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Ward B, Kollios J, Smith F, Klim S, Senz A, Kelly AM. Characteristics and outcome of patients transported by police to emergency departments under section 351 of the Mental Health Act 2014 (Vic). Emerg Med Australas 2021; 34:263-270. [PMID: 34643031 DOI: 10.1111/1742-6723.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the ED under section 351 (s351, police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV). METHODS This is an observational cohort study conducted in two metropolitan teaching hospitals in Victoria. Participants were adult patients brought to ED under s351 of the MHAV. Data collected included demographics, event circumstances, pre-hospital and ED interventions and outcome. Analyses are descriptive. RESULTS The present study included 438 patient encounters. Median age was 34 years. In 84% of encounters (368/438) patients were co-transported with ambulance. The most common primary reason for detainment was suicide risk/intent (296/438, 67.6%) followed by abnormal behaviour without threat to self or others (92/438, 21%). In ED, parenteral sedation was administered in 11% (48/438). Physical restraint was applied in 17.6% (77/438). Psychiatric admission was required in 23.5% (103/438). In 63 cases, psychiatric admission was involuntary (14.4%). Most patients (297/438, 67.8%) were discharged home. A subset of patients had recurrent s351 presentations. Eighteen (5.6%) patients accounted for 22% (96/438) of all events. CONCLUSION Most patients brought to ED under s351 of the MHAV had expressed intention to self-harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s351 is consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of the use of these powers. There were a concerning number of patients with multiple s351 events over a short period.
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Affiliation(s)
- Beth Ward
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Jason Kollios
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Fiona Smith
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Ainslie Senz
- Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
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2
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Wondemaghen M. Policing mental illness: Police use of section 136 - Perspectives from police and mental-health nurses. MEDICINE, SCIENCE, AND THE LAW 2021; 61:266-274. [PMID: 33599166 DOI: 10.1177/0025802421993363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ideological shifts in mental health-care policy such as deinstitutionalisation have meant police have had to make decisions about the care of persons with a mental-health crisis. This study examines how police in five English counties respond to crisis calls when employing the powers afforded in section 136 of the Mental Health Act 1983, and the effectiveness of the national Street Triage pilot scheme. Qualitative interviews with 30 police officers and mental-health nurses were collected as data sources. The analysis shows that police have previously struggled with the significant number of crisis calls, whilst also finding mental-health services inadequately sourced, leading to some detentions in police cells as alternatives to health-based places of safety. However, the scheme has made positive changes in alleviating these issues when mental-health nurses are co-located with police, highlighting the need to strengthen their partnership by facilitating the sharing of information, responsibilities and decision making in order to ensure police cells continue to be avoided as alternative places of safety.
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3
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Robins JE, Morley KI, Hayes RD, Ross KR, Pritchard M, Curtis V, Kalk NJ. Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt. Drug Alcohol Depend 2021; 224:108725. [PMID: 33940325 DOI: 10.1016/j.drugalcdep.2021.108725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. METHODS We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. RESULTS Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001). CONCLUSIONS The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.
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Affiliation(s)
- John E Robins
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Katherine I Morley
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; Innovation, Health, and Science, RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia
| | - Richard D Hayes
- Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Kezia R Ross
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Vivienne Curtis
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; Health Education England, 4 Stewart House, 32 Russell Square, Bloomsbury, London, WC1B 5DN, UK
| | - Nicola J Kalk
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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Odejimi O, Bagchi D, Tadros G. Typology of psychiatric emergency services in the United Kingdom: a narrative literature review. BMC Psychiatry 2020; 20:587. [PMID: 33302905 PMCID: PMC7727184 DOI: 10.1186/s12888-020-02983-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 h. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UK. METHOD Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 h. Excluded studies did not describe a PES, non-English, and were not conducted in UK. RESULTS Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK. CONCLUSION All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.
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Affiliation(s)
- Opeyemi Odejimi
- Urgent Care Pathway, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Dhruba Bagchi
- Urgent Care Pathway, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - George Tadros
- Aston Medical School, Aston University, Birmingham, UK
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Cresswell M. Rise in the use of section 136 of the Mental Health Act 1983 in England and Wales: A viewpoint on Loughran (2018). MEDICINE, SCIENCE, AND THE LAW 2020; 60:140-146. [PMID: 31865860 DOI: 10.1177/0025802419896916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article provides a critical viewpoint on Loughran’s recent work in Medicine, Science and the Law on the causes of the rise in the police’s use of section 136 (s136) of the Mental Health Act 1983 (Loughran M. Detention under section 136: why is it increasing? Med Sci Law 2018; 58: 268–274). The rate of this rise seems significant: by 2014, it was five times more likely that a person in England would be detained in a hospital under s136 than it was in 2000, and the trend has continued to the present day. This viewpoint considers the significance of the s136 rise from the theoretical perspective of causal analysis.
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Abstract
There has been a significant increase in the use of section 136 of the Mental Health Act 1983 in England and Wales, particularly over the past 10 years, but the reasons for this increase remain unclear. This paper presents a history of English mental-health legislation and the current evidence relating to the use of section 136. It suggests that changing police attitudes, socio-economic factors and diminished resources amongst both the police and mental-health services may have contributed towards its increase. The strain placed on health services may have also resulted in a greater reliance on the police force as an access point to NHS care and could result in the inappropriate use of section 136. With the principle of the 'least restrictive option' at the heart of the Mental Health Act, this advocates the need for reform.
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Affiliation(s)
- Matthew Loughran
- Haringey Addictions Services, The Grove Drug Treatment Service, London, UK
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Eswaravel A, O'Brien A. A retrospective cohort study describing the characteristics of patients under 18 years old in one section 136 suite. MEDICINE, SCIENCE, AND THE LAW 2018; 58:222-232. [PMID: 30149768 DOI: 10.1177/0025802418790856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Section 136 of the Mental Health Act 1983 is an authority allowing police officers to remove a person 'who appears to him to be suffering from mental disorder' from a public area. There has been much media coverage regarding the inappropriate detention of minors under section 136 and the suggestion that many were taken to police cells, as there were no suitable places of safety. Although previous studies describe characteristics of a typical individual detained under section 136, few distinguish the differences between adults and adolescents. Profiling these adolescents can help to identify adolescents at risk, allowing for earlier intervention and prevent the inappropriate detention of individuals. Data were collected retrospectively for all patients under 18 years of age who were brought to a section 136 suite in south-west London over a five-year period. The typical profile of an adolescent presenting to this suite was a 16-year-old female of white ethnicity who was sectioned in a public area due to attempted suicide or deliberate self-harm. The individual is more likely to have mental or behavioural difficulties, a history of abuse, be under the care of local authorities and have had previous convictions compared to adolescents in the general population.
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Sondhi A, Luger L, Toleikyte L, Williams E. Patient perspectives of being detained under section 136 of the Mental Health Act: Findings from a qualitative study in London. MEDICINE, SCIENCE, AND THE LAW 2018; 58:159-167. [PMID: 29742992 DOI: 10.1177/0025802418774966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Detention under section 136(1) of the Mental Health Act 1983 allows for the police to arrest a person from a public place and remove them to a 'place of safety', typically an emergency department or mental-health unit if it is 'in the interests of that person or for the protection of other persons in immediate need of care or control'. Aims/objective: The aim of this study was to describe the views and perceptions of the process for people with lived experience of mental distress who have been detained under section 136 of the Mental Health Act 1983. Method Semi-structured interviews were conducted with a non-probability sample of people with lived experience of mental distress who have been detained under section 136 across Greater London. Interviews were transcribed and thematically analysed using grounded theory. Fifty-eight people with lived experience of mental distress detained under section 136, including four carers, participated in this study. Results Three interwoven themes were identified: (a) process or procedural issues; (b) the professional-patient relationship; and (c) the importance of a supportive therapeutic environment. Conclusion The length of time, multiple assessment points and processes juxtapose against the need for a humane physical environment and supportive therapeutic interactions from all professional agencies. It is unclear how changes proposed in the Policing and Crime Act 2017 will address these patient needs.
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Affiliation(s)
- Arun Sondhi
- 1 Therapeutic Solutions (Addictions) Ltd, UK
| | | | - Lina Toleikyte
- 3 Health Equity Unit, Health Improvement Directorate, Public Health England, UK
| | - Emma Williams
- 4 Canterbury Centre for Policing Research. Canterbury Christ Church University, UK
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9
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O'Brien A, Sethi F, Smith M, Bartlett A. Public mental health crisis management and Section 136 of the Mental Health Act. JOURNAL OF MEDICAL ETHICS 2018; 44:349-353. [PMID: 29061655 DOI: 10.1136/medethics-2016-103994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/15/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
The interface between mental health services and the criminal justice system presents challenges both for professionals and patients. Both systems are stressed and inherently complex. Section 136 of the Mental Health Act is unusual being both an aspect of the Mental Health Act and a power of arrest. It has a long and controversial history related to concerns about who has been detained and how the section was applied. More recently, Section 136 has had a public profile stemming from the use of police cells as places of safety for young, mentally disturbed individuals. This paper explores the current state of health of this piece of legislation. Specifically, we consider whether alternative approaches are more suitable for those individuals in crisis and/or distress who come into contact with the police. This requires careful thought as to the proper role of both health and criminal justice professionals who are daily grappling with an ethically contentious domain of multiagency work.
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Affiliation(s)
- Aileen O'Brien
- Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Faisil Sethi
- ES1 Psychiatric Intensive Care Unit (PICU), Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Smith
- Head of Suicide Prevention and Mental Health, British Transport Police, London, UK
| | - Annie Bartlett
- Institute of Medical and Biomedical Education, St George's, University of London, London, UK
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10
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Decision-Making Behaviour under the Mental Health Act 1983 and Its Impact on Mental Health Tribunals: An English Perspective. LAWS 2018. [DOI: 10.3390/laws7020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Burgess JL, White SJ, O'Brien A. Retrospective cohort follow-up study of individuals detained under Section 136. BJPsych Open 2017; 3:281-284. [PMID: 29163984 PMCID: PMC5677989 DOI: 10.1192/bjpo.bp.117.005694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/30/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. AIMS To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. METHOD Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. RESULTS After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. CONCLUSIONS Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Jennifer L Burgess
- , BA(Oxon), MBBS, Campus of Ageing and Vitality, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK, and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah-Jane White
- , BSc, MSc, MRCPsych, MD, Population Health Research Institute, St George's University of London, London, UK
| | - Aileen O'Brien
- , MBBS, BSc, MRCPsych, MD, Springfield Hospital, South West London and St George's Mental Health NHS Trust, London, UK, and St George's University of London, London, UK
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Addison M, Stockdale K, McGovern R, McGovern W, McKinnon I, Crowe L, Hogan L, Kaner E. Exploring the intersections between novel psychoactive substances (NPS) and other substance use in a police custody suite setting in the north east of England. DRUGS-EDUCATION PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1378620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle Addison
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Kelly Stockdale
- School of Psychological and Social Sciences, York St John University, North Yorkshire, York, United Kingdom of Great Britain and Northern Ireland
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - William McGovern
- School of Social Work and Communities, Northumbria University, Allendale House, Coach Lane Campus (West), Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Iain McKinnon
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Crowe
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Hogan
- Northumbria Police, Newcastle City Centre Police Station, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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Jenkins O, Dye S, Obeng-Asare F, Nguyen N, Wright N. Police liaison and section 136: comparison of two different approaches. BJPsych Bull 2017; 41:76-82. [PMID: 28400964 PMCID: PMC5376722 DOI: 10.1192/pb.bp.115.052977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method Two police liaison and section 136 schemes were developed alongside police services at different sites within the same NHS trust. In one, a mental health nurse worked with frontline police attending incidents related to mental health. The other involved nurses providing advice from the police control room. Section 136 detentions were measured over two 6-month periods (6 months apart) before and after practice change. Data analysed included total numbers of section 136 assessments, outcomes following subsequent assessment, and relevant diagnostic and demographic factors. Association of any change in section 136 total numbers and proportion subsequently admitted was investigated in both sites. Results The model involving a nurse alongside frontline police showed significant reduction in section 136 numbers (38%, P < 0.01) as well as greater admission rates (P = 0.01). The scheme involving support within the police control room did not show any change in section 136 detention but showed a non-significant (P = 0.16) decrease in subsequent admission. Clinical implications Mental health nurses working alongside frontline police officers can help improve section 136 numbers and outcomes.
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Affiliation(s)
- Oliver Jenkins
- Acute Inpatient Services, Norfolk and Suffolk NHS Foundation Trust
| | - Stephen Dye
- Acute Inpatient Services, Norfolk and Suffolk NHS Foundation Trust
| | | | | | - Nicola Wright
- Acute Inpatient Services, Norfolk and Suffolk NHS Foundation Trust
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Oxburgh L, Gabbert F, Milne R, Cherryman J. Police officers' perceptions and experiences with mentally disordered suspects. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:138-146. [PMID: 27773436 DOI: 10.1016/j.ijlp.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
Despite mentally disordered suspects being over-represented within the criminal justice system, there is a dearth of published literature that examines police officers' perceptions when interviewing this vulnerable group. This is concerning given that police officers are increasingly the first point of contact with these individuals. Using a Grounded Theory approach, this study examined 35 police officers' perceptions and experiences when interviewing mentally disordered suspects. Current safeguards, such as Appropriate Adults, and their experiences of any training they received were also explored. A specially designed questionnaire was developed and distributed across six police forces in England and Wales. Nine conceptual categories emerged from the data that highlighted how police officers' level of experience impacted upon their perceptions when dealing with this cohort. As a consequence, a new model grounded within Schema Theory has emerged termed Police Experience Transitional Model. Implications include the treatment and outcome of mentally disordered suspects being heavily dependent on whom they encounter within the criminal justice system.
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Affiliation(s)
- Laura Oxburgh
- Department of Psychology, Goldsmiths University of London, UK
| | - Fiona Gabbert
- Department of Psychology, Goldsmiths University of London, UK.
| | - Rebecca Milne
- Institute of Criminal Justice Studies, University of Portsmouth, UK
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Olajide K, Tyrer P, Singh SP, Burns T, Rugkåsa J, Thana L, Paul M, Islam Z, Crawford MJ. Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments. Personal Ment Health 2016; 10:191-204. [PMID: 26992030 DOI: 10.1002/pmh.1332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/04/2015] [Accepted: 12/10/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The UK guidelines on the treatment of personality disorder recommend avoiding compulsory treatment except in extreme situations. Little is known about how often patients with personality disorder are detained or how this compares with the treatment of other mental disorders. OBJECTIVES Our aim is to test the hypothesis that people with personality disorder are infrequently detained under the Mental Health Act (MHA) and that risk factors associated with detention are the same as those for people with other mental disorders. METHOD We used a retrospective, quantitative study of MHA assessments. RESULTS Of the 2 087 assessments undertaken, 204 (9.8%) patients had a diagnosis of personality disorder; 40.7% of assessments in the personality disorder group resulted in detention, as did 69.7% of patients with other mental disorders. A higher proportion of people with personality disorder received no intervention following assessment compared with those with other mental disorders (20.6% vs. 4.7%, p < 0.001). Study centre and a history of admission were risk factors for detention in both groups. Risk was a predictor of detention in those with other mental disorders. CONCLUSIONS Detention rates in patients with personality disorder are lower than those for other disorders but are still substantial. Risk factors for detention in patients with personality disorder differ from those with other mental disorders. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kike Olajide
- Centre for Mental Health, Imperial College London, London, UK
| | - Peter Tyrer
- Centre for Mental Health, Imperial College London, London, UK
| | | | - Tom Burns
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Lavanya Thana
- Centre for Mental Health, Imperial College London, London, UK
| | | | | | - Mike J Crawford
- Centre for Mental Health, Imperial College London, London, UK
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Pugh D, Laidlaw J. Sections 135 and 136: Running a health-based place of safety in Gloucestershire. MEDICINE, SCIENCE, AND THE LAW 2016; 56:99-106. [PMID: 26081606 DOI: 10.1177/0025802415583867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Maxwell Centre, a health-based place of safety (POS) adjacent to a psychiatric hospital, was opened in Gloucestershire in February 2009. It provides a POS for people detained under Sections 135 and 136 of the Mental Health Act 1983 as amended in 2007. Prior to the opening of the Maxwell Centre, police cells were the only designated POSs. To assess the impact of the opening of this new facility, we undertook a service evaluation. In the five years (February 2009 to December 2013) following the opening of the Maxwell Centre, the use of Section 136 increased by more than 60%.
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Affiliation(s)
- David Pugh
- Independent Consultant, Gloucestershire, UK
| | - Jim Laidlaw
- 2gether NHS Foundation Trust, Gloucestershire, UK
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17
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Zisman S, O'Brien A. A retrospective cohort study describing six months of admissions under Section 136 of the Mental Health Act; the problem of alcohol misuse. MEDICINE, SCIENCE, AND THE LAW 2015; 55:216-222. [PMID: 24966337 DOI: 10.1177/0025802414538247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Section 136 of the Mental Health Act 1983 empowers police to remove a person they believe to be suffering from a mental disorder from a place to which the public have access, if they deem them a risk to themselves or others. In the UK, the number of Section 136 orders is increasing. OBJECTIVE This retrospective cohort study identified the demographic profiles, circumstances of detention and assessment outcomes of all individuals detained under Section 136 between February 2012 and July 2012 at a London Mental Health Trust. The study explored the relationship between alcohol and/or drug use, the process and outcomes. DESIGN AND METHOD This study retrospectively obtained data from electronic notes for a six-month period. Demographic details were recorded. Other variables included previous admissions, reasons for assessment, evidence of intoxication, time taken for assessment and discharge outcomes. The effects of alcohol and/or drug intoxication on the process were recorded. RESULTS A total of 245 individuals were assessed during the time period. Threatening to self-harm (n = 100, 44.8%) was the most common reason for assessment. Of the 245 patients assessed, 108 (44.1%) were found to be intoxicated with drugs and/or alcohol. Intoxication resulted in longer assessment times and a decreased likelihood of admission to hospital (p < .000).
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McGrath L, Reavey P. Seeking fluid possibility and solid ground: Space and movement in mental health service users' experiences of ‘crisis’. Soc Sci Med 2015; 128:115-25. [DOI: 10.1016/j.socscimed.2015.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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B. Menkes D, A. Bendelow G. Diagnosing vulnerability and “dangerousness”: police use of Section 136 in England and Wales. JOURNAL OF PUBLIC MENTAL HEALTH 2014. [DOI: 10.1108/jpmh-09-2012-0001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Police in England and Wales are empowered, under Section 136 of the Mental Health Act 1983 (s136), to detain individuals thought to be a danger to themselves or to others. Use of this authority is widespread, but varies across districts and attracts controversy because of inconsistent application and the fact that it requires police to make judgements about mental health. The purpose of this paper is to examine police attitudes to and criteria for using s136.
Design/methodology/approach
– The authors conducted focus groups with 30 officers in urban and rural areas of three different regions across England and Wales. Group interviews were audio-recorded, transcribed, and analysed using open and axial coding.
Findings
– Use of s136 authority has major implications for police work; liaison with mental health services is seen as desirable but often ineffective due to resource constraints and the latter's lack of availability. The decision to invoke s136 depends on social context and other particulars of individual cases.
Research limitations/implications
– Although the findings have limitations with respect to generalisability across the whole of the UK, there are patterns of responses which have major implications for policy recommendations.
Practical implications
– Police decisions to apply s136 reflect an implicit values-based classification of and response to emotionally disturbed behaviour, in light of available institutional and social supports.
Social implications
– Tasked primarily with protecting the public and keeping the peace, police “diagnoses” of risk often contrast with that of mental health professionals.
Originality/value
– A highly original piece of research which has attracted further funding from BA/Leverhulme.
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Apakama DC. Emergency department as a 'place of safety': reviewing the use of Section 136 of the Mental Health Act 1983 in England. MEDICINE, SCIENCE, AND THE LAW 2012; 52:1-5. [PMID: 22106444 DOI: 10.1258/msl.2011.010154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Section 136 provides the lawful authority for the removal, by the police, of the person to whom the provision applies, from a place to which the public have access. There has been a longstanding debate as to the most appropriate place of safety for these patients. The aim of this article is to review the literature and determine the ideal place for the detention and assessment of these patients and clarify the responsibilities of the staff of the agencies involved in the detention. It concludes that there is no single most appropriate place of safety for all groups of patients. Rather, there should be a range of options to enable the assessment in the most suitable environment for individual cases according to their needs at the time.
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Affiliation(s)
- Dorothy C Apakama
- Emergency Department, University Hospital Coventry & Warwickshire NHS Trust, Coventry, West Midlands CV2 2DX, UK.
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