in some areas this happens too frequently and for reasons not consistent with the term “exceptional”. She therefore described as promised the scope of the new regulations that are being developed to define those specific circumstances. She said that the regulations would cover a series of considerations which an officer must take into account in each case when making a judgment as to whether to take the person to a police cell. The regulations will also make clear that certain situations do not justify use of a police station and also how a person should be cared for at a police station.
These are all very welcome and in the short term will certainly help further to reduce the use of police cells. This is all good, but if I were a practitioner, manager or commissioner, the reality is that in the current climate if someone tells me to do X except in exceptional circumstances, this would not be on the top of my agenda. But if it is included in the Bill, even with delayed implementation, it will move to the top of my agenda to sort out because I will know that, before long, I will not be able to do it at all.
I am grateful to the noble Lord, Lord Patel of Bradford, who is unable to be in his place today, for his support for this amendment based on his practical experience visiting almost 20 police custody suites and talking to police and other staff there. It is their experiences and feedback that have led him to the conclusion that no one, regardless of their age, should be taken to a police cell as a place of safety. In the notes that he shared with me, the noble Lord quotes the Royal College of Psychiatrists, HM Inspectorate of Constabulary, HM Inspectorate of Prisons, the Care Quality Commission and Healthcare Inspectorate Wales all saying the same thing—that police cells should never be used. They do not fulfil the requirement of the 1983 Act that people should be taken to a place of safety. A police cell is not a place of safety if the mental health of the person is going to deteriorate there, which it is. NICE guidance also states that:
“If a service user with a mental health problem becomes aggressive or violent, do not exclude them from the emergency department. Manage the violence or aggression … do not use seclusion. Regard the situation as a psychiatric emergency”.
Putting someone in a cell cannot be regarded as anything but exclusion and is therefore contrary to NICE guidance.
I accept that there is a cost to this. It has been calculated that 33 additional beds are needed across England and Wales to achieve the zero target. This would cost a total of £96.4 million and would save the police £16 million over 10 years, and who knows how much in the way of on-costs for the NHS. But it is not just more beds that are required. The interviews conducted by the noble Lord, Lord Patel, brought out a number of problems in addition to the shortage of beds. Other reasons given were insufficient staff at the health-based places of safety, the person being turned away because they had consumed alcohol, and the person displaying violence or having a history of violent behaviour. Sometimes people stayed in a police cell longer than was desirable because of difficulties in accessing approved mental health professionals to make the assessment, particularly out of hours and at the weekend, which might have a great deal to do with cuts to local authority funding. All of these things are linked. However, it is not rocket science to put them right and to put them right within a very few years.
Does the Minister think it is beyond the capability of various government departments to put them right by April 2019? Surely if it is possible in Merseyside and Hertfordshire, it is possible anywhere. I beg to move.