The link between mental health and deaths and serious injuries in police custody

Following the Home Secretary’s announcement last year of a major review into deaths and serious incidents in police custody, a consultation entitled, Independent Review of Deaths and Serious Incidents in Police Custody, recently closed.

The consultation sought views across 17 key questions, including what ways could the risk of death and serious incidents in police custody be avoided, what actions could be taken by police to avoid such events following the use of force, what actions could be taken by police and other organisations to reduce the risk of self-inflicted deaths with 48 hours of police custody and, to what extent is mental health a factor in deaths and serious incidents in police custody.

The review, which is being conducted by Dame Elish Angliolini QC, will examine the procedures and processes surrounding deaths and serious incidents in police custody, including the lead up to such incidents, the immediate aftermath, through to the conclusion of official investigations.

In the first of a series of blogs centred around our response to the consultation we look at the link between mental health and deaths and serious incidents in police custody.

Based on our experience of working with the families of those that have died in custody and with individuals who have experienced some form of serious incident while in custody, we know that mental health and the mismanagement of those suffering from mental health conditions is often a contributory factor. In our response we highlighted issues surrounding the availability and role of mental health services in custody, the use of sectioning and, the training and education of police officers in our consultation response.

Greater interaction between the police and mental health services

We consider that many serious incidents and deaths could be prevented if there was greater interaction between the police and local mental health services.

Every police station should be able to call upon at least one mental health professional to provide support in the management of persons with mental health difficulties in custody. This would reduce the burden on police officers and could reduce the level of risk to the detained person in custody.

This recommendation was part of the Independent Commission on Mental Health Policing Report published in May 2013. We are aware of a number of constabularies, including Hertfordshire and Suffolk, having introduced this measure although we don’t believe that the Metropolitan Police has done so yet and would like to see this become a national initiative.

We’d also like to see national adoption of the street triage scheme – an ongoing initiative that sees a number of police forces and mental health services work together to ensure people get appropriate care when police are called to a person in distress. The results to date have been encouraging and it’s vitally important that the treatment of people with mental health issues in custody is not a postcode lottery.

Ultimately, we feel the early involvement of a mental health professional when dealing with a detainee showing any signs of mental illness or distress will lead to better outcomes.

All too often mental health professionals are excluded from decision-making at the police station about whether someone is fit to be interviewed under caution or detention; instead the decision is left to a forensic medical examiner (FME), who is not always sufficiently qualified to make an assessment about mental capacity.

Sadly, we’ve seen many cases where the FME has made very poor decisions regarding someone’s capacity for interview. In one such case, the FME assessed our detained client as being fit to be interviewed in a police station, despite representations to the contrary. Our client gained access to a knife which they used to threaten several people, before stabbing themselves in the police station custody suite. This could have been avoided had the risk the deceased posed to himself and others been properly identified and there been early intervention from a qualified mental health professional.

Training and education

Often the inadequate care people with mental health issues receive in custody can be attributed to a lack of training and education amongst police officers. This is an issue requiring urgent attention, specifically to help police officers better identify the mental health risk factors of those they are in contact with, ensuring they know when to seek mental health service support.

Crucially, training needs to be given to officers about how they perceive the sometimes challenging behaviour of people in custody who have mental health problems. Our experience tells us that officers’ default reaction to challenging behaviour is to view it as being criminal or difficult, rather than relating it to a mental health issue. We have acted for clients where police officers have laughed at their strange behaviour in police custody, treating it as something for ridicule rather than evidence of someone in crisis requiring assistance.

A far greater understanding about the appropriate application of s.136 of the Mental Health Act 1983 (“MHA”) is also required. This allows the police to take someone they think has a mental illness or is in need of care from a private place to a place of safety, such as a hospital or police station for up to 72 hours. The importance of having a clear protocol for the removal of a detainee to a ‘place of safety’ in accordance with s.135 of the Act is also required, often referred to as being sectioned.

This protocol should set out clearly the steps that should be taken to locate an appropriate place of safety for a detainee and for the escalation of the matter should local health services be unable to comply with requests to facilitate detention. To coincide with this, greater resources and co-operation is required between the police and the relevant healthcare providers to ensure that there are available places. Just recently a frustrated Metropolitan Police officer tweeted his battle to find a hospital bed for a detainee.

There needs to be a clear joint protocol for the police and local mental health detention services, to allow for quick and decisive action to be taken regarding placement location once a person has been detained under s.136 of the MHA. We are concerned that due to inadequate NHS funding and facilities, local mental health detention services are refusing to accommodate individuals that the police have detained under the MHA which results in the person being held in an unsuitable location and them being deprived of necessary treatment.

There should be a requirement for each police force and each NHS trust to have in place a clear jointly constructed protocol for the placement of persons detained under the MHA. This protocol should allow for contingencies should there not be available beds at the closest mental health detention facility and has clear rules regarding the placement of individuals under the influence of drugs or alcohol.

Alongside this, it would be wholly beneficial to have one member of police staff based in the control room of each police station, or county central control-room, who is trained in mental health management and who is responsible for the co-ordination of efforts to secure a place of safety for a detainee. This would speed up the process for the detainee, reduce the burden on the individual officers, and free up police resources to be applied elsewhere.

The importance of custody officers identifying and addressing risk factors to keep detainees safe during their time in custody cannot be underestimated and should be a key focus for better training and education. We see frequent examples of custody officers being unable to fulfil their role to keep detainees’ safe. We have particular concerns that custody officers treat the risk assessment process when people arrive in custody as nothing more than a ‘tick-box exercise’. This initial risk assessment process should be reviewed to ensure that it is being treated as a dynamic and effective process which produces a Safer Custody plan tailored to the specific risk factors of the detained person.

Post Release

As with the initial custody risk assessment we also have concerns that the pre-release risk assessment is being treated as a ‘tick-box exercise’ by the officer completing it. As a consequence, the process is often inadequate in terms of identifying and minimising risks to the welfare of detainees upon release. One way of addressing this might be to amend the custody record so that the relevant officer has to carry out a thorough pre-release risk assessment which considers all of the factors addressed in the initial risk-assessment, as well as the following additional factors:

• The nature and seriousness of the offence for which they have been arrested;
• The detainee’s living circumstances;
• Whether the person has means of transport to their onward address.

Should any relevant risk factors be identified, reasonable steps should be taken prior to release to make available to the detainee access to services which could help to reduce the identified risk factors: this might include referrals to community mental health or drug and alcohol support services. Reasonable steps should also be taken to assist the detained person with safe transport to their onward address and/or assistance in finding safe accommodation if required.

Alongside this, there needs to be far greater consideration of the appropriateness of bail conditions and the impact that they will have on the individual. This is particularly relevant to cases where the person is deprived of their ability to contact family members due to them being witnesses to the alleged offence; or prevented from returning to their home address. We have acted for the family of a deceased person in inquest proceedings where stringent bail conditions left the subject isolated from his family and friends. This may have contributed to his negative state of mind at the time of his self-inflicted death following release from custody. Careful consideration needs to be given to whether such bail conditions are proportionate and necessary in the circumstances rather than being applied indiscriminately.

Information regarding the availability of mental health services in the community must be provided to all detainees upon their release from custody as a standard.

Further, if mental health services and/or drug and alcohol support services have been involved in the detainee’s care during their period of custody, those services should be involved in pre-release risk assessments also, and be available to speak with the detainee prior to release.

In our view, the duty of care the police have to those they detain extends to their release and their actions at this critical stage may have a real impact on what happens to someone in the immediate hours after their release, particularly if it was the detainees’ first time in custody.

In further blogs we will examine other issues brought up by the review, including the role of the police after someone has died in their custody.