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Home > Articles > Thames Valley Police

Thames Valley Police: Policing Mental Ill Health

An article by Inspector Jan Penny, mental health lead for Thames Valley police.

My name is Inspector Jan Penny and I am the force mental health lead for Thames Valley Police. This article is designed to explain some of the situations and the powers and legislation under the Mental Health Act 1983 (MHA) that police use when supporting people who are experiencing mental ill health.

Reasons for transferring a person to a place of safety

If a police officer finds a person in a place to which the public have access who appears to the Officer to have a mental disorder and to be in immediate need of care or control that person may be removed by the Police Officer to a place of safety. The purpose of removing someone in this way is to allow them to be examined by a Doctor and interviewed by an Approved Mental Health Professional (AMHP). The place of safety is usually either a nominated psychiatric hospital or police custody. This power is under S136 MHA.

Police Officers are not trained to diagnose mental disorders. The decision to detain someone in this way will be based on the presenting behaviour of the person and the belief by the Officer that the person has a mental disorder and that immediate care or control is needed to protect that person or others from that person.

Private vs Public locations

What is also important is that this power cannot be exercised if the person is found in a private location - only if they are in a place to which the public have access. If we find someone in distress in a private location then our only real option is to call a Doctor to the premises unless there is a medical emergency when we may assist someone to the A&E; department. Sometimes due to someone’s behaviour we may have to arrest them for offences and once in police custody a Doctor will decide if a MHA assessment is necessary.

The decision as to which place of safety will be used will be based on the person’s presenting behaviour, any intoxication issues and availability of the hospital place of safety. The preference will always be the hospital but this is often not possible.

Section 136 (S136) and other holding powers

Once removed to a place of safety a person may be detained for up to 72 hours to allow an assessment under the MHA to take place. Following the assessment any necessary arrangements for the person’s treatment or care will be made. If admission to hospital is decided to be necessary the person may be admitted formally usually under Section 2 of the MHA or informally if they agree to go voluntarily and have the capacity to make this decision. If hospital admission is not necessary any other ongoing support will be considered. Occasionally a person will not need any further support at all and this is often due to intoxication being the cause of the original behaviour and not mental illness. It is rare for someone to be discharged from a S136 with no onward support being recommended. Only a Doctor can discharge a S136 and then only if the Doctor is satisfied that the person does not have a mental disorder within the meaning of the Act: “Any disorder or disability of the mind”.

Police Officers will not take the decision to detain someone under S136 lightly and will try and look for the least restrictive option. The police should not, however, be taking someone to hospital on a voluntary basis. If there are no grounds for detention of the person then the situation will be handed over to health professionals.

In Oxfordshire, there is on average one S136 detention every day.

Gaining access to premises

Sometimes police are asked to assist in gaining access to premises to allow an AMHP and one or two Doctors access to someone who may be in need of a MHA assessment. If entry to the property is denied access may be gained with the provision of a Magistrate’s warrant under S135(1) of the MHA which will be executed by a Police Officer. The warrant allows access to search for a person and to remove them to a place of safety for the assessment if necessary. The role of the Police in these situations is only to execute the warrant and to “Prevent a Breach of the Peace”. Basically this means trying to ensure that people and property do not come to harm.

Missing persons

There are a variety of sections within the Mental Health Act that restrict the liberty of individuals. Sometimes people are formally admitted to hospital, sometimes they will be placed under a Community Treatment Order or a Guardianship Order for example. When individuals do not adhere to the restrictions placed on them about where they are supposed to be when detained under the MHA they may be reported to the Police as being Absent Without Leave (AWOL). If the patient’s whereabouts are known but they are not where they are supposed to be then they are simply AWOL. If their whereabouts are unknown then they may also be reported to Police as a Missing Person. This could then also include patients who are admitted to hospital on a voluntary basis and so would not be AWOL.

If there is concern about an AWOL or Missing patient’s welfare then the Police may be required to search for them. This can and does take up a huge amount of Police and other organisations' time and resources particularly if a person is considered to be at high risk or harm or for causing harm to another. Patients are reported to us on a regular basis and if the person is an informal patient, once we locate them we will assess their welfare and inform the hospital we have found them. It will then be a matter for the hospital to decide how to proceed and if the person needs a further MHA assessment with a view to admitting them to hospital formally. If we locate the person in a public place then the provisions of S136 may apply. If the patient is AWOL then Police do have a power to return them to the hospital. We would do this if we believed the patient was particularly vulnerable or they were presenting a risk to other people. Otherwise we would expect the hospital to make the necessary arrangements to return them.

Sometimes in order to return patients who are AWOL Police need to gain entry into private premises. In order to do this a Magistrate would need to issue a S135(2) warrant in order to allow Police and if necessary other authorised professionals to enter premises and remove the person back to the hospital.

Dealing with high-risk situations

While dealing with the situations I have described may be distressing and time consuming for Police Officers and Professionals let alone the individual who is unwell, they are relatively straight forward in terms of legislation and protocol. By far and away the most difficult situations to deal with are when someone deliberately puts themselves in danger. There are many reasons why people do this and so to generalise will be dangerous and probably insulting. However, for the purpose of this article I will just talk about a few of the possibilities.

  • Some people are so unwell that they see taking their own life is their only course of action or escape.
  • Some people feel so unwell that they believe causing self harm is the only way of drawing attention to their plight. Alternatively the self harm is a means of alleviating other more distressing emotions.
  • Some people have a personality disorder and when feeling distressed exhibit risk taking behaviour.
  • Some people will not make their self harm public and if Police come across them it is usually as a result of a call from a concerned third party. Police will do all they can to support the person but ultimately we have to assist them in gaining access to the appropriate health professional.
  • Some people will make their attempts very public by for example, placing themselves on a railway line or climbing onto bridges or other high buildings. Situations such as this are really very serious as it is not just the distressed person who will be at risk.

While we will always seek to provide support for people in crisis there are inevitably times when actually we will also seek recourse through the criminal justice system. Having a mental disorder does not automatically prevent people from being able to and being required to take responsibility for their actions. Certainly individuals who continually exhibit this type of problematic risk taking behaviour are likely to find themselves in a Court of Law as well as being offered treatment from health professionals. For example having to close the A34 for a couple of hours when someone is threatening to jump from an overhead bridge is not only very distressing for all the people involved and any witnesses but also has huge financial implications.

Whenever Police are called to deal with a situation involving someone who is mentally vulnerable we will always attempt to work in partnership with the relevant health and social care professionals and any family or friends of the individual. Thames Valley Police has an interagency joint working protocol which covers all aspects of joint working to manage mental ill health in the community.

Mental Health Act (MHA) summary

Below is a really brief summary of all the important Sections of the Act courtesy of

The summary is also included in the policy/guidance section of the OMHF Resource library.

Part I

Section 1 – the definition of mental disorder: “‘mental disorder’ means any disorder or disability of the mind; and ‘mentally disordered’ shall be construed accordingly”.

Part II – this is the terminology you will hear AMHPs and MH professionals using:

Section 2 – the power to detain someone believed to be suffering mental disorder for assessment (and treatment). The order lasts for up to 28 days and cannot be extended or renewed. It is imposed after application by an AMHP and two Drs one of whom must be “section 12 approved” The patient has a right of appeal against detention to a Mental Health Review Tribunal.

Section 3 – the power to detain someone for treatment of mental disorder. This order lasts for up to six months and can be renewed. It is imposed after application by an AMHP and two Drs one of whom must be “section 12 approved”. Right of appeal against detention to a Mental Health Review Tribunal.

Section 4 – the emergency power to detain someone for assessment for up to 72hrs. This is in effect a s2 detention, but is imposed where an AMHP and only one s12 Dr believe it is needed and delay for a 2nd doctor is impracticable. No right of appeal.

Section 5(2) – a ‘holding power’ for Drs to detain an inpatient in hospital for up to 72hrs for assessment under the Act. Cannot be used in A&E; because the patients there are not (yet) “inpatients”. Can be used by non-psychiatric doctors on inpatients with psychiatric problems who are on ‘general’ medical wards in a non-psychiatric hospital.

Section 5(4) – a ‘holding power’ for a nurse of the prescribed class – usually a more senior psychiatric nurse – to detain someone for up to 6hrs: either for consideration by a Dr of whether to use their 5(2) holding power; or to arrange an MHA assessment. Again, this holding power can only be used on patients already admitted.

Section 6 – the AMHPs authority to detain and convey someone to hospital for admission under the Act.

Section 12(2) – Various things in the MHA can only be done by or must include a “section 12 approved doctor”. Such Drs are those “having special experience in the diagnosis or treatment of mental disorder.”

Section 13 – the AMHPs duty to undertake MHA assessments and make applications for admission.

Section 17 – the right of hospitals to grant leave as part of rehabilitation and recovery. Such leave might be very brief when first granted – an hour or so – and it may be supervised by a staff member. However, as patients near release it may be for a weekend, for several days or longer. It is a very necessary part of rehabilitation and recovery for patients.

Section 17A – the right of hospitals to release a patient from detention subject to Supervised Community Treatment (SCT), otherwise known as a Community Treatment Order (CTO. If the conditions are not complied with, a person can be recalled and failure to return makes them ‘AWOL’ under the Act.

Section 18 – the power to (re-)detain AWOL patients and return them to hospital. There is NO power of entry in order to do so. Can only be exercised in a public place or where legal permission to enter a private building or dwelling has been obtained.

Section 19 – the authority of hospitals to transfer patients between different MH facilities.

Part III - these are sections relevant to decisions by criminal courts and prisons

Sections 35 & 36 – powers to remand an ‘accused person’ to hospital for assessment / treatment.

Section 37 – the power of a Crown Court to impose a hospital order upon a person convicted or found responsible for an offence. This order can be imposed after a full conviction following a successful defence of insanity; or following conviction for manslaughter on the grounds of diminished responsibility. The order lasts until such time as the Responsible Clinician believes it needs to be discharged but patients retain a right of appeal (under different rules) to a Mental Health Review Tribunal.

Section 38 – an interim hospital order: can be imposed on a convicted or responsible person to undertake assessment and treatment as to whether a full hospital order is the right outcome.

Section 41 – a restriction order, sometimes known as a ’37/41 order’. Courts can ‘restrict’ an order made under s37 which subsequently prevents the Dr from taking decisions to released the patient, transfer the patient to a different psychiatric hospital or to allowing them periods of s17 leave from hospital. It obliges the Dr to have such decisions authorised by the Ministry of Justice Mental Health Unit. Such restriction orders can only be imposed if the original court was satisfied that the patient posed a “significant risk of harm to the public.”

Section 42 – anyone detained under a restricted hospital order is never just ‘released’. They are always released under this section, in what is known as conditional restricted release. If restrictions or conditions are breached, the Secretary of State for Justice, through the Ministry of Justice Mental Health Unit, can issue a warrant for the return of that patient to a named hospital. They then assume the status of a s37/41 restricted patient.

Section 47 – a “transfer direction” authorises the moving of a convicted prisoner to a hospital, if they develop a need for mental health treatment whilst serving their sentence. By virtue of s47(3) MHA, such a patient is then treated in hospital ‘as if’ they had been sentenced to a s37 hospital order by a court. This is sometimes referred to a ‘Notional s37′.

Section 48 – same power as per s47, but for remand and other prisoners (such as immigration detainees) in contrast to s47 for convicted prisoners.

Section 49 - a “restricted transfer direction” imposes restrictions upon leave, discharge or transfer without Ministry of Justice permission, as per s41 MHA. Sometimes, this is known as a ’47/49 order’, but it for our purposes the same as ’37/41 order’.

Section 50 – is a “remission direction” to remove a s47 MHA patient back to prison if their detention in hospital for mental health treatment is no longer required but their sentence of imprisonment is not yet up.

Parts IX and X – offences and police powers

Section 127 – criminal offence of wilful neglect of an inpatient.

Section 128 – criminal offence of assisting a person to absent themselves without leave from hospital; or harbouring such patients after absenting themselves.

Section 129 – criminal offence of obstruction of an AMHP

Section 132 – the rights which must be explained to someone when detained in hospital, including where detained following s135(1) warant or s136 as a place of safety.

Section 135 – warrants under the Act for (1) assessments on private premises; and (2) recovering patients who are absent without leave.

Section 135(6) – legal definition of a place of safety.

Section 136 – police power to detain someone who appears to have a mental disorder and in immediate need of care or control and remove them to a place of safety. Power only if person is in a place to which the public have access and the detention may lasts for up to 72hrs to enable a MH assessment to take place.

Section 137 – authority to regard someone subject to an application for admission under the Act as being ‘in legal custody’.

Section 138 – power to recover someone who has absented themselves from detention under s135(1) or s136 and return them to a place of safety. Power lasts for 72hrs after they went missing or after arrival at the place of safety; whichever is sooner.

Publication date: August 2012.

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