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 .