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Questions about health care in police custody

Up to Implementation Plans
May 31. 2012
professor louis appleby

The dominant theme for me lately has been police custody and how to improve health care standards there. I want to get your views.

Last week I visited the police headquarters in Preston to hear how the Lancashire force is working with the local NHS - one of the earliest of the "early adopters" of collaboration on commissioning.  I spoke at a BMA conference on forensic health, to an audience of mainly FMEs.  All week I have been hearing about police concerns about section 136, especially over the continued use of police stations as places of safety.

So, here are my questions:

What is the main thing you would specify in an ideal contract for custody health care?

What are the qualifications/experience you would require in FMEs of the future?

Why are police stations still used for S136 patients, in your experience? How often are S136 patients refused assessment because they are drunk?

Hope to hear from you.

Louis Appleby

June 01. 2012
ivan trethewey


Having read your question Do you mean what qualifications should HCP have ?

Most forces are now using Nurses for the majority of their custody work. I believe their should be a National Standard agreed for any HCP to work in a custody suite. In my experience the those with an A & E background who have had some mental health training seem to be more comfortable in their custody surroundings. Coupled with a national standard/qualification we should progress the necessary changes quickly that allow qualified nurses to take hospital bloods for drink and drug driving as an example.

The sec 136 debate has been going on for years and will continue I fear until all aligned police areas have properly resourced places of safety with the resilience to take mos people referred save for the very violent. Some persons under the influence of alcohol will never actually be in a position to be alcohol free before an assessment can be made.


Ivan Trethewey

June 01. 2012
professor louis appleby

Yes, broaden the q to all professions - it was FMEs I was speaking to on Monday and I know what qualifications they said they had.

The S136 debate is certainly not new. My q is about how often these things actually happen and why. One thing that is certain is that the number of S136 patients brought to health care has multiplied in the last 5 years - now 14,000 per year, 75% of whom do not go on to another section of the MHA.


June 06. 2012
Charlotte Louise Winter

Hi Louis,

 access to appropriate places of safety has been identified as an issue in the north east - however the big diversion project’s current state analysis has found  widely differing experiences by the different police forces in the region in accessing these designated places of safety.

I’m having a bit of a nightmare trying to post the full report on here - I have now wrote out a detailed replyto you  3x only for it to be deleted when I try to attach and post the report so my apologies for referencing to the full report rather than giving you the headlines as I endeavoured to do!

The full report can be accessed using the link below however the sections which will be of particular interest to you in relation to our findings on section 136  are:

 Pages 34- 37

Pages 53-70




June 07. 2012
professor louis appleby

Hi Charlotte

This is a very relevant report - thanks for persevering with the technology.

I'm struck by the comments of staff that they do not turn people away whenever there is a whiff of alcohol and by their concerns that some people are brought in on S136 when their problem is severe intoxication.  This is of course the mirror image of what the police say. The report refers to joint work on these issues - I'm sure this is what's needed.

The police also feel frustrated when they have to hang around while we get hold of staff - it sounds as if they are right on this point.

It's a good point about the number of people taken straight to custody, ie is it falling as the number going to HBPOS rises? At the recent RCPsych meeting on S136, the police agreed to pull their data together to answer this.


June 11. 2012
Adele Owen

Greater Manchester Police have recently initiated four multi agency GM task and finish groups to resolve identified issues. One of the TFG is to look at sect 136 MHA when alcohol is a factor ie, to clarify responsibility for the person's care, appropriate places of safety etc.

Officers are finding that they are turned away from A&E once a decision is made that the alcohol intoxication is not a physical health concern, they are refused access to a police custody suite as they are not an unmanagable risk in a health setting (nor under arrest for an offence) and that mental health staff are refusing them access to a sect 136 Suite as they aren't staffed or they wish to keep them free for someone ready for an assessment.

 Officers are expected to return them to the sect 136 suites when they are sober for a mental health act assessment but where, in the meantime are they expected to take them? Are these vulnerable people not entitled to their Rights? Police have no power to breathalyse such people to determine when they have reached the 'level' deemed appropriate (by that particular Trust) for assessment. Some areas in health are still breathalysing those detained rather than relying on their professional judgement.

Hopefully, the TFG will resolve all these issues. 

June 11. 2012
professor louis appleby

Interesting. Whatever the TFG comes up will be useful to others facing similar problems.


June 20. 2012
martin newton

It is the usual anecdote here of "we can't asess whilst under the influence"

I'm not sure i agree with this in entirity - there is still a question of the risk the individual poses to themselves or others and this can be assessed.

the problem is that there is no safe place for folk to detoxify in order to meet agency requirements to be assessed. I have come across individuals who will get themselves arrested "to prevent breech" in order to ensure they have somewhere for the night.

Police cells are safe but they are not the right environment for this.

what we need is short term "wet" accommodation which allows folk to reach a point where an accurate assessment of their wellbeing can be made. 

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