London METROPOLITAN Working together for a safer London South POLICE and Maudsley t TERRITORIAL POLICING NHS Foundation Trus Joint Protocols Working in Partnership with Mental Health Issue s
South London & Maudsley NHS Foundation Trus t & Metropolitan Police ; Lambeth, Southwark, Lewisham, Croydon & Bromley
The protocols describe the roles and responsibilities of each agency when dealing with the following incidents
1 . Disturbances on hospital wards and other mental health facilitie s
2. Gu idance re: restraini ng patients by Po lice and med icating patients by nursing staff
3. Offences committed by people suffering from mental illnes s
4. Guidance re: custody procedures and case disposal options
5 . Absence without Leave (The reporting of patients who are found to be missing from the wa rd or who do not return at the agreed time)
6 . The retu rning of patients reported as missin g
7. Detain ing people requiri ng i mmediate ca re and control in a pub lic p l ace (s136 Menta l Health Act 1983)
8. Mental health assessments within the communit y
9 . Patient transfers & conveyanc e
Effective Date : September 2012
Review Date : February 2013
1 Stuart Bell - Borough Commander Signature ...... Lewisham Metropo litan Police
Borough Commande r Signature ...... So u thwark Metropolitan Police
David Musker - Borough Commander Signature ...... Croydon Metropolitan Police
Stephanie Roberts - Borough Commander Signature ...... Bromley Metropol itan Police
Matthew Bell - Borough Commander Signature ...... Lam be th Metropolitan Po lice
Gus Heafield - Acting Chief Executive Signature ...... So u th London and Ma u dsley N HS Fo u ndatio n
London Ambulance Service Signature
2 Introduction to Joint Police Protocols
The police are often the first point of contact for a person in a mental health crisis . Every year for example, some 11,000 people are taken to a police station as a `Place of safety' under the Mental Health Act . Up to 15% of incidents the police deal with are thought to have some kind of mental health dimension . A study in Westminster suggested that 30% of daily police work centred on people suffering from mental illness (Sainsbury Briefing 2008) .
A large volume of police work relates to initial contacts and interactions with people who have a mental health problem or who are emotionally vulnerable . Within South London and Maudsley NHS Foundation Trust (SLaM) we work in partnership with the Metropolitan Police Service (MPS) to provide streamlined services to service users, staff and the general public . Our objective is to treat mental illness effectively, to work in partnership to promote mental well-being and support others by sharing our clinical expertise and knowledge . This multi-agency approach requires improved liaison and greater clarity between mental health agencies and the MPS regarding our respective roles and responsibilities. We recognise that through this collaboration our combined efforts in the management of mental health needs for our area can be effective, responsive and cost effective thus ultimately beneficial for the patient population, our staff, police officers and our community .
These protocols have been developed by the SLaM/5 Borough Police Partnership and are based upon the PAN London MPS and Mental Health services guidance .
Local principals informing this policy have been agreed through local partnership events .
Courtesy and Respect In managing difficult and potentially stressful / dangerous situations together we aim to maintain professional courtesy and respect in order to achieve the best possible outcomes for the patient, our staff, police officers and our community .
Communication We recognise that clear and concise communication is critical for the best outcome when working together . For this reason we should avoid medical terminology and Police jargon, speak clearly and simply, offering any information intended to prevent harm or assist in providing positive outcomes to every situation . Withholding of information vital for effective risk management is not in the ethos of good partnership, working and safety .
Collaboration Situations that require police support should be addressed and managed collaboratively whenever practicable . Understanding each others role's, responsibilities and functions in situations must promote better outcomes and joint approaches to the situation are more likely to be resolved positively .
3 1 . DISTURBANCES ON HOSPITAL WARDS AND OTHER MENTAL HEALTH FACILITIES
Occasionally disturbances occur on the hospital wards and in community mental health settings . Nursing staff / community based staff are usually able to manage these incidents . However if they are unable to control the situation they will ask for the assistance of the Police to restore order . It is important that effective communication be established between the officers attending and staff on scene to enable an early and safe conclusion to the incident .
Police powers in this situation ar e To prevent a Breach of the Peace, The protection of life, The prevention of Crime The lawful arrest of offenders .
As well as receiving training in Conflict Resolution : Police officers carry personal protection equipment which consists of handcuffs, CS spray and a baton, some officers will also have access to TASER and firearms. If they deem it necessary, officers are entitled to use their issued personal protection equipment to deal with potential threats to their safety and that of others . The police response and powe rs to intervene Whilst hospital staff may have power to restrain and control detained psychiatric patients, that power does not extend to police officers . The options available to police revolve around limited legal powers and are each described below . Containment and Negot iation • Consider requesting a hostage negotiator for advice or to attend the scene . Containing and negotiating should be considered where this would not increase the risks involved . Stand by and suppo rt hospital staff • Stand by to prevent a breach of the peace whilst a medical control and restraint team restrain the patient. Detention and Restraint for prevention of harm to others • Police Powers in the Detention and Restraint for prevention of harm to others - • Section 3 Criminal Law Act : "A police officer may use such force as is reasonable in the circumstances in the prevention of crime : or in effecting or assisting in the lawful arrest of offenders or suspected offenders or of persons unlawfully at large ."
Breach of the Peace:
• A police officer may arrest and detain, using reasonable force anyone who is committing, or they have reasonable cause to believe is about to commit, a breach of the peace.
4 • Once the person has been restrained and is under control they can be handed back to hospital staff if it is safe to do so . Detention and Restraint for prevention of harm to self • In a Public Place the ideal response to a suicidal or self harming individual would be to consider detention under Section 136 MHA. There are sound reasons for this . If section 136 is used there is a power to keep the person detained at a place of safety until an assessment has taken place regardless of how their behaviour changes .
However in private premises Section 136 must not be used and Mental Capacity legislation could offer a tactical solution . The first question to consider when faced with a suicidal individual in private premises is;
- "Do you believe the person has an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn't matter whether the impairment or disturbance is tempora ry or permanent) "
Evidence of such an impairment might be obvious for example from a number of observations that show the person is suffering from severe distress, irrational thought processes, acute trauma, intoxication, concussion, confusion or dementia . The majority of people who police come across in suicidal/serious self harm type situations will normally fall into one of these categories and will often be acutely traumatised and distressed .
Therefore if the answer to this question is YES then the second question to consider will be ; "Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to make it? "
A person is suicidal for a reason - normally due to some traumatic event and it is arguable in the fast moving immediate situations that Police deal with that acute trauma is preventing them from thinking through and making a rationally thought out choice . Such a rationally thought out choice might include seeking medical assistance or support of family/friends/counsellors etc to deal with their acute trauma. The person's inability to consider these alternative choices can strongly indicate that the person is lacking the mental capacity to end their own life at that particular time . Form 434 steps officers through a slightly more detailed way of making this decision, but this is essentially what it will amount to .
Patient/service user as offender or suspect: When dealing with a patient/service user as an offender or suspect where If an offence has been committed or reasonably suspected . It should be investigated in the usual way . Consider arrest for the offence if the general arrest conditions apply. For a person detained under a relevant section of the Mental Health Act the NHS retain the responsibility for the patient and a member of staff must accompany the person to the Custody Suite . Administration Where restraint has been used, or an injury is apparent or alleged, a supervisory officer must be informed and the person concerned must be medically examined and any injuries fully documented . A full written record must be made in an Evidence and Actions Book (EAB) and also recorded on the Intelligence system (C(mint+) using the marker "Mental Health Issue" and, where a crime has been alleged, a Crime report made on the Crime Reporting information System (CRIB .) The offence of caus ing nuisance or disturbance in NHS premises
5 Section 119 Criminal Justice and Immigration Act 2008 created an offence of whilst on NHS premises causing a nuisance or disturbance to a member of NHS staff . Several conditions must be met before the offence is proved and Section 120 creates a power of removal .
Post Police Incident
It is proposed that following disturbances that require Police assistance, a de-brief will be held between nursing staff /Community based staff and Police . This process will enable improvements to be made in the working relationship between these agencies and also for good practices to be highlighted . The names of staff taking part in the incident and de-brief will be recorded by the senior nurse or community based supervisor on duty . Any recommendations/ good practices identified can be brought to the attention of the Mental Health Liaison Committee at their next meeting .
The following protocol is intended to standardise the response to disturbances on hospital wards or community mental health settings that require Police attendance .
• 999 call received by CCC/METCALL: Call handler will create CAD message and set appropriate call grading. Officers will be deployed accordingly . CCC may contact venue for additional information or an update . • Wherever possible a supervising officer will attend the scene . • Senior officer attending to identify self to ward manager/senior person on duty and assess situation . • Risk assessment to be jointly conducted with Police to ensuring safety of all concerned and that adequate resources attend . • Police with the assistance of nursing /community based staff will restore order . (see guidelines re restraining patients) • Offences committed will be identified by Police . • Police will arrest /summons /deal with offenders as necessary ( see offences committed by persons suffering from mental illness) . • Once the risk of a breach of the peace has ceased to exist, a phased withdrawal of Police and take over by Hospital staff will be made as the situation is resolved as the joint dynamic risk assessment allows it. • Return to normality. • Joint De-brief to be conducted .
Good Partnership Practic e Be clear around the risk of the patient/others and self in the situation .
Communicate risk as appropriate to the situation.
Information sharing of risk may be critical to the safety of the patient, other and staff.
6 Disturbances on Hospital wards and other mental health facilities Flow chart Incident reported to METCALL 4CAD number generate d Communication of risk to patient, self, and others should be stated.
If situation merits, Have supervisor (MET) and Senior Manager/ Medic present
Senior Police officer on scene to liaise with Staff in Charge/senior manager/Medical staff
Communication & Assessment of risk : to include Persons, Objects and Place. Identify together if enough Officers /Staff present. Is medical assistance required ?
Police/staff aim to restore order Awareness of Guidance on risks during restraint part of the process 7 Offences committed - identified and responded to as in line with CRIS report generated victim/service/trust nolicv
Joint Assessment that the situation is safe/order rectnred_
De-brief to be conducted - inclusive of Police/Trust staff
8 2. GUIDANCE RE: THE RESTRAINING OF PATIENTS BY POLICE AND MEDICATING PATIENTS B Y NURSING STAF F
This guidance was written to help police officers and hospital staff to understand the police role in relation to requests to help restrain patients for the purpose of rapid tranquillisation . Following calls to disturbances on hospital wards, Police have been asked in the past to assist in restraining a violent or potentially violent patient whilst nursing staff give the patient necessary medication, either orally or by injection, to calm them down . Section 139 of the Mental Health Act 1983 provides immunity from both civil and criminal liability for the actions of any person taken in pursuance of the act, i .e., assisting staff as described above . However, following legal advice from the Metropolitan Police Solicitors Branch, officers are instructed that under no ordinary circumstances will officers restrain a patient whilst nursing staff inject/give medication to that patient. Only in the most extreme of cases can this occur if jointly agreed/discussed with all the risks identified, this must be suppo rted by senior clinical/medical staff present.
They will only restrain a patient to prevent a breach of the peace occurring /continuing. Although this may seem very unhelpful to the nursing staff, the reasons for this are as follows ; • Officers will not be acting in the lawful execution of their duty • They will therefore be acting as private individuals • They will not be covered by their service regulations
Police Tactical Option s In extreme circumstances, where police officers are present during the violent restraint of a person who medical staff wish to tranquillise, a valid tactical option is to restrain the person to prevent a breach of the peace until sufficient hospital staff are available . Once hospital staff are assembled, the officers then hand over the patient to hospital staff to administer treatment as they consider appropriate . In extreme cases of violence or where insufficient hospital staff are on duty to safely restrain and administer rapid tranquilisation, officers present may feel they have little choice but to continue restraining the patient . Where hospital staff administer medication in these circumstances, then full details must be recorded in an EAB (Evidence and Actions book) and reported to the borough commander through the BMHLO (Borough Mental Health Liaison Officer) . The nominated SMT lead should raise this with senior staff in the health trust to ensure that arrangements are made for sufficient staff to be available where patients require rapid tranquilisation. The protocol described below should be read in conjunction with the protocol for dealing with disturbances on hospital wards and community mental health settings . The following protocol is designed to g ive clear guidelines as to the roles of Pol ice and nursing staff during incidents when a patient is to be medicated against their will. • If necessary to prevent a breach of the peace/further breach of the peace occurring, officers are legally empowered to assist in restraining the patient . • Once the patient is secure, nursing staff will take over the restraint of the patient . • If deemed necessary, nursing staff will then administer medication/treatment to the patient . • Once this has been completed, officers will again assist nursing staff with restraining the patient if restraint is still necessary to prevent a breach of the peace/further breach of the peace occurring and only if nursing staff are unable to manage the patient without Police assistance . • Police will then withdraw from the ward once the fear of a breach of the peace has subsided . • A de-brief will then take place between Police and nursing staff .
Good Partnership Practice for SLAM staff. Be clear around the risk of the patient/others and self in the situation .
9 Communicate risk as appropriate to the situation.
Information sharing of risk may be critical to the safety of the patient, other and staff.
Maintain communication with the police and observe for evolving risks to the patient, others and self.
Monitor the patient and whe re possible maintain physical observations as required in physical interventions. Obtain medical support and emergency equ ipment.
The restrain of a patient can be life threatening and therefore every observation and known history of risk should be relayed to the Officer in Charge.
Known or suspected substance use
Physical health proble m
Prolonged restraint
Level of exhaustion
Consider in Acute Behavioural Disturbanc e
(See Trust Promoting Safe &Therapeutic services Policy 2011 )
Police officers are issued with personal protection equipment which consists of handcuffs, CS spray and a baton . If they deem it necessary, officers are entitled to use their issued personal protection equipment to deal with potential threats to their safety and that of others . In such cases observation of the patient's physical well-being should continue to be monitored and supported by Trust nursing and medical staff .
10 Guidance re the retraining of patients by Police and medicating patients by nursing staff Flow chart
To prevent aBOP/further BOP occurring, officers CAN assist in restraining a patient
Once the patient is secure, nursing staff to take over restraint
Officers WILL NOT restrain a patient whilst nursing staff inject/medicate that patient (Unless in extreme circumstances - see guidance)
Nursing staff will then administer medication
Officers to assist nursing staff to restrain patient IF RESTRAINT IS STILL NECESSARY to prevent a BOP
Fear of BOP subsided, Police to withdraw
11 De-brief to take place
12 3. OFFENCES COMMITTED BY PATIENTS ON HOSPITAL WARDS AND OTHER MENTAL HEALTH FACILITIES
Police are regularly called to hospitals and community mental health sites to report crime committed by people suffering from mental health problems . Occasionally attending officers may be reluctant to use their powers of arrest or summons as they feel their actions may not be in the best interests of the patient or the public . However the views of the victims of crime must be taken into account when dealing with such offences and there may be a real need for the offender to be placed into the criminal justice system . The following protocol is intended to standardise Police response to such incidents.
• Officers attending will make contact and liaise with the senior person on duty . The fitness of the patient to be interviewed for any offences should be assessed by the Ward Doctor and a statement made (proforma is available) . • Any allegations made will be recorded and investigated by Police to determine whether an offence has been committed . • Generally (but not exclusively) Police will require a complaint from the victim before proceeding but where there is a question of the victims Mental Capacity to understand what has happened or to recognise it as an offense Staff should make the complaint on behalf of the victim . • When offences have been committed, Police should consider whether the General Arrest conditions apply and the suspect is considered fit to be interviewed before arresting the suspect. If the Fitness for Interview assessment cannot be made at the time and there is no possibility of forensic evidence being lost, Police should consider proceeding by way of summons or arresting and interviewing the suspect at a later date when the Fitness to Interview has been confirmed . • Should the victim not wish to proceed Police should consult with staff to consider the Mental Capacity issues. • The investigating officer will give regular updates to the victim as to the progression of the case.
The decision to arrest remains solely with the Police officer. There may be occasions that affecting an arrest may not be possible or appropriate at that time. If a person is not arrested for an offence, it does not preclude their prosecution for that offence at a later stage .
The decision to charge and prosecute
The general MPS advice is that in minor cases it may be more appropriate to deal with mentally disordered offenders by diverting them away from the criminal justice system . However, where offences are serious, or show an element of violence, the offender should normally be prosecuted . Such action will allow the courts to deal with the offender appropriately, enabling an accurate offending profile to be established .
The Home Office Circular 12/95 gives further guidance as to the decision to charge and prosecute.
• The decision to charge must be guided by what is in the public interest • Mental disorder should never be the only factor considere d • Police must not feel inhibited from charging where other factors indicate that prosecution is necessary in the public interest • The CPS, in reviewing a case must balance the effects on a persons mental health if prosecuted against the needs of society
13 The decision to charge an offender is generally made by the Police. The Crown Prosecution Service, using their agreed guidelines, reviews all such cases . The CPS w ill take a pro-active approach in relation to prosecuting cases involving violence and possessing offensive weapons , knives etc.
14 Offences committed by patients on hospital wards and other mental health facilitie s
Flow chart
Police attend venue and make contact with senior person on duty
Any allegations made will be recorded and investigated by Police
If offence committed, is the victim willing to substantiate the allegation ?
Yes 1 No
Police either arrest or Police will take summons, which ever withdrawal statement is more appropriate and create a crime report
Investigating officer will regularly update victim
This process is further supported by the Trusts Local Security management Specialist who will pursue crime reports and support the victims of crime during criminal proceedings .
15 4. CUSTODY PROCEDURES AND CASE DISPOSAL OPTION S
Issues have previously arisen surrounding the investigation procedure, mental health act assessment and correct case disposal decision for detainees believed suffering from mental health problems. To assist all parties to ensure that the correct balance between providing the proper care for such a detainees and ensuring a correct case disposal decision is reached, the following protocol is to be adopted .
• Person arrested is brought before the Custody Officer who begins the initial custody reception procedure . • If the Custody Officer believes the arrested person may be suffering from mental illness an FME or Custody Nurse will make an initial assessment. • FME or custody Nurse states that a mental health assessment is not required and the detainee is fit to detain and interview, continue investigation through to case disposal . • FME or Custody Nurse states that a mental health act assessment is required for the detainee, Custody officer will arrange assessment but the investigation is to continue at this stage . • Custody Officer will brief Mental Health Act team (MHA team) re possible case disposal decisions upon arrival . • If a mental health act admission is not recommended by the MHA team, Custody Officer will update the custody record accordingly and advise the investigating officers . • If a mental health act admission is recommended by the MHA team a case disposal decision should then be taken by the Custody Officer . (see below ) • If a detainee is to be charged and then released to hospital under section, they must be given a court date to correspond with the availability of the court diversion service .
Note for Custody Officers
If the Mental Health Act team state that the detainee requires hospital admission under section, the detainee will be deemed as not fit to be interviewed . A further discussion should then take place between the investigating officer, the MHA team and the Custody Officer who will then decide upon the appropriate case disposal decision depending on the current position of the investigation .
When deciding to keep a detainee in police detention despite the MHA team indicating that a hospital admission is necessary, the Custody Officer must fully record their reasons for making such a decision . In cases of refusing bail after charge, the availability of properly secure hospital accommodation should also be considered .
The Mental Health Act Team are unable to section a detainee who will be remaining in Police detention as the Mental Health Act states that once a person is sectioned they must be taken to a venue to receive immediate medical treatment for their condition .
16 Custody procedures and case disposal options
Flow chart
Arres t
Custody Reception
FME Called for Fitness to Detain
Assessment Required?
Arrange Assessment BUT Continue Investigation
Brief MHA team re possible case disposal decisions
No Continue Investigation MHA admission indicated Yes
Case Disposal
Charge Bail to Return Caution / NFA
Suitable for bail? Court Sectioned No Yes Sectioned
Hospital Released Hospital I I Released on bail
17 5. ABSENCE WITHOUT LEAV E
The reporting of patients who are found to be missing from the ward or do not return from leave at the agreed time .
Periods of negotiated time out of the ward or to go on leave are an important part of a patients care programme designed to prepare and assess their suitability for discharge . The conditions of the pass will be discussed with the patient and a time agreed for returning to the ward . However, occasionally a patient will not return from leave or otherwise absent themselves without permission from the ward .
Nursing staff should be aware, within reason, of patients' whereabouts at all times. The following protocol is designed to cla rify the procedure for reporting patients that are either missing from the ward or who have not returned to the ward after an agreed period of leave.
• Full descriptive details will be maintained for every patient, which will be given to Police if an individual goes missing from the ward . • If a patient is found to be missing/otherwise absent, nursing staff will carry out a search of the ward and the hospital grounds in an attempt to locate them . • If the patient is not found, nursing staff to initiate basic enquiries into patients likely whereabouts before contacting Police, i .e. friends, family etc . • Where a patient has failed to return to the ward after an agreed period of leave, ward supervisor will wait for 4 hours after the expiry of the agreed period of leave prior to contacting Police . • If the patient's whereabouts have not been identified, or they have not returned after the 4 hour period, ward supervisor will contact Police to report the patient as a missing person . • Police will attend the ward and complete a Merlin (Missing Person) Report, completing all necessary actions . • Police will then circulate patient as a missing person and initiate enquiries to establish the whereabouts of the patient . • Regular updates will be given to the ward supervisor by the investigating officer as to the current situation of Police enquiries . • When missing patients' whereabouts are discovered by Police, the ward supervisor will be informed . Police will no longer class the person as missing . • Missing persons Merlin report will be updated with the location of the missing person and all enquiries will cease . • The patient will remain shown as missing on the PNC until the ward advise that the patient has been collected by their staff . • If the missing patient is located by nursing staff or returns to the ward, the ward supervisor will immediately inform Police. • When a missing person returns to the ward, nursing staff will carry out a full de-brief of the patient and inform Police of the details obtained .
The information obtained during the de-brief as to the patient's movements/locations during their absence may assist the speedy return of the patient if they abscond again . It may also be useful in refusing/restricting passes from the ward in the future .
18 Reporting patients that are missing
Patient believed missing from ward /not returned after 4 hours of expiry of period of leave, staff carry out search of ward/hospital
Patient still not found, ward staff to initiate basic engs re possible whereabouts
Patient's location still not identified/not returned after 4 hour period, War d supervisor to contact police to report patient as missing
Police attend and compile missing persons form
Police then circulate patient as missing and initiate enquiries as to location, providin g regular updates to ward superviso r
Patient found to be living at an address by Police, ward supervisor informed, Police will no longer consider patient as missing (see protocol re returning of patients)
Location of patient discovered by ward staff or returns to ward, ward supervisor t o notify Police immediately
De-brief of returned patient to be conducted by ward staff and relevant details passed to Police
19 6. THE RETURNING OF PATIENTS REPORTED MISSING FROM THE WARD S
Sectioned patients If a sectioned patient who is reported as missing is discovered in a public place, Police are empowered under sect 18 of the Mental Health Act 1983 to return the patient to the venue from which they are missing, using force if necessary. (See appendix for full powers under sect 18) .
However, when the whereabouts of a sectioned missing patient are discovered or known, it is the responsibility of the ward to arrange an escort to accompany the patient back to hospital . The return of patients is not a Police responsibility. Police will only assist in returning the missing person to the ward in the following circumstances ,
• They are violent or potentially violent • May be a danger to the publi c • Are likely to be an immediate danger to themselves • Police agree this is within a reasonable distanc e
Voluntary patients If the missing patient was admitted to hospital on a voluntary basis and is found by Police in a public place, there is no power to forcibly return the patient to hospital. In these circumstances Police will attempt to persuade the person to return to hospital . If they refuse the ward supervisor will be informed accordingly . If officers believe that the person is in need of immediate care and control and in a public place, they should detain the person under 136 of the act and the protocol for 136 presentations should be followed . (see page 13)
Section 135 (2) warrants If a missing sectioned patient is found to be living or staying at a certain premises and refuses to return to the ward, it is the responsibility of the hospital to obtain a section 135 (2) warrant which will enable the patient to be taken from a premises by force if necessary and returned to the ward . If nursing staff require Police assistance to execute the warrant, the protocol in place for mental health assessments in the community is to be adopted .
If a missing voluntary patient is found to be living or staying on premises, the ward will be informed in order that the patient can be visited to assess their current mental state .
20 7. DETAINING PEOPLE REQUIRING IMMEDIATE CARE AND CONTROL (s136 MENTAL HEALTH ACT 1983)
This document refers to persons detained in a public place requiring immediate care and control, under Section 136 of the Mental Health Act 1983 .
The aim of this policy is to secure the competent and speedy assessment by a doctor and an Approved Social Worker of the person detained under Section 136 of the Mental Health Act . It is also the aim of the policy to act at all times in the patient's best interests .
The designated places of safety for South London & Maudsley NHS foundation trust are :
Southwark Eileen Skellern Ward Maudsley Hospital - 0203 228 2070 Lambeth Eden Ward Lambeth Hospital - 0203 228 6155 Croydon Gresham PICU Bethlem Royal Hospital - 0203 228 4075 Lewisham Johnson Unit Ladywell unit Lewisham Hospital - 0203 228 609 1
If the person appears to be in need of care and has physical injuries, the patient should be conveyed to the nearest Accident and Emergency Department (King's College Hospital, Guys, Lewisham or St Thomas's Hospital) . The police duty officer is to liaise with the Accident and Emergency consultant/registrar and the mental health team to establish how long the police need to remain in the department.
Officers will conduct checks to establish if the person is a patient missing without authorised section 17 leave. If they are missing, the police will contact that venue to arrange the persons return .
If not missing, officers will exercise their power to detained under Section 136 and consider searching the person using powers provided by Section 32 PACE .
The section 136 suite/place of safety is not suitable for a person :
• With any medical condition such as an injury, exposure to CS sprays/Taser or displays signs or symptoms of an illness . In this case the Ambulance Service should be called or the person removed to the nearest Accident and Emergency Department .
A person who is "incapable through Drink or Drugs" must be taken to A&E .
*If a person presents with an alcometer reading of less than 80BAC mm % they will be assessed . If the reading is between 80 and 100BAC mm % the person will remain until safe to assess . WHERE THE READING IS GREATER THAT 100 BAC mm % the person may be considered too incapacitated to assess, this is still dependent on other features of incapacity or risk.
Incapacity can be difficult to establish, it may not always be possible to take an alcometer reading and sign and symptoms of intoxication to incapacity are about the persons ability to stand, hold weight, respond coherently. The intoxicated individual could be at more risk of physical collapse and may be better suited to be assessed in an A+E department. This decision should be based on the risk presentation. It may be that illicit drug consumption is responsible for intoxicated behaviour. One indicator of drug use is lack of alcohol in reading or by smell etc or other observation such as dilated or pin- point pupils etc.
• A person whose behaviour poses an unmanageably high risk to other patients, staff or users of a healthcare setting . In these cases a police station may be used .
21 Where a person is detained under Section 136 and is thought to be under the influence of Drink or Drugs, but not incapable, should be taken to the 136 Suite/Place of Safety .
If the section 136 suite is considered to be the most appropriate place of safety for the individual: From Sam on Monday 1 October 2012, the Police should contact the Trust's main switchboard on 0203 228 6000 and ask for the `Bed co-ordinator' covering the Borough they are from (or in the case of the British Transport Police, the Borough in which they have detained the person under Section 136) .
Switchboard will put the Police through to the respective bed co-ordinator.
On receipt of the call, the bed co-ordinator will check availability of the local suite by checking Bed State Live and / or by calling the respective suite if necessary to confirm . If the suite is available, the bed co-ordinator will advise the Police to convey the patient there .
If the local suite is not available for whatever reason, the bed co-ordinator will advise the Police of the alternative suite within the Trust that they may use, inform that suite that they are to receive a Section 136 presentation and provide the contact details to the Police .
After contacting the unit, the police should convey the person directly to the hospital with the Form 434 if a supervisor has attended the scene . If a supervisor has not attended the scene, the Form 434 should be obtained from the unit on arrival and should be completed before taking the person to be detained into the unit . It is recognised that in very exceptional circumstances the need to ensure the safety of the person may take priority over the completion of the form prior to entering the 136 suite .
On arrival at the 136 suite, the senior officer will be met by the Section 136 co-ordinator . The person should remain in the police van at this time .
The Section 136 co-ordinator will be informed whether person has been searched or not . If the person is violent or potentially violent, the senior police officer and Section 136 co-ordinator will negotiate the length of time officers will stay at the hospital . If the police are restraining the person, they should continue to do so until the 136 nurse is confident that nursing staff are sufficient and available to take over the restraint. Any dispute over length of time police are required to stay will be resolved by the duty officer and the Section 136 suite co-ordinator .
If the 136 suite is not available the Section 136 co-ordinator will identify an alternative venue for section 136 admissions within the Trust .
If no venue is identified, the person will be taken to the nearest police station as a place of safety or to another Trust facilities identified by MEfCALL . It is MPS policy and a requirement of the MHA Code of Practise that a police station should only be used on an exceptional basis . If a police station is used the MHA code places two clear responsibilities upon health and care agencies .
1 . They should work with the police to arrange transfer to a more suitable place of safety . 2. They should work to locally agreed target times to either transfer the person or attend the police station .
A person detained in a place of safety under Section 136 may be transferred to another place of safety within the duration of the Section (72 hours) .
22 There is no reason why police should be responsible for transferring a person from one place of safety to another in preference to other agencies . The decision about whether police will be involved in such transfers and decisions about using police vehicles will be made by a police supervisor. Clearly, the safety of the detainee and others will be a factor the police supervisor will take into account when risk assessing such decisions . For reasons of risk to the patient, safety and the avoidance of stigmatisation, transfers should be carried out by ambulance in preference to a Police vehicle. A Police vehicle should only be used where an ambulance has been requested and is unavailable or where the person is too violent to be conveyed by ambulance. In cases where the person is taken by a Police vehicle due to the level of violence then a member of the LAS crew should be asked to travel in the Police vehicle to monitor the detainee and the ambulance should be requested to follow behind to deal with any medical risks or sudden collapse . Detaining people requiring immediate care and control under s136 Mental Health Act 1983
Person in a public place requiring immediat e
Physical injury? Yes
Contact venue to Are they arrange return Yes missing?
No
Use s136 powers , consider s32 search
Incapable/ Accident Police Disorderly DRUNK? CS spray and Station used emergency
No Alcohol Under Influence
Police Station s136 suite available? Assessed A No MetCall to contact Bed Manager - who within 4 Hours will check availability of all PoS suites within Trust
Yes
Call Ambulance to transport unless : Significant delay of ambulance Urgent reason/risk 8. MENTAL HEALTH ASSESSMENTS WITHIN THE COMMUNIT Y
The Mental Health Act 1983 allows an Approved Mental Health Worker ( AMHP) to make an application for admission to hospital of a person believed suffering from mental illness either for assessment (sect 2 or 4) or for treatment (sect 3) .
Approved Mental Health Worker ( AMHP) will take the lead in co-ordinating assessments under the act. They are responsible for ensuring that all necessary arrangements are made to convey the patient to hospital in a lawful and humane way .
When necessary, Police will be asked to assist in this process . Police involvement is divided into two very distinct areas;
Police attendance to manage risks: • Clearly, where Police attendance is sought because of conce rns about safety there is a strong argument that a warrant MUST be sought , primarily so that the person can be removed from the situation, using force if necessary, to a place of safety where an assessment/application can be completed . Whilst there is nothing to prevent Police officers attending an assessment in these circumstances without a warrant, the ability of th e Police to create and maintain a safe working environment for everyone present will be severely limited . This should therefore form a key part of the decision making process .
Police attendance to promote co-operation. • In these circumstances, Police help is sought to support the multi-agency team by promoting the cooperation of the person to be assessed . These are generally situations where previous experience suggests that the person to be assessed will be significantly more cooperative with the multi-agency assessment team if a uniformed Police officer is present. Where the reasons for requesting Police attendance are not related to risk and there is little risk of access to premises being refused then a warrant is unlikely to b e available.
Assessments are divided into 3 levels of precedence : • Level 1 Immediate : Within 24 Hours: • Level 2 Urgent : Within 72 Hours; • Level 3: Routine : As soon as reasonably practicable :
It is important that the correct precedence is given to Assessment requests to provide the appropriate level of response and appropriate allocation of resources.
Police help is sought in order to gain access to premises and/or to provide protection for and ensure the safety of everyone present . This includes the multi-agency team, the person subject of the assessment and any occupants or visitors to the premises whilst the assessment takes place . Police assistance is usually sought to manage one or more of the following risks :
• A risk that entry to the premises will be refused • A risk that the person who will be subject of the assessment or anyone else inside the premises will become violen t • A risk that the person to be assessed will harm themselve s • A risk that the person to be assessed will abscond before the assessment or the application for compulsory admission to hospital has been complete d • A risk of attack by an aggressive dog or other dangerous animal present inside the premises
24 Because of their status, role and function, there is an implied expectation that the Police will provide security and safety at any Mental Health assessment they attend because this is normally the reason for seeking Police support . In relation to these identified risks, it is crucial to understand and recognise that without warrant Police powers to proactively intervene and take preventative measures against these risks will be limited .
A warrant granted unde r Section 135(1) Mental Health Act 1983, provides: • Power to enter the premises • Power to search the premises for the service use r Power to restrain the service user for the purpose of removal to a place of safety l Power to optionally remove the service user to a place of safety for 72 hours and assess them at that place instead of their own home 2 .
Without a warrant, Police officers and the multi-agency team of which they form part are present as invited guests and until an incident occurs, officers will be powerless to act .
Ideally Police will be given 24 hours notice of an intended assessment . Occasionally an assessment will need to be carried out urgently due to a person's deteriorating mental health . In these cases both agencies will endeavour to carry out the assessment process as quickly as possible.
The follow ing protocol is intended to standa rdise the procedures relating to the assessment process.
The requesting AMHP will complete Mental Health Assessment Request Form Part One and email it to the relevant Borough Police team . The following mailboxes apply :
Borough Email address Bromley PYMailbox- .GPC(a)_met.police . u k
Croydon zdmailbox-.gpc(a)_met.police . u k
Lambeth Ixmailbox-.gpc(a)-met.police . u k
Lewisham pl mail box-.gpc(a)-met.police.uk
Southwark mdmail box-.gpc(a)-met.police . u k
• Operations Office and DRC staff will complete Part 2 Police Assessment and confirm whether Police assistance is deemed necessary and set the level of response . • Operations Office will arrange for the appropriate Police resources and agree a time and Rendezvous (RVP) with the AMHP. [NOTE it is essential that ALL PERSONS involved attend the RVP and DO NOT under any circumstances, approach the final address without the permission of the Police Supervisor.] • At the RVP, Police will liaise with the senior AMHP to determine any change in the risk assessment and the roles respective agencies will perform during the assessment . • Police will remain at the address in support of the assessment period and or in the requirement of transportation for place of safety .
The LAS will usually transport patients to hospital . Police will only ag ree to provide transport for patient transfers if the following conditions apply. • The patient is violent or potentially violent, and
25 • The LAS crew consider it unsafe to use an ambulance, and • Police have been informed in advance of the destination of the patient, and • Police agree this is within a reasonable distance, and • A member of NHS staff accompanies the patient in the Police van, and • The ambulance follows in close proximity, ready to respond to any medical emergency . For reasons of safety, Police will only convey the patient in a Police van . No other form of Police vehicle will be used. Police transport will never be used to convey patients who have been sedated. • Any dispute in relation to the transfer process will be resolved by the Duty Officer and the senior AMHP on duty . • At the conclusion of the Assessment a comprehensive de-brief will take place between all agencies. It is important that the de-brief is conducted so that good working practises can be identified, deficiencies rectified and any recommendations to improve the assessment process can be highlighted to the next meeting of the Mental Health Liaison Committee. • The Mental Health Assessment Request Form, fully completed , with de brief notes will be forwarded to the Borough Mental Health Liaison Officer at the address shown Out of Hours and Emergency Procedure: • If out of office hours and an emergency, • The requesting AMHP will complete the Mental Health Assessment Request Form Part One and email it to the relevant Police Borough mailbox (see table above), for example at Southwark this is mdmailbox-.q [email protected]. Police.uk. They will also telephone METCALL via 101 to arrange Police attendance : Note all information contained in Part 1 of the Request Form must be passed to METCALL to allow for proper risk management . • If Police are required, appropriate resources will be allocated and a time and Rendezvous (RVP) arranged . [NOTE it is essential that ALL PERSONS involved offend the RVP and DO NOT under any circumstances, approach the final address without the pe rmission of the Pol ice Supervisor.] • The completed Mental Health Assessment Request form must be handed to the supervising officer immediately the AMHP arrives at the RV P • At the RVP, Police will liaise with the AMHP to determine whether there has been any change in the risk assessment and confirm the roles respective agencies will perform during the assessment. • Thereafter the procedure will be as for a pre-planned assessment .
26 Mental Health assessments within the community
Flow chart
Out of hours and an r In office hours, AMHPS emergency, AMHPS to to email risk assessment contact MetCal l assessment to Ops office
Police response No Inform AMHPS agreed of reasons
Yes
CAD created and controller to ensure supervisor and sufficient resources attend RVP
At RVP, risk assessment rechecked and specific roles agreed
Patient transferred to Assessment completed, hospital patient sectioned Yes No
All agencies Police transport to be withdraw from used only if certain the scene criteria apply, see patient transfer protocol
De-brief to be conducted
Pro-forma to be returned to mental health Liaison Officer
27 9. PATIENT TRANSFERS & CONVEYANCE
The transfer of patients from hospital or a private address to another hospital may become necessary if a more secure environment is deemed suitable for the care/treatment of a patient . Occasionally Police will be asked to assist in patient transfers . The primary role of the Police in these circumstances will be to stand by to prevent a breach of the peace . The transfer of such patients will normally be by hospital transport or LAS ambulance . Police will only agree to provide transport for patient transfers if the following conditions apply.
• The patient is violent or potentially violent, and • The LAS crew consider it unsafe to use an ambulance, and • Police have been informed in advance of the destination of the patient, and • Police agree this is within a reasonable distance, and • A member of the nursing staff accompanies the patient in the Police van, and • The ambulance follows in close proximity, ready to respond to any medical emergency . For reasons of safety , Police will only convey the patient in a Police van . No other form of Police vehicle will be used. Police transport will never be used to convey patients that have been sedated . The following protocol is intended to standa rdise the procedures relating to patient transfers:
• Ward supervisor/AMHP to FAX risk assessment document to Operations Office at the Met Police outlining their reasons for requesting Police assistance . • Operations office staff will complete the risk assessment and agree a time for the assessment to take place if Police assistance is deemed necessary . • If out of office hours a nd an emergency, AMHP to contact MetCall* having all necessary information to hand . • If Police are required, a CAD message will be created and if necessary scheduled for the beginning of that tour of duty when the assessment is to take place detailing the necessary Police response . • In line with the agreed risk assessment, MetCall will ensure that a supervisor and sufficient officers attend the RVP given at time agreed to assist in the proposed patient transfer . • The completed pro forma will be handed to the supervising officer prior to their attendance at the RVP . • At the RVP, Police will liaise with the AMHP /ward supervisor to determine any change in risk assessment and the roles respective agencies will perform during the transfer . • Any dispute in relation to the proposed transfer will be resolved by the Duty Officer and the Ward supervisor/ senior LAMHP on duty . • At the conclusion of the transfer a de-brief will take place between all agencies . • The pro forma, with completed de brief will be forwarded the Mental Health liaison Officer to the address shown.
Due to the demands of Policing, there may be occasions where the Police are unable to assist in an agreed patient transfer. If this situation occurs MetCall will immediately inform the ward supervisor/AMHP and arrangements will be made to re-schedule the proposed transfer as soon as practicable .
*MetCall - MetCall is the name given to the Police control room who receive and prioritise all 999 and 101 telephone calls . Staff should consider whether the incident is an emergency, in which case they should dial 999 ; or for all non-emergency contact staff should dial 101 .
28 Patient transfe r
Flow Chart
Out of hours and an In office hours, AMHPS emergency, AMHPS o r or ward supervisor to fax ward supervisor to risk assessment to Ops contact controller office
Police response agreed ONLY if criteria for patient transfer in Police Inform of vehicle is met, see reasons opposite page No
Yes
CAD created and controller to ensure supervisor and sufficient resources attend RVP
At RVP, risk assessment rechecked and specific roles agreed Any disputes to be resolved by Duty Officer and AMHPS/ ward supervisor
Patient transferred to new location
De-brief to be conducted
Pro-forma to be returned to mental health Liaison Officer Recall warrants
Section 37 of the Mental Health Act 1983 empowers the courts to make a hospital order as an alternative to a penal disposal for offenders who are found to be suffering from mental illness at the time of sentencing such as to warrant their detention in hospital for treatment .
Section 41 of the Mental Health Act 1983 further empowers the Crown Court to add a restriction order to a hospital order, restricting the discharge of the offender from hospital if it considers that it is necessary for the protection of the public from serious harm .
When offenders that are subject to a hospital order or restriction order, are deemed well enough to be discharged from hospital, that discharge will be either absolute or conditional . If certain conditions are met, for example the offender's behaviour or condition suggests a need for further hospitalisation ; the Home Secretary may issue a recall warrant, also known as a 37/41 warrant, to return the offender to hospital for further treatment .
Recall warrants are usually faxed to the AMHP managing the offender and they do not look like a normal warrant of arrest. They will also name the hospital the offender is to be taken to . The following protocol is intended to standardise the response to the issuing of a recall warrant by the Home Sec retary.
• In office hours, AMHP to fax request for police assistance to the Operations office at the Met . Police . • Operations office staff will complete the risk assessment and agree a time for the proposed execution of the warrant to take place . • If out of office hours a nd an emergency, AMHP to contact MetCall having all necessary information to hand . • A CAD message will be created and if necessary scheduled for the beginning of that tour of duty when the execution of the warrant is to take place detailing the necessary Police response . • In line with the agreed risk assessment, MetCall will ensure that a supervisor and sufficient officers attend the RVP given at time agreed to assist in the proposed execution of the warrant. • The completed pro forma will be handed to the supervising officer prior to their attendance at the RVP . • At the RVP, Police will liaise with the AMHP to determine any change in risk assessment and the roles respective agencies will perform during the incident. • Any dispute in relation to the proposed transfer will be resolved by the Duty Officer and the senior LAMHP on duty (see patient transfer protocol) . • At the conclusion of the incident a de-brief will take place between all agencies . • The pro forma, with completed de-brief will be forwarded the Mental Health liaison Officer to the address shown.
It should be noted that the re is no power of entry attached to a recall warrant. If entry is opposed the AMHP must apply fo r a sect 135(2) warrant to enable pol ice/social services to enter.
30 Recall Warrants
Flow chart
Out of hours and an emergency, AMHPS t o In office hours, AMHPS contact controller to fax risk assessment to Ops office
Police response agreed
CAD created and controller to ensure supervisor and sufficient resources attend RVP
At RVP, risk assessment rechecked and specific roles agreed
Patient transferred to Warrant hospital Executed Yes No
All agencies Police transport to be withdraw from used only if certain the scene criteria apply, see patient transfer protocol
De-brief to be conducted
Pro-forma to be returned to mental health Liaison Officer
31 10. INFORMATION SHARING -A BRIEF GUIDE
INFORMATION SHARING A pull-out guide to facilitate safe and effective exchange of information between South London and Maudsley NHS Foundation Trust and the Metropolitan Police , in accordance with the Trust Information Sharing policy .
The purpose of this guide is to outline the procedure for effective information flow between the Trust and the Police without jeopardising patient confidentiality .
The information disclosed to the recipient is disclosed in confidence and for the use of the recipient organisation only. Unless otherwise stated , there should no onward disclosure of information .
Trust staff: this section must not be read in isolation from the full the Trust Information Sharing Policy and is intended to be a practical , day-to-day guide.
PART A) REQUESTS TO THE TRUS T
1 - Initial contact by the Metropolitan Police Se rvice should be made to :
Routi ne requests
Sam - 5pm (Monday to Fr iday)
Data Protection Office (DPO ) Tel : 020 3228 517 4 Fax: 020 3228 313 2 datagrotectionoffice a-slam.nhs.uk
Weekends and Bank Holidays
The next working day to the Data Protection Office .
Urgent requests - Police Custody Officer/Nurses (IMMEDIATE ATTENTION )
24 hours a day , 7 days a week
Lewisham Croydon Tel : 0208 333 3478/3479 ext 8423 and then Croydon Psychiatric Liaison Team: ask for the Psychiatric Liaison Nurse Tel : 0203 228 080 9
If no answer, call the Mayday Hospital on :
0208 401 3000 and ask for Bleep 71 4
Lambeth Tel : 0203 228 6000 and then ask for the Duty Senior Nurse for Lambet h
Southwark Tel : 0203 228 6000 and then ask for the Emergency Team Leader for Southwar k
32 Urgency of requests: a) Routine enquiries : All enquiries that relate to historic information about patients will be considered `routine' and will be processed within working hours within a reasonable timeframe . b) Urgent enquiries (often by Police Custody officers/Custody Nurses) :
This document acknowledges that nurses are further duty -bound by confidential ity through the terms of the ir professional code of conduct. A Custody Nurse may require information to assist in :
1) Managing the care and treatment of prisoners while being held in police detention . 2) Making a pre-release assessment. 3) Making arrangements for further support by mental health services after release.
The Police Officer or Custody Nurse making the request will supply the following informs Jon:
By telephone or using an appropriate e-mail address (if not urgent)
About themselves Name, job title and telephone numbe r
About the subject they are enquiring about The name and date of birt h • What information is required • Why it is required (indicating an y relevant immediate risk of harm/deat h or statutory reason)
For routine and urgent requests: Confirm if they have capacity to provide consent. • Confirm if the person has given their consent to obtain disclosure (even if consent is not given, information may still be given)
33 Summary of General Principles for Routine and Urgent Enquiries :
Ask for the foll owing details to be provided : - Requestor's full name , job title , phone number and email address . - Record the reason behind the information request . - Do they have the person 's consent ? - Authenticate the caller 's ID by ringing back the main landline contact numbe r
Is the informarion required urgent? No Refer the request to the Data Protection Office
Ye s
Before checking the ePJS record , s eek authoris ation for disclosure fro m : The relevant Gene ral Manager or i f they are n ot available the Data P rotection Office. - Sen ior Manager `On Ca ll' (out of hours).
If authorisation is given, provide the information to the person who made the request.
Make a record of the disclosure on ePJS includi ng th e follow ing d etails : Who made the request ? Why they needed this information? Who authorised disclosure ? What information was disclosed ?
Summary of General Principles fo r
Critical requests (IMMEDIATE RESPONSE )
All Borough s
Tel : 0203 228 6000 and then ask for the Duty Senior Nurse for Lambet h
As a last resort contact the `on call' Director via the switchboard on Tel : 0203 228 6000
C) Critical enquiries : A case will be considered `critical' if there is immediate risk of harm to the subject or others and information needs to be provided immediately to protect individuals e .g . hostage situations, presence of weapons, acts of terrorism, etc. Critical Enqui ries wi ll only be generated by scene of crime Firearms Off icers.
34 c) Critical enquirie s
Ask for the foll owing details to be provided : - Requestor's full name , job title , phone number . - Verify that the case is genuinely `critical' (i.e. there is immediate risk of harm to the subject or others and information needs to be provided immediately to protect individuals e .g . hostage situations , presence of weapons , acts of terrorism , etc.) - Check if the telephone number provided is 020 7275 3553 . If not, escalate to Director on -call to make the decision of disclosure via 020 3228 600 0
Provide the information disclose ON LY the following information:
• Whether they are known to SLaM Trust . • Whether they are currently engaged with services . • Known risk factors - to self or others . • Diagnosis or nature of mental health problem . • Recent significant life changes that can be established from patient records that may impact on behaviour .
Make a record of the disclosure on ePJS includi ng th e follow ing d etails : Who made the request ? Why they needed this information? Who authorised disclosure ? What information was disclosed ? Record the date and time of the disclosur e
2- Trust Response
SLaM staff under the terms of this arrangement may disclose ONLY the following information :
• Whether they are known to SLaM Trust . • Whether they are currently engaged with services . • Known risk factors - to self or others . • Diagnosis or nature of mental health problem . • Recent significant life changes that can be established from patient records that may impact on behaviour.
3- Trust staff will keep a written record:
Trust staff will file a copy of the information exchange on ePJS under the `Events' tab, indicating what information was provided, when, why and to whom.
35 PART B) REQUESTS TO THE METROPOLITAN POLIC E
1 - Initial contact by a SENIOR member of the SLaM Trust should be made to :
Sam - 5pm (Monday to Friday)
Lewisham's BMHLO Croydon's BMHL O
Bromley's BMHLO Southwark's BMHL O Police Sergeant Richard White Police Sergeant David Ch ristie Tel : 101 Tel: 020 7232 669 1 Email: richard.c.white(a)-met.golice.uk Team : Operations MD (Events & Menta l Team: NE-Cluster SNT Health ) Email: david.christiea-met.golice.uk
Lambeth's BMHLO Inspector Russell Taylo r Tel : 07766 776046 Email: russell.tavlor4a-met. prin. police.uk Team: Partnership Unit
Weekends and Bank Holidays
The next working day for the relevant BMHLO .
2- The person making the request will supply the following information :
In writing on headed paper or using an appropriate e-mail address or by telephon e
About the subject they are enquiring about Name and date of birth? • What information is required? • Why is it required? (indicating any relevant immediate risk o f harm/death or statutory reason )
About themselves Name, job title and telephone numbe r
3- The Police will keep a written record:
The Police may respond to information requests via MPS Form 141A .
If you are sharing information , you must create a Crimint+ Information Repo rt as soon as possible after the sharing has taken place .
36 4- Police overview of sharing process following a disclosure reques t
Record Gather Information in Sharing Accordance with ISA Request
Information Perform Information NOT Suitable ,■■i SHARE i■■' Suitable to to Share Assessment Share
Inform Person Requesting Information of Decision Share Sanitise and Apply MPS Not to Share Information in `Protective Marking Scheme' Accordance with to all Information ISA
Record Details of Disclosure on Crimint+
37 Appendix
The following items are included to act as a reference point to all parties using this document .
1 . Useful telephone numbers and contact po ints
2. Powers to return patients who have absconded without leave
3. Definition of a place of safety under MHA 1983
4. Definition of Section 136 MHA 1983
5. Definition of a breach of the peace , including power to restrai n
6. Search policies and relevant legislation
7. Definition of public /private places in hospital building s
8. Alcohol /drugs policy
9. Human Rights Act consideration s
10. Pro-forma relating to the mental health assessment in the community, patient transfers and recall warrants
11 . Missing persons enquiry form
38 1 . Useful telephone numbers and contact po ints
LEWISHAM Johnson Unit (PICU) (Place of Safety Suite) Tel : 0203 228 6091 Ward Manager : Nick Caswel l Tel : 0203 228 608 2 Clinical Service Lead : Caroline Sweeney Tel : 07964 125094 Clare Ward Tel : 0203 228 022 9 Ward Manager: Ian Spicer Tel : 0203 228 023 4 Clinical Service Lead : Denis Muganga Tel : 0203 228 6069 Wharton Ward Tel : 0203 228 022 7 Ward Manager: Amy Quinn Tel : 0203 228 024 3 Clinical Service Lead : Denis Muganga Tel : 0203 228 6069 Powell Ward Tel : 0203 228 0245 Ward Manager: Carlos Forni Tel : 0203 228 024 7 Clinical Service Lead : Denis Muganga Tel : 0203 228 606 9
LAMBETH Eden Wa rd (PICU) (Place of Safety) Tel : 0203 228 615 5 Ward Manager: Tracey Ugbele Tel : 0203 228 6263 Clinical Service Lead : Caroline Sweeney Tel : 07964 125094 Nelson Wa rd Tel : 0203 228 6604 Ward Manager: Polly Ragooba r Tel : 0203 228 6218 Clinical Service Lead : Tel : 0203 228 639 1 Leo Ward Tel : 0203 228 624 1 Ward Manager: Rosy Edis Tel : 0203 228 6239 Clinical Service Lead : Tel : 0203 228 6391 Luther King Ward Tel : 0203 228 615 8 Ward Manager: Maria Nery Tel : 0203 228 621 6 Clinical Service Lead : Tel : 0203 228 6391 McKenzie Ward Tel : 0203 228 641 7 Ward Manager: Sue Vicary Tel : 0203 228 6255 Clinical Service Lead : Beverley Baldwi n Tel : 0203 228 6571 Tony Hillis Unit Tel : 0203 228 6157 Ward Manager: Tel : 0203 228 659 1 Clinical Service Lead : Beverely Baldwi n Tel : 0203 228 657 1
SOUTHWARK Eileen Skellern 1 Ward (PICU) (Place of Safety) Tel : 0203 228 2070 Ward Manager: Amadu Timbo Tel : 0203 228 2065 Clinical Service Lead : Caroline Sweeney Tel : 07964 125094 Eileen Skellern 2 Ward Tel : 0203 228 2080 Ward Manager: Joanne Crawford Tel : 0203 228 5098 Clinical Service Lead : Paddy Quin n Tel : 0203 228 5093 John Dickson Ward Tel : 0203 228 209 0 Ward Manager: Nazma Soormally Tel : 0203 228 2084 Clinical Service Lead : Paddy Quinn Tel : 0203 228 5093 Ruskin Unit Tel : 0203 228 51 93 Ward Manager: Yasmeen Beebeejaun Tel : 203 228 5192/3 Clinical Service Lead : Paddy Quinn Tel : 0203 228 509 3
Jim Birley Unit Tel : 0203 228 331 1 Ward Manager: Andy Blockley Tel : 0203 228 506 3
39 Clinical Service Lead : Paddy Quinn Tel : 0203 228 5093
Aubrey Lewis 3 (AL3) Tel : 0203 228 269 0 Ward Manager: Wellington Kapfunde Tel : 0203 228 5303 Clinical Service Lead : Paddy Quin n Tel : 0203 228 509 3
C ROYDON
Gresham (PICU) (Place of Safety) Tel : 0203 228 407 5 Ward Manager: Bertram Jones Tel : 0203 228 4586 Clinical Service Lead : Caroline Sweeney Tel : 07964 125094 Gresham 1 Ward Tel : 0203 228 454 6 Ward Manager: Tel : 0203 228 406 5 Clinical Service Lead : Penny Cuttin g Tel : 0203 228 4463 Gresham 2 Ward Tel : 0203 228 402 3 Ward Manager: John Clarke Tel : 0203 228 402 3 Clinical Service Lead : Penny Cuttin g Tel : 0203 228 446 3 58 Ashburton Road Tel : 0208 654 4301 (crisis unit for men) Manager: Maureen Brooks -Spence Tel : 0208 654 430 1 Clinical Service Lead : Penny Cutting Tel : 0203 228 4463 158 Foxley Lane Tel : 0203 228 5500 (women's unit) Manager: Sarah Wood Tel : 0203 228 550 2 Clinical Service Lead : Penny Cuttin g Tel :0203 228 4463 Westways Tel : 0203 228 580 0 Manager: Aroon Jeeneea Tel : 0203 228 5891 Clinical Service Lead : Beverley Baldwi n Tel : 0203 228 657 1
Head of Clinical Pathway Ann Carrington Tel : 0203 228 281 1 (Inpatients) Psychosis CA G Deputy Director Lou Hellard Tel : 0203 228 6393 Inpatients & Complex Care Psychosis CA G
40 2. Powers to return patients who have absconded without leav e
The return and re-admission of patients absent without leave
Th is area is covered by Sect 18 MHA , 1983. Sect 18(1) states that,
If a patient, (a) absconds, (b) fails to return from authorised leave , (c) absents themselves from a place where they are required to reside during a period of leave ,
They may be taken into custody and returned to the hospital or place by any AMHP, hospital staff, police officer or any person authorised in writing by the hospital managers to do so .
Timings
Various sections of the Mental Health Act 1983 impose time limits during which a patient can be retaken under Sect 18. These run from the first day of absence and are as follows :
Section 2 patients 28 days Section 3 patients 6 months Section 4 patients 72 hours Section 5(2) patients 72 hours Section 5(4) patients 6 hours
Patients concerned in criminal proceedings or under sentence who are remanded to hospital and have absconded
All of the sections below give police a power to arrest a person without warrant who absconds from such detention . They are not restricted to time limits . When apprehended, the patient will be taken before the court who imposed the original remand/order to be dealt with .
(a) Section 35, remand to hospital for report on accused mental condition (b) Section 36, remand of an accused person to hospital for treatmen t (c) Section 38, interim hospital orders imposed by the court
3. The definition of a place of safety under the Mental Health Act 1983 .
Section 135(6) states that a `place of safety' can b e
(a) social services residential accommodatio n (b) a hospita l (c) a police station (d) a mental nursing / residential care hom e (e) any suitable place which the occupier will allow to be used as suc h
NOTE, The mental health codes of practice advises that `as a general rule' it is preferable that a hospital rather than a police station is used as the place of safety .
41 4. Section 136 of the Mental Health Act 1983
A police officer who comes across a person who appears to the officer to be suffering with mental disorder and who immediately needs to be either cared for or controlled (whether in their own interests or to protect others) may, without a warrant, apprehend the person and take him/her to a place of safety.
This power can only be exercised in a place where the publ ic have access.
A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling them to be examined by a registered medical practitioner and to be interviewed by an approved social worker and of making any necessary arrangements for his treatment of care .
If brought to a police station as the place of safety, the provisions of the Police And Criminal Evidence act 1984 (PACE) code of practice, part C apply .
5. Breach of the peace.
The definition of a breach of the peace has been shaped by stated case and provides powers of arrest, intervention and detention using force if necessary . A breach of the peace can occur in private as well as public places.
A breach of the peace is committed whenever harm is done, or is likely to be done to a person, or, in their presence to their property, or, whenever a person is in fear of being harmed through assault, affray, riot or other disturbance .
Power to detain a person to prevent a breach of the peace
This is defined by the stated case Albert v Lavin, 1981, which concluded that every citizen has the right to detain any person who is committing a breach of the peace . The House of lords also stated that a police officer who reasonably believes that a breach of the peace is about to take place is entitled to detain any person without arresting them, to prevent that breach of the peace in circumstances which reasonably appear to him to be proper. The detained person should be released as soon as the danger of the breach of the peace has ceased .
6. Search policies and relevant legislation
The following is produced to give clarification of the relevant legislation that applies to each organisation in relation to searches .
Police powers of searc h
Searching people a rrested under section 136, Mental health Act 1984 The power of arrest for section 136 is a preserved power under sect 26 of PACE . The fact that a person has been arrested allows for a search to be made under section 32 of PACE, which states ,
42 "A constable may search an arrested person, in any case where the person to be searched has been arrested at a place other than a Police station, if the constable has reasonable grounds for believing that the arrested person may present a danger to themselves or others. "
The power of search is a continuing one and may be used at any time before arrival at the Police station. However It has been deemed not to be within the spirit of the act to apply section 32 beyond a reasonable time once a person arrives at a place of safety.
Searching people for offensive weapons/bladed articles In brief, the power to search for offensive weapons and bladed articles is afforded to Police by sect 1 of the Police And Criminal Evidence Act 1984 and can only be exercised in public places. This power cannot therefore be exercised on the hospital wards . The power can only be exercised if the officer has reasonable grounds to suspect that the person is unlawfully carrying an offensive weapon/bladed article .
Searching people for drugs In brief, the power to search for drugs is afforded to Police by sect 23 of the Misuse of Drugs act 1971 . Unlike the power to search for offensive weapons etc, the power to search for drugs can be exercised in a private place , i .e . the hospital ward . Again, this power can only be exercised if the officer has reasonable grounds to suspect that the person is in unlawful possession of a controlled drug.
Police powers of stop and search are governed by a set of principles known as the codes of practice, which must be adhered to at all time .
7. Private and public places within hospital building s
The following areas are defined as publ ic places within hospital premises The entrance to the building, corridors and stairways to which the public are allowed access The following areas are defined as private places within hospital premises The wards themselves, any areas designated / marked as privat e
8. Alcohol/drugs policy
Alcohol/drugs and mental state assessment cannot assess individuals who are intoxicated with drugs or alcohol, due to the influence of those substances on a person's mental state .
• If staff observe that an individual who has presented to the department is clearly intoxicated they will be advised to re-present when sober . • If staff suspect that a person has consumed alcohol prior to attending the clinic they will be advised that staff will breathalyse them . The level of that reading will determine whether they can be addressed of if they will be asked to return when sober .
If a person presents with an alcometer reading of less than 80BAC mm % they will be assessed. If the reading is between 80 and 100BAC mm % the person will be asked to wa it for the level to drop. WHERE THE READING IS GREATER THAT 100 BAC mm % THE PERSON WILL BE ADVISED TO RETURN AT A LATER TIME/DATE.
In some circumstances individuals may present to the with an alcometer reading greater than 100BAC mm% but who are considered to be at significant risk of self harm . These individuals may be permitted to wait in a safe area until their levels have dropped sufficiently to allow assessmen t
43 to take place . However, this is only on the understanding that they do not present any disruptive or aggressive behaviour.
Alcohol and police referrals Police referrals, informal or section 136 MHA 1983 are subject to the some criteria as above .
9. Human Rights Act consideration s
The Human Rights Act 1998 incorporates articles contained in the European Convention on Human Rights and Fundamental Freedoms into domestic law . It is a very significant piece of legislation and will have enormous impact upon the way public authorities do business .
Any infringement by a public authority of another person's rights must be justified . Always consider the following principles enshrined in the mnemonic PLAN.
Proportionality Action must be fair and achieve a balance between the needs of society and the rights of the individual. You must consider all the different options available capable of achieving the objective and select the least intrusive .
Legality Actions must be supported by legislation or stated cases .
Accountability Actions will be open to scrutiny. You should fully record your actions and the options considered . Show what factors influenced your decision, include reasons for not taking action .
Necessity Action must be `necessary in a democratic society' . You must be able to justify any infringement of rights.
10. Pro forma relating to the mental health assessment in the community and patient transfers.
See document attache d
11 . Missing persons enquiry form See document attached
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