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Place of safety orders in England: changes in use and outcome, 1984/5 to 2010/11

  • Patrick Keown (a1) (a2)
Abstract
Aims and method

To detail changes in the use of place of safety orders in England, including the outcome of these detentions, using publicly available data.

Results

There was a sixfold increase in the rate of the Mental Health Act Section 136 detentions to places of safety in hospitals between 1984 and 2011. The use of Section 135 and the rate of subsequent detention under Section 2 or 3 also increased, but the proportion of people detained fell as the absolute rate of detention increased. There was a wide variation between regions in the use of hospitals or police stations as places of safety. The change in the annual rate of detention under Section 136 was associated with the annual change in the population of England.

Clinical implications

The increase in detentions to places of safety in hospitals may in part reflect their move from police cells. It may also reflect a real increase in overall rate of detention and possibly a change in the threshold for the use of Section 136 detentions.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Patrick Keown (patrick.keown@newcastle.ac.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Turner, T, Ness, M, Imison, C. ‘Mentally disordered persons found in public places.’ Diagnostic and social aspects of police referrals (Section 136). Psychol Med 1992; 22: 765–74.
2 Dunn, J, Fahy, TA. Police admissions to a psychiatric hospital. Demographic and clinical differences between ethnic groups. Br J Psychiatry 1990; 156: 373–8.
3 Pipe, R, Bhat, A, Matthews, B, Hampstead, J. Section 136 and African/Afro-Caribbean minorities. Int J Soc Psychiatry 1991; 37: 1423.
4 Borschmann, R, Gillard, S, Turner, K, Lovell, K, Goodrich-Purnell, N, Chambers, M. Demographic and referral patterns of people detained under Section 136 of the Mental Health Act (1983) in a south London Mental Health Trust from 2005–2008. Med Sci Law 2009; 50: 1518.
5 Hotopf, M, Wall, S, Buchanan, A, Wessely, S, Churchill, R. Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996. Br J Psychiatry 2000; 176: 479–84.
6 Department of Health. Inpatients Formally Detained in Hospitals under the Mental Health Act 1983 and Other Legislation. TSO (The Stationery Office), 2006.
7 Docking, M, Grace, K, Bucke, T. Police Custody as a ‘Place of Safety’: Examining the Use of Section 136 of the Mental Health Act 1983. Independent Police Complaints Commission, 2008.
8 Dhani, A, Kaiza, P. Police Service Strength England and Wales, 30 September 2010. Home Office Statistical Bulletin 2011; 3 (http://www.homeoffice.gov.uk/publications/science-research-statistics/research-statistics/police-research/hosb0311/hosb0311?view=Binary).
9 BBC News. Sussex Police mental health detentions ‘intolerable’. 25 November 2010 (http://www.bbc.co.uk/news/uk-england-sussex-11836744).
10 Keown, P, Weich, S, Bhu, K, Scott, J. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988–2008: ecological study. BMJ 2011; 343: d3736.
11 Goldberg, D. Improved investment in mental health services: value for money? Br J Psychiatry 2008; 192: 8891.
12 Keown, P, Mercer, G, Scott, J. A retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and the number of psychiatric beds in England 1996–2006. BMJ 2008; 337: a1837.
13 R (Sessay) v South London and Maudsley NHS Foundation Trust (2011) EWHC 2617 (QB). (http://www.mentalhealthlaw.co.uk/R_(Sessay)_v_South_London_and_Maudsley_NHS_Foundation_Trust_(2011)_EWHC_2617_(QB))
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BJPsych Bulletin
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Supplementary Table S1

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Place of safety orders in England: changes in use and outcome, 1984/5 to 2010/11

  • Patrick Keown (a1) (a2)
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eLetters

Why commissioners need to know about Section 136

Julie S Chalmers, Consultant Psychiatrist
14 May 2013

The article by Patrick Keown in the March edition (1) was a timely contribution to discussions currently taking place about the use of Section 136 between the Royal College of Psychiatrists, Home Office, Department ofHealth, Police, Health and Social Care Information Centre, and Care Quality Commission (CQC).

A major and longstanding problem in understanding the trends in the use of this power has been the failure to collect complete information on the use of Section 136, as the author points out, referring to data collected in 2005-2006. We would like to draw attentionto more recent data collected in 2011-2012 (2). This shows a dramatic increase in rates of detention under Section 136 of 43% in six years, from 16,500 to 23,569.

Whilst the number taken to custody suites has fallen from 11,500 (2005-2006) to 8,667 (2011-2012), this figure still far exceeds the anticipated number if custody suites were used in "exceptional circumstances only", asdescribed in the Mental Health Act (1983) Code of Practice (3), and reiterated in College guidance.

In 2012, the Association of Chief Police Constables (ACPO) collected information on the use of Section 136 in all 43 police areas. 37% of those detained on Section 136 continue to go to a custody suite although this varies between force areas. Despite approximately £130 million of capital funding havingbeen made available for Section 136 suites seven years ago, there are several police forces in England that still do not have access to hospital places of safety 24 hours a day and/or when demand exceeds capacity. This unacceptable variability in provision is clearly a commissioning issue and in March 2013 the College produced guidance for local commissioners in order to help identify shortfalls in local service provision (4).

The Multi Agency Mental Health Act Group chaired by the College is collecting more detailed information on local services and would be delighted to receive completed surveys from members to inform further discussions.

References: 1. Keown P. Place of safety orders in England: changes in use and outcome, 1984/5 to 2010/11.The Psychiatrist 2013; 37: 89-93. 2. Inpatients Formally Detained in Hospitals Under the Mental HealthAct 1983 and Patients Subject to Supervised Community Treatment - England,2011-2012, annual figures

3. Department of Health (2008) Mental Health Act 1983 Code of PracticeTSO ( The Stationery Office).

4. Royal College of Psychiatrists. Guidance for Commissioners: Service Provision for Section 136 of the Mental Health Act 1983 (Position Statement PS2/2013) RCPsych 2013 http://www.rcpsych.ac.uk/pdf/PS02_2013.pdf - for the reporthttp://www.rcpsych.ac.uk/pdf/PS02_2013_survey.pdf - for the survey

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Conflict of interest: None declared

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