New Clause 26 - Assessment of care and support needs of persons detained under mental health legislation in police cells

Care Bill [Lords] – in a Public Bill Committee am 10:30 am ar 4 Chwefror 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

‘(1) Police constabularies must record the following information about persons under 18 years of age detained in police cells under section 136 of the Mental Health Act 1983—

(a) the age of each such detainee;

(b) the period of time each detainee was accommodated in a police cell;

(c) what assessments of—

(i) medical; and

(ii) social care and support

needs were made and by whom; and

(d) what the result was in each case.

(2) The Secretary of State must publish an annual report containing the number of persons detained in police cells under the Mental Health Act 1983 broken down by—

(a) police authority area;

(b) age of detainee; and

(c) length of detention.

(3) Within 12 months of this Act coming into force, the Secretary of State must prepare and lay before each House of Parliament a report on the implications for the effective, efficient and economic provision of integrated health and social care arising from the imposition of a charge upon local authorities and NHS commissioning bodies, as appropriate, for the use of police cells for the detention of persons under mental health legislation.’.—(Paul Burstow.)

Brought up, and read the First time.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I beg to move, That the clause be read a Second time.

I will speak briefly to the new clause, which stands primarily in the name of my hon. Friend the Member for Totnes. Unfortunately, because of the accident that she sustained—the visible evidence of which we have all seen—she cannot be here today, which is a great pity because I know that she would have spoken with authority and passion about this topic. We debated quite recently with a Home Office Minister the unacceptable use of police cells to house people who have committed no crime by dint of section 136 of the Mental Health Act 1983, which allows them to be taken to what is euphemistically termed a “place of safety”. People in that position are often taken to a jail cell rather than being treated on a hospital ward. New clause 26 is designed to bring information about that practice—some of the figures are shocking—more clearly into the public domain, and it would be useful to hear the Minister’s comments on the proposal.

Some 36% of those subject to place of safety orders—7,761 people—find themselves in police cells rather than in hospital. The average length of stay, according to Her Majesty’s inspectorate of constabularies, is 10 hours and 32 minutes, so a person in that situation may be stuck in a cell for more than 10 hours. If we drill down into those figures, the experimental collection of data is starting to provide, for the first time, a much clearer picture across the age range. One of the things revealed is that, in the first year for which figures are available—just last year—263 children and young people were put in police cells as a place of safety. We do not yet know how many hours they were kept in the cells, which is why we need the new clause, which deals with understanding the scale of the scandal that that figure of 263 represents. Each and every one of those people deserved something better; they deserved to be placed in a proper place of safety and to have access to treatment.

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton

I completely agree with what the right hon. Gentleman says. It is a scandal that people with mental health problems find themselves in a police cell rather than a place of safety. Does he recognise the pressure that that puts on the police, as they have to look after those people, as well the massive strain it causes to their budgets?

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

The hon. Gentleman is absolutely right to highlight that. The police themselves say that such a use of their resources is inappropriate. However, as part of effective policing, awareness of mental health, and proper training in first aid for dealing with mental health issues, may result in more people being taken to the right place rather than being kept in a cell in a police station. If someone who had broken their leg was taken to a police cell, everyone would just accept that that was nonsense and that it should not happen, but it seems to be acceptable in our society that that happens to people with mental health problems.

First, will the Minister tell us, even briefly, where we are with liaison and diversion schemes in custody suites? The Treasury was due to sign off on them, but has that happened? Secondly, there have been some good findings from street triage, which is an effective way for psychiatric nurses to work with the police to divert to the right provision in the first place, so where are we on that?

If the Minister does not accept the new clause—I suspect that he has reasons not too—will he indicate what further steps the Government are taking to address the serious problem of children and young people, in particular, finding themselves in the wrong place and not getting the right care? There is nothing like the parity of esteem we expect and should now demand in our health service between physical and mental health.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I thank my right hon. Friend for his words. We would probably all agree that the current practice, with so many people ending up in a police cell, is intolerable. It is bad enough when an adult with mental health problems ends up in a police cell when they do not need to and should not be there; it is quite horrific when children end up there. We are taking steps to address that practice.

As my hon. Friend the Member for Burton said, the practice is a crazy waste of police resources. Police officers, with the best will in the world, are not trained to understand and cope with people with mental health problems. For all sorts of reasons, this intolerable practice has to end.

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton

I thank the Minister for focusing on an issue that is close to my heart. Does he accept that mental health units and beds are closing across the country as there is a movement towards crisis teams and care within the community? While that suits some, it does not suit everyone, and we need to ensure that those crisis teams not only are properly resourced to deal with people at the point of crisis, but have somewhere to refer them if the crisis is so severe that an in-patient bed is needed.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

My hon. Friend makes that case well. There is a danger that we lump all mental health beds into one category and fail to recognise that we can be dealing with an extraordinary array of circumstances.

The trend, over the past two decades or so, of significantly reducing reliance on long-stay in-patient care in mental health institutions is absolutely right. It happened under the previous Government and it was right that that happened. There you go, Mr Rosindell; I am paying tribute to work done under the previous Government. The extent to which people, either with learning disabilities or with mental health problems, have in the past been hidden away from public view in long-stay institutions is completely wrong. In the vast majority of cases, the objective should be for people to be able to live independently, with support if necessary, in their communities.

That trend is absolutely right, but at the same time it is critical that beds are available for crisis care, so that when someone is in the middle of a mental health crisis and needs to go somewhere safe, therapeutic, caring and compassionate, they do not end up in a police cell. That is intolerable, and although the use of police cells has come down significantly over the past few years, it is still far too high and that has to change.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 10:45, 4 Chwefror 2014

I am sure that the Minister knows what I am going to say, and I really want to echo the words of the hon. Member for Burton. As the Minister knows, I rang him on Friday about a case involving one of my constituents. A young woman, who is under 18, has  already experienced not being able to get a bed in Leicester twice. The first time, she was sent to Woking, and the second time, to Northampton. On Friday, she was told that there was not a single child and adolescent mental health bed in the NHS or the independent sector anywhere in the country. It is at crisis point. The Minister told me that NHS England is reviewing the problem. I hope he can tell me what is happening right here, right now, because a review can take a long time. A number of people contacted me via Twitter saying that exactly the same thing was happening. The police, including my chief constable, who leads for the Association of Chief Police Officers on mental health issues, said that they are increasingly concerned about the number of children being kept for unacceptable periods in police cells. I would really appreciate it if the Minister updated the Committee on what is happening.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

We did talk on Friday and I have asked NHS England to treat it as a matter of absolute priority. I am not in a position now to give a full response, but I will undertake to contact the hon. Lady before the end of today with as full a response as I am able to provide. For the record, I share the view that this young girl’s experience is not acceptable, full stop.

A review by NHS England of CAMHS tier 4 capacity and services that are available is under way. Again, there is a sensible move towards trying to care for children in the community and trying to enable them to remain at home if possible, or perhaps with a therapeutic, supportive foster carer, if that is not possible, rather than putting them into in-patient care, particularly away from home. Sometimes in-patient care is necessary. Sometimes, because of the particular mental health issue, there may not be—and never has been—availability in that particular town of an in-patient facility. That is a reality, I am afraid, because not every town has the level of need for the whole range of different conditions that might emerge at any particular time, but the principle of care close to home, or as close to home as possible, is absolutely paramount, and I share the hon. Lady’s concern about the case that she raised.

Photo of Debbie Abrahams Debbie Abrahams Llafur, Oldham East and Saddleworth

All of us would agree with the points that the Minister and my hon. Friend the Member for Leicester West made about the availability of local care, particularly for young people. Other Members have also made the point, with which I wholeheartedly agree, that it is never appropriate to place people with mental health problems in police cells. However, I want to ask the Minister a genuine question: how will the mental health tariff deflator support his aims? I met my local mental health trust on Friday. The 0.3% deflator, which is effectively a cut, has meant that it will lose almost £1 million.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I thank the hon. Lady for her intervention. Let me be clear, as I have been already: the decision that was made was not acceptable. We must challenge the lack of parity of esteem between mental and physical health wherever we find it, whether that is in the Department of Health, NHS England, Monitor or at a local level.

The hon. Lady will be aware that the tariff is just one element of the total equation for funding services locally, particularly in mental health, because although we currently  have advisory national tariffs, mental health services are still effectively funded in large part through block grant. My view is that there is an urgent need to move away from that approach. I have frequently made the case about the lack of equilibrium between the funding for physical and for mental health. The fact that we have an 18-week target for physical health and no targets or access standards in mental health drives where the money goes in the system. If a local commissioner knows that they must deliver the 18-week target, in which there is intense political interest, that means that money goes into acute hospitals, not into mental health. We must therefore create a better equilibrium.

I will make it clear again: we have written it into the mandate that NHS England must make measurable progress towards parity of esteem by 2015, including in the financing of services. I expect it to deliver that.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

I am glad the Minister made that point about parity of esteem. On the work force, does he agree that there is a big shortage of trained staff in mental health generally, and particularly in CAMHS, which he mentioned earlier? Does he think that, as part of that parity of esteem, it is vital to recruit and train staff in such areas in order to make the real change that he says he wants to achieve?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I agree that there is a shortage. Through the mandate to Health Education England, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich is putting a much greater focus on mental health in health professionals’ training than there has ever been in the past. There is a whole separate section of the mandate to ensure that HEE delivers improvements in the mental health training of all clinical staff. One critical issue involves GPs, who currently deal with substantial numbers of mental health problems as part of their case load and yet in most cases have very little training in mental health, because it is optional in their training. There is an extraordinary mismatch between the nature of their day-to-day work and the training that they receive. We are determined to end that.

We are investing £54 million in CAMHS over this Parliament as part of a programme initiated by my right hon. Friend the Member for Sutton and Cheam to improve the skills of people working in CAMHS so that ultimately—I think it is by 2017—children in all parts of the country will have access to psychological therapies. That is called the IAPT—improving access to psychological therapies—programme. The hon. Member for Sefton Central is right that, in many areas, the work force does not currently have the required skills, so that programme will deliver the necessary change.

Finally, we have been clear in our response to the Francis inquiry that all providers—acute trusts and mental health trusts—will have to publish their performance on staff numbers on wards compared with the safe level, so that we have the transparency that will enable us to hold providers to account.

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton

I thank the Minister for his detailed knowledge on this topic. On transparency, I am sure he will agree that it is positive that a number of police and crime commissioners and police forces now employ  mental health workers to go out with the police. They recognise that many of the people they encounter have mental health problems, not criminal problems, and that that is the best way to deal with them. However, too many police authorities are not able to send people to a place of safety because there are no beds available, so they have no choice but to keep them locked up in the cells. To make the process more transparent, will the Minister look at how to make it easier for people to find out for themselves whether mental health beds are available in their area?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

The sort of transparency that I have described will help people find out about the situation in their local area. My hon. Friend is absolutely right about those great, innovative schemes. I will return to them in a moment. The thrust of our approach is to join up more effectively the work of mental health services and the police. They both deal with the same cohort of people, but when somebody has a crisis in a public place, it is often the police who get there first. For them to work in a silo and not deal closely with the mental health practitioners in the local area would be madness, but that is the way in which services have worked hitherto. It is good that we are addressing that problem.

I visited Bethnal Green police station recently when we launched the liaison and diversion service. I can confirm to my right hon. Friend the Member for Sutton and Cheam that the Treasury has approved the first phase of a roll-out of a nationwide liaison and diversion service. It is world leading, and we should be proud of it. If the pilots demonstrate that it works, it will create a national service to ensure that people in the criminal justice system who are arrested or arrive at court have a proper assessment and get access to the care and treatment that they need. We hope it will divert people away from prisons and from reoffending, which is damaging to them and the wider public. My right hon. Friend’s points were absolutely right.

I thank my hon. Friend the Member for Totnes and my right hon. Friend the Member for Sutton and Cheam for tabling the new clause, which raises several important issues about section 136 of the Mental Health Act 1983. Section 136 has been discussed in the House, most recently in a Westminster Hall debate last November on police involvement with people with mental health problems. I acknowledge the valuable contribution of my hon. Friend the Member for Totnes to that debate.

The new clause would place duties on the police and the Secretary of State to gather and report information on police use of section 136. The Health and Social Care Information Centre recently included for the first time data collected by police forces on the use of section 136 in police custody suites in its annual report on people detained under the 1983 Act. We are therefore starting to see a degree of transparency. The report included information on the number of detainees who are under 18, although it did not include further detail of their ages.

When I visited Bethnal Green police station, I asked about the use of their police cells under section 136. They said, “In that inner-city area, we have a very good arrangement with local mental health services. We don’t use the police cells for section 136 place of safety cases.”  If it can work there, it can work anywhere. It requires proper collaboration. If police forces and mental health services work properly together, they can crack this problem. It is not beyond the wit of man to do it, but it requires absolute determination to achieve change.

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton 11:00, 4 Chwefror 2014

My hon. Friend is right, but unfortunately the reality on the ground is that mental health beds are being closed. In my constituency, the Margaret Stanhope facility closed, meaning that police now have to travel to Stafford for a facility, if they are looking for a place of safety, and that can be a two and a half hour round trip. That means two police officers in a police car travelling for two and a half hours, when they should be on the beat, keeping people safe.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

My hon. Friend makes the point well. That is the wrong way to proceed. Incidentally, the Care Quality Commission will create a Google map of health-based places of safety this year. Its survey of beds, staffing levels and hours of operation will begin shortly. That will enable people to hold to account both police and health services in their local areas and is additional to the data on people going to health-based places of safety that the Information Centre has published for some years.

The Government are not obliged by statute to collect and publish these data, but intend to continue to improve its quality. Having said that, in general neither the Home Office nor I think it appropriate to impose centralised data collection burdens on the police or mental health professionals, when it is important that local commissioners and service providers understand and use their local data to improve mental health services. Ultimately, that is what it is all about. Their aim must be to use those data to ensure that mental health services meet the needs of their local population, so that when police or other emergency services respond to a young person, for example, the right services can rapidly be accessed and police custody can be used minimally as a place of safety, only where it is necessary for the protection of that individual or of others.

We have done a great deal of work already on what we expect from NHS mental health crisis services. We do not expect anyone in mental health crisis to be turned away from the NHS. It is important that services work together to make this a reality locally. At my request, the relevant national organisations for the professions that respond to mental health crises, including NHS England, ACPO, the Association of Police and Crime Commissioners and the Royal College of Psychiatrists have agreed a mental health crises care concordat, which will be published shortly. It will set out, for the first time, the standards of response that people suffering from mental crisis and requiring urgent care should expect, and the key principles that local health and justice partners should follow.

I reassure the Committee that my officials, together with Home Office officials, are working on every aspect of sections 135 and 136 of the Mental Health Act, building on the concordat agreements, to deal with this fundamental issue. That must be done to ensure that vulnerable people receive proper care and support without risks to their safety. The priority must be to radically  reduce the use of section 136 overall, but where it is used people should be taken to appropriate health-based places of safety in all but the most exceptional cases.

The Home Secretary announced last year that there would be a review of sections 135 and 136 of the Act, focusing on the use of police powers. We are jointly considering the scope of that review and I am happy to write to my right hon. Friend the Member for Sutton and Cheam and my hon. Friend the Member for Totnes with more details about what is proposed.

The Government want to drive improvements to mental health crisis care, so that local mental health services are always available when needed. Last year, the Government published the refreshed mandate for NHS England, which included a new requirement for the NHS, so that every community has

“plans to ensure no one in mental health crisis will be turned away from health services.”

My hon. Friend the Member for Burton mentioned street triage pilots, when talking about police forces using people with mental health skills as part of their operation. In fact, those pilots are a collaboration between the mental health trust and the police force in a number of areas, nine of which are being funded by the Department of Health this year. They are already showing how closer working between relevant professionals can improve service responses and people’s experiences.

I went out with the street triage team in Leicester last summer. I saw them in action dealing with the mental health crisis. An elderly gentleman had his wife in an armlock; he was suffering from the early stages of dementia and there was a medication issue. The police officer told me that in the past they would have had no option: they could not have left him with his wife, because she was at risk, so they would have had no option in the evening but to take him to a police cell. How unacceptable is that? They had a mental health nurse with them in the car, and she was able to access a mental health bed locally and ensure that she could get him into that bed. She talked to him and encouraged him to agree that it was a sensible way forward. Crisis resolved in a brilliant way. I pay tribute to the professionals on both sides. They told me about how they were learning new skills as a result of working with another professional on the other side of the divide. What is going on in the pilot areas is exciting.

We are also currently updating the 1983 Act’s code of practice. We will strengthen the chapter on police powers to improve practice so that people in crisis are helped to find the right support. The CQC is increasing its inspection and review of health-based places of safety and mental health crisis services more widely. We have ratings and are introducing them into mental health. If local mental health trusts are not providing proper crisis services, they will not get a good rating. They will be held to account for failures.

Given all the work we are doing, I hope that my right hon. Friend the Member for Sutton and Cheam will agree that it is not necessary to tie the Government, in the Bill, to laying a report before Parliament on the specific suggestion of charging the NHS and local authorities for the use of police cells as a place of safety. My instinct is that charging could bring unintended consequences, such as the potential for perverse incentives. Furthermore, I am not aware of any appetite on the  part of the police for such a reform. We could consider the matter further, for example, as part of the review that we will shortly undertake into sections 135 and 136 of the 1983 Act. I hope he feels that this has been a useful debate on incredibly important issues that have a profound effect on the lives of many mentally ill people. In the light of the reassurances I have offered, I hope that he will not press the motion.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

It has been a useful debate, which has brought live situations to the attention of the Committee. The Minister said that he would write to me and my hon. Friend the Member for Totnes, and I assume the whole Committee by extension. I am grateful for that. On the basis of what he has said, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.