Thursday, 7 July 2016

Dyfed Powys Police - Mental Health : Working Together - Part 1

Karen Clarke and Jason Hawkins - Police Community Support Officers in Brecon
Section 136
If it appears to a police officer that you as a person in a public place are:
 “suffering from mental disorder” and are: “in need of immediate care or control”, he or she can take you to a place of safety

You will be kept in hospital, or the place of safety you were taken to, so that you can be examined by a doctor and interviewed by an approved mental health professional and any necessary arrangements can be made for your treatment or care.  Mind – About Sectioning.

Over the past six months, Dyfed Powys Police has held regular mental health awareness training sessions for staff and partner organisations in Powys. As PAVO’s representative on the Section 136 sub-group, which was set up to reduce the inappropriate use of Section 136 of the Mental Health Act 1983, I was invited to attend. 

So it was in May I found myself at the Combined Services Centre in Llandrindod Wells with a room packed full of professionals from the Police, Powys Teaching Health Board, Powys County Council, Welsh Ambulance Service and a number of voluntary sector organisations, all gathered to learn more about Section 136. And, specifically, the role of the various agencies involved in working collaboratively to ensure appropriate and sensitive detentions occurred in the county.

It was a really interesting day. Packed full of information and just putting names to faces was invaluable. So it was agreed I could share with a wider audience, albeit very briefly, some of the content from the key speakers, and also highlight the extent of the collaborative nature of this work. 


Inspector Brian Jones (photo left), the mental health lead with Dyfed Powys Police, facilitated the session. He updated us on this blog last year about a pilot project in Powys requiring the Police Inspector’s authority before police mental health powers can be used. 

Partnership working – Louisa Kerr (photo right), Mental Health Partnership and Project Manager, PTHB

Louisa outlined the legal framework for delivery of mental health services in Powys, which is overseen by the Powys Mental Health Planning & Development Partnership. Its goal is: “to unlock the benefits of wellbeing in terms of physical health, educational attainment, employment and emotional security”.

Multi-agency partners – Brian Jones, Inspector Dyfed Powys Police

When a person is in crisis, it is increasingly the case that the first port of call – whether it be that person, a friend, family member, stranger or organisation that makes the call – is the police.

Brian spoke about the S136 protocol, incident reviews, the challenge of Powys’s geography, data collection, and his key responsibility as an Inspector with powers to authorise the use of S136. As taking away someone’s liberty is such a serious thing to do there is a lot of work looking for alternative options before a S136 is used. For example, someone could stay with family or friends overnight and then a better option be found the following morning. “Now it is a last resort to use a S136. It was much more usual in the past. (We are talking about) a patient that is not well. Going into custody or out of the area is not the best option.” 

Brian threw a question to the floor: “Why do we need mental health awareness training?” The responses included these comments: 
  • We want to know how we can best work with people we come across. We want to put them in the right direction. 
  • It is about recognising the problem and realising that partnership organisations are out there. 
  • There is a lot more openness and honesty about mental health now and this is a major plus. 
  • To improve the partnership approach. To talk to each other more – to look at the bigger picture. We are all working to the same end. 
  • We are hoping to achieve a better understanding of what our individual roles are. 
  • To find out how we fit in and can support each other. 
  • For a better understanding of the S136 process and how it might impact on people we work with. 
The rest of the day was spent looking in more depth at the individual roles of specific agencies and mental health professionals.

What is mental health? – Stephen Novick, Consultant in Adult Psychiatry

Stephen began by telling us about the Rosenhan Experiment from 1973 – “on being sane in insane places”. It proved that it is extremely hard to diagnose mental health illnesses.

“Many people who commit suicide are not known to mental health services or mentally ill. Mental health problem sounds better. Mental health illness suggests some people get it and some don’t. Anyone can have a mental health problem.”

Stephen ran through some of the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, (a diagnostic manual from the United States). However, he said there was very little in the way of hard science except in relation to dementia. “Look at the symptoms, signs, behaviours… what else – drugs and alcohol.”

“People believe all sorts of weird things, but that does not mean they are ill. If they are behaving oddly, it may be a cultural thing.”

With this level of uncertainty around defining mental disorder, it’s not surprising that professionals from different agencies are called upon to agree that certain detentions (sections) are necessary before they go ahead. Stephen went on to describe scenarios when a S136 could be used by the police for a 72 hour detention at a “place of safety”, and to clarify the difference between Sections 2 and 3

Brian emphasised at this point that the role of the police is “the protection of life. There’s no getting away from that.”

Community Mental Health team – Kath Arnold, Integrated CMHT manager, Brecon

Kath introduced us to the many and varied roles of professionals employed in the CMHT, including psychiatrists, community psychiatric nurses, social workers, occupational therapists, support workers and clinical psychologists. They support people with “complex/high risk presentations that cannot be managed in primary care.” Primary being the GP surgery, and secondary care the CMHT. I feel the need for a flowchart coming on!

Care and Treatment planning is a key element of the team’s work as a requirement of the Mental Health (Wales) Measure, the legislation which governs provision of mental health services. “This gives you the opportunity to set goals in all areas of your life, create a plan and, in the process, to take more control of your own recovery.” Hafal, A step by step guide.

There followed a brief discussion about the value of Advance Statements for Crisis Planning, a subject covered in a separate post. So far the day was proving very interesting.

Look out for Part 2 of this post next week to find out more about the roles of the Approved Mental Health Practitioner, the Crisis Resolution Home Treatment Teams, staff at Felindre Ward of Bronllys Hospital, and the Emergency Duty Team of Powys County Council Social Services in relation to Section 136 detentions. And, not forgetting, Jan Rogers' powerful personal story of coming into contact with the police during a mental health crisis.

Update: read Part 2 here.

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