Mental Health Place of Safety Briefing for Birmingham

1. Mental Health Place of Safety Briefing for Birmingham The Oleaster Heartlands, City, Good Hope and Queen Elizabeth Hospitals Birmingham Police

2. s136(1) MHA 1983 If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety.

3. s136 KEY POINTS 1. Found 2. Place to which the public have access 3. Mental disorder 4. Immediate need of care or control 5. Own interests or the protection of others 6. Remove them to a place of safety

4. SETTING THE SCENE YouTube - Places of Safety part 1 of 5.mp4

5. s136 MHA or OFFENCE? Down to the discretion of the arresting officer, however: Where both are possible, you should arrest for the offence and remove to a police station, unless: 1. The offence is trivial, potentially ‘victimless’, 2. The police may be implored to prioritise MH; 3. The behaviour is likely to be symptomatic of the mental health problem. SERIOUS OFFENCES SHOULD LEAD TO ARREST

6. INTOXICATION & MENTAL HEALTH Before arresting anyone under s135/6 MHA who is known to be affected by drugs / alcohol, EXTREME CAUTION should be applied by the police to that decision. Officers should question their own ability to discern mental illness from intoxicated / bizarre behaviour where they would be able to legally describe someone as ‘drunk’. 1. Nothing in law prevents an arrest under s136 whilst drunk 2. Ultimately, this decision is for the arresting officer Drunk & Incapable or Drunk & Disorderly may be preferred.

7. INFORMATION UPON ARREST Tell the person very clearly what’s going on, but: 1. Do NOT use the word ‘arrest’ 2. Do NOT ‘caution’ the person. Both will have the impact of criminalising the person and it is NOT legally necessary. Keep clearly explaining what’s happening

8. ARREST AFTER ARREST, 3 VITAL THINGS: 1. Police control – ambulance on 999 2. Ambulance Service should influence the PoS decision through assessment 3. Police officers are legally responsible for the decision about which PoS will be used

9. CONVEYANCE 1. The person remains in police custody and should be accompanied by the AO; 2. Via Ambulance wherever possible, police vehicle following behind; 3. Police vehicle only where the detainee is too violent for ambulance; 4. Even then, paramedic to travel IN the police vehicle, ambulance following.

10. PRE-HOSPITAL DOCTOR To be considered by paramedics if they assess that the arrested person is too disturbed to transfer without consideration of them being sedated prior to ambulance transfer with ongoing medical oversight by a doctor. A decision for the AMBULANCE SERVICE only.

11. WHICH PLACE OF SAFETY? THERE ARE THREE PoS OPTIONS: 1. Birmingham Emergency Departments urgent medical care and mental ill health; 2. The Oleaster, Place of Safety the majority of PoS detentions; OR 3. Birmingham Police Custody Stations the final contingency plan.

12. EMERGENCY DEPARTMENT YouTube - Places of Safety part 2 of 5.mp4

13. MEDICAL EMERGENCY? First, any RED FLAG conditions? 1. These have been developed by NHS consultants (ED / Psych); 2. Indicates urgent or underlying medical conditions which require ED; 3. Risks of serious, unpredictable and / or untoward consequences if unmanaged. REMOVAL IS TO A&E WHERE RED FLAGS ARE KNOWN OR SUSPECTED

14. RED FLAGS (1) Dangerous Mechanisms: • Blows to the body • Falls > 4 Feet • Injury from edged weapon or projectile • Throttling / strangulation • Hit by vehicle • Occupant of vehicle in a collision • Ejected from a moving vehicle • Evidence of drug ingestion or overdose Serious Physical Injuries: • Noisy Breathing • Not Rousable to verbal command • Head injuries • Loss of consciousness at any time • Facial swelling • Bleeding from nose or ears • Deep cuts • Suspected broken bones

15. RED FLAGS (2) Attempting self-harm: Head banging Use of edged weapon (to self-harm) Ligatures History of overdose or poisoning Psychiatric Crisis Delusions / Hallucinations / Mania Possible Excited Delirium: Two or more from: Serious physical resistance / abnormal strength High body temperature Removal of clothing Profuse sweating or hot skin Behavioural confusion / coherence Bizarre behaviour

16. ED as PoS Police Officers will always remain at ED in support of NHS staff until: 1. RED FLAGS are ruled out; 2. The person is transferred elsewhere; 3. s136 is concluded within ED; OR 4. ED staff otherwise suggest that it would be appropriate for the police to leave.

17. WHAT IF NO RED FLAG? Secondly, where RED FLAGS do not apply, removal should occur to the locally agreed psychiatric place of safety at: The Oleaster, Edgbaston. Police telephone in advance of arrival.

18. PLACE OF SAFETY YouTube - Places of Safety part 3 of 5.mp4

19. AS A LAST RESORT The police station is still part of the Place of Safety arrangements, but should be used: 1. On an exceptional basis only; AND 2. As a last resort. Nine Police Stations across Birmingham

20. INITIAL ARRIVAL Upon initial arrival, the arresting officer should fully brief: 1. ED receiving nurse; 2. PoS receiving nurse; OR 3. Police Station custody sergeant. (All referred to as the PoS Guardian.)

21. DECISION TO DETAIN The PoS Guardian has to decide whether to accept the detention of that individual: 1. Each has the right to refuse; 2. Each will have concerns about the risks and threats involved; 3. Each may require support from other agencies in order to proceed confidently and safely. Clear communication about all of the above is vital.

22. DRUGS & ALCOHOL Are NOT an automatic basis for excluding an individual from a PoS: 1. May be indicative of other underlying problems; 2. Can require clinical / nursing oversight during ‘sobering up’; AND 3. May require active police support to prevent escape or disturbance; AND 4. To protect NHS staff and / or property.

23. AGGRESSION NOT in itself a reason to remove someone to a Police Station: 1. May be indicative of other underlying problems; 2. May require clinical / nursing oversight or pharmacological intervention; AND 3. May require active police support to prevent escape or disturbance; AND 4. To protect NHS staff and / or property. Paramedics should advise / direct on this, as well as NHS PoS Guardians.

24. UPON ARRIVAL POLICE OFFICERS SHOULD ENSURE: 1. A full briefing of the PoS Guardian. 2. Contact a DR and an AMHP 3. Full PNC and FLINTS (intelligence) checks 4. Part A of the MHA Monitoring Form 5. Reach a conclusion about the person’s RISK STATUS

25. MHA MONITORING FORM No police officer will leave the PoS or ED or Custody Office without completing Part A of the Mental Health Act monitoring form and handing it to the PoS Guardian This is vital to evaluating the PoS arrangements and improving how they work.

26. HANDOVER PERIOD NO LONGER THAN ONE HOUR: 1. Will include background information checks by police and NHS staff; 2. Each agency will rate the detainee LOW RISK, MEDIUM RISK or HIGH RISK; 3. Professionals will seek to agree the risk basis of that individual by FULL SHARING OF RISK INFORMATION

27. JOINT RISK ASSESSMENT 1. Where it is agreed that the individual is LOW RISK, the police may leave after the handover period; 2. Where it is agreed that the individual is HIGH RISK, the police will remain throughout the assessment or until the risk reduces;

28. MEDIUM RISK DETAINEES Detainees may be MEDIUM RISK on the basis of their current presentation AND / OR on the basis of previous behaviour: If PoS staff are content for the police to leave, they may do so; If they require support, it will be given but the duty sergeant will determine how many officers will remain to provide it.

29. DISPUTE RESOLUTION WE WILL NOT ALWAYS AGREE! 1. Disputes about which PoS should be used are to be expected; 2. Disputes about risk assessment and police support in the PoS are to be expected; 3. Disputes about drugs / alcohol / aggression are to be expected. ... AND THIS IS OK! Refer it to the MAG.

30. OVERCOMING DISPUTES Arresting Officer – PoS Guardian Duty Sergeant – PoS Manager If a dispute remains, document the decisions taken and by whom, then refer the matter to the MAG for consideration.

31. TRANSFER BETWEEN PoS May now occur, under s136(3) MHA 83: 1. Always check in advance that the subsequent location can / will accept; 2. Conveyance via Ambulance; 3. Must be authorised by AMHP or DR; 4. Further INFORMATION SHARING upon arrival to the new PoS Guardian

32. POLICE STATION YouTube - Places of Safety part 4 of 5.mp4

33. CRIMINAL OFFENCES IN PoS Risk management should prevent this, however: 1. Offences of violence against staff = arrest and remove to the Police Station; 2. Offences against NHS property = request greater police support or arrest and remove if not possible. Full criminal investigation should always occur.

34. MHA & CRIMINAL LAW MHA assessment may occur in custody as part of a criminal investigation, however: All assessment AND investigation must occur within 24hrs. The police should inform / remind the FME and / or the AMHP of the timeframes imposed by PACE.

35. AT CONCLUSION 1. Where the police remained involved with the detention during assessment, they will bear responsibility for returning the individual home, if required. 2. Where the police left the individual in NHS detention by agreement, the NHS will bear responsibility for returning them.

36. TEAMWORK Each professional needs to regard themselves as part of one, large multi-agency team, working across the various organisational boundaries and putting the vulnerable, arrested person at the centre of decision-making. Failing to ‘go the extra yard’ will force other professionals towards levels of risk they are almost uniquely unqualified to manage.

37. REFLECTIONS YouTube - Places of Safety part 5 of 5.mp4

38. MULTI-AGENCY GROUP A monthly meeting of all relevant managers to oversee the PoS operation in Birmingham. Will collate data from MHA Monitoring Forms to influence PoS operations. Provides feedback to staff where disputes have been highlighted. PLEASE ROVIDE FEEDBACK TO DRIVE THIS PROCESS – WE NEED TO KNOW

39. LEADERSHIP TO STAFF This protocol and this briefing needs to be delivered to your staff. Leadership is vital. Direct oversight of PoS operations and staff is required, if communication and problem-solving is to be effective. Being able to lead by seeing the problem from the other side, is key to avoidance of problems. There is NO prescribed perfect answer to everything.

40. SUPPORTING MATERIAL There will be locally identified leads for s136 PoS Operations in each agency. This presentation, the protocol document, an aide-memoir for police officers and other material will be made available on intranets during March. Good luck!