INTER AGENCY JOINT WORKING PROTOCO L FOR THE …

0000LONDON BOROUGH

ENFIELDCouncil

Barnet, Enfield and Haringe yMental Health NHS Trust

Barnet and Chase Farm HospitalsNHS Tru s t

BRITISH Norh Middlesex University NosH pitalTRANSPORTmqj , IF POLIC E

This protocol must also be read in conjunction wit hMetropolitan Police Instructions and associated Standard Operating Procedure s

METROPOLITAN Working togetherforasaferLondonBritish Transport Police r :: ;:POLIC E

Metropolitan Police Serv iceLondon Ambulance Service TERRITORIAL POLICING

London Boroughs of Barnet , Enfield & HaringeyBarnet and Chase Farm Hospitals NHS TrustNorth Middlesex University Hospital NHS TrustBarnet , Enfield & Haringey Mental Health NHS Trust

INTER-AGENCY JOINT WORKING PROTOCO LFOR THE MANAGEMENT OF MENTAL HEALT H

Version : Version 2 .0Policy Lead/Author & Position : Andrew Smith - Mental Health Law ManagerResponsible Directorate : Nursing , Quality & SafetyReplacing Document(s) : Multi-agency Joint Protocols : s135 , s136 , s6

Conveyancing , Missing Persons , s17E CTO recal lApproving Committee / Group : Multi-agency Joint Monitoring GroupDate Approved /Ratified : November 201 2Ratified by : Trust Policy Group (BEHMHT )Previous Reviewed Dates : 2005 and 200 8Date of Current Review : October 201 1Date of Next Review : October 201 5Relevant NHSLA Standard : Standard 6 - Criterion 8 : Absent without Leave

(AWOL)Target Audience : BEHMHT and Local Authority mental healt h

services , London Ambulance Service (LAS) ,Metropolitan Police Service (MPS) , BritishTranspo rt Police (BTP )

Inter-Agency Joint Protocol Mental Health (V2 .0) 1

EQUALITY STATEMEN T

Barnet, Enfield and Haringey NHS Trust aims to design and implement services , policies andmeasures that meet the diverse needs of our servi ce, population and workforce , ensuringthat none are placed at a disadvantage over others . It takes into account the Equality Act(2010) including the Human Rights Act 1998 and promotes equal opportunities for all .

This document has been assessed to ensure that no employee receives less favourabletreatment on the protected characteristics of their age , disability , sex (gender) , genderreassignment, sexual orientation , marriage and civil partnership , race , religion or belief ,pregnancy and maternity .

Members of staff , volunteers or members of the public may request assistance with thispolicy if they have particular needs . If the member of staff has language difficulties anddifficulty in understanding this policy , the use of an interpreter will be considered . Barnet ,Enfield and Haringey NHS Trust embraces the four staff pledges in the NHS Constitution an dthis policy is consistent with these pledges .

It is important to be aware of the potential for disproportionate admission to hospital ofparticular ethnic groups and in particular admission under the Mental Health Act . Care andtreatment decisions should not be inappropriately affected by ethnicity . Because of this theTrust' s monitoring of the Mental Health Act takes particular notice of ethnicity and concernsare raised as appropriate in order to inform and influence the Trust 's equalities agenda .

Consultation Record of Procedural Document Form

Name and Title of Individual Date Consulte d

Joint Protoco l Monitoring Group Member Organisations 21 September 201 1Common Menta l I llness (CMI) Service Line 21 September 201 1Joint Protoco l Monitoring Group Member Organisations 25 May 201 2Common Menta l I llness (CMI) Service Line 25 May 201 2

Contributing Authors : 21 September 201 1Joint Protoco l Monitoring Group Members 25 May 201 2Joint Protocols Development Group 31 August 201 2

Name of Committee Date of Commi ttee

Joint Protoco l Monitoring Group 13 September 201 1Joint Protoco l Monitoring Group 12 June 201 2Trust Policy Group 27 September 2012

Version Control Summary

Version Date Section Author Comments2 .0 Aug Several MH Law All changes required to consolidate the five

2012 Sections Manager separates into one Joint Protoco l2 .0 Aug Several MH Law All changes required to transfer to the BEH

2012 Sections Manager standard approved policy format2 .0 Sept Several MH Law All amendments required by the Join t

2012 Sections Manager Protocols Development Grou p


Table of Contents

1 .

2 .

3 .

4 .

5 .

6 .

7 .

8 .

9 .

Policy Statement

Introduction

Aims

Overview

Definitions & Abbreviations

Places of Safety

MHA 1983 - Section 136 & Mentally Disordered People in Public Places

MHA 1983 - Section 135 & Assistance Requests for MHA Assessments

MHA 1983 - Service User Missing from a Healthcare Setting or AWO L

10 . MHA 1983 - Transport, Conveyance and Sect ion 6

11 . MHA 1983 - Section 17E Recall from Community Treatment Order s

12 .

13 .

Mental Capacity Act 2005

Information Exchang e

14 . Monitoring Compliance and Effectiveness

15 . Dissemination , Implementation and Disputes

16 . Contributors

17 . References

18 . Append ices

Appendix I - HPCMHT Acute Assessment Centre s136 ProcedureAppendix 2 - Transfer between places of safetyAppendix 3 - AAC Procedure to prevent absconsion incident sAppendix 4 - Contact details - police, PoS and AMHP se rv iceAppendix 5 - Joint Risk Assessment request for police at MH AssessmentAppendix 6 - Where Police Assistance is immediately requiredAppendix 7 - Flowchart for se rvice user missing from hospita lAppendix 8 - Pan-London Guidance Notes relating to flowchar tAppendix 9 - Missing Persons Information Pack for Polic eAppendix 10 - Return of Patient under section who is AWO LAppendix 11 - Application and Execution of Warrants under s135(2 )Appendix 12 - Delegation of Authority to Convey a Patient to Hospita lAppendix 13 - Section 17A MHA 1983 Community Treatment Order sAppendix 14 - Guidance notes for BEHMHT staff - Section 135(2)Flowchart I - Action when recalling a patient subject to CTO (re -recall )Flowchart 2 -Action when recalling a patient subject to CTO (when AWOL )Flowchart 3 -Action when recalling a patient subject to CTO (post recall )

19 . Equality Impact Assessment and Analysis Form

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POLICY STATEMEN T

1 . 1 In accordance with Section 118 of the Mental Health Act 1983 as amended by theMental Health Act 2007 (referred to subsequently as the Mental Health Act) , theDepartment of Health issues a Code of Practice to provide guidance for managersand staff of Health and Social Services in undertaking duties under the Act .

1 .2 The code requires statuto ry agencies to draw up protocols for a range of MentalHealth Act duties . These `joint protocols' have been combined to form a jointly agreedpolicy for the management of mentally disordered patients , which follows . This policyincorporates the recent changes to Mental Health Act legislation and represents goodpractice in inter-agency co-operation .

1 . 3 This policy has been negotiated between the London boroughs of Barnet , Enfield andHaringey Social Services , the Metropolitan Police Service , the British TransportPolice , Barnet , Enfield and Haringey Mental Health NHS Trust , Barnet and ChaseFarm Hospitals NHS Trust and the London Ambulan ce Service .

1 . 4 The policy creates an opportunity for the agencies involved to restate theircommitment to speed , efficiency and dignity when dealing with people subject to theprovisions of the Mental Health Act.

1 . 5 The implementation of this protocol will be regularly monitored by the standing multi-agency Joint Protocol Monitoring Group (JMG) . Any questions about the protocolshould be addressed to the author detailed on the front page .

2 . INTRODUCTIO N

2 . 1 This document sets out the recognition that working together to improve provision topeople suffering from mental disorder , who come into contact with Police and/or othe remergency services , is both a necessity and a priority . It provides an operationa lprotocol for the management of the use of places of safety (PoS) , under sections 13 5& 136 of the Mental Health Act (MHA) along with the agreed protocols for managin gmentally disordered patients who are missing , absent without leave or recalled from aCommunity Treatment Order (CTO) and the transportation and conveyance ofpersons detained under the Act where partners have required the support of service sin order to act in the best interest of a person . Partner agencies are listed (at 17 .below - Contributors) .

2 . 2 This protocol is based upon protocols that were drawn up in accordance with the PanLondon Guidance , as agreed by the London Mental Health Partnership Group anddeveloped by the London Development Centre for Mental Health , and brings togetherfive Joint Mental Health Act Protocols into a cohesive single document :

■ Joint MHA Protocol S136■ Joint MHA Protocol S135■ Joint MHA Protocol Missing Persons■ Joint MHA Protocol s1 7E Recall from CT O■ Joint MHA Protocol s6 Conveying of Mentally Disordered Person s

2 . 3 The use of this protocol will ensure compliance with relevant legislation , nationalguidance and other sources of standards for the NHS and the Police (listed below at18 . below - References) . It also outlines relevant aspects of the Mental Capacity Actand information sharing .


3 . AIMS & OBJECTIVES

The aims and objectives of this protocol are :

3 . 1 to ensure efficient , effective and dignified assessment arrangements for ALLdetainees who need to be removed to a PoS .

3 . 2 to outline the roles and responsibilities of each of the organisations named in theprotocol , providing guidance for ambulance service personnel , medical and/or otherhealthcare practitioners , Approved Mental Health Professionals (AMHPs as defined inS114 Mental Health Act) , and police officers .

3 . 3 to describe best practice in obtaining and executing S135 warrants and assessingpatients believed to be suffering from mental disorder on private premises or in aplace of safety and monitor how and in what circumstances S135 warrants areobtained and executed .

3 . 4 to ensure that the most humane and least threatening method is used to complete theMental Health Act assessment and that no harm comes to the patient or others .

3 . 5 to ensure effective risk assessment by the police service , ambulan ce service andAMHP service to ensure removal of mentally disordered persons to the mostappropriate location by the most appropriate means .

3 . 6 to provide clear protocol for the use of the powers to convey a person to hospitalunder S . 6(1) Mental Health Act and ensure that persons detained under the Act areconveyed to hospital in an appropriate vehicle and in the most humane way possiblefollowing an assessment of their mental health needs by a doctor and AMHP .

3 . 7 to ensure the use of a dedicated psychiatric PoS for S136 detentions on the majorityof occasions , exemplifying best practice .

3 .8 to ensure the use of Police Stations as a PoS , only in exceptional circumstan ces andwhere it is medically safe to do so .

3 . 9 to facilitate the swift and safe return of mentally disordered patients who are reportedto the Police as absent without leave or missing .

3 . 10 to ensure action taken in an emergency situation , where a person who is believed tolack mental capacity and whose life may be at risk or who may suffer harm if action isnot taken to safeguard them is in that person 's best interests and in a way that placesthe least restrictions on the person ' s rights and freedom of action .

3 . 11 to ensure appropriate intelligence is submitted in a timely and effective way and thatinformation shared is for a justifiable purpose , that it is in the public interest and isproportionate to the situation with due regard shown to the implications of the Humanrights Act 1998 and the Data Protection Act 1998 .

3 . 12 to give guidance on action to be taken when a patient , subject to a CTO , is recalled

3 . 13 to facilitate good working relationships between all parties involved in implementingthe protocol and work jointly across organisational boundaries in achieving theseintentions .


4 . OVERVIEW

4 . 1 This protocol document has been prepared by the multi-agency Joint ProtocolMonitoring Group (JMG) . The bodies associated with this protocol are members ofthe JMG .

4 . 2 It outlines the agreed procedures to be adopted and the roles and responsibilities ofeach of the contributing organisations .

4 . 3 The documented procedures reflect the requirements of :

• London Ambulance Service (in Barnet, Enfield and Haringey )• Barnet, Enfield and Haringey Mental Health NHS Foundation Trust• Barnet and Chase Farm Hospitals NHS Trus t• Barnet Local Social Services Authority• Enfield Local Social Services Authority• Haringey Local Social Services Authority• Metropolitan Police Service (in Barnet, Enfield and Haringey )

4 . 4 The protocol relates to individuals who are detained by the Police under S135 and136 MHA for removal to a PoS , for those mentally disordered patients who ar ereported missing or absent without leave , the transportation and conveyance fo radmission or return of such persons , dealing with mental health assessments ofmentally disordered offenders while in custody and utilising Criminal Justice Menta lHealth Panels and actions carried out under S5 and S6 MCA . It also sets out theinformation exchange considerations between the relevant organisations . (MHA CoP;chapters 10, 11, 22 and MCA CoP, chapters 5, 6)

4 . 5 It is agreed between all parties that those detained/restrained are a JOINTmanagement responsibility from the point of detention/restraint to the point of disposalor admission to hospital and it is eve ry organisation 's responsibility to ensure supportfor the other(s) , throughout the period of restraint/detention (including conveyance) inaccordance with the legislation and guidance .

4 . 6 PCT Commissioners will ensure sufficient PoS , fit for purpose , including contingencyconsiderations , are commissioned in healthcare or other non police station settings .This provision will include the appropriate level of qualified medical staff and themonitoring of the PoS provision . A police station should not be assumed to be th eautomatic second choice if the first choice , hospital PoS is not available . (MHA CoP;pars 10. 17 and pars 10.22)

4 . 7 A senior professional in each agency will be responsible for the implementation ,monitoring and on-going strategic management of this protocol . An annual review ofthe operation of this protocol will occur involving those professionals from all partne rorganisations listed . Minor amendments of the protocol may take place from time t otime by consultation but without the need to renew the signatures . (MHA CoP; pars10. 16)

4 . 8 Each partner will designate a manager from their organisation (Police Inspector &equivalent) as responsible for on-going operational , day-to-day monitoring of th eprotocol , as well as being the day-to-day point of contact to resolve challenges arisin gfrom operational implementation of this protocol . Problem solving , where it cannotoccur at the time , will be managed in a regular and documented forum (at least eve ry6 weeks) . This will involve attendance by key staff including the designate d


managers from the relevant Health Trusts , Ambulance Service and Police liaisonofficer. It will be referred to in this protocol as the Problems in Practice (PiP) althoughthere may be local variation on the title . This PiP will inform a strategic forum/steeringgroup whose responsibility it will be to address non-compliance with protocols at asenior and strategic level . (MHA CoP; pars 10 . 19)

4 . 9 It is envisaged that NHS/LSSA professionals will be robustly supported by Polic eOfficers wherever a health-setting is used and where those individuals present a` manageable high risk ' . Risk is inherent in the joint operation of detentions unde rS135 and S136 MHA and must be managed . Police Supervisors in particular shoul densure this as the Police are legally responsible for the prevention of crime . Thisincludes risk of assault to NHS/LSSA professionals . (MHA CoP; pars 10. 17)

4 . 10 Any actions taken under this protocol must take full account of the guiding principlesgoverning the use of the Mental Health Act (Code of Practice Chapter 1 )• Purpose• Least Restrictio n• Respect• Participation• Effectiveness, Efficiency and Equity

5. DEFIN ITIONS & ABBREVIATIONS

5 . 1 In this protocol all references to the Mental Health Act refer to the Mental Health Act1983 as amended by the Mental Health Act 2007 .

5 . 2 Definitions for the following terms are provided in the Mental Health Act 1983 asamended by the Mental Health Act 2007 :

• Community Treatment: Section 17A• Nearest Relative : Section 26(3 )• Responsible Clinician : Section 34(1 )• Local Social Services Autho rity: Section 145(1 )• Approved Mental Health Professional : Section 145(1 )• Patient: Section 145(1) , Hospital: Section 145(1) , Medical treatment: Section 145(1 )

5 .3 Definition of "Place of Safety"

A "place of safety" means residential accommodation provided by a local socialservices authority under part I I I of National Assistance Act 1948 , a hospital as definedby the MHA , a police station , an independent hospital or care home for mentallydisordered persons or any other suitable place the occupier of which is willingtemporarily to receive the patient .

BEHMHT and its partner agencies strongly support the principle that where possiblethe local psychiatric facility should be used as a preferred pla ce of safety . This doesnot preclude other options as follows :

• A police station can be used where the detainee's level of violence does not allowthem to be safely left at a hospita l

• A&E should be used where the detainee's physical health indicates thatimmediate medical assessment/intervention is necessar y

Inter-Agency Joint Protocol Mental Health (V2.0) 7

5 .4 Abbreviation s

AMHP

AWOL

BEHMHT

CAD

CCC

CM

CMHT

CAMHS

CoP

CPA

CTO

DPA

ECHR

EDT

IBO

ISA

LD

LSSA

M HA

MHT

MCA

Misper Unit

NoK

PACE

LAS

Merlin

MPS

PICU

PoS

PS

PCT

RC

RMP

RH

SCT

SOAD

SpR

s12 doctor

Approved Mental Health Professional (defined by MHA)

Absent without Leav e

Barnet, Enfield and Haringey Mental Health NHS Trust

Computer Aided Despatch - the compute rised messaging systemused by the police to log and respond to calls for assistance .

Central Communications Command (police)

CAD terminology for `completed message '

Community Mental Health Tea m

Child and Adolescent mental Health Service

Code of Practice , (either to MHA , MCA or PACE , as specified)

Care Programme Approac h

Community Treatment Order

Data Protection Act 1998

European Convention on Human Rights

Emergency Duty Team

Integrated Borough Operations - the local borough ` communicationsroom ' .

Information Sharing Agreement

Lea rn ing Disabilities

Local Social Services Authorities

Mental Health Act 1983 (revised 2007)

Mental Health Trust

Mental Capacity Act 2005

Missing Person Unit

Next of Ki n

Police and Criminal Evidence Act 1984

London Ambulance Service

Computerised missing person system .

Metropolitan Police Service

Psychiatric Intensive Care Uni t

Place of Safety

Police Sergeant

Prima ry Care Trust

Responsible Clinician

Registered Medical Practitioner

Responsible Hospital

Supervised Community Treatment

Second Opinion Approved Doctor

Specialist Registrar in Psychiat ry

A doctor approved under The Mental Health Act (section 12) ashaving specialist knowledge of psychiat ry

Inter-Agency Joint Protocol Mental Health (V2 .0) g

6 . PLACES OF SAFETY

6 . 1 Under the MHA a place of safety may be a hospital , a residential care home , a policestation , or any other suitable place where the occupier is willing to receive the patient .In most circumstances the place of safety will be the respective Borough 's mentalhealth facility as listed below .

Barnet and Enfield Boroughs :Acute Assessment CentreGround Floor, The Chase BuildingChase Farm Hospital SiteEnfield EN2 8 .11Telephone : 020 8375 1122

Haringey Borough : Acute Assessment CentreHaringey Prima ry Care Mental Health Team (PCMHT )St . Ann 's Hospita lHaringey N15 3THTelephone : 020 8442 6706 or 020 8442 6000

6 . 2 Where it is considered that the individual is in need of additional medical interventionor treatment the local A&E department is the appropriate place of safety . The patientcan subsequently be transferred between places of safety under Section 136 , seeparagraph 6 below .

6 .3 The Code of Practice (10 . 22) advises that "a police station should not be assumed tobe the automatic second choice if the first choice place of safety is not immediatelyavailable . Other available options , such as a residential care home or the home of arelative or friend of the person who is willing to accept them temporarily , should alsobe considered " .

6 .4 However, where there grounds to justify use of the section 136 power but alsogrounds to arrest for a criminal matter that is not trivial , the individual should bearrested under both provisions This empowers the Custody Officer to detain theindividual under the MH act should the criminal matter be resolved prior toassessment .

6 .5 ROLES AND RESPONSIBILITIES BEFORE ARRIVAL AT PLACE OF SAFETY

6 .5 . 1 Role of the Pol ice

If a decision is taken to detain an individual under the Section 136 of the MentalHealth Act, the Police will :

Contact , via Central Communications Command (CCC) , the Ambulance Service .(Such requests for assistance will be considered a Catego ry C2 Response withinthe terms of LAS Policy and Procedures and as such will have a target responsetime of 30 minutes , unless the incident is deemed life threatening in which case itwill be determined as a Catego ry A response with a target response of 8 minutes .Whilst exceptions apply - for example no ambulance being available - as ageneral rule the person must be taken to the place of safety by ambulance inaccordance with the agreement between the LAS and MPS , unless they are soviolent or dangerous that it is ne cessa ry to use a police vehicle .


• Contact , via Central Communications Command (CCC) the Senior Nurse in theappropriate mental health facility (as listed above) and provide any informationthey have about the person regarding their identity , the circumstances leading totheir removal under Section 136 and any indication that they may present a risk orharm to themselves or others ;

• Search the detained person prior to transporting them to the place of safety ; theofficer may seize and retain anything found if there are reasonable grounds tobelieve that the person searched may use the item to cause physical harm tothemselves or others , or facilitate an escape .

6 .5 .2 Role of the Ambulance Se rv ice

The role of the ambulance crew in such circumstances is to :

• Assess the individual 's medical condition and administer any immediate medicalassistance as required ;

• Assist the police in deciding on the most appropriate "place of safety" ;

• Convey the person to the place of safety by ambulance o r

• Assist the police in conveying the individual to the place of safety as appropriate ;

• Where the individual is to be conveyed to the place of safety by poli ce vehicle ,he/she should be accompanied in the police van by a member of the ambulan cecrew , to monitor the detainee and the ambulance should be requested to followbehind .

6 .5.3 Role of Senior N urse at P lace of Safety

As soon as the appropriate mental health facility has been informed by the poli ce thata detained person is to be brought in under Section 136 , the Senior Nurse should :

• Obtain patient details and check against the database . If the person's histo ryindicates previous violence during assessments , advise police via Duty Officer inControl Room ;

• Contact and co-ordinate arrival of the on-call psychiatrist and Approved MentalHealth Professional and arrange their a ttendance;

• To make suitable arrangements for their care ;

• The MHA Code of Practice requires that Doctors examining patients should ,wherever possible , be approved under section 12 of the Act . A mental healthassessment should be carried out by a doctor and where the examination has tobe conducted by a doctor who is not approved under section 12 , the doctorconcerned should record the reasons for that . To prevent delays , the in-houseduty doctor should be called to conduct an initial medical and psychiatricassessment .

• Advise police of any potential delays in process of assessment (for example ,AMHP or on-call psychiatrist delays) .


• Arrange for an interpreter if indicated .

6 .6 A&E DEPARTMENTS AS A PLACE OF SAFETY

6 .6 . 1 If an A&E Department is used as a place of safety , the following actions shouldbe implemented :

• If the Unit Nurse in the borough hospital has been informed by the Police that anindividual is being brought in under Section 136 and is to be taken to the localA&E Department , immediate contact should be made with the A&E Department ' sPsychiatric Liaison Nurse (if one is available) so that any information about theindividual can be handed over ;

• A&E staff should be informed by either the ambulance crew and/or Unit Nurse inthe borough hospital/Police or the A&E liaison professional , of the estimate timeof the detained person 's arrival ;

• Following any necessa ry medical treatment consideration should be given totransferring the patient under section 136 (see paragraph 6) to a more appropriateplace of safety for the purposes of the psychiatric assessment ;

• If the psychiatric assessment is to take place at A&E the Police will normallyremain within the A&E Department until the AMHP or Section 12 doctor hasassessed that the patient not longer presents a risk to either staff or other patient sor until such time as is necessa ry to ensure the safety of those involved .

6 .7 NOTE ON CONVEYANCING

6 . 7 . 1 In most instances , the person will be conveyed to the place of safety by ambulance ,as described above - they should be accompanied by a Police Officer with the Poli cevehicle following behind . Police should not normally bring people to the AAC who arenot subject to s136 or s135(1) of the MHA 1983 .

6 . 7 .2 However, in circumstances where this is felt to be too dangerous because of , forexample , violence (but excluding *acute behavioural disorder ', the individual may beconveyed by police transport . A member of the ambulance crew will accompany theindividual in the police vehicle , with the ambulance following behind .

6 . 7 .3 (Note : the main feature of *acute behavioural disorder, as defined by the Poli ceComplaints Authority , are a period of agitation , excitability, perhaps paranoia , coupledwith great strength , aggression and non-pain compliance . Sudden collapse an ddeath may follow . If this is diagnosed , the individual should always be conveyed t othe place of safety by ambulance . ) Police transport in these cases will be used onl yas a last resort .

6 .8 TRANSFER BETWEEN PLACES OF SAFETY

6 . 8 . 1 It is possible for patients to be transferred from one place of safety to another withinthe maximum 72 hour detention period . Any decision to transfer should be based onpatient welfare , clinical need , patients ' wishes and best interests (Code of Practice10 . 37) . The level of risk must be considered and documented . In a medica lemergency patients may need to be transferred to an A&E unit to ensure their welfare


6 . 8 . 2 If patients are conveyed between places of safety this should be done in a mannerwhich is "most likely to preserve their dignity and privacy consistent with managingany risk to their health and safety or that of other people " (Code of Practice 11 .2) .

6 . 8 .3 Unless it is unavoidable , a person should never be transferred to another place ofsafety unless it has been confirmed that that pla ce of safety is willing and able toaccept them (Code of Practice 10 . 39)

6 . 8 . 4 Prior to transfer there needs to be a discussion between practitioners as to whetherthe transfer is in the individual's best interests and to see whether the POS is willingto accept the transfer prior to SU being transferred .

7 . SECTION 136 & MENTALLY DISORDERED PEOPLE IN PUBLIC PLACE S

7 . 1 THE LEGISLATIO N

The prima ry legislation affecting this protocol is the Mental Health Act 1983 , Section136 . The protocol is required by the Mental Health Act Code of Practice and definesthe roles and responsibilities of :

a) A police officer in detaining an individual in a public place and conveying thatindividual to a place of safety ;

b) Doctors , nurses and Approved Mental Health Professionals (AMHP) in theassessment and care of the individual ; and

c) The London Ambulance Service (LAS) in providing immediate medicalassistance as required and in conveying the individual to a place of safety .

7 .2 POLICE OFFICER DETAINS INDIVIDUAL UNDER SECTION 13 6

The Mental Health Action Section 136 states that :

1) If a constable finds in a place to which the public have access , a person whoappears to be suffering from a mental disorder , and appears to be inimmediate need of care or control , the constable may , if he thinks it necessa ryto do so in the interests of that person , or for the protection of other persons ,remove that person to a place of safety within the meaning of Section 136 .

2) A person removed to a place of safety under this section may be detainedthere for a period not exceeding 72 hours for the purpose of enabling him/herto be examined by a registered medical practitioner , and to be interviewed byan Approved Mental Health Professional and for making any necessa ryarrangements for his/her treatment or care .

7 .3 POLICE OFFICER CALLS FOR AMBULANCE VIA CONTROL DES K

7 . 3 . 1 If a decision is taken to detain an individual under the Section 136 of the MentalHealth Act , the police will inform the local mental health facility and contact theambulance service via the control desk .

7 . 3 . 2 Such requests for assistance will be considered a Catego ry B Response within theterms of LAS Policy and Procedures and as such , will have a target response time of14 minutes .


7 . 3 . 3 Where no ambulance is available , or it is inappropriate to wait for one (such as in apublic order situation where the risks of remaining will increase risks) , PoliceTransport will be used to convey persons detained under Section 136 to a place ofsafety .

7 . 3 . 4 The role of the ambulance crew in such circumstances is to :• Assess the individual 's medical condition and administer any immediate medica l

assistance as required ;• Assist the police in deciding on the most appropriate "place of safety " ;• Convey the person to the place of safety by ambulance o r• Assist the police in conveying the individual to the place of safety a s

appropriate ;• Where the individual is to be conveyed to the place of safety by police van ,

he/she should be accompanied in the police van by a member of the ambulancecrew, whenever possible , and the ambulance crew will follow ;

• On arrival at the place of safety , the ambulance crew will negotiate the han dover of the management of the individual to medical , nursing staff and police ,when and as appropriate and complete all necessa ry documentation .

7 .4 AMBULANCE CREW DECIDE IF MEDICAL TREATMENT REQUIRED ELSEWHER E

7 .4 . 1 In most circumstances , the local mental health facility will act as the place of safety(see 7 . 9 CHILDREN AND YOUNG PEOPLE below)

7 .4 . 2 Where the ambulance crew considers that the individual is in need of additionalmedical intervention or treatment , in consultation with the police they will convey theindividual to an A&E Department by ambulance .

7 .4 . 3 A Police Officer will travel with the individual in the ambulance and the Police vehiclewill follow .

7 .4 . 4 If the detained person is taken to a place of safety in the police vehicle , they shouldbe accompanied by a member of the ambulance crew , with the ambulance following .

7 .5 HANDOVER

• On arrival at the Acute Assessment Centre (AAC) , Police shall give the SeniorNurse a verbal account of the circumstances - the Senior Nurse and Police Officerin charge should conduct a joint risk assessment of the individual ' s immediatephysical and mental state , and jointly plan for his/her management whilst in theplace of safety ;

• "Agreed hour" starts - a police supervisor will sanction poli ceassistance/intervention for up to one hour ; beyond which the senior nurse willcontact the Trust on-call manager who will in turn contact the Police duty officer todiscuss the exceptional circumstances requiring police to remain ;

• The AAC should not refuse to accept the individual simply on grounds that theyhave consumed some alcohol ;

• Acceptance to the 136 suite where excessive use of intoxicating liquor / drugs isindicated is at the discretion of the Senior Nurse ;

• If a patient has been medically cleared already from an emergency department ,the AAC should not normally refuse to accept them on medical grounds (unlessfor instance there has been significant worsening in their physical condition) .


• If appropriate AAC suite(s) are already in use for some reason , the AAC shouldsupport the LAS/MPS by seeking to locate and direct them to the closest suitablealternative place of safety .

• Police Officers must inform NHS staff where restraint has been used on Section136 patients ;

• Where police officers have used restraint , NHS staff may wish to consider anexamination of the person concerned at an early stage . Calling the Police FMEshould also be considered ;

• If a Police Officer is made aware of any faith of cultural needs of the persondetained , they should bring this to the attention of a member of the receivingmedical staff at the earliest opportunity ;

• Care should be taken that any risk assessment carried out at this stage is notbased on stereotyped images or inappropriate generalisations .

• Any property seized from a patient who is searched by a Police Officer needs tobe recorded by the Police Officer in his notebook ;

• The Senior Nurse will then escort the individual , with the Police , to the Section136 Suite - at this point the "subject" becomes a "service user" and is theresponsibility of the Trust , any further searches to be carried out by hospital staff;

• Police to complete form 434 - the top copy of the form will be sent to the MentalHealth Police Liaison Officer and the second copy retained by the hospital . SeniorNurse to record time of individual 's arrival at place of safety and time AMHPservice was notified that an assessment is required .

• Senior Nurse to arrange for food , drink and clothes for patient if required , assistduty psychiatrist and AMHP with assessment and constantly review with thePolice the necessity for them to remain at the place of safety ;

• Staff at the place of safety should carefully assess the situation and avoid allowingpatients held under s136 in the s136 suite at the AAC to abscond from the room .

7 .6 ASSESSMENT

• The duty psychiatrist should make eve ry effort to examine the patient as soon aspossible and a brief physical examination should be carried out before psychiatricassessment;

• The duty psychiatrist should , if at all possible , be approved under section 12 of theAct . If they are not , this should be noted together with the reasons why (Code ofPractice 10 .27) ;

• The assessing doctor may need to consult with other professionals , includingmedical seniors , nursing staff and an AMHP before arriving at his/her final medicaldecision regarding the need for further action . Experience and good practiceguidance would suggest that such consultation would normally be considereddesirable , if not essential ;

• If the duty psychiatrist concludes the patient is not suffering from any form ofmental disorder within the meaning of the Act , the power to detain under section136 lapses and the patient must be discharged from detention immediately .Consultation with medical seniors and other professionals may be particularlyimportant before reaching this decision . Where patients are discharged fromdetention for this reason it may be appropriate to offer advice about other forms ofsupport or assistance .


• Eve ry individual with a degree of mental disorder who is detained under section136 must be interviewed by an AMHP , regardless of his or her need for furtherdetention under the Act . These patients may not be released from detention untilassessed by an AMHP or the 72-hour period has expired (Code of Practice10 . 33) ;

• Eve ry effort should be made to ensure that the assessment is undertaken within aperiod of 4 hours and should be completed within 24 hours in all circumstances .

• However , there are exceptions such as where the AMHPs in the patient 's homeborough/area are the decision makers and there is no need for the AMHP to comeout as the patient will require assessment on arrival at the receiving place ofsafety (also EDT AMHPs may not be able to out of hours and in certaincircumstances) .

• Where it is likely the assessment will be prolonged , it may be more appropriate forthe patient to be accommodated on a ward in the unit where the Section 136 Suiteis, rather than in the Section 136 Suite itself . The Code suggests where a hospitalis used as a place of safety , it is a local decision whether the person is admi tted toa bed on arrival or whether that happens only after they have been interviewedand examined (Code of Practice 10.25) ;

• If the patient needs a full Mental Health Act assessment this will be co-ordinatedby the AMHP . The Bleep Holder or nurse in charge will provide assistance asappropriate ;

• It is expected that L .B of Barnet AMHP Service (including out of hours se rv i ces)respond to request for assessments of Barnet residents taken to A&E as a pla ceof safety or to the Acute Assessment Centre or S .136 suite at Chase FarmHospital .

• AMHP Services will respond to requests for assessments in the usual way forresidents from other areas picked up within the local borough boundaries .

• No-fixed Abode or Homeless Individuals should be referred to the Local Authorityor AMHP Service from within the Borough boundaries from which they werepicked up by the Police .

7 .7 PATIENTS ' RIGHTS

• The Bleep Holder or nurse in charge must give any person brought in undersection 136 information about their rights whilst detained immediately , or as soonas is practicable if the person 's mental state will not allow them to absorb thisinformation immediately . They must :

- advise the patient in private that they are subject to detention under section136 for up to 72 hours and that their detention may only extended if anothersection is applied ;

- explain why it has been necessa ry to detain the patient in this way ;- advise the patient of their rights under section 136 orally and in writing using

the DoH rights leaflet and complete the reverse side of the form 434accordingly .

• Patients should be advised that they are entitled to independent legal advice froma solicitor . Efforts should be made to facilitate this if they request it . Each unitmust maintain an up to date list of approved solicitors who are prepared to offer a24 hour duty se rv i ce to persons detained under the Act .


• The patient is entitled to have one person of his/her choice informed of theirdetention under the Act , and of their whereabouts . The Bleep Holder/nurse incharge co-ordinating the patient 's assessment must enquire who the patientwould like informed and make eve ry effort to see they are contacted .

• Reasonable inquiries should be made as to whether there is anyone with LastingPower of Attorney or a Court of Protection appointed Deputy under the MentalCapacity Act 2005 (MCA) . If the patient is assessed as lacking capacity a ttemptsshould be made to contact these individual s

• If the person detained is under 18 years of age , a parent or another adult withparental responsibility (which may be the local Authority if they are a Looked AfterChild) should be informed of their detention and rights .

• If patients are detained in a police station and are also to be interviewed inconnection with a police investigation , the police should arrange an AppropriateAdult. This should not normally be the AMHP who assesses under section 136 .

7 .8 SCT and SECTION 17 LEAV E

If it emerges that the patient is already subject to Supervised CommunityTreatment (SCT) under section 17A or is on leave of absence under section 17 ,efforts should be made to contact the patient 's Responsible Clinician (RC)immediately . If appropriate , recall powers should be used and any need forsubsequent admission or revocation of SCT should be assessed separately .Further details are set out in the Trust's Supervised Community Treatment Policy .

• Please note : an application for detention under section 3 will have the effect ofending the SCT so should not be made for someone who is known to be on SCT .An application for section 2 is only valid where the person is not known to be onSCT .

7 .9 CHILDREN AND YOUNG PEOPLE

• It is useful to bear in mind what the Care Quality Commission (CQC) had to say inits first annual report 'Monitoring the use of the MHA in 2009/10' :

"We are aware of at least one occasion when a hospital refused to take anadolescent patient into its designated place of safety because it was notconsidered to be age-approp riate accommodation, as required under section131A of the Act (see page 22) . . . . . . Ideally, local policies developed as a result ofthe Royal College of Psychiatrists' guidance will establish alte rnative places ofsafety for children and adolescents . . . . . .where there are no such arrangements, itis our view that any hospital- based place of safety must usually be a better optionfor children and adolescents than a police cell, even if the place of safety is notentirely self contained. This approach is consistent with the guidance in the Codeof Practice on emergency accommodation . We will remain vigilant that servicesdo not misinterpret the age-approp riate accommodation requirements to excludechildren and adolescents from places of safety. "

• S136 also applies to Children and Young People who may be subject to the Act .• 'Where a child or young person aged under 18 is admi tted to , or remains in ,

hospital (whether compulsorily or not) for treatment for mental disorder , themanagers of that hospital must ensure that the child or young person ' senvironment in the hospital is suitable , having regard to their age (subject to thei r


needs) . But accommodation in an environment which would not normally besuitable for a person of that age is permissible if the patient's individual needsmake such alternative accommodation necessa ry, or more appropriate , for thepatient " ) . (MHA Reference guide to the Mental Health Act 1983 (2008) Page 289)

• A child or young person under 16 with an acute mental health episode shouldusually be taken to A&E and then transferred to a paediatric ward for furtherassessment by Child and Adolescent Mental Health Service (CAMHS) . Thisenables care to be provided by staff trained in the provision of holistic health car eto children and adolescents including any concurrent physical health concerns .

• If a child under 16 years of age is the subject of detention under Section 136 andA&E or a paediatric ward is not perceived to be a suitable environment for thechild , hospital managers should discuss with a CAMHS Consultant Psychiatrist,using a 136 Suite as the most appropriate accommodation until the Mental HealthAssessment has taken place .

• A young person of 16-17 years of age should be assessed in A&E or the 136Suite depending upon the assessed clinical needs and the risk of harm tothemselves and others .

• For any assessment involving a child or young person under 18 years of ageeve ry effort must be made to have that person assessed by a specialist in Childand Adoles ce nt Mental Health or to seek their specialist advice if they are unableto attend .

• If, following a Mental Health Act Assessment , a subsequent hospital admission isrequired , suitable age appropriate accommodation for a child or young personunder 18 years of age will be identified by a CAMHS consultant .

• A safeguarding risk assessment will be carried out by the AMHP and a referralmade to Children 's Services in the area that the child is usually resident if thereare any safeguarding concerns or the child is considered to be a child in need .Any safeguarding concerns should be documented within the child ' srecords/notes and the information passed on to any subsequent health provider ifthe child or young person is admi tted .

7 . 10 LEARNING DISABILITIES

• If it appears the detained person may have a learning disability , eve ry effort mustbe made to have that person assessed by a specialist in Learning Disability or toseek specialist advice if other services are unable to a ttend , unless this wouldlead to unacceptable delays in completing the assessment .

7 . 11 RESTRICTIONS ON DETENTION AND TREATMENT OF PERSONS DETAINEDUNDER SECTION 136

• Section 136 cannot be renewed or extended ; further detention , if appropriate ,should be under section 2 or 3 . It is very unlikely that it would be appropriate for apatient detained under section 136 to have their period of detention extendedunder section 4 (Code of Practice 10 . 52)

• Even where a patient detained under section 136 is admitted onto a ward they arethere solely for the purposes of assessment under section 136 . If the assessmentcannot be competed in 72 hours they should not be further detained under section5(4) or section 5(2) .

• There is no authority under the Mental Health Act for the compulso ry treatment ofa patient detained under section 136 . If the patient has capacity to consentmedication may only be given with their valid consent . If the patient is no t


competent to consent then treatment can only be given under the provisions ofthe Mental Capacity Act 2005 (MCA) . MCA procedures should be followed (forfurther advice see Trust Mental Capacity Act Guidance) . MCA also confirms thatrestraint can be used to administer treatment if it is both necessa ry to preventharm to the person and proportionate to the circumstances .

• Patients detained under section 136 cannot be given leave of absence as this isnot something that the MHA 1983 makes available to those subject to short term(72hr) holding powers .

7 . 12 SUPPORT OF PERSON NOT DETAINED IN HOSPITA L

• If following assessment , a person detained under Section 136 is not to beadmitted to hospital , it is the responsibility of the assessing team to makesatisfacto ry arrangements for the return of the person to the community .


8 . SECTION 135 & ASSISTANCE WITH REQUESTS FOR MHA ASSESSMENTS

8 . 1 THE LEGISLATIO N

Section 135 provides the means by which a police officer can lawfully enter privatepremises , by force if necessa ry . The purpose of the warrant is to search for and ifnecessa ry remove the person to a place of safety so that their condition can beassessed .

72 hours is the maximum period allowed for detention , and Section 135 has twodistinct components : 135(1) and 135(2) .

Section 135 of the MHA 1983 is defined as follows :

135(1 )"If it appears to a justice of the peace, on information on Oath laid by an approvedmental health professional, that there is reasonable cause to suspect that a personbelieved to be suffering from mental disorder-

(a) has been, or is being, ill-treated, neglected, or kept otherwise than underproper control, in any place within the jurisdiction of the justice , or

(b) being unable to care for himself, is living alone in any such place ,

the justice may issue a warrant authorising any constable to enter, if need by forceany premises specified in the warrant in which that person is believed to be , and ifthought fit, to remove him to a place of safety with a view to the making of anapplication in respect of him under Part 11 of the Act , or of other arrangements for histreatment or care "

135(2)"If it appears to a justice of the peace, on information on oath laid by any constable orother person who is authorised by or under this Act, to take a patient to any place , orto take into custody or retake a patient who is liable under this Act to be so taken orretaken

(c) that there is reasonable cause to believe that the patient is to be found onthe premises within the jurisdiction of the justice , and

(d) that admission to the premises has been refused or that a refusal of suchadmission is apprehended,

the justice may issue a warrant authorising any constable to enter the premises , ifneed be by force , and remove the patient"

• A patient who is removed to a place of safety in the execution of a warrant issuedunder this section 135 may be detained there for a period not exceeding 72 hours .

• A constable , an approved mental health professional or a person authorised byeither of them for the purposes of this subsection may , before the end of theperiod of 72 hours mentioned above , take a person detained in a place of safetyunder that subsection to one or more other places of safety .


8 .2 ENTRY TO PRIVATE PREMISES WITHOUT A S135 WARRAN T

• AMHPs should bear in mind their powers under Section 115 to enter and inspectpremises where a mentally disordered person is believed to be living if they havereasonable cause to believe that a person is not under proper care - but this doesnot permit entry in the absence of consent and does not confer any power toremove a patient .

• The Police have some powers of ent ry to private premises , both under CommonLaw and under the Police and Criminal Evidence Act 1984 . However these areonly likely to be a possible alternative to S135 in circumstances where there is animminent danger to life or limb , or breach of the peace , or likelihood of seriousdamage to property .

• Section 18 allows an AMHP , a police officer , or a member of staff from thedetaining hospital to take into custody and return to hospital patients who areAWOL . It is unnecessary to apply for a warrant under S135 if the owner or co-occupier gives permission for mental health professionals to enter the premises ,providing access by invitation .

8 .3 ASSESSMENT ON PRIVATE PREMISES WITHOUT A S135 WARRANT ORPOLICE ASSISTANC E

• Before car ry ing out a mental health assessment of a person on private premisesthe AMHP has the responsibility for gathering background information in order toundertake a risk assessment (see Risk Management Policy) . This will enable theAMHP to determine how the assessment can be safely implemented , andwhether or not police presence is required .

• There are occasions when the AMHP may have concerns about visiting anaddress to complete a Mental Health Act assessment , but there are no grounds toapply for a S135 warrant or for the Police to attend . If this is the case the personmust go with another professional member of staff and inform their office of theaddress they are a ttending (Lone Working Policy) .

• In these circumstances it is good practice for an AMHP to inform the Poli ceControl Room /Joint Mental Health Policing Unit before car rying out theassessment (see Appendix 3 for police contact details) .

• All assessments which are carried out without police involvement should include ,for the safety of the AMHP , another professional member of staff who willaccompany the AMHP . The "other professional" could be the person 's care co-ordinator (if known to services and on enhanced CPA) , a community mentalhealth nurse , a social worker or a member of the duty team .

• Advance warning of an assessment will allow the police to respond quickly if thesituation changes and is perceived by the AMHP as becoming dangerous . If thissituation arises the AMHP should immediately leave the premises and dial 999(see Appendix 5 : 'Where police assistance is immediately required " ) .

• If following the mental health assessment an application for detention under theMental Health Act is made , but the patient refuses to come to hospital , if thesituation is not critical the AMHP should withdraw and discuss the situation withtheir line manager . They should also discuss the situation with the LAS and th e


police and review the most appropriate way of conveying the person to hospital(see Conveyancing below) .

8 .4 WHEN TO USE 135(1 ) AND WHEN TO USE 135(2 )

8 .4 . 1 When to use Section 135(1 )

Section 135(1) should be used where there is a concern about a person who isNOT currently liable to be detained under the MHA .To obtain a warrant under Section 135(1) there must be reasonable cause tosuspect the person is suffering from mental disorder and has been , or is being ,ill-treated , neglected , or kept otherwise than under proper control OR is unable tocare for themselves and is living alone .The person empowered to obtain a warrant under this Section is an AMHP .

Therefore if a doctor , CPN or other is concerned about a person in private premiseswho may be mentally disordered and meet the conditions detailed above , an AMHPshould be contacted .

8 .4 .2 When to use Section 135(2 )

Section 135(2) confers a similar power to enter a private premises to take intocustody any patient who is ALREADY liable to be detained under the MHA in thefollowing circumstan ces :

• Detained patients who are AWOL , including those who have failed to return fromauthorised leave .

• Patients who are liable to be detained under the MHA but have absconded whilstbeing conveyed to hospital .

• Patients subject to guardianship who have absconded from the pla ce where theyare required to reside .

• Supervised Community Treatment patients who have not returned to hospitalfollowing recall , or have absconded whilst recalled .

A magistrate may issue a warrant under Section 135(2) provided they are satisfiedthat there is reasonable cause to believe that the patient is to be found on thepremises , and admission to the premises has been refused , or that a refusal of suchadmission is apprehended .

Unlike Section 135(1) a warrant under Section 135(2) does not necessarily have to beobtained by an AMHP .

Staff should bear in mind the need for strategies of pro-active care as an alternativeto obtaining a 135 warrant : e . g . calling repeatedly, calling at different or unexpectedtimes , approaches through relatives or friends . Use of such methods first may be , inany case , prove necessa ry in order to convince a magistrate to grant a warrant under135 .

8 .5 DUTIES AND RESPONSIBILITIE S

The following duties and responsibilities have been identified :

• Police Officers have prima ry responsibility for executing the warrant , gaining entryto the premises , restraining if necessa ry for the purpose of removing the patien t


from the premises and providing security and safety to those present .

• Ambulance Service to provide transport to remove patient to hospital .

Trust Mental Health Act Management to process 135 warrants , enter onto Trustdatabase , monitor use , prepare reports and statistics as necessa ry and raiseconcerns through joint monitoring arrangements .

8 . 5 . 1 For Section 135(1 )

• AMHP must obtain a warrant from the Magistrate and be responsible for co-ordinating the assessment and completing risk assessment (see Appendix 4 -Joint Risk Assessment Form) .

• Registered Medical Practitioner to accompany police office r and AMHP to assesswhether person is to be removed to a place of safety , and to consider making arecommendation for detention under the MHA .

8 . 5 .2 For Section 135(2 )

Officer of the staff of the hospital to which the patient is liable to be detained toobtain warrant from the Magistrate , complete risk assessment (see Appendix 4 -Joint Risk Assessment Form) and co-ordinate assessment , except when the135(2) is for an SCT patient liable to be recalled to hospital in which case thepatient ' s care co-ordinator is responsible for obtaining the warrant and co-ordinating the recall pro cess (see 11 . below - Section 17E Recall from CTOs) .

8 .6 GUIDANCE ON OBTAINING A S135 WARRAN T

• Application for warrants under S135 should be made in writing to a Magistrate forthe area in which the premises is located . The warrant shall identify the premisesto which it relates and identify , as far as is practicable , the name of the personsought .

• Magistrates are likely to ask anyone applying for a S135 warrant why they areapplying for one and if reasonable attempts to enter without a warrant have beenmade . Those applying for warrants should be prepared for this .

8 .7 EXECUTING A S135 WARRANT

• S135 warrants authorise ent ry on occasion only , two copies should be made -one for the police and one for the owner /occupant , ent ry and search must bewithin one month of the warrant's date of issue and a search under the warrantcannot extend beyond that needed to identify whether the person sought is there .

• Once a warrant under Section 135 has been obtained , the person responsible forco-ordinating the assessment will take the following action :

- Contact the local police and the brief them about the patient , their behaviour ,circumstances that are causing concern and the intended action (seeAppendix 3 for police contact details) .

- Complete a risk assessment using the format locally agreed for the purposearrange for it to be sent to the police .


• Co-ordinate an assessment , arranging for the police and doctor(s) to attend at anagreed time , date and place .

• The LAS no longer agree for an ambulance to attend at an agreed time , date andplace . (A new protocol for LAS response to calls from AMHPs or doctors to attendMHA assessments in the community was launched on 20 March 2012 . ) Under thenew protocol , these are the agreed response times :

8 minutes - life threatening situations or where the safety of the patient or staffare at immediate risk , including where there is active restraint leading to a riskof positional asphyxi a30 minutes - Urgent request where the patient is for example agitated ordistressed and where a greater delay is felt likely to result in deterioration ofthe situatio n60 minutes - Where a patient is informal or compliant and not in any danger ofharm to self or others (under this protocol , 60 minutes is the agreed maximumtime to wait for an ambulance )

• If a warrant has been issued under S135(1) the police officer must beaccompanied by an AMHP and at least one doctor , the AMHP and doctor have ajoint role to assess whether the patient should be removed to a place of safety .

• If a warrant has been issued under S135(2) the poli ce officer need only beaccompanied by one person authorised to retake the patient (this could be doctor/ AMHP /nurse) .

• The power to remove the patient only applies if such action is thought to benecessary .

• If the occupier of the premises is present at the time when the police officer seeksto execute the warrant , the police officer shall :

- Identify themselves to the occupier .- Produce the warrant for the occupier and supply them with a copy .- Complete and sign the endorsement section at the bo ttom of the warrant .- Leave a copy of the warrant on premises (if the occupier is not present and

entry has been executed) .

It should be borne in mind that a warrant under S135(1) gives powers but doesnot compel the police to force ent ry to the premises or convey the patient tohospital if the patient is cooperating with the assessment . However the policeshould remain in attendance as the person being assessed may change theirmind at any point during the course of the assessment and police assistance maythen be required . The warrant is executed once ent ry to the premises has beenaffected by the police , be it by force or invitation .

• It is a criminal offence under Section 129 of the MHA to obstruct those exercisingtheir functions under the Act . Therefore if an authorised person wants to searchpremises for a mentally disordered person and they are obstructed in their searchit may be helpful to remind any person(s) causing the obstruction that they arecommitting an offence , as a means of persuasion to gain access to the property .

8 .8 LEVEL OF POLICE RESPONS E


The number of police present and the how closely they control the assessmentwill va ry according to the level of assessed risk . As part of the co-ordinatingprocess the AMHP or other co-ordinating officer must review with the police onthe basis of the risk assessment any factors which indicate a high level of risk .The Police will car ry out their own risk assessment based on all availableinformation . On occasion use will be made of the Territorial Support Group (TSG)to provide the police support to Section 135 operations , as determined by policeprocedure .

The risk assessment should include :- History of risk of inju ry to self or others- Forensic histo ry- Histo ry of violence- Known previous use of firearms or other weapons- Known presence of another vulnerable person (e . g . a child) in the house

• Where the presence of risk factors suggests a higher level of risk the police willagree a proportionate response .

• This will affect :

- The urgency with which the assessment is arranged to take place

- The number of police officers detailed to attend

- Other safeguards as determined by the police

8 .9 S135 ASSESSMENT

• Once ent ry has been gained Section 135(1) allows a person to be assessed , andif their mental state and general condition warrants it , to be removed to a place ofsafety for up to 72 hours for a full mental health assessment . The place of safetywill be in line with the arrangements for Section 136 (see 7 . above - S136) .

• The 72 hours starts from the time the person arrives at the place of safety . If theperson escapes from the place of safety they can be retaken but not after the 72hours have expired .

• An alternative outcome is that whilst Section 135 is used to gain ent ry to thepremises , a full assessment under Part II of the MHA will then take place usingtwo doctors for Section 2 or Section 3 . If assessed as meeting the requirementsfor Section 2 or 3 , the patient will then be transported to hospital and admi ttedformally .

• It should not be ruled out that the outcome will be a decision that the person doesnot need , and does not meet the criteria for, detention . If removal and or detentionunder the MHA is not necessa ry professional should withdraw from the premisesand make it clear to the occupant that they are also free to leave .

8 . 10 TRANSPORTATION TO HOSPITA L

• When the outcome is removal to hospital/place of safety , use will normally bemade of an ambulance .

• The Police should remain in attendance until the person has been removed from


the premises and taken into the ambulance unless he/she is so violent that apolice van is required .

• Police should also remain if specifically requested by the LAS crew .

• Under Section 135 (1) the AMHP has the ultimate responsibility to ensure that thepatient is conveyed to hospital in a lawful and humane manner and should giveguidance to those asked to assist .

• The AMHP or a delegated other should accompany the patient and the policeshould follow in case the situation changes and their assistance is required .

• If there is a clear histo ry of risk of violence , in removing a person to hospital , thepolice should manage the overall process of entering and securing the premisesand the safe removal of the service user by the police , but only using policetransport if necessa ry, with the AMHP and or member of the ambulance staffaccompanying in the police van , with the ambulance following closely behind .

8 . 11 RIGHTS OF PATIENTS DETAINED UNDER S13 5

• Where a hospital is used as a place of safety it is the responsibility of the staff , onbehalf of the hospital managers , to provide the detained patient with informationabout their legal rights in accordance with Section 132 of the MHA . (See Code ofPractice 10.45 to 10 . 48)

8 . 12 CONSENT TO TREATMEN T

Detaining in a place of safety under S135 does not confer any power under partIV of the MHA to treat them without their consent (see Code of Practice 10 . 49) .They are in exactly the same position as patients who are not detained under theMHA in respect of consent to treatment . In emergencies , however , it may bepossible to provide treatment under the Mental Capacity Act if the treatment is intheir best interests and they lack the capacity to consent to it .

8 . 13 TRANSFER BETWEEN PLACES OF SAFETY

• The MHA 2007 introduced a power to transfer patients detained under S135 fromone place of safety to another as long as this is within the 72 hour period allowedbefore the power of detention expires (see Code of Practice 10 . 34 to 10 . 39 fordetailed guidance) .

• Detentions under S135 (1) are normally arranged in advance . Therefore as thelocal psychiatric unit will usually be the identified place of safety it will be lesslikely that transfers between places of safety will be require d

• Any decision by a doctor or other healthcare professional to transfer to anotherplace of safety must be based on clinical need in the interest of the patient ' shealth and safety .

• The decision whether to transfer a person to a different place of safety shouldreflect the individual circumstances of each case . For example , transfer to A&E todeal with a medical emergency .

• The original time of detention and time of any transfer should be clearly recorded


and this information shared between the transferring and receiving place ofsafety .

8 . 14 TERMINATING S135 (1 )

• The authority for detention under this section ends after the assessment processhas been completed and it has been decided to make no application in respect ofthe person detained under Part II of the MHA .

• A person who is detained in hospital under S135 pending completion of theirassessment cannot have their detention extended by the use of a S5(2) or S5(4) .


9 . SERVICE USER MISSING FROM A HEALTHCARE SETTING OR AWO L

These are the procedures to be adopted and the roles and responsibilities of both theMetropolitan Police Se rvice and staff of Barnet, Enfield & Haringey Mental HealthNHS Trust, in the event of a service user being missing from hospital or otherhealthcare setting .

The procedures below apply to both informal patients and those detained under theMental Health Act 1983 . The term ` hospital ' in this part of the protocol also coversother `healthcare settings ' .

The procedures and related flowchart are to ensure that consistency in practice isachieved across all the boroughs and services which make up the Barnet , Enfield &Haringey Mental Health NHS Trust .

They are aligned with the Pan London Guidance on service users missing fromhospital and other healthcare settings and were approved by the London MentalHealth Partnership Group and developed by the London Development Centre forMental Health , on their behalf (Appendix 6) .

9 . 1 ADVANCE PLANNING FOR ALL SERVICE USERS ADMITTED TO HOSPITAL

• On admission of a patient to hospital , the clinical team should immediately carryout and document an interim care plan and risk assessment . These documentsare dynamic and will be regularly updated .

• Nursing staff will also develop a 'missing person 's information pack '2 which willcontain information about the patient and in certain cases , a photograph shouldthey go missing whilst on the ward .

• The pack will contain information about the person , which will be shared with thepolice and used by them to complete information on their MERLIN database .

• All patients admitted to Mental Health Wards should be asked to sign a consentform , authorising the taking of their photograph . It should be explained to patientswho voluntarily agree to this process , that the taking of their photograph is toassist in hospital and patient security arrangements . It should also be stressedthat the photograph will be returned to the patient upon discharge .

9 .2 RESPONSE TO A SERVICE USER WHO IS MISSING

9 . 2 . 1 Serv ice User Not Where He/She Ought To Be

If a service user is found to be missing , staff will initiate this protocol as detailedbelow . In implementing the protocol , the overriding principles are to :

• Determine clearly that the service user is in fact missing ;• Consider what , if any , risk his/her absence poses either to him/herself or others• Consider whether to call the police and/or others to help locate the service user ;• Consider what action should be taken when the person is located ;• If subject to detention under the Mental Health Act , to consider if and how the

se rv ice user should be returned to hospital 4 .

2 Missing Person 's Information Pack - see Appendix 84 For patients detained under the Mental Health Act - see Appendix 9


9 . 2 . 2 Hospital Staff Conduct Immediate Search of Wards and Ground s

• If a service user is missing , the staff member in charge of the ward or area willarrange for hospital and/or security staff to make a thorough search of the unitand the grounds within the hospital complex . Additionally, the staff member incharge will inform the service user' s family/relatives/carers that the patient ismissing .

• The service user's family/relatives/carers must be kept informed of all actionstaken by the Trust staff throughout the period during which they are missing .

9 . 2 .3 Hospital Staff Carry Out and Document Risk Assessment

• On establishing that the service user is missing , the staff member in charge of theward or unit, in conjunction with others , will car ry out a risk assessment in linewith the Trust ' s policy on risk management .

In doing so , they will determine whether the risk presented by the service user isHigh , Medium or Low , as described in the Association of Chief Police Officers'Risk Assessment , (see 9 . 2 .4 below) . This format must be used to help decidewhether or not to seek police assistance in locating the service user and returninghim/her to the hospital . (Note : if the service user is detained under a Section ofthe Mental Health Act , this does not in itself indicate medium or high risk . )

• In the event that the service user 's absence is considered to constitute a mediumor high risk , the staff member in charge of the ward/unit should inform his/her linemanager or duty manager out of hours .

• Consideration should also be given as to whether it would be appropriate to treatthe service user 's absconsion as a Serious Untoward Incident according to theTrust 's Incident Management Policy .

9 . 2 . 4 Hospital Staff Make Decision on Level of Ris k

• As soon as nursing staff are aware that a service user has gone missing , theservice user's clinical team must decide whether the risks presented to theservice user and to others by the fact that they are missing , are of a low , mediumor high risk .

• The Association of Chief Police Officers' Risk Assessment factors (which areused by the Police to determine levels of risk) states :

Low R isk : "no apparent threat of danger to either subject or the public "

Medium Risk: "risk posed likely to place the subject in danger or they are a threatto themselves or others"

High Risk: "risk posed is immediate and there are substantial grounds forbelieving that the subject is in danger because of their ownvulnerability or mental state , or the risk posed is immediate andthere are substantial grounds for believing that the public is indanger through the subject 's mental state"


9 . 2 .5 Low Risk : Hospital Staff Attempt to Locate Service User and Return Within SpecifiedTime Limit

If it is determined that the service user is of low risk , the minimum response which willbe provided will be as follows :

• Immediate search of the ward , unit and hospital grounds ;

• If the patient is detained , inform the Mental Health Act Administrator that thepatient is AWOL ;

• Inform service user's family/relatives/friends - at the same time make enquiries asto whether they have seen the service user or if he/she has returned to home , oris with them ;

• Inform the community mental health team and other involved agencies ; and

• Seek their help in locating the patient .

• The risk status of the missing person is to be periodically reviewed by the hospitalas this may change due to factors such as the passage of time without medicationor their vulnerability . In the event of a change to medium or high risk the PoliceCentral Communications Command (CCC) is to be informed .

9 . 2 . 6 Service User Located and Returned Within Time Limit

Once the service user is found , a decision should be made by the service user ' sclinical team as to how and when the service should return to hospital .

Possible options for return of the service user include :

• Visit to service user's home by their named staff member , supported by acommunity mental health professional ;

• Service user assessed by clinical team for period of leave ;

• Discussion held with service user as to whether they should immediately return tohospital in order to complete their in-patient stay ; o r

• Remain on leave and return at an agreed date for further assessment by theirclinical team (for example , at the next ward round) ;

• In the event of the service user 's continued absence , staff should regularly reviewthe level of risk they present , with a view to possible upgrading of level of risk tomedium or high .

• Low risk missing persons should be reported to the police after 24 hrs . This canbe done over the phone . Police can then create a Merlin report and circulatedetails .

9 . 2 .7 Medium or High Risk: Hospital Staff Report Service User to Police as Missin g

If a missing servi ce user is assessed as being of either medium or high risk , the staffmember in charge of the ward/unit will notify the Police Control Room and will arrangefor an officer to attend the hospital to take details for a Merlin Report and a PoliceRisk Assessment .

The Grab Pack will contain the following information :


• A recent description of the person , in line with the poli ce Merlin documentation ;

• In the case of forensic patients , a recent photograph of the se rvice user (ifavailable) .

• In the case of service users from other Trust services/units , a photograph is nottaken as a matter of routine but may be done so in accordance with Trust'sPolicy on photographing patients , where it is considered that there is a particularrisk to the se rv ice user or others in the event of his/her absconsion ;

• The most recent multidisciplinary clinical risk assessment;

• Essential medication or treatment required in order to preserve life (as opposedto improving the quality of life) ;

• The name and dosage of any medication along with the predicted or anticipatedeffect of failing to receive it ;

• Any physical inability to interact with others or diagnosed medical conditionlinked to vulnerability , e . g . visual impairment , Alzheimer's ;

• Any other factor(s) or circumstances , which may affect the risk of assessment ofthe missing person .

9 . 2 .8 Police Car ry Out Risk Assessment

Once it has been reported to the Police that a service user is missing the Police willcarry out their own risk assessment , based on the information provided by the Trust .The criteria they will use are described above (see paragraph 4) . The Police will alsoconduct any enquiries necessa ry and inform their supervisor and the Trust of theiractions .

9 . 2 . 9 Police and Hospital Staff Develop and Document Joint Action Pla n

A Joint Action Plan regarding the management of the patient once they are locatedand how they will be safely returned to hospital must be made with the Police once aservice user has been reported as missing .

The Joint Action Plan must include proactive actions in terms of what each respectiveagency will do should the service user be located .

The Police will not deal with the return of a patient on their own . A minimum level ofhospital resources must therefore be available for the joint operation to locate andreturn missing service users to hospital . All joint action will require :

• A planning/briefing meeting ;

• A documented risk assessment

• A de-briefing meeting .

If a patient of medium or high risk is not found , the police and the patient ' s clinical andcommunity mental health team should , if appropriate , consider referring the patient tothe Multi-Agency Public Protection Arrangements (MAPPA) .

All decisions to refer a service user to MAPPA must be discussed with a Servi ceManager and/or Assistant director for that service , prior to any referral being made .


9 .3 RETURNING THE SERVICE USER TO HOSPITA L

9 . 3 . 1 Return of Patients to Hospital , Who is Absent Without Leave and Under A Section ofthe Mental Health Act (AWOL) .

9 . 3 . 2 If a detained patient who is missing is located before the limit of their section expires ,the patient can be apprehended and returned to the ward from which they are AWOL(see Appendix 9) . The preferred method of returning the patient to the ward is byambulance . If necessa ry, Police may escort the patient by riding in the ambulanceand/or following in a police vehicle if the patient is likely to be dangerous or violent .

9 . 3 . 3 The patient may be returned to their ward by Police transport in extreme cases asabove . The highest qualified member of the LAS crew should accompany in th epolice vehicle and the ambulance follows behind . However, it is preferable that prio rto police transport being used , there should be attempts made by hospital staff andcommunity based mental health staff to encourage the patient to return of their ow nfree will .

9 . 3 . 4 The power of arrest and the use of reasonable force in relation to the retaking ofAWOL patients can be given to nominated persons (including a constable and otherhospital staff) under Section 18 of the Mental Health Act 1983 .

9 . 3 .5 Note : Section 18 does not provide a power to enter premises by force . Unless theowner of the property provides wri tten consent to the police to be on the premises ,the hospital ward staff will be informed of the whereabouts of the missing patient andthe Mental Health Trust will then consider the use of a Section 135(2) warrant toobtain accesss .

9 . 3 . 6 In the absence of a Section 135(2) warrant , a police office may use force to enter an dsearch any premises for the purposes of saving life or limb or preventing seriou sdamage to property (Section 17 , Police & Criminal Evidence Act 1984) providing th eofficer has reasonable grounds for believing that such threats are likely . The use ofcriminal law to carry out a forced ent ry to private premises should not be resorted to ,unless there is an immediate need to prevent serious harm .

9 . 3 . 7 Any decision taken in relation to patients who are currently liable to be detained underthe Mental Health Act must take full account of the guiding principles governing theuse of the Mental Health Act (Code of Practi ce - Chapter 1) .

• Purpose

• Least Restriction

• Respect

• Participatio n

• Effectiveness, Efficiency and Equity

6 See Trust 's Protocol and Pan London Guidance for the Assessment of Persons on PrivatePremises (Section 135)


9 .4 RETURN OF INFORMAL PATIENTS WHO ARE ABSENT AGAINST CLINICALTEAM ADVIC E

There is no power to apprehend a service user who is not detained under the MentalHealth Act , i . e . an informal patient who is reported as missing . Action by the Policewill therefore be confined to :

• Use of Section 136 : If the se rvice user is found in a public place and appears tobe suffering from a mental disorder and is in immediate need of care and control ;

• Informing hospital staff of the patient 's whereabouts if located on privatepremises , so that the clinical team can consider further appropriate action . Theperson will no longer be regarded as missing once the hospital is notified .

9 .5 DE-BRIEFING , LEARNING AND PREVENTIO N

9 . 5 . 1 On his/her return to the hospital , the service user should be reviewed as soon aspossible by the staff member in charge . In most cases , the service user should alsobeen seen and examined by the ward or duty doctor .

9 . 5 . 2 Any relevant information obtained from the interview with the service user will beconsidered by the service user's clinical team for further development of their careplan and risk assessment .

9 . 5 . 3 Any lessons learnt from the incident will also be considered by the staff member incharge and Service Manager and translated into appropriate action , so as to preventsimilar incidents reoccurring .


10 . TRANSPORT, CONVEYANCE AND SECTION 6 MHA 1983

The Mental Health Act Code of Practice requires Local Social Se rv ices Authorities(defined in S . 145 (1) Mental Health Act) , the NHS and the local Police Authority toestablish a clear protocol for the use of the powers to convey a person to hospitalunder S . 6(1) Mental Health Act.

These procedures outline the roles and responsibilities of each of the organisationsinvolved , therefore providing guidance for ambulance service personnel , medicaland/or other healthcare practitioners , Approved Mental Health Professionals (AMHPs- as defined in S114 Mental Health Act) , and police officers .

The overall aim of this protocol is :

` To ensure that persons detained under the Mental Health Act are conveyed tohospital in an approp riate vehicle and in the most humane way possiblefollowing an assessment of their mental health needs by a doctor and anApproved Mental Health Professional. '

10 . 1 COMMITMENT OF SIGNATORY BODIES

London Ambulance Se rvice will exercise its authority to convey under S .6 (1)Mental Health Act, using the most appropriate vehicle for the presentingcircumstances .

Barnet , Enfield and Haringey Mental Health NHS Trust recognises theimportance of mu l ti-agency work under the Menta l Hea l th Act. The Trust iscommitted to providing an efficient and effective response to requests for supportand/or assessment . Barnet, Enfie ld and Haringey Menta l Hea l th NHS Trust wi llalso ensure that mental health staff have appropriate training to support actionsthat may be required, such as bed management, in the execution of this protoco land procedures .

Barnet, Enfield and Haringey Local Social Se rv ices Authorities will makeavailable Approved Mental Health Professionals (AMHPs) under S . 114 MentalHealth Act for the purposes of activity under this protocol and procedures asappropriate . Barnet, Enfield and Haringey Local Social Se rvices Authoritiescommit themselves to providing an efficient and responsive 24-hour AMHPService . During working hours an AMHP will be provided by the local AMHP rotaservice and by the relevant local out of hours servi ce at all other times .

• Metropolitan Police Se rv ice recognises the importance of multi-agency workunder the Mental Health Act and in particular , with supporting London AmbulanceService in the delive ry of its conveyance responsibilities . Metropolitan PoliceService is in the process of forming a Tri-Borough Mental Health Liaison Tea m

10 .2 CONVEYANCE PROTOCO L

10 . 2 . 1 A properly completed application for admission under the Mental Health Act , togetherwith the required medical recommendations , gives the applicant (an AMHP or theNearest Relative - as defined in S . 26 (3) Mental Health Act) the authority to conveythe patient to hospital .

10 . 2 . 2 A patient will be conveyed to hospital in the most humane and least threatening way ,consistent with ensuring that no harm comes to the patient or to others (se e


paragraph 5 . 5 below) .

10 . 2 . 3 MHPs authorised to convey under the Mental Health Act will have all the powers of apolice constable in respect of , and for the duration , of the conveyance of the patient .

10 . 2 . 4 All patients subject to an application for admission under the Act will be conveyed tohospital by London Ambulance Service using an appropriate vehicle and with suitabl ytrained staff . In situations where the risk of inju ry to patients or staff is likely , theassistance of Metropolitan Police may be required . The emphasis within the Menta lHealth Act 1983 code of practice is strongly geared towards the use of ambulanc etransport arranged by health and social care and the preservation of the patient ' sdignity and privacy . The key message is the use of police vehicles to transpor tpatients should only be considered , only as a last resort , where the patient is violentor dangerous or it is a matter of extreme urgency .

10 . 2 . 5 The patient should only be conveyed by private car in exceptional circumstances andif the AMHP is satisfied that the patient does not present a danger to themselves orothers . There should always be at least one escort for the patient other than thedriver . The car driver must have appropriate car insurance cover.

10 . 2 . 6 Where a patient , previously admitted to hospital is returned to that hospital from S . 17Mental Health Act leave or community treatment , the expectation is that the patientwill be conveyed by a member of the hospital ward staff or a staff member who knowsthe patient .

10 . 2 . 7 If the assistance of the London Ambulance Servi ce is requested , it will use the mostappropriate vehicle available . This may be a volunteer car driver with an escort toconvey the patient . The London Ambulance Service will make eve ry effort to returnthe escort to his/her starting point , although this cannot be guaranteed .

10 . 2 . 8 Where a patient is subject to S . 17 Mental Health Act leave or community treatmentand is non-compliant with the care plan and needs to be returned to hospital , theResponsible Clinician (defined in S .34 (1) Mental Health Act) , or other staff acting onhis/her behalf, will need to decide the most appropriate conveyance required , and co-ordinate the agencies to effect the recall to hospital .

10 . 2 . 9 In this particular situation , the Responsible Clinician , or other staff acting on his/herbehalf, should arrange for the London Ambulance Service to be sent written authorityto convey the patient and to be given the name of the authorising clinician . This maybe done by fax, or else by telephone followed up by post at the earliest opportunity .

10 .2 . 10 Where a member of the public has had a warrant served on them under the auspicesof S . 135 (1) Mental Health Act, and is required to be conveyed to a hospital subject todetention under the Mental Health Act , or to a place of safety for the purpose of a fullMental Health Act assessment , the organising of the conveyance arrangements willbe the responsibility of the AMHP .

10 .2 . 11 Where a detained patient has absented themselves from hospital and is to bereturned following a warrant issued under the auspices of S . 135 (2) Mental HealthAct , the most appropriate conveyance arrangement will be organised by any personauthorised by the hospital managers .

10 .3 ROLES AND RESPONSIBILITIES


10 .3 . 1 The Approved Mental Health Practitioner (AMHP) will take the lead in all ma ttersrelating to conveyance to hospital of patients who are liable to be detained under theMental Health Act . The AMHP will consult appropriately with staff from otheragencies .

10 .3 . 2 The AMHP will establish the most appropriate conveyan ce arrangements. This willinclude an assessment of risks needing consideration when conveying the patient tohospital . The risk assessment will be shared with the London Ambulance Service ,Police , and other colleagues . The risk assessment will be formally recorded .

10 .3 . 3 Where the Nearest Relative is the applicant , the assistance of an AMHP should bemade available , to give guidance and help on all aspects of conveyance and othermatters related to the admission .

10 .3 . 4 When the AMHP is the applicant he/she has a duty to ensure that all necessa ryarrangements are made for the patient to be conveyed to hospital . Where anapplication for compulso ry admission to hospital appears likely to take place , it isconsidered best practice to inform the London Ambulance Service well in advanceand prior to signing any Mental Health Act papers .

10 .3 . 5 The AMHP should ensure the needs of the patient are taken into account (see above ,paragraph 4 . 2) and give particular consideration to :

- The patient' s wishes .- The views of relatives or friend(s) involved with the patient .- The views of other professionals involved who know the patient .- His or her judgment of the patient ' s state of mind , and the likelihood of the

patient behaving in a violent or dangerous manner .- The impact that the use of a police vehicle may have on the patient ' s

relationship with the community to which he or she will return .- Previous experience of conveying the patient .

10 .3 .6 The AMHP is permi tted to delegate the task of conveying the patient to anothe rperson , for example personnel from the London Ambulance Service or th eMetropolitan Police Service . It is good practice and generally expected however tha tthe AMHP will personally accompany the patient to hospital . The AMHP retainsultimate responsibility to ensure that the patient is conveyed in a lawful , safe andhumane manner, and must be ready to give the necessary guidance to those askedto assist . If the task is delegated , a form of authorisation should be given to th edelegated person (see : Appendix 11) .

10 .3 . 7 If the AMHP delegates the conveyance of the patient she/he must be confident tha tthe person accepting this responsibility is competent and fully aware of thei rresponsibilities in relation to this task . (The vehicle and crew dispatched would beconsidered as part of the LAS tasking process and may result in an A&E Suppor tcrew being dispatched . IF the patient is violent or likely to abscond then A&E Suppor tcrews should only be dispatched if they have a suitable escort) .

10 .3 . 8 Where there are delays in arranging admission , it may be necessa ry for the AMHP todelegate the task of co-ordinating conveyance to hospital to a second AMHP . This isacceptable in exceptional circumstances . If the task is delegated , a form ofauthorisation should be given to the delegated person (see : Appendix 11) .

10 .3 . 9 In exceptional circumstances , the AMHP may delegate the responsibility forconveying the patient to a professional worker other than an AMHP and not


accompany the patient to hospital . The AMHP must discuss this decision with theduty manager prior to delegating their authority . The AMHP or duty manager mustcontact the hospital accepting the patient and confirm the papers have been received .It is considered good practice to fax a copy of the papers to the receiving hospitalprior the patient arriving there . If the delegated organisation encounters difficulty withthe arrangements , it will need a means of contacting the AMHP or the relevant dutymanager . The AMHP will provide these contact details on the delegation form (see :Appendix 11) .

10 .3 . 10 The AMHP should take into account the needs of the patient and the views of th eNearest Relative , the London Ambulance Service or Police when deciding whether t oaccompany the patient to hospital in the same vehicle . A decision should be reache dby negotiation with the above , depending on individual circumstances . If the patienthas been sedated , the London Ambulance Service will advise on the mostappropriate vehicle to be used . In such circumstances , the patient should b eaccompanied by a nurse , a doctor or a paramedic experien ced in this area .

10 .3 . 11 Only suitably qualified medical practitioners can prescribe medication and/o rauthorise and arrange any nurse escort . If the medical practitioner has to leave prio rto the patient being conveyed to hospital he/she must ensure that the AMHP i sinformed of how to contact him/her or the duty psychiatrist in his/her absence. In theevent of detention under S .4 Mental Health Act the assessing doctor will have thi sresponsibility .

10 .3 . 12 If the patient would prefer to be accompanied by another professional or by any otheradult , that person may be asked to escort the patient provided the AMHP is satisfiedthat this will not increase the risk of harm to the patient or to others .

10 .3 . 13 The AMHP should request the assistance of the Metropolitan Police if there is anassessed risk of violence during the assessment , conveyance , or admission process .If the request for police assistance is for a pre-planned assessment the AMHP shouldcontact the Tri-Borough Mental Health Liaison Team .

10 .3 . 14 If the assistance of the Metropolitan Police is required within a less than 24 hou rperiod , the AMHP should phone Met Call on 0300 123 1212 , stating a request fo rassistance with conveyance to hospital under the Mental Health Act . The AMHPshould then give details of the patient , the address and any information arising fro mhis/her risk assessment . The Metropolitan Police call handler will provide the AMH Pwith a computer-generated CAD `serial number' .

10 .3 . 15 If the situation during the assessment deteriorates and risks increase prior to th earrival of the Police , the AMHP will telephone 999 , quote the serial number and as kfor the request for assistance to be upgraded . The evidence for the upgrade requestwill be based on previous knowledge of the patient and his / her presentingbehaviour . The Joint Risk Assessment will be completed and the AMHP will ensurethat the reasons for requesting more urgent assistance from the Metropolitan Policeare accurately recorded on the agreed documentation .

10 .3 . 16 Where the risk assessment conducted by the AMHP concludes that there is a threa tof violence or harm or a risk that the patient will abscond , the AMHP will discuss th emerits of the Metropolitan Police attending for the Mental Health Act assessmen titself, and/or providing an escort in any subsequent conveyance of the patient t ohospital . The jointly agreed Risk Indicator Checklist will be completed and used as th ebasis for discussion between AMHP and Metropolitan Police about the presentin grisks .


10 .3 . 17 In order to expedite the transfer of responsibility for the patient , the AMHP shouldensure that the receiving hospital is expecting the patient , and telephone ahead withlikely time of arrival . The AMHP should ascertain the name of the person who will beformally receiving the admission papers .

10 .3 . 18 The AMHP should arrive at the same time as the patient at the hospital and remainthere until he/she has ensured that :

• The admission documents have been delivered , checked for accuracy andreceived on behalf of the Hospital Managers .

• Any other relevant information is given to the appropriate hospital personnel .

• The patient has been detained in a proper manner .

10 .3 . 19 If the AMHP has accompanied the patient in a vehicle provided by either the LondonAmbulance Service or the Metropolitan Police , eve ry effort will be made to return theAMHP to a convenient location by that means . If this is not possible , the AMHP , plusany escort , will need to use the services of a taxi or other transport .

10 .3 . 20 The Metropolitan Police will respond to a request for assistance where there is athreat of violence or harm to the patient , other persons or property , or a risk thepatient will abscond . The AMHP and police will agree the most appropriate responseto ensure the safety of all concerned - which may or may not require action by thepolice . Metropolitan Police will ensure that any action they take is proportionate to th esituation presenting . They will also , where this is not inconsistent with their duty t oprotect persons or property or the need to protect themselves , comply with an ydirections or guidance given by the AMHP while the patient is being conveyed t ohospital .

10 .3 . 21 Where an AMHP requests the assistance of the Metropolitan Police , this will be metas far as practicable . The Police will use their discretion on the number of officers t obe deployed but their overriding duty is to protect the patient from self harm , andothers , including themselves , from the actions of the patient . Where , for operationa lreasons , Police find this difficult , there will be discussion between the Duty Inspecto ror Sergeant for the borough concerned and the AMHP or appropriate Mental Healt hDuty Manager .

10 .3 . 22 In exceptional circumstan ces where there is concern about the safety of the patient orother persons, a police vehicle may be used with the police and AMHP as an escort ,if appropriate . If the patient is to be conveyed by the Metropolitan Police , policestanding orders require that the patient is searched .

10 .3 . 23 Where there is a risk of violence or harm to persons or property , and the police haveconveyed the patient to hospital , the admission should be effected as efficiently aspossible and the time spent by Police in hospital restricted to the minimum requiredfor safe transfer of responsibility .

10 .3 . 24 Where it is necessa ry to use NHS transport services to convey the patient to hospita lthe responsibility lies with Barnet , Enfield and Haringey Mental Health NHS Trust o rthe Prima ry Care Trust in whose area the journey arises . This is the situation for bot hNHS and private healthcare patients . In London , NHS transport se rvices are provide dby London Ambulance Service . The patient must be conveyed to a named hospita lexcept in the case of acute hospital over-spill (see paragraphs 8 . 1 - 8 . 2 below) .


10 .3 . 25 Where a privately funded patient is requesting admission to a particular privatehospital , the patient will be responsible for the cost of the transport .

10 .3 . 26 Staff employed by the London Ambulance Service should , where it is not inconsistentwith their duty , comply with any directions or guidance given by the AMHP . If the crewof the vehicle provided by London Ambulance Service believes that by conveying thepatient in their vehicle they would put themselves , the patient or other road users atrisk , they may refuse to convey the patient and other assistance should be requested .

10 .3 . 27 An escort should only be provided if needed and appropriate . This will depend onindividual circumstances , and must be agreed between the AMHP , the S . 12(2) MentalHealth Act-approved doctor , the General Practitioner (if present) , personnel fromLondon Ambulance Service and , where appropriate , the Metropolitan Police .

10 .3 . 28 The escort could be the AMHP or , with the AMHP 's agreement, any other adult , oranother professional person . The escort must have an appropriate level of training tomeet the patient 's needs and welfare . This should not preclude the Nearest Relativeexercising their right to accompany the patient . If the patient has been sedate dhe/she should be accompanied by a suitably trained professional .

10 .3 .29 As a guide , the use of escorts should be considered in the following situations :

• Where the protection and/or support of both the patient and transport

• se rv ice personnel is required ;

• Where the presence of a particular escort , e .g . relative , friend , nurse , socialworker , will assist in the patient's conveyance to hospital .

• Where presence of the Police is needed to prevent a breach of the peace orbecause the patient presents a physical risk to others .

• Further detailed guidance can be found in Chapter 10 in the Mental Health ActCode of Practice , 2008 .

10 .4 LONDON AMBULANCE SERVICE RESPONS E

10 . 4 . 1 When requested , London Ambulance Service has duty to provide an appropriatevehicle and suitably trained staff to convey the patient to hospital .

10 . 4 . 2 The assessing doctors and AMHP need to agree the required time of the patient ' sarrival at the receiving hospital . This time frame must be agreed between the AMHPand `Ambulance Control ' . All patients detained under the Mental Health Act whorequire NHS transport to convey them to hospital are considered as `urgent' in thesense of requiring transport within an agreed time .

10 . 4 . 3 As soon as it becomes clear that NHS transport is required , the AMHP should contactthe London Ambulance (LAS) Emergency Operations Centre (EOC) giving as muc hdetail as possible . A patient ' s journey will be entered into the computer system , whichwill be assigned a unique incident number . The AMHP may contact the LAS EOC atany stage giving the incident number , to update or discuss the progress of th eincident . If the admission is stopped at any stage it is the responsibility of the AMH Pto contact LAS EOC and cancel the journey .

10 . 4 . 4 An urgent referral may be upgraded to an immediate request by the AMHP if :


• The patient 's mental state deteriorates ; or

• Ambulance control are unable to meet the agreed time frame for hospitalarrival and the AMHP does not agree to extend the time frame because of thepatient's mental condition .

10 . 4 . 5 Due to the complexity of some of the journeys , the discussion between the AMHPand LAS Emergency Operations Centre should make the exact circumstances of thesituation completely clear . If any difficulties arise , the AMHP should ask to be referredto the Operations Centre Manager (OCM) .

10 .5 RESTRAINT

10 . 5 . 1 In the process of conveying a patient to hospital any of the parties can use such for ceas is proportional and reasonable in the circumstances . Although it is not possible tobe definitive as to what proportional means in practice , there should be consultationwith the patient , the Nearest Relative and other professionals to assist in thi sjudgement . Each situation must be assessed on its individual merits and be informe dby the medical assessment(s) and the AMHP assessment .

10 . 5 . 2 All AMHPs must work in line with organisational Health & Safety and Violence atWork policies .

10 . 5 . 3 If physical intervention is necessary then the use of minimum force (acting undercommon or statute law) may be required to maintain the safety of the staff and othersinvolved in the conveyance arrangements . The circumstances and reasons for doingthis must be recorded in the Mental Health Act assessment documentation .


11 . SECTION 17E RECALL FROM COMMUNITY TREATMENT ORDERS (CTOs)

11 .1 OVERVIEW

11 . 1 . 1 CTOs are used most often for higher risk , "revolving door" patients who are difficult toengage and/or non-compliant with treatment , so as to put themselves or others atrisk . It is likely to include those on current extended Section 17 leave from hospitaland those on Section 25A Community Supervision Orders (which will be superseded) .

11 . 1 . 2 Joint applications from the Responsible Clinician (RC) formerly the ResponsibleMedical Officer (RMO) and Approved Mental Health Professional (AMHP) formerlyApproved Social Worker (ASW) are both required to place a patient on a CTO . Thepatient will already be on a Section 3 (or 37) Hospital Treatment Order prior to beingplaced on a CTO .

11 . 1 . 3 In effect when a patient is placed on a CTO , the underlying Section 3 Order is"suspended ", lying inactive unless the CTO is revoked following recall of the patientwhen it is then reactivated .

11 . 1 . 4 CTOs are initially renewable after six months and yearly thereafter . As long as theCTO is in place , the underlying Section 3/37 Order remains suspended .

11 . 1 . 5 If a patient fails to keep to the Mandato ry or Discretiona ry conditions of the CTO , theResponsible Clinician can decide to recall the patient . Patients who breakDiscretiona ry Conditions must also fulfil the criteria of being an immediate o rimminent risk to themselves or others to justify recall . Frequent "routine " recall ofpatients who break Discretiona ry Conditions but are otherwise not unwell i sinappropriate . (The RC should reconsider the effectiveness and practicability of CTO sin such cases . )

11 . 1 . 6 A patient must be served written notice of recall to signal the recall process . I fdirectly/personally served to the patient , the notice takes immediate effect . If contactcannot be made with the patient , the written notice is then either hand-delivered o rsent by first-class post to the patient 's last known address . If hand-delivered , thenotice is deemed to be served (and takes effect) on the day after it is delivered-that is ,the day (which does not have to be a working day) beginning immediately afte rmidnight following delive ry . If sent by post , the notice is deemed served on th esecond working day after delive ry .

11 . 1 . 7 A patient who is recalled and who fails to respond to the written notice or refuses t oagree to return immediately to hospital is deemed AWOL . Recall proceduresinvolving the police can be commenced ONLY AFTER THE PATIENT HAS BEE NSERVED WRITTEN NOTICE OF RECALL . A discretiona ry time period (ranging fro mone to several days) may be allowed (at the RC ' s discretion) for the patient torespond / comply with the Recall Directive before the recalled patient is deeme deffectively AWOL . (This time period may not apply if the situation is more urgent . )This means that the police will be notified only after the patient has been directl ygiven the notice (or it has been delivered to their address) and has failed to mak econtact/failed to agree to return to hospital voluntarily within an agreed time period . I tis at this point that he/she is judged to be AWOL .

11 . 1 . 8 Following the recall process , the Responsible Clinician (RC ) has 72 hours with whichto assess the patient , leading to one of the following :


• release of the patient (with , perhaps a review/revision of the agreed conditions) ;

• revocation of the CTO and hospitalisation under the underlying section ;

• treatment release of the patient ; or

• complete discharge of the CTO/underlying section order .

11 . 1 . 9 This protocol describes best practice in responding to these situations so as to ensurethe safe return of patients to hospital . It describes the role and responsibilities ofeach se rv ice potentially involved in locating and returning patients to hospital . It hasbeen made as comprehensive as possible , but recognises that it cannot addresseve ry eventuality and that the needs of individual patients and the judgement an dexperience of professionals will influence the application of the protocol . The protoco lwill be amended and revised in the light of experience .

11 . 1 . 10 This protocol will form the basis of a joint working agreement between :

• Barnet, Enfield & Haringey Mental Health NHS Trus t

• Haringey Social Se rv ices

• Metropolitan Police Haringey , Borough Operational Command Unit (BOCU)

• London Ambulance Service

11 .2 GUIDING PRINCIPLE S

11 . 2 . 1 Vulnerable patients , subject to CTOs , who are recalled , may be at risk .

11 . 2 . 2 Patients , subject to CTOs , are recalled to health and social se rv ices already involve din their care . Therefore the people best placed to respond to the needs of patients wil lprimarily be in these agencies , which will have a shared responsibility with the policefor locating and returning patients to hospital . The Care Co-ordinator (or other tea mmember co-ordinating the recall process) must identify and book a bed beforeseeking police involvement . The bed will usually be in the relevant local mental healt hinpatient unit (preferably on the relevant sector ward) but may be in another unit if th epatient is believed to be outside the catchment area .

11 . 2 . 3 The Metropolitan Poli ce will assist in locating and returning patients , subject to CTOs ,who are recalled to hospital when there is genuine and serious concern that th eperson is an immediate risk to themselves or to others . The police will also routinelyassist in locating and returning those patients who break Mandato ry Conditions (an dwho are deemed AWOL) whether or not there are serious risk concerns . This may bedone on a less urgent basis if there are no clinical / risk concerns .

11 . 2 . 4 These patients need to return to hospital as soon as possible in order that their careand treatment can continue , and this procedure needs to be undertaken with duerespect to their safety and dignity , as will as the safety and well being of carers andstaff.

11 . 2 . 5 In appropriate cases (i . e . those with significant risk to others and where the publi cinterest outweighs the confidentiality imperative) , consideration should be given toinforming the Police when a patient is made subject to a CTO , for inclusion on theCRIMINT system . This information sharing could be helpful if a patient comes intocontact with the Police and the situation the Police encounter indicates a relapse /deterioration in mental health . It may also help facilitate a faster response . However ,


the decision to share confidential information in this way will need to be carefullyconsidered on an individual case by case basis . For this purpose the Police can becontacted on the following email address : YR MentalHealth(aD- met . pnn . police . uk

11 . 2 . 6 The agreed place for assessment of recalled patients will normally be the hospital inthe borough where they reside i . e . Edgware Community Hospital (Barnet) , ChaseFarm Hospital (Enfield) and St . Ann 's Hospital (Haringey) . However , patients may berecalled to other hospitals or community mental health centres for onward transferafter assessment or admission .

11 .3 ROLE OF RESPONSIBLE CLINICIAN (RC )

11 . 3 . 1 A patient, subject to a CTO , may be recalled to hospital if their Responsible Cliniciandecides that they need to receive medical treatment for their mental disorder in ahospital and that , if they were not recalled to hospital for treatment , there would be arisk of harm to the patient 's health or safety , or to other people .

11 . 3 . 2 There is also a power to recall a patient to hospital if they fail to comply with one ofthe mandatory conditions of the order .

11 . 3 . 3 The RC may recall a patient by giving them wri tten notice of recall using Form CT03 .A copy of the form must be sent to the managers of the hospital , the RC must also tellthose managers the name and address of the Responsible Hospital (RH) .

11 . 3 . 4 The patient may be recalled to any hospital , not just the Responsible Hospital (RH) .In practice , a patient should not be recalled to any hospital unless it has bee nestablished that the target hospital can accept them - hospital managers are notobliged to accept patients just because a RC has issued a recall notice . In practice ,the Responsible Clinician will delegate the responsibility the securing of a bed and th eco-ordination of the recall process to the Care Co-ordinator .

11 . 3 . 5 A patient may be recalled even if they are already in hospital at the time . This couldhappen , for example , if a patient attends hospital either voluntarily or to comply with acondition of the CTO , but then refuses to ac ce pt the treatment the responsibl eclinician thinks is needed . If the patient , or someone else , would be at risk if th epatient does not have that treatment , the patient could be formally recalled to allowthe treatment to be given without the patient ' s consent .

11 .4 ROLE OF CARE CO-ORDINATOR

11 . 4 . 1 Care Co-ordinator under the Care Programme Approach (CPA) may come from arange of disciplines and settings . Most Care Co-ordinators are members of a CMHT .They may also be members of staff from residential settings in both the statuto ry andnon-statuto ry sector. In practice , patients subject to a CTO will usually have their caremanaged by a community mental health team (CMHT) under the Enhanced CPAprocess . They will therefore have CMHT Care Co-ordinators . It is the responsibility ofthe CMHT Care Co-ordinator to lead and co-ordinate action required to locate an dreturn a patient , subject to a CTO , who has been recalled to a ward .

11 . 4 . 2 The Care Co-ordinator has a responsibility to assist in locating and returning thepatient to the hospital with due regard to staff safety and the well being of the patient .

11 . 4 . 3 In the absence of the Care Co-ordinator , responsibility lies with the Team Manager ofthe Community Mental Health Team and to delegate responsibilities related to thisaction to other named team members .


11 . 4 . 4 Where appropriate and with due regard to local Health and Safety policies , the CareCo-ordinator will visit the patient at home or any other known location with the aim ofencouraging the patient to return to the ward . The patient should be conveyed tohospital in the least restrictive manner possible . If appropriate , the patient may beaccompanied by the Care Co-ordinator or a family member , carer or friend .

11 . 4 . 5 Risk assessments will have been carried out on all patients in accordance with thecurrent Clinical Risk Assessment and Management Policy and the Care ProgrammeApproach (CPA) Policy . Patient care plans will reflect the level of risk identified foreach individual .

11 . 4 . 6 Establish the last time that the patient was seen .

11 . 4 . 7 Scrutinise the care plan and other relevant documentation for an indication as to thepatient 's whereabouts .

11 . 4 . 8 Contact the patient's residence (if on the telephone) to attempt to establish contact .

11 . 4 . 9 If contact is not made at the patient's residence then contact the identified relative ,carer or friend to whom they may have gone or who may know their whereabouts .

11 .4 . 10 The Care Co-ordinator will ensure that there is a clear timescale to the recall process ,particularly with regard to when any Recall Notice takes effect and will also co-ordinate the delive ry of the Recall Notice to the patient .

11 .4 . 11 Once it has been established that the patient has been recalled , and is considered tobe AWOL , the Care Co-ordinator will , in liaison with the RC , assess and determin ethe level of risk related to the patient . The degree of urgency in locating and returnin gthe patient to hospital will be communicated to other agencies involved . This RiskAssessment will take into account previous assessment of risk and managemen tplans , as well as the following specific factors relating to the person AWOL :

• any active symptoms which indicate an increased risk to self ;

• risk to others ;• alcohol abuse ;

• drug abuse ;• involvement in any incidents /unusual behaviour prior to recall ;• any family or social crises /events which might have bearing on their

whereabouts ;• age or physical condition which may increase risk ; and• details of whether they have been AWOL before including :

- the outcome ;- whether they come to any harm ;- where were they found ;- how did they return to the hospital ; and- who was involved .

11 .4 . 12 The above information will determine whether the person is low , medium or high riskand will assist the Police when the missing person notification is made . There is aprofessional obligation to ensure that police are provided with relevant information asappropriate where required in these cases . In high risk cases the Police should be


informed immediately; in medium and low risk cases this may be delayed . In additionto an assessment of risk the Police will need the following information for theircomputerised Merlin system :

- name ;- date of birth ;- address and telephone number ;- status under the Mental Health Act and expi ry date of Section ;- an accurate , updated physical description ; and- the name and contact number of others involved , e . g . Care Co-ordinator , RC , GP .

11 .4 . 13 The ability of the Police to trace the patient may depend on this . The Police will alsoneed to know what action has already been undertaken to locate the patient .

11 .4 . 14 The Care Co-ordinator must pre-confirm the place of Recall (i . e . ward bed) andprovide the police with the ward /unit details .

11 .4 . 15 Police involvement in locating and assisting in returning the patient to the ward will bedependent on :

level of risk and urgency ;risk of violence , self harm or harm to others ; andfailure of the patient to comply with Mandato ry Conditions (i . e . to makethemselves available for medical examination when needed to for consideration ofextending the CTO or , if necessa ry, to allow a Second Opinion AssessmentDoctor to provide a Part 4A certificate authorising treatment . )

11 .4 . 16 The nearest relative is to be informed that the patient is now considered AWOL(statuto ry requirement of the Mental Health Act 1983 in relation to detained patients) .

11 .4 . 17 Members of the family, friends or significant others are to be informed as appropriate ,with due regard to the patients ' previously expressed wishes /Advanced Directive .

11 .4 . 18 Other agencies directly involved in the care of the patient, including the GP are to beinformed .

11 .4 . 19 Once the location of the patient is known , but the patient is refusing to allow access ,an application under Section135 (2) of the Mental Health Act 1983 may be made(Appendix 10) .

11 .4 . 20 It is the Care Co-ordinator ' s responsibility to help ensure that the patient ' s home islocked and secured before they leave for hospital . If the police have had to force ent ryto secure access to the patient, the Care Co-ordinator will also need to ensure thatappropriate repairs are completed .

11 .4 . 21 When the patient is located out of area there may be occasions when an AWO Lpatient has left the local area and it will not be possible for staff to undertake visits t olocate and return the patient . It is the responsibility of the Care Co-ordinator to liais ewith services local to the patient , and negotiate their assistance in locating an dreturning the patient . When a patient is known to be at a particular address , contactwill be made with the local Social Services and the Police . They will agree a plan toreturn the patient . An ambulance must be used to transfer the patient to hospital .(Long distance repatriations are the responsibility of the home Trust to organise -LAS might consider the request as an extra contractual journey - especially if PTSsuitable . )


11 .4 . 22 If there is a significant delay in arranging the transfer of the patient , it may benecessa ry to arrange for the patient to be seen and assessed overnight in a localmental health facility . After the patient has been assessed overnight it may bepossible to transfer the patient back by taxi , if their mental state is assessed as beingsufficiently stable .

11 .4 . 23 If the patient has been apprehended by the police in another area , the Care Co-ordinator will take responsibility for organising the transfer of the patient to thehospital . Appropriate statuto ry transfer forms will need to be filled .

11 .4 . 24 When the patient is to be transferred directly from a police station , this must be byambulance .

11 .5 OUTCOMES AND RESOLUTION S

Once the patient 's whereabouts has become known and there has been a resolutionof the AWOL situation , the following actions will be undertaken by the CareCo-ordinator , or delegated to another named member of staff on duty .

All relatives , carers , the GP and other agencies contacted during the recallprocess should be informed of the outcome .It is particularly important to inform the Police as soon as possible as they may becar ry ing out numerous lines of inqui ry including the interviewing of people knownto the patient .Details of the recall and any known factors which precipitated the recall must berecorded on the AWOL monitoring form and in medical and nursing records ,including the time contact was made with the next of kin , family , friends and otheragencies .

11 .6 ROLE OF THE METROPOLITAN POLIC E

11 . 6 . 1 The primary responsibility for locating and returning patients to the ward lies with theCare Co-ordinator.

11 . 6 . 2 Police intervention will be limited to those occasions where there is a risk of a breachof the peace involving violence or a threat of violence , or there may be a danger tothe public , or where a patient may be an immediate danger to themselves or wherethe patient has breached CTO Mandato ry Conditions and there is no realistic" informal" way of getting them to comply with the Recall Notice .

11 . 6 . 3 The Police will attempt to locate an AWOL patient whose whereabouts is not known .If a recalled patient is reported missing to the local Police , the Police will grade theenqui ry according to the Risk Assessment. This will be done on the computerisedMerlin System . The grading will be either : high , medium or low . Enquiries will beinitiated which could include :

information passed to local officers and / or surrounding poli ce boroughs ;circulation on the Police National Computer ;visits to locations where intelligence suggests missing patient might be /hasbeen previously ; and


enquiries with relatives /friends .

11 .6 .4 The amount of resources given to the enquiry wi ll depend on the risk assessment andassociated grading .

11 .6 .5 If a patient, subject to a CTO and who has been reca lled, is found in a pub l ic p l aceand is considered to be presenting a risk to themse l ves or the pub l ic, the patient maybe transferred to the hospita l by an officer of the hospita l or the Po l ice under theAbsent without Leave provisions of Section 18 of the Mental Health Act 1983.

11 .6 .6 If the location of the patient is known , and steps are being taken totransfer the patient to hospital , the Police will respond to requests forassistance made by the Care Co -ordinator or delegated person .

11 .6 .7 Pol ice assistance shou l d be requested if there is evidence to suggest that there isimmediate danger to this patient or others, a potentia l threat of vio lence or the needfor physica l restraint .

11 .6 .8 When requesting Po l ice assistance, fu ll information shou l d be given of any potentia lrisk factors which may be re levant to the safety of the patient, the pub l ic, or anyonee lse, including the Pol ice, invo lved in the process - e .g . the possib l e invo l vement ofweapons or substance misuse . Sufficient notice shou l d be given to the Po l ice in orderthat resources can be dep loyed effective ly.

11 .6 .9 Attending po l ice officers wi ll take the fo llowing actions .

• Consult and co-operate with the Care Co-ordinator , or other professionalspresent , in respect of requests over the method and timing of assistance .

• Prese rve the peace and ensure public safety , assisting if the need for use ofrestraint may reasonably be anticipated .

• Help to effect the admission to hospital in a peaceful way , even by simply beingthere .

• Accompany the patient in the ambulance where judged necessa ry to preservethe peace and ensure public safety .

• Consult with other professionals involved to decide whether in extremecircumstances the Police vehicle is the most appropriate means to transport thepatient to hospital .

• Where attending police officers assist in conveying the patient to the place ofRecall (hospital ward) , their input will cease at the point when the patient is safelyhanded over to ward staff .

11 .6 . 10 When access is denied , the Police will assist in the execution of a warrant issuedunder Section 135(2) of the Mental Health Act 1983 (Appendix 10) .

NB : Consideration should be given throughout to any Advanced Directive .

11 .7 TRANSPORT

11 . 7 . 1 An ambulance is usually the preferred means of transfer to hospital . However, theremay be occasions when other forms of transport will be appropriate and expedient .Staff should not use their own transport . Judgements regarding transport should beclinically led .


11 . 7 . 2 There may be circumstances when alternative transport arrangements may beacceptable if the patient is agreeable to transfer to hospital and there is no identifiedrisk either to members of staff or the patient .

11 . 7 . 3 Transfer in a police van should only be considered in ve ry exceptional circumstanceswhen restraint is required or the threat of violence is high .

11 . 7 . 4 If the patient is sedated , an ambulance will be the only form of transport to be used .

11 . 7 . 5 To arrange an ambulance through the London Ambulance Service :

Ring 020 7827 4597 .

11 . 7 . 6 The following information will be required :

• name and address of the patient ;• the name of the Responsible Clinician / GP or AMHP / ASW ;• rendezvous point with other professionals involved ;• name and contact number for other professionals involved ;• an indication of the patient 's condition (e .g . whether sedated , attitude to

readmission) ;• time of arrival of the ambulance ;• where the patient will be going ; and• whether there will be Police involvement .

11 . 7 . 7 To arrange a taxi , contact the Administration Services Manager . The followinginformation will be required :

• name , status and place of work of the person requesting the taxi ;• address from which the member of staff and patient are to be collected ;• destination ; and• the expected time of arrival of the taxi to make the collection .

NB : The name of the patient must not be disclosed to the taxi firm .

11 . 7 . 8 Professionals involved must be confident that transferring the patient to hospital bytaxi does not pose a risk to the patient or to anyone else involved .

11 . 7 . 9 Two members of staff should accompany the patien t

11 .8 RISK ASSESSMEN T

11 . 8 . 1 All decisions and the rationale for them must be recorded in the patient 's notes andcommunicated to other workers involved in the patient ' s care , including the GP .

11 . 8 . 2 When there is a resolution of events and decisions made about the futuremanagement of this patient , these must be communicated to other workers involvedin the patient ' s care , including the GP .

11 . 8 . 3 If after assessing the level of risk , the Care Co-ordinator feels that this patient isvulnerable and at significant risk to themselves or to others , then the full proceduredetailed above should be implemented .


12 . MENTAL CAPACITY ACT 2005

12 .1 THE LEGISLATION

The Mental Capacity Act 2005 provides the legal framework for acting and makingdecisions on behalf of individuals over the age of 16 who lack the mental capacity tomake particular decisions for themselves . Everyone working with and/or caring for anadult who may lack capacity to make specific decisions must comply with this Act .

12 .2 DEFINITION :

Capacity is the ability of an individual to make decisions regarding specific elementsof their life .

Mental Capacity Act 2005 Code of Practic e

The test is : Can this person make this decision at this time?

A person's lack of capacity will be due to a disorder or disturbance of the mind orbrain whether temporary or permanent .

12 .3 WHAT CAN AFFECT A PERSON'S CAPACITY?

• Dementia

• Learning disabilitie s

• Mental health problem s

• Stroke and other brain injuries

• Tempora ry impairment due to medication , intoxication , illness or trauma such asbereavement or inju ry .

12 .4 MENTAL CAPACITY ACT - THE PRINCIPLES :

If you are paid to work with someone who might lack mental capacity , you must bylaw , work within these five principles ; these are the values that underpin the MCA .

1 . A person must be assumed to have capacity unless it is established that theylack capacity .

II . A person is not to be treated as unable to make a decision unless all practicablesteps to help them to do so have been taken without success .

Ill . A person is not to be treated as unable to make a decision merely because it isan unwise decision .

IV . An act done or decision made under this Act for or on behalf of a person wholacks capacity must be done or made in their best interest .

V . Before the act is done or the decision is made , regard must be had to whetherthe purpose for which it is needed can be as effectively achieved in a way that isless restrictive of the person ' s rights and freedom of action .


12 .5 TWO STAGE TEST OF CAPACITY :

There are two basic questions to consider :

1 . Does the person have an impairment of or disturbance in thefunctioning of their mind or brain at this moment?

IF YES

2 . Is the impairment or disturbance sufficient that the person lacks thecapacity to make the decision needed at this time ?

- always assess this in relation to the specific decision to be made- an unwise decision does not necessarily indicate lack of capacity

12 .6 FUNCTIONAL TEST OF CAPACITY

A person is able to make a decision for him/herself if he/she is able to meet ALL ofthe following criteria :

1 . Understand the information relevant to the decision

2 . Retain that information

3 . Use or weigh up that information as part of the process of making the decisionand

4 . Communicate their decisio n

Protection from liability is afforded if you follow the process . Where the MCA hasbeen applied a record must be made using the following guide :

Justification must be established together with an explanation that due considerationwas given the principles of the MCA , that capacity was assessed in relation to thespecific situation and a judgement was formed that on the balance of probabilities theassessor reasonably believed the person lacked capacity to make that particulardecision .

12 .7 SECTION 5 MCA

Section 5 explains that anything you do for or to a person believed to lack capacity isregarded as having that person 's consent , provided the following conditions are met :


• you reasonably believe the person lacks capacity

• you reasonably believe that what you plan to do is in the person 's bestinterests

• you reasonably believe that what you plan to do is the least restrictive optionto meet the identified need

12 .8 SECTION 6 MCA

• Section 6 explains that any restriction or restraint needed in the person 's bestinterests must in addition to being the least restrictive option that meets the need .It must also be a proportionate response to the risk of harm to that person and theseriousness of that harm .

This restraint must not amount to a deprivation of liberty , for example a personrestrained by police for care or treatment may not be removed to police custody .

• The Mental Capacity Act does not replace the appropriate use of the relevantsections of the Mental Health Act .

• If a non medical person is trying to assess capacity it would be good practice toseek advice from an Ambulance Technician , Paramedic or Doctor as necessa ry .

• A person lacking capacity may come into the care of a range of variousprofessionals ; each professional must make their own assessment of capacityand identify a course of action in the person 's best interests as described above .

• Except in an emergency where Police have assessed capacity and remove aperson themselves , the requirement for police assistance should only be as aresult of the need for support in managing the person 's behaviour where they areactively resistant , where there are other security issues or to prevent a breach ofthe peace threatened by others (such as family members) .

Where a person presents no such risk or there is no risk of a breach of the peacePolice a ttendance is unlikely to be necessa ry . Certainly in a medical emergencyan ambulance should be the first consideration as they are qualified not only todeal with the medical issue but are trained to assess capacity .

• Any authority to convey a person will be under the protection of S5 and S6 of theMCA and any use of transport should follow the same principles as in the matrixcontained within the Transport and conveying section of this protocol p37 .

• Where police have removed a person under the MCA to hospital for treatment ,the requirement for continued police presence will be decided on risk .

• Any transport or conveying carried out under the MCA must meet therequirements under S5 and 6 of the MCA 2005 above .

• There is a legal requirement for all statuto ry authorities who have a responsibilityto care for people who may lack capacity to comply with the Mental Capacity Act .


13 . INFORMATION EXCHANGE

Effective policing and joint working is dependent on efficient informationmanagement . This includes the processes of obtaining , recording , storing , reviewing ,deleting and sharing information , including personal information , for policingpurposes . While there are clear advantages to the sharing of information with others ,information should not be shared purely as a ma tter of routine . Each case must beviewed individually with informed decisions made about whether to share or not . Thefollowing information explains how Police will manage information and each partneragency will have their own information management policy .

Joint partners are expected to share such information that would reasonably berequired to :

- Conduct an effective risk assessment .

- Ensure individual and/or public safety .

- Allow safe access onto private premises .

- Allow for the mental health assessment of an individual and their safe removal tohospital .

31 . 1 INFORMATION SHARING AGREEMENTS (ISA ) :

Within the context of this protocol , ISA have been specifically considered andprecluded as the information exchange does not require the regular and scheduledsharing of Police or partner information and the overarching Community SafetyPartnership ISA provides sufficient safeguards .

The sharing of information is carried out with due regard to the relevant provisions ofthe Data Protection Act (1998) , the Crime & Disorder Act the Human Rights Act(1998) and Barnet , Enfield and Haringey Mental Health NHS Trust's Sharing ofInformation Policy .

31 .2 INFORMATION FOR A POLICING PURPOSE :

For the purposes of information exchange , policing purposes are :a) Protecting life and property ;

b) Prese rv ing order;

c) Preventing the commission of offences ;

d) Bringing offenders to justice ; and

e) Any duty or responsibility of the Poli ce arising from common or statute law .

Partners are expected to share such information that would reasonably be requiredto :

• Prevent crime ;

• Ensure individual or public safety ;

• Conduct an effective risk assessment .


The sharing of information is carried out with due regard to the relevant provisions ofthe Data Protection Act (1998) , the Crime & Disorder Act , the Human Rights Act(1998) and the Barnet, Enfield & Haringey Mental Health NHS Trust 's Sharing ofInformation Policy .

Once the information can be shown to meet a policing purpose then the legal basisfor holding it can be established . Any information subsequently shared will only beshared for the purposes of the above and will be on a case by case basis.

31 .3 EUROPEAN CONVENTION ON HUMAN RIGHTS ACT 1998 IMPLICATIONS :The ECHR contains a number of fundamental rights which have a bearing on themanagement of Police information . Article 8 of the ECHR protects an individual ' s rightto privacy and family life . This right is not absolute but may not be inte rfered withexcept ` in accordance of the law , in pursuit of a legitimate aim ; and necessa ry in ademocratic society' . This places a responsibility to set a clear aim for obtainin gpersonal information (a policing purpose) and a test of proportionality of how theymeet this aim .

31 .4 IS THE POLICE INFORMATION PERSONAL DATA?Once the policing purpose is established the issue arises of whether the informatio nis covered by the Data Protection Act 1998 (DPA) . If the information is personal o rsensitive personal data then , under terms of the DPA , it must be managed i naccordance with the eight data protection principles . Personal data is defined by theDPA as information about a living person who can be identified from that data .

31 .5 WHAT DOES THE DATA PROTECTION ACT 1998 REQUIRE ?

The DPA requires personal information to comply with the eight data protectionprinciples :• Being fairly and lawfully processed• Being processed for limited purposes and not in any manner incompatible with

those purposes• Adequate, relevant and not excessive• Accurate and where necessary, up to date• Not being kept for longer than is necessary• Being processed in accordance with individual rights• Secure• Not being transferred to countries outside the EU without adequate protectio n

31 .6 WHAT EXEMPTIONS ARE THERE FROM THE DATA PROTECTION ACT 1998?

The DPA also requires information to be made available to the subject of thatinformation at their request , with certain exemptions .

There are a number of exemptions from the DPA and of particularly relevance toPolice information is section 29 which creates exemptions to certain data protectionprinciples where data is processed or shared for the purposes of:• Prevention or detection of crim e• Apprehension or prosecution of offenders• Assessment or collection of any tax or dut yThe exemptions apply to certain principles of the DPA where the application of thoseprinciples would be ` likely to prejudice ' the purposes referred to above . Theseexemptions must be applied on a case-by-case basis and cannot be used to justifyroutine data processing .


31 .7 OBLIGATIONS OF THOSE RECEIVING POLICE INFORMATION :

Those to whom information is made available must comply with the followingobligations :• Police information made available in response to a request should be used only

for the purpose for which the request was made .• If other information available , at the time or later , to the person or body

requesting Police information tends to suggest that Police information isinaccurate or incomplete , they should at the earliest possible moment inform thePolice of such inaccuracy or incompleteness , either via the local MH liaisonOfficer or the TVP force MH Lead .

31 .8 PROCEDURES TO BE FOLLOWED :

Where information as described above is shared within the regular PiP or CJMHPmeetings this exchange must be recorded in the minutes together with the purpose ofthe exchange as per ` Information for a policing Purpose ' above . Any other exchangemade on an ad hoc basis must be recorded in a similar way by utilising recordingmedium such as a Police command and control log .

Minutes and other records of meetings such as rolling emails must contain a record ofthe confidentiality agreement signed by each representative at the meeting , such as :

"The purpose of this confidentiality agreement is to record the intention betweenmembers of this group (insert name of group) to keep confidential any exchange ofpersonal information relating to individuals . It is agreed that the exchange of anyinformation will be strictly controlled and only released for specific and legitimatepurposes . This agreement is necessa ry to facilitate the exchange of informationnecessa ry in order to achieve one or more of the following policing purposes :

• Protecting life and property• Preserving orde r• Preventing the commission of offences• Bringing offenders to justice and• Any duty or responsibility of the Police arising from common or statute law

Any exchange of information will be carried out with due regard to the provisions ofthe Data Protection Act 1998, the European Convention of Human Rights and theManagement of Police Information (MOPI) 2006 .

Where personal information is shared a certificate outlining the legality must beincluded after each individual, such as :

"This information is provided in pursuance of the Data Protection Act 1998, theEuropean Convention on Human Rights 1998 and standards set by the Managementof Police Information 2006 and is done so for the purposes of : (Select one or more)• Protecting life and property• Preserving orde r• Preventing the commission of offences• Bringing offenders to justice and• Any duty or responsibility of the Police arising from common or statute la w

This information has been shared because . . . . . . . . . (be specific) "


14 . MO N ITOR ING ARRANGEMENTS, COMPLIANCE AN D EFFECTIVE NESS

14 . 1 MONITORING SECTION 136

• This protocol and the wider use of Section 136 will be regularly monitored andreviewed by the Trust-wide JMG , in line with the Mental Health Act Code ofPractice 10 .42 to 10 . 44 .

• The JMG consists of senior representatives from the Barnet , Enfield & HaringeyMental Health NHS Trust , London Ambulance Service , London MetropolitanPolice , A&E and the three Boroughs ' Local Authorities .

• Monitoring includes target times for the commencement and completion ofassessments , response times for all agencies involved , use of 136 in relation toethnic minorities and children , and review of circumstances where the individual isconveyed to an Accident & Emergency Department (A&E) for treatment .

• In addition , each of the three boroughs review local application of the protocolthrough their Local Joint Protocol Monitoring Groups .

• The local groups consist of representatives of the respective borough LocalAuthorities , managers from the Trust's local mental health services (includingborough Mental Health Act Manager) and the Metropolitan Police Servi ce .

• The local monitoring groups monitor and review the application of the protocol inrelation to local services and circumstances , identify and discuss general areas ofconcern and specific practice issues and monitor documentation , including theMetropolitan Police Form 434 . The local group will also provide regular reportsand representation to the Trust-wide group .

14 .2 MONITORING SECTION 13 5

The wider use of S135 will be regularly monitored and reviewed by the Trust-wideJMG .

• Monitoring will include target times for the commencement and completion ofassessments , response times for all agencies involved , the sharing of information ,development of a multi agency risk assessment , method of conveyance andadmission to hospital and ethnicity of those detained under S135 (see 18) .

Each of the three boroughs will review the local application of this protocolthrough their Local Joint Protocol Monitoring Groups . The local groups consist oflocal representatives of the various authorities and managers from the localmental health services . These local monitoring groups will monitor and review theapplication of s135 protocol in relation to local services and circumstances ,identify and discuss general areas of con cern and specific practice issues andmonitor documentation . The local groups will provide regular reports andrepresentation to the Trust-wide Joint Monitoring Group .


14 .3 MONITORING CONVEYANCE & SECTION 6

• The effectiveness of the local conveyan ce arrangements will be formally reviewedon a bi-annual basis . This review will be undertaken by the multi-agency JointProtocol Monitoring Group(JMG) , convened

14 .4 MONITORING CTO RECALL

• Police Liaison Groups will monitor the effectiveness of services responding to theneeds of patients , subject to CTOs who have been recalled , and will review theimpact of this protocol on the welfare of those patients and on the use of limitedresources .

The following factors will be monitored :• date and time of recall incidents ;• status of the patient ;• action taken monitored against policy guidelines ;• outcomes ; and• equality and diversity impact .

15 . DISSEMINATION , IMPLEMENTATION & DISPUTES

• Members of the Joint Protocol Monitoring Group will facilitate the dissemination ofthe Joint Protocol within their services .

• The Joint Protocols will be included in internal training programmes for all themember organisation s

• In circumstances where difficulties with the protocol need immediate a ttention , thematter should be taken up with the professional 's respective line manager or dutymanagers , if out of office hours .

• Disputes and difficulties in relation to the interpretation and implementation of thisprotocol should be taken to the Local and Trust-wide Joint Protocol MonitoringGroups , as appropriate .

16 . CONTRIBUTORS

LIST OF PARTNER AGENCIES :

• Barnet, Enfield and Haringey Mental Health NHS Trust ;

• Local Authorities of Barnet, Enfield and Haringey

• Barnet and Chase Farm Hospitals NHS Trust

• London Ambulance Service

• Metropolitan Police Service

• British Transport Policy


17 . REFERENCES

This protocol is developed in compliance with the following legislation :

• Mental Health Act 1983 (MHA) .

• Code of Practice (CoP) to the MHA , revised 2008 .

• Mental Capacity Act 2005 .

• MCA CoP 2007 .

• Police and Criminal Evidence Act 1984 (PACE) .

• Code of Practice , Code C , to PACE , revised 2008 .

• Human Rights Act 1998 .

• Data Protection Act 1998 .

Due regard has been further given to the following guidance , case law and otherspecialist literature :

• Royal College of Psychiat ry Standards on S136 (2008) .

• Independent Police Complaints Commission of the use of Police cells fordetentions under S136 (2008) .

• Academy of Medical Royal Colleges Report on Managing Urgent MentalHealth Needs in the Acute Trust (2008) .

• NICE Guidelines on the Short-term Management of disturbed /violentbehaviour (2005) .

• NPIA Safer Detention Guidance , NPIA (2006) .

• NPIA Guidance on Police Responses to People with Mental III Health orlearning disabilities (2010) .

• Home Office Circular 17/2004 .

• Home Office Circular 66/1990 .

• R v Ashworth Hospital Authority (2005) , House of Lords .

• Management of Police Information Guidance 200 6

18 . APPENDICE S


APPENDIX 1 - HPCMHT S136 ACUTE ASSESSMENT CENTRE PROCEDURE

Barnet, Enfield and Haringey

Working together for a safer LondonHaringey .• , . I


SECTION 136 - APPENDIX 2TRANSFER BETWEEN PLACES OF SAFETY - Code of Practice (2008)

10. 34 A person removed to a place of safety under section 135 or section 136 may be moved to adifferent place of safety before the end of the maximum 72-hour period for which they may bedetained. The maximum period of detention begins from the time of the person 's arrival at the firstplace of safety to which they are taken and cannot be extended if the person is transferred to anotherplace of safety.

10. 35 The person may be taken to the second or subsequent place of safety by a police officer,an AMHP or a person authorised by either a police officer or an AMHP.

10. 36 A person may be transferred before their assessment has begun, while it is in progress or afterit is completed and they are waiting for any necessary arrangements for their care or treatment to beput in place . If it is unavoidable, or it is in the person 's interests, an assessment begun by one AMHPor doctor may be taken over and completed by another, either in the same location or at another placeto which the person is transferred .

10. 37 Although it may be helpful for local policies to outline circumstances in which a person is usuallyto be transferred between places of safety , the decision in each case should reflect the individualcircumstances, including the person 's needs and the level of risk. For example, where the purpose ofthe transfer would be to move a person from a police station to a more appropriate healthcare setting ,the benefit of that move needs to be weighed against any delay it might cause in the person 'sassessment and any distress that the jou rney might cause them.

10. 38 Someone with the authority to effect a transfer should p roceed by agreement wherever possible .Unless it is an emergency, a person should not be transferred without the agreement of an AMHP, adoctor or another healthcare professional who is competent to assess whether the transfer would putthe person 's health or safety (or that of other people) at risk. It is for those professionals to decidewhether they first need to see the person themselves .

10. 39 Unless it is unavoidable, a person should never be moved from one place of safety to anotherunless it has been confirmed that the new place of safety is willing and able to accept them .

SECTION 136 - APPENDIX 3

AAC Procedure to prevent absconsion incident s

To prevent such incidents , the following instructions are to be followed :

1 . See plan of sliding doors (next page) .

2 . Patients detained under the Mental Health Act 1983 MUST be nursed in the Safety Suite .Acute Assessment Centre (AAC) staff to seek assistance from the Response Team if theSafety Suite door needs to be opened .

3 . Patients should not be allowed to use the corridor .

4 . Relatives who obstruct staff in the execution of their duties are to be removed by securitystaff or the poli ce .

5 . Please ensure waiting area and toilets are checked before front doors are locked at 10pm(last night , a member of the public was found sleeping in the toilets) .

Please notify all bleepholders (specifically regarding management of the sliding doors a t


night) . For further clarification please speak to Kris Gopaulen or Mohammad in AAC directly .


NOTE :Bleep holders must remind AAC night staff to lock all doors at 10pm for safety andsecurity reasons. AAC staff can communicate with public and patients through theintercom located at the AAC reception .

In the event of an emergency (fire/cardiac arrest),the nurse in charge to unlock the 3 sliding doors

immediately to facilitate access


SECTION 135 - APPENDIX 4

POLICE / PLACE OF SAFETY / AMHP CONTACT DETAILS :

POLICEThe Joint Mental Health Policing Unit operates across Barnet ,Enfield and Haringey . They are based at :

St. Ann's Police StationSt. Ann's RoadTottenha mN15 5RD

Tel : 020 8345 0955 / 020 8345 0987Mobile : 07884 47571 6

PLACES OF SAFETY (BEHMHT )

Haringey : Acute Assessment Centre (AAC)St. Ann's Hospita lSt. Ann's RoadLondon N15 3THTel : 020 8442 6706

Barnet & Enfield :

Acute Assessment Centre (AAC)The Chase Buildin gChase Farm HospitalThe RidgewayEN2 8JLTel : 020 9375 1122

AMHP SERVICES (OFFICE HOURS AND EMERGENCY DUTY)

Haringey : Office hours - 020 8442 6046Out of hours - 020 8348 3148

Enfield: Office hours - 020 8379 3977Out of hours - 020 8379 1000

Barnet: Office Hours - 0845 389 2989Out of hours - 0845 389 2989


Request by Community Mental Health Team for police attendance at a pre-planned Mental HealthAssessment

<<< Insert here - Intranet Link to Form 435A »>

This form is for Approved Mental Health Professionals (AMHPs) and Community Mental Health Tea m

(CMHT) staff to request police resources at a pre-planned mental health assessment . It is essentia l

before completing this form that you read the MPS guidance document contained in Form 435A .

This document may be subject to evidential disclosure

Part 1 Request for police assistance

Part 2 Record of police decision to attend or not attend a mental health assessmen t

Part 3 Record of the tactical plan at a pre-planned mental health assessmen t

InstructionsThis form is in 3 pa rts . Part 1 is for completion by the AMHP when requesting police a ttendance at apre-planned mental health assessment . The AMHP or CMHT staff must send a copy of the warrantapplication (information) on return of this document to police . Part 2 is for the police officerresponsible for responding to such requests to record a risk assessment and details of the decision toattend or decline attendance . In cases where it has been agreed that police will attend , Part 3 is forthe police officer who made that decision to record a tactical plan and briefing for the benefit ofofficers who will attend the assessment . Once Pa rts 1 , 2 and 3 are completed the whole form mustbe passed to the officer(s) tasked to attend the assessment .

Details of the person to be assessed

Address ofAssessment

Inter-Agency Joint Protocol Mental Health (V2 . 0) 62

Description ofaddressincluding floorlevel , balcony& fire escapeaccess ,number ofentry/exitdoors , knownhazards

Other knownaddresses

Tel Gender Aae /DOB

I EA Code SDE Code

Description(include marks ,features ,+ a ++ nnQ)

Alias/Nickname

Self Defined Ethnicity (SDE) CodesAsian or British Asian (A)

Al Ind i anA2 Pak istaniA3 Bang l ades h iA4 Any other Asian ba ckground

Black of Black British (B )BI Ca ri bb eanB2 AfricanB9 Any other B l ack backg ro und

Chinese or Other Ethnic Group (0)01 Ch inese09 Any other ethn ic g rou p

Mixed (M )M1 Wh i te and B l ack Ca ri bb ea nM2 Wh i t e and B l ack AfricanM3 Wh i t e and Asia nM9 Any other mi xed backg rou n d

White (W)W1 BritishW2 I rishW9 Any other wh ite backg ro und

Ethnic Appearance (EA) CodesI Wh i te - North Europe an2 Wh i te - South Europ ean3 B l ack4 Asia n5 Ch i nese, Japanese o r any So u th Eas t

Asia n6 M i dd le Eastern0 Not recorde d / Unknown

Details of Approved Mental Health Professional (AMHP) / Community Mental Health Team(CMHT) making the request

Applicant Name/ Tea m

Tel Fax

Mobile Date


Has a warrant been obtained? If so , under which section .If no , state reasons .

Police assistance is sought to manage one or more of the following risk s

Risks of access to firearms / Weapons

Risks of Violence / Assaults

Risks of Self-Harm

Risks of being unable to access or remain on the premise s

Risks of resistance whilst being conveyed to hospital /psychiatric unit ❑

Risks of absconding before the assessment has been complete d

Other risks - specify below

(continuation sheet at rear )


Is there evidence of self neglect?

Does the person have any physical healthproblem?

Any other persons , children or vulnerable adults atthe address? Add details (name , dob , etc)


There is an expectation that the completing officer will conduct a full range of intelligence checksusing all available intelligence systems (to include IIP , Daris , Custody, Crimint , Cris and PNC)

Record findings in IIMARCH briefing .

Results of police risk assessment & recommended control measures to reduce ris k

As a result of the information supplied by the Approved Mental Health Professional in Part 1 and th eintelligence obtained from the above checks , I have identified that the following risks may be present at th eplanned mental health assessment . I have also indicated my recommended control measures andcontingencies to reduce the risks identified

RELEVANT CONTROL MEASURE✓ all This list is only suggestive . It is up to each ✓ al l

GENERIC RISKS that supervisor to make a judgment about thatapply whether or not the control measure actually apply

applies and tick the box only if it does apply• Ent ry using a Section 135 MHA 1983 ~

warrant

Risks of access to firearms or weapons ❑ • Police control ent ry and secure premises ❑

and subject of assessmen t

• Rapid ent ry

• Ent ry using a Section 135 MHA 1983warrant ~

Risks of Violence ❑ • Police control ent ry and secure premisesand subject of assessment ❑

• Rapid ent ry0-

0 Ent ry using a Section 135 MHA 1983warrant 11

Risks of self-harm including falls from heightand using otherwise innocent items easily ❑ • Police control ent ry and secure premises

accessible inside the premises and subject of assessment ❑

• Rapid ent ry0

Risks of being unable to access or remain • Ent ry using a Section 135 MHA 1983

on premises ~ warrant 11

Risks of resistance whilst being conveyed to • Ent ry using a Section 135 MHA 1983~ warrant 11

hospita l

Risks of absconding before the assessment • Ent ry using a Section 135 MHA 1983

has completed ~ warrant 11

Other risks (please explain )


The following information should be included within this section .• The name , date of birth , description and PNCID number of the person to be assessed• The reason a mental health assessment is being carried out• The person 's anticipated reaction to the assessment• Details of other occupants inside the premises• The briefing should follow the IIMARCH formula , a suggestion of suggested contents follows . .• Where possible obtain and enclose a photograph of the subject .

Officer SafetyThe following information should be included within this section .• Details of known previous violence from anyone inside the premise s• Details of known hazards inside the premises incl; balconies, windows above ground level• Other known hazards• Whether attendance is with or without a S135(1) Mental Health Act 1983 wa rrant

All officers attending mental health assessments must be aware of the tactical options that are available wherea ttendance is on warrant. These are summarized below.

If a ttendance is with a warrant this provides a power to enter the premises and a power to remove the personto a place of safety. It is essential that officers and particularly supervisors who attend mental healthassessments with a warrant fully understand that it provides a power to deal with high risk behaviour. Where,during the assessment process , the person being assessed engages in high risk behaviour such as thoselisted on page 5 of this form , the wa rrant allows police to immediately remove the person from the premises toa place of safety.

IntentionIs always to effect a safe entry to the address and create a safe working environment to allow the assessmentto take place. To assist if required the Approved Mental Health Professional in escorting the person subject ofthe assessment to a hospital/psychiatric unit/similar care facility by ambulance . Add other information asrequired.

Method1 . Agree and RVP with AMHP that is out of view of the address.

2 . Where Police attend mental health assessments they will always take the lead in ente ring thepremises, secu ring the safety of the person to be assessed and creating a safe working environment in whichthe assessment can be carried out.3 . Method of entry (police knocking on the door, rapid unannounced entry, locksmith gaining entry, otheroptions) .4 . If Police attendance at this assessment is with a S135 (1) MHA 1983 warrant, then the following risksand contingencies will apply . A wa rrant provides power to enter and remove a person from premises. Howeveran assessment may take place whilst on the premises with the consent of the person being assessed,meaning that where the person objects they could be removed to a place of safety for the assessment tocontinue there.

Risk ContingencyPerson objects to being assessed on premisesPerson attempts access to windows/balconiesPerson enters kitchen or other areas whereaccess to articles capable of causing injuryare readily availablePerson presents other risks

Remove to a place of safetyRemove to a place of safety

Remove to a place of safetyRemove to a place of safety

Where persuasion and negotiation fails to stop the subject of a mental health assessment engaging in high riskbehaviour, the most appropriate course of action will usually be immediate removal under the autho rity of awarrant.


Briefing , Administration &record of deploymentr'en I'l -n+c -m nr! T ime of + hc nrnnnccr! ~cccccmcn~ •

CRIMINT to be completed by the officer designated to effect the warrant . Form 101 to be completed .CAD to be opened prior to deployment and closed once the subject arrives at the hospital .

Officer Deployment (First Attempt )Record officer deployment for further attempts on p .1 1

Admin .No .

RankName or Warrant number .

OCU BOCU Sh ow i f MediGFAW T i me OnNum be r D rive r, etc Duty

2

3

4

5

6

7

PS

PC

PC

PC

PC

PC

PC

Information / Intelligence(Give details of any information available, print and enclose photograph of subject, and map tovenue . )

INFORMATIONThe subject of this briefing is FULL NAME , DOB DD/MM/YYYY (?? years) , PNCID 00/OOOOA . Thesubject is described as . . . . The subject is (inse rt useful Intel / info) . Not known to MAPPA . Subject isknown to have . . . . . . . .This is pa rt of a pre-planned operation concerning the execution of a warrant issued under Section135 of the Mental Health act 1983 at INPUT ADDRESS .

OFFICER SAFETYThis Warrant is issued under (enter section) and allows for a Constable accompanied by an approvedmental health practitioner and a registered medical practitioner TO ENTER SAID PREMISES on oneoccasion only, within one month from the date of issue of the warrant, if need be by force, and ifthought fit, to remove said person to a place of safety as defined in the act for their treatment andcare.

INTENTIONThe intention of this operation is to effect a safe entry to the venue to facilitate the assessment and ifneed be assist the AMHP in the escorting of the subject to an awaiting London Ambulance (onlyusing reasonable force if necessary) and to convey the subject to HOSPITAL in the rear of thevehicle .

METHODRVP agreed with AMHP is at LOCATION . The MoE will be by Police knocking at the door of thepremises in company with the AMHP and Sec 12 Doctor . If refused entry, verbal communication willbe used . Upon failure of this , a locksmith will be used to gain ent ry . There will be a minimum of twouniformed officers present . The premises are on the ground floor / 1st floor, etc . . . . . . . . . . . . . . . . .

ADM IN ISTRATIONA nri m i n f io fn ho nmm r% l c#cr! by #hc nffi ncr rlc~inn~ ~cr! fn cffcn# lAi-mrr-n n f r-7nrm 1111 fn ho nmm r% lc #cr! by


designated officer . CAD to be closed upon reception of subject at place of safety .

RISKA full risk assessment has been completed by the AM HP, together with this briefing note .

COMMUNICATIONAssigned channel for this event will be ****** dispatch 1, or as directed pending a critical incident .

HUMAN RIGHTSPropo rt ionality - The subject is believed to be suffering from a mental illness and therefore needs tobe assessed using a warrant to gain access to enforce engagement .Legality - A section 135 (*) Mental Health Warrant has been issued by Magistrates .Accountability - Officers present are to account for their own actions and justify any use of forceNecessity - The service of the warrant is required for the subjects own safety and well being and thatof the public .


Ambulance Transport

Yes I No

The LAS were requested to provide aore-booked ambulance for thi s

A pre-booked ambulance has been arranged for this assessmen t

An ambulance was requested whilst at the premise s

No ambulance was available , police transpo rt was used to convey the patient

Details of police supervisor authorising this tactical pla n

Name Rank

Signature Date

Once completed please send a copy of this form t o

The Mental Health Project Team15th Floor Nort hEmpress State Building

Attach any supporting documents /printed pages post


Reasons for Second Attemp t

r'en I'l -n+c -m nr! T ime of + hc nrnnnccr! ~cccccmcn~ •

Officer Deployment (Second Attempt)

Admin . RankNo .

1 PS

2 PC

3 PC

4 PC

5 PC

6 PC

7 PC

Name or Warrant number .OCU I BOCU I Sh ow if MediGFAW I T i me OnNum be r D rive r, etc Duty

Reasons for Third Attempt

rren Il~4n ~r%rl T i mn of fhn r~rnr~n~nel ~~~n~~ mnr~} •

Officer Deployment (Third Attempt )

Admin . RankNo .

1 PS

2 PC

3 PC

4 PC

5 PC

6 PC

7 PC

Name or Warrant number .OCUNum ber I B

OCU I DSho

w rveri eMediGFAW I Time O n

Inter-Agency Joint Protocol Mental Health (V2 . 0) 72

SECTION 135 APPENDIX 6 Where Police assistance is immediately require d

Where a pre-planned assessment has been conducted without police involvement, but because ofthreatening behaviour or violence displayed during the assessment it becomes necessa ry to call policefor assistance , use should be made of the 999 Emergency System .

2 . In such cases , the AMHP will contact the Poli ce Control Room who will deal with the request .

3 . The Police Operator will create a CAD message which will include the following information :

• Address of the assessment ;• Name and date of birth of the person to be assessed ;• Confirm the need for urgent Police assistance ;• The name and telephone number of the ASW responsible for the assessment ;• Details of other persons likely to be on the premises ;• Details of any histo ry or violence ;• Any other known or potential risk factors .

5 . The Police Controller will :

Tag the CAD message for the a ttention of the Borough Mental Health Liaison Officer ;Advise the ASW of the estimated time of Police arrival at the scene and supply the CADnumber ;Contact the Police Operations Office to ascertain the availability of non-core team staff whocould assist in the operation .

6 . The Police Controller will ensure that a risk assessment is completed . If this request is made duringoffice hours , they will seek the assistance of the Borough Intelligence Unit .

7 . The Police Controller , under the authority of the Duty Officer or the Police Operations Office willdetermine the level of Police response required at the scene based on the outcome of the riskassessment .

8 . The Police Controller , under the authority of the Duty Officer or the Police Operations Office will ensureappropriate Police resources are identified , tasked and briefed .

9 . Forced entry to private premises can only be affected if covered by Common Law or an Act ofParliament . The following power of ent ry may be used in appropriate circumstances :

• Where a warrant under Section 135(1) or (2) of the Mental Health Act 1983 is executed ;• For the purpose of saving life or limb or preventing serious damage to property (Section 17 PACE

1984) ;• For the purpose of recapturing a person who is unlawfully at large (this includes those who are

AWOL under Section 18 of the Mental Health Act 1983 and whom the constable is pursuing(Section 17(1) (d) PACE 1984)) ;

• To prevent a breach of peace under Common Law .

10 . The use of criminal law to affect a forced ent ry to private premises should not be resorted to unlessthere is an immediate need to prevent serious harm .

11 . If a person who is liable to be detained under the Mental Health Act is involved in a violent incident o rviolence is credibly threatened or the patient resists admission , the police may, using no more thanreasonable force , intervene to restrain and to remove the person and escort him/her to hospital .

12 . Section 137 of the Mental Health Act gives power to any police constable or authorised person to useforce to detain a person for this purpose . Once a person is taken into custody under this section , theyare deemed to be in legal custody .


SERVICE USER MISSING FROM A HEALTHCARE SETTING OR AWOL - APPENDIX 7

Pan London Guidance

PAN-LONDON FLOWCHART FOR LOCAL PROTOCOLS :

1 . Serv ice user notwhere he or sheought to be

2 . Hospital staffconduct immediatesearch of wards andgrounds

3 . Hospital staffcarry out anddocument riskassessment.

4 . Hospital staffmake decision

~ on level or risk

7. Medium or high risk.Hosp i tal staff reportse rvice user to thepol i ce as m iss ing .

8 . Police carry out riskassessment .

9 Police and hospitalstaff develop anddocument joint actionplan

Inter-Agency Joint Protocol Mental Health

IMPORTANT : THISFLOWCHART (PART A) MUSTBE READ IN CONJUNCTIONWITH THE ACCOMPANYINGGUIDANCE NOTES (PART B)

5. Low Risk. Hospitalstaff attempt to locateservice user and returnwithin specified timelimi t

/6 . Serv ice userlocated andreturned within

time limit?

6a . No furtheraction

* the term "hospital", used throughout this

flowchart, also covers other healthcare

(V2 .o) 75

PAN -LONDON GUIDANCE NOTES FOR LOCAL PROTOCOLS :SERVICE USER MISSING FROM HEALTHCARE SETTING (PART B )

IMPORTANT : THESE GUIDANCE NOTES (PART B) MUST BE READ IN CONDUCTIONWITH THE ACCOMPANYING FLOWCHART (PART A )

The objective of the attached flowchart (part A) and this guidance document (part B) isto ensure consistency across London in the provision of a safe , secure andsupportive service to se rvice users , carers and members of the community , along withthe creation of a local implementation document (part C) . The completed protocol forAssessment on Private Premises consists of these three documents , which should beused together.

Any action taken by agencies , either unilaterally or jointly , must be :

• Proportionate• Lega l• Accountable• Necessary• Based on the best available informatio n

and in accordance with the Human Rights Act and other legislation (see appendix) .

These documents provide a framework of minimum standards around which local partneragencies are able to ensure clear arrangements are in place for the planning andimplementation of local Mental Health Act assessments . It is recognised that many sucharrangements already exist , and that these documents provide an opportunity to review ,consolidate and build upon good practice .

It is essential that all such local arrangements are documented and publicised to all staff , andare readily available for reference .

PAN -LONDON GUIDANCE NOTES FOR LOCAL PROTOCOLS :SERVICE USER MISSING FROM HEALTHCARE SETTING (PART B )

Each numbered section refers to the numbered boxes in the flowchart (Part A)

Advance planning for all se rvice users admitted to hospita l

There is an expectation that :

• On admission , hospital staff will immediately car ry out and document a care needsassessment and a risk assessment .

• These documents will be dynamic and regularly updated .• These documents will be available to ward staff on a 24 hour basis .• Hospital staff will explain clearly to service users their expectations of standards of

behaviour while resident on the ward• Hospital staff should develop a "grab pack " which will contain information to be

shared with the police which will be helpful in the event of the service user goingmissing . The pack should contain sufficient detail to enable Metropolitan police staffto complete the MERLIN document .


• Staff should consider the possibility of including photographs of the se rvice user in the"grab pack " .

• All hospital staff (including agency staff) and police officers should be aware of thelocal protocol , the location of the "grab pack" and its contents .

Dealing with a service user who is missin g

1 . Serv ice user not where he or she should be• The various scenarios should be listed , e . g . : missing from the ward , missing

from escorted leave , failing to return from leave .

• Each Trust should have a protocol which sets out who will be informedimmediately and , and who will coordinate the hospital response .

2 . Hospital staff conduct immediate search of hospital ward and ground s

• There shou l d be a statement of the minimum response that hospita l wi ll provide

3 . Hospital staff carry out a documented risk assessmen t

• Car ry ing out a risk assessment requires a risk assessment model , including astatement of the risk that is being evaluated (risk of what and to whom and when ?) .Local organisations should consider the joint adoption of the risk assessment modelused by the Association of Chief Police Officers (see box below) , which underpinsthese guidance notes .

• The "grab pack", compiled on the service user ' s admission , will be a major resource .

• A trained member of hospital staff should be available to car ry out an• immediate risk assessment .

• A trained member of hospital staff should be available to carry out an immediate riskassessment .

• A decision should be made about whether the risk is low , medium or high .

4 . Low risk : hospital staff attempt to locate and retur n

• The hospital should state the minimum response which it will provide , include asearch of the buildings and grounds , telephone enquiries with service user's homeaddress , friend , relatives , enlisting help from other agencies , e . g . social services .

5 . Location and return of service user within time limi t• There should be a local agreement about the length of time which is allowed for initial

action by the hospital in locating a service user assessed as low risk .

6. Report se rv ice user as `missing person' to police

• There should be a clear statement about the purpose of reporting a missing servi ceuser to the police , particularly when the hospital knows the service user ' s location .

• A missing person report will be completed by Police , using MERLI N

7 . Documented police risk assessment• Pol ice wi ll use the Association of Chief Po l ice Officer's risk assessment factors to

determine the leve l or risk .


Association of Chief Police Officers ' risk assessment model

Low : There is no apparent threat of danger to either subject or the public

Medium : The risk posed is likely to place the subject in danger or they are athreat to themselves or others

High : The risk posed is immediate and there are substantial grounds fo rbelieving that the subject is in danger because of their own vulnerabilityor mental state or the risk posed is immediate and there are substantia lgrounds for believing that the public is in danger through the subject'smental state .

• Police will require high quality information to car ry out their risk assessment . Hospitalstaff should consider , generally in advance when compiling the "grab pack", whatinformation will be shared with the poli ce .

8 . Joint , documented action plan

• The joint action plan should document how the identified risks are going to bemanaged , and the service user safely returned .

• The documented plans should cover both proactive actions (which agency will dowhat ?) and a reactive plan (what action should eb taken if police come across theservice user in the normal course of their duties?) . As many contingencies aspossible should be covered .

• It needs to be clear who within both agencies will car ry out this role .

• There should be an acknowledgement that the police should not be expected to dealwith the situation on their own - a minimum level of hospital resources should beavailable for the joint operation to locate and return the se rv ice user .

• Any visit to premises to re-take service users must be treated as pre-plannedoperation , requiring structured and documented risk assessment , planning andbriefing processes .

• There should be a mechanism in place for referring missing service users to Multi-Agency Public Protection Arrangements (MAPPAs) where relevant .

• Legal considerations must be taken into account .

Power to re -take• There is no power to re-take and return to hospital a patient who is not liable

to be detained under the Mental Health Act .• If the patient is liable to be detained under the Mental Health Act and is absent

without leave , he or she may be taken into custody and returned to thehospital by an AMHP , any officer on the staff of the hospital or place fromwhich the patient is absent , any constable , or any person authorised in writingby the managers of the hospital .


Entry to premises and Section 135 (2) warrant s

• There is no power of ent ry without a warrant .• Unlike Section 135 (1) , a Section 135 (2) warrant can only be granted if it

appears to the magistrate that admission to the premises has been refused orthat refusal of admission is apprehended .

• The warrant can be applied for by any constable or any other personauthorised under the Mental Health Act to re-take a patient absent withoutleave , as above .

• Who applies? Staff trained to apply for warrants? Out of hours applications?Warrant for premises outside or cou rt area - which court can issue warrant?Who applies , practical arrangements?

• The warrant , if granted , authorises any constable to enter the premises , ifneed be by force , and remove the patient . The warrant also authorises theconstable to be accompanied by a registered medical practitioner and / oranyone authorised to re-take a patient absent without leave , as above .

• The hospital should inform the police immediately if the service user returns to thehospital .

De -briefs , learning and prevention

It should be the responsibility of the hospital to ensure that the se rvice user isinterviewed on return , as soon as possible . The hospital should decide who shouldconduct the interview , taking into account whether there ought to be an independentperson involved .Any relevant information from the interview should be fed into the servi ce user's careplan , risk assessment and into action to prevent similar incidents .

APPENDIX: SUMMARY OF RELEVANT LEGISLATION

Human Rights Act

Section 6(1) of the Human Rights Act 1998 makes it unlawful for a public authority to act in away which is incompatible with under right under the European Convention for the Protectionof Human Rights and Fundamental Freedoms . It is essential that any proposed course ofaction be :

• Proportionate

• Lega l

• Accountable

• Necessary

• Based on the best available informatio n


Health and Safety Legislatio n

Participating agencies are subject to the requirements of the Health & Safety at Work etc Act1974 and all other relevant statuto ry provisions and recognised codes of practi ce . They alsoaccept their responsibility for the health and safety of other people who may be affected bytheir activities .

All pre-planned operations must be risk assessed and risk managed and this requires highquality information

The Race Relations Act 1976 as amended by the Race Relations (Amendment) Act 2000,and the Code of Practice on the Duty to Promote Race Equality

All public authorities have a general duty to :

• Eliminate unlawful racial discrimination• Promote equal opportunities• Promote good relations between people from different racial groups .

Mental Health Act Code of Practic e

All service users will `be given respect for their qualities , abilities and diverse backgrounds asindividuals and be assured that account will be taken of their age , gender, sexual orientation ,social ethnic , cultural and religions background , but that general assumptions will not bemade on the basis of any of these characteristics' .

Disability Discrimination Act 199 5

It is unlawful for service providers to treat disabled people less favourably for a reasonrelated to their disability .

Data Protection Act 199 8

Anyone processing personal data must comply with the eight enforceable principles of goodpractice . They say that data must be :

• Fairly and lawfully pro cessed ;

• Processed for limited proposes ;

• Adequate , relevant and not excessive ;

• Accurate ;

• Not kept longer than necessa ry;

• Processed in accordance with the data subject ' s rights ;

• Secure ;

• Not transferred to countries without adequate protection .


Barnet, Enfield and HaringeyMental Health NHS Trust

Working together for a safer London

TERRITORIAL POLICIN G

MISSING PERSONS INFORMATION PACK

SERVICE USER MISSINGFROM A HEALTHCARESETTING OR AWOL -APPENDIX 9

Information to be given to Police in event of a patient / service user, who isassessed as being of either medium or high risk is and is missing from ward o r

place of residence .

Surname : Gender:

Forename : Date of Birth :

Preferred Name / Alias : Religion :

Title : Ethnicity :

Address : Preferred language Communication :

Legal Status :Section : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Post Code :

Telephone No :Covered by Section 11 7

Mobile No :

Subject to Supervised

Nearest Relative : (as defined by the MHA) Discharge:

Or Holder of Parental Responsibility

Name : Home Office Restriction : YES / NO

Address : Statuto ry Supervision by th eProbation Service : YES / NO

Post Code :

Telephone No :Ward :

Mobile No :Consultant :

Telephone No :

Main Carer :

Relationship:

Address :

Post Code :

Telephone No :

Inter-Agency Joint Protocol Mental Health

Name of CMHT:

Care Coordinator :

Address :

Post Code :

Telephone Number:

Mobile No :

(V2 .0) 82

1 . Description of Patient / Service User

(in the case of Forensic Patient attach photograph if available )

2. Summary of Risk Assessment :

Please attach latest risk assessment .

Please indicate if of high or medium risk: 0 0Low Medium High

3 . Essential Medication and Treatment required in order to prese rve life

• Name and dosage of current medicatio n

• Predicted or anticipated effect patient effect if not taken

4 . Description of any physical disabilities or diagnosed medical condition ,eg : usual impairment Alzheimer's

5 . Any other factor or circumstance about the missing person which may affectthe risk of Police risk assessment .


SERVICE USER MISSING FROM A HEALTHCARE SETTING OR AWOL - APPENDIX 1 0

Return of Patient Under Section Who is Absent Without Leave (AWOL)

1 . Before Police transpo rt is used , attempts should be made by hospital staff and

community based mental health staff to encourage the person to return of their

own free will .

2 . The power of arrest and the use of reasonable force in relation to the retaking of

AWOL patients is given to nominated persons , including a constable and other

hospital staff , under Section 18 of the Mental Health Act 1983 .

3 . If a missing person is located before the limit of their section expires , the patient

can be arrested and returned to the ward from which they are AWOL using Police

transpo rt . Depending on the location found the police where practical may take

the detained person to a local place of safety . Fu rther transpo rt to the required

hospital being the responsibility of the NHS .

4 . Section 18 does not provide a power to enter premises by force . Unless the

owner of the prope rty provides written consent to police being on the premises

(for example , where a patient has returned to his /her parent's home and the

parent gives permission for police to enter the prope rty) , then the hospital ward

staff will be informed of the whereabouts of the missing patient and the Mental

Health Trust will then consider the potential use of a Section 135 (2) warrant to

obtain access .

5 . In the absence of a Section 135 (2) warrant , a police officer may use force to

enter and search any premises for the purposes of saving life and limb , or

preventing serious damage to property (Section 17 Police & Criminal Evidence

Act 1984) providing the officer has reasonable grounds for believing that such

threats are likely .

6 . The use of criminal law to affect a forced ent ry to private premises should not be

reso rted to unless there is an immediate need to prevent serious harm .


SERVICE USER MISSING FROM A HEALTHCARE SETTING OR AWOL - APPENDIX 1 1

Procedures for the Application and Execution of Warrantsissued under Section 135 (2)

1 . Police powers of ent ry onto private premise s

1 . 1 Forced ent ry to private premises can be effected if authorised by either Statue orCommon Law .

1 .2 The police , in appropriate circumstances may forcibly enter a property without awarrant to arrest. For example :

• A person suspected of an offence (Section 17 (1)(b) PACE 1984 )

• For the purpose of saving a life or limb or preventing serious damage to property(PACE : S17 (1)(e) )

• For the purpose of recapturing a person who is unlawfully at large and whom theofficer is pursuing (PACE : S17(1)(d) )

• NB : The House of Lords in D 'Souza v Director of Public Prosecutions (1992) heldthat the pursuit must be almost contemporaneous with the ent ry of the premises .It is not enough for the police , having formed the intention to arrest , to a ttend thepremises .

• To prevent a breach of the peace occurring , if the officer reasonably believesthat an imminent breach is likely . There is no requirement that the breach beserious (McLeod v Commissioner of Police (1994) .

1 .3 The use of criminal law provisions to effect a forced entry to private premises shouldnot be considered unless there is an immediate need to prevent serious harm .

2. Basis for an Applicatio n

2 . 1 Section 135(2) provides for a Police constable and / or any other person authorised bythe Mental Health Act to make an application to a Magistrate for the issue of awarrant in respect of a person who is currently liable to be detained i . e . still subject toSection 2 , 3 , or 37 and who is Absent without Leave from a hospital or registerednursing home (S18 Mental Health Act 1983) .

2 .2 . The Justice of Peace needs to be satisfied on information laid on oath by any constableor other authorised person :

i) That there is reasonable cause to believe that the patient is to be found onpremises within the jurisdiction of the justi ce; and

ii) That admission to the premises has been refused or that a refusal of suchadmission is apprehended .

2 . 3 The Justice may then issue a warrant authorising a Police Constable and /orauthorised persons to enter the premises , if need by force and to remove thepatient . (S135(2)(b) .


3 . Applying for a warrant .

3 . 1 NB : Warrants issued under S135(1) are subject to the general warrant requirementsset out in subsections 16 - 16 of the Police and Criminal Evidence Act .

3 .2 It has been queried whether in view of the the Human Rights Act 1998 , formal noticeshould be given to a client of the intention to make an ex-pane application for awarrant under S135(1) or (2) in order not to contravene their right to a fair trial .Concerns have been expressed that any notice e of intention to apply for a warran tmight be counter productive , as the individual may abscond , demonstrate moredisturbed behaviour , or put themselves or other at further risk .

3 .3 Legal advice suggest that the S135 powers can be categorised as emergenc ypowers in relation to which the European Court sets a somewhat lower standard i nenforcing Convention requirement6s .

3 .4 However the Local Authority/ Trust needs to explicitly consider in each case whetherany interference with the person ' s rights is justified and subsequently whether to givenotice .

3 .5 If a court can be satisfied that in the particular circumstances , the applicant hasthought through and balanced the various factors and decided that notice should notbe given and can explain that decision , then it is unlikely that the court wouldoverride that decision .

3 .6 Any decision to inte rfere with a convention right needs to be carefully documented .

3 . 7 An application for a warrant may be made by :

• A Police Constable• Any other person who is authorised under this Act to retake patients : i . e :

■ Any other officer on the staff of the hospita l■ Any Approved Mental Health Professiona l■ Any person authorised by the Hospital Managers

Or

• In the case of a patient subject to Guardianship , any officer on thestaff of a local social se rv ices authority .

3 . 8 . 1 The Police Service will not be expected to make warrant applications . Thisresponsibility will normally lie with either the Mental Health Act Administrator or theService Manager with responsibility for the ward or another member of Trust staff withdelegated responsibility . Only in exceptional circumstances should an AMHP be askedto act as applicant .

3 .9 With office hours the Mental Health Act Administrator should liaise with the Court Officeof the Magistrates Court serving the petty sessions area in which the relevantaddress is located . Out of Hours a list of Justice of Peace contact numbers isavailable via the Police Control room .

3 . 10 The application for the warrant may be made ex-pane and the information to support itmust be in writing (Section 15(3) PACE .


3 . 11 The Mental Health Act Administrator/ Service Manager will be asked by the magistrateto provide proof of their professional identity , answer questions and /provide supplementa ryinformation , either on oath or consequent on affirmation .

3 . 12 In order to protect individual confidentiality an AMHP may ask the Clerk to the Justicesto temporarily clear the court whilst the application takes place .

3 . 13 The warrant should identify , as far as is practicable the person to be sought (S15(6)PACE) . However the procedure may still be invoked even if the name of the mentallydisordered person is not known . (S135(5) ) . In these circumstances the phrase ` 1female / 1 male : name currently unknown ' should be used . Although the warrantneed not name the individual it must clearly specify the premises to which it relates .

3 . 14 The warrant should specify the name of the person who applies for the warrant , thedate of which it is issued and the fact that it was issued under the Mental Health Act1983 (Section 15(6) PACE) .

4. Procedure for seeking police assistance in executing the warrant

4 . 1 Requests for police assistance will fall into two categories ;

i) Pre-planned Request - where police assistance is required with more than 24hours notice and

ii) Urgent Request - where police assistance is required with less than 24 hoursnoted .

NB : Weekends and Public Holidays should be excluded when calculating the24 hours notice .

5. Executing the Warrant

5 . 1 In executing the warrant , a Police Constable may be accompanied by a registeredmedical practitioner or any other person such as a Hospital Officer or AMHP who isauthorised to take or retake the patient . Any Police Officer can assist in theexecution . The Hospital Officer in attendance need not necessarily be the HospitalOfficer who initially applied for the warrant .

5 .2 When forced ent ry is required the means of ent ry and method of ensuring safety willbe at the discretion of the police , following consultation with the Hospital Officer .

5 .3 The warrant will authorise an ent ry on one occasion only (Section 15(5) PACE) .

5 .4 Entry and search under the warrant must be within one calendar month from the dat eof its issues (S16(3) PACE) . It must also take place at a reasonable hour unless itappears to the Constable executing the warrant that the purpose of the search maybe frustrated on an entry at a reasonable hour (S16(4) PACE) .

5 .5 The occupier of the premises is present at the time , when the constable seeks toexecute the warrant the Constable should :

o Identify him /herself ,


o Produce the warrant ,

o Supply occupier with a copy of the warrant .

5 .6 If the occupier is not present but some other person who appears to the Constable tobe in charge of the premises is present , the above procedure should be followed inrespect of that person S16 (5-7) PACE) .

5 .7 If there is no person present who appears to be in charge of the premises , the PoliceConstable should leave a copy of the warrant in a prominent position .

5 .8 Any search that takes place may only be to the extent required for the purpose of thewarrant (S16(8) PACE) .

5 .9 The role of the Police Constable is to gain ent ry to the premises , by force ifnecessa ry and to assist the persons authorised to retake the person under S18 toexercise this power and remove the patient to the place where he /she is required toreside , under the terms of his /her detention .

5 . 10 The Police Constable executing the warrant must endorse it stating whether the personsought was found (Section 16 (9) PACE) .

6. Transport

6 . 1 Transport to hospital will normally be by ambulance which may require a policeescort if the person has a histo ry of violent behaviour .

6 .2 Police transport will normally only be used to convey persons who :

• are violent or potentially violent;• may be a danger to the public; or• are likely to be an immediate danger to themselves .

6 .3 Police transport will not be used to convey people who have been sedated as theywill require constant clinical supervision from a medical practitioner or a nurse .

6 . 4 Police transport will not be used to convey people between hospitals or within suchcomplexes .

7. De-briefing

7 . 1 Following conclusion of the incident a short debriefing should take place between th eAMHP and the police attending the address to discuss any problems or suggestion sfor improvements to the protocol . Details of the incident including the ris kassessment and any action should be recorded on the Police CRIMUINT system ,even in cases where no violence has occurred . The fact that police attended meansthat there was a perceived risk of harm to self or others and has potentia limplications for future safety .

8. Return of Warrants .

8 . 1 The Mental Health Act Administrator /Hospital Officer will be responsible for thereturn to the Clerk to the Justices (for the petty sessions area in which the issuingJustice of the Peace acts) of any warrant which has been executed , or which has not


been executed within the time authorised for its execution .

8 .2 The returned warrants will be retained for a period of 12 months during which timethe occupier of the premises to which the warrant relates will be allowed to inspect it .

8 .3 The Hospital Officer should place a copy of the warrant on the patient ' s medical fileand a copy should be retained by the Mental Health Act Administrator who willaggregate the information and provide regular statistical feedback on usage of thisprovision .

8 .4 The Police Constable responsible for executing the warrant will complete an ent ry inMPS Book 101 .


APPENDIX 12 TRANSPORT , CONVEYANCE AND SECTION 6

DELEGATION OF AUTHORITY TO CONVEY A PATIENTTO A HOSPITAL UNDER THE MENTAL HEALTH AC T

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name of Patient)

I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (your name )

have made an application for the admission of the above patient to :

(name of hospital or registered nursing home) on the requisite form , suppo rted by theappropriate medical recommendations .

I am an * Approved Mental Health Professional/ the Nearest Relative (*delete asappropriate) within the meaning of the Act .

I delegate my authority to convey the patient to the above hospital to :

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (name )

You may use reasonable restraint to achieve the objective of conveying the person tohospital but you should use the least restriction possible whilst ensuring the patient 'sand other person 's safety .

Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (your signature)

Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (address on forms )

Contact mobile telephone details if you need to speak with me/the duty managerabout this delegation arrangement :

Date authority issued : . . . . . . . . . . . . . . . . .

Date authority expires : . . . . . . . . . . . . . . . . .


APPENDIX 13 SECTION 17E RECALL FROM COMMUNITY TREATMENT ORDE R

Extract from Mental Health Act 2007 (Section 17A )

(1) The responsible clinician may by order in writing discharge a detained patient from hospitalsubject to his being liable to recall in accordance with section 17E [below] .

(2) A detained patient is a patient who is liable to be detained in a hospital in pursuance of anapplication for admission for treatment .

(3) An order under subsection (1) above is referred to in this Act as a "community treatment order" .

(4) The responsible clinician may not make a community treatment order unless-

(a) in his opinion , the relevant criteria are met; and

(b) an approved mental health professional states in writing-

(i) that he agrees with that opinion ; and

(ii) that it is appropriate to make the order .

(5) The relevant criteria are-

(a) the patient is suffering from mental disorder of a nature or degree which makes itappropriate for him to receive medical treatment ;

(b) it is necessary for his health or safety or for the protection of other persons that heshould receive such treatment ;

(c) subject to his being liable to be recalled as mentioned in paragraph (d) below , suchtreatment can be provided without his continuing to be detained in a hospital ;

(d) it is necessary that the responsible clinician should be able to exercise the power undersection 17E(1) [below] to recall the patient to hospital ; and

(e) appropriate medical treatment is available for him .

(6) In determining whether the criterion in subsection (5)(d) above is met , the responsible clinicianshall , in particular, consider, having regard to the patient 's history of mental disorder and anyother relevant factors , what risk there would be of a deterioration of the patient ' s condition if hewere not detained in a hospital (as a result , for example , of his refusing or neglecting to receivethe medical treatment he requires for his mental disorder) .

(7) In this Act-

force ;"community patient " means a patient in respect of whom a community treatment order is i n

"the community treatment order ", in relation to such a patient , means the communitytrea tment order in force in respect of him ; and

"the responsible hospital ", in relation to such a patient , means the hospital in which he wasliable to be de tained immediately before the community treatmen t order was made, subjectto section 19A [below] .

XI I


APPENDIX 14

Application for Section 135(2 )

Guidance Notes for Barnet, Enfield & Haringey Trust Staff

It is possible that there will be occasions when it may be necessa ry, in the interests ofthe patient , to gain access by force to the premises where they are known to be .These instances are likely to be rare , but when they occur , will reflect a degree ofurgency and concern which will require prompt and well co -ordinated action on thepart of those involved in the care of the patient . Early notification of the local policeauthorities is therefore essentia l in order to plan a co-ordinated response .

Section 135(2) provides for the issue of a warrant to a police officer to enter premises ,using force if necessary , for the purposes of retaking a patient who is already l iab le tobe detained .

In it iat ing 135(2 )

Applications for a warrant , using Form MH 72 under Section 135(2) can be made by :

• Approved Mental Health Professional s• any officer on the staff of the hospital• by any constable• any person authorised in writing by the managers of the hospital NB : Note that, for

CTO cases, it is the CM HT Care Co-ordinator who is l ike ly to l ead this process .

Any member of the Trust staff who may be required to make an application underSection 135(2) will require authorisation in writing from the managers of the Trust .

Prior to the application for a warrant , a risk assessment should be undertaken inconsultation with the Responsible Clinician , other medical staff involved , a seniormember of the nursing staff (F Grade or above) and anyone else involved in the careof the patient . The decision to apply for a warrant under Section 135(2) should bemade by senior medical and nursing staff within the Trust . Applications should bemade by trained permanent members of staff.

For Trust staff, whether inpatient ward staff or CMHT staff members (for CTO cases) ,to apply for a warrant under Section 135(2) the following action must be taken :

• Liaise with Barnet, Enfield and Haringey Police Mental Health Unit (MHU)notifying them of the intention to apply for a warrant and requestassistance . The MHU contact details are ;

MHU : T 020 8345 0987 (24hr answer-phone) ,

Mobile : 07884 475 716 ,

E-mail- [email protected] .u k


• Liaise with relevant ward/local C MHT to inform them of the plan and requestassistance as necessary .

• Contact the Clerk of the Court Magistrates Court to arrange to layinformation on oath before a Justice of the Peace .

• Obtain from MH72 (Information in Support of an Application for Warrant toenter premises and remove patient (Section 135(2)) - a supply of which arekept on the wards .

• Form MH72 to be completed giving evidence/reasons to suspect that the criteria issatisfied in respect of the person - the person should be named on the application .

• Obtain wri tten authorisation from Trust managers detailing the status of theapplicant, that they are authorised to `take or retake ' the patient and the status ofthe person authorising .

Within court hours (9 . 00 am - 4.00 pm) an officer of the Trust or an Approved SocialWorker may apply for the warrant .

I Documents to be taken to the Court

The following documentation is required :

• completed Form MH72 (Supplies on the Ward with AWOL Policy) ;• obtain a letter of authorisation from , RMO / RC or Care Co-ordinator (a sample

letter is shown below) and• photo ID/ name badge of staff member/ UKCC Pin Card .

I At the Magistrates Court

At the Court, ID and relevant papers need to be presented to the Clerk of the Court . Itmay also be worth asking the Clerk what exact procedures to follow e .g . which courtto go to ; where to find the ` list caller' who needs to know why the applicant is there sothat the case can be put on the list . The staff member will be required to take the oathin front of a magistrate and may be questioned about the circumstances of the case .

Once the Warrant has been issued and obtaine d

The following action is necessary :• return to the hospital/CMHT base ;• liaise with the Police - (obtain a CAD Number for the assignment) - who will

execute the warrant;• order an ambulance ;• alert and organise relevant workmen (e .g . Locksmiths) ; and• organise two staff members (may be ward staff and Care Co -ordinator) .


I SAMPLE LETTER

STRICTLY PRIVATE & CONFIDENTIAL

The Justice of the PeaceHaringey Magistrates CourtThe Court HouseBishops Road

London N6 4HS

TO WHOM IT MAY CONCERN

Re : Joe Public, 289 St Ann's Road N1 5

Detained under Section 3 Mental Health Act 1983Section Expires January 28 199 8

This is to confirm that the bearer of this letter, Eric Monk, Registered Mental

Health Nurse , Pin Number . . . . . . . . . has authorisation to obtain a warrant to

enable a constable to enter premises and retake the above named patient wh o

absconded from Greene Ward at the Psychiatric Ward on 00 /00/0000 .

Thank you for your co -operation in this matter .

Yours sincerely ,

Clinical Services Manager


Additional Information

During out of hours , the Police will need to be given sufficient information so that aPolice Constable may obtain a warrant from a magistrate .

Prior to removal of a patient under Section 135(2) , a minuted briefing meeting shouldbe organised between Trust staff , the Police and anyone else involved in this action .

In executing a warrant , the Police are in charge of the situation . Trust staff are thereto advise and assist the Police Officers . The Police at the scene are responsible forthe safety of the patient , staff, members of the public and their own officers .

When a patient is removed under Section 135(2), they should be transferred back tohospital in an ambulance .

Magistrates Cou rt :

Haringey Magistrates Cou rtThe Cou rt HouseBishops RoadLondon N6 4HSTel : 020 8340 3472

Police Station :

Haringey Mental Health & Community Engagement Team ,

St . Ann 's Police Station ,

289 , St . Ann 's Road ,

Tottenham ,

London .

N15 5RD .


Pat ient notcompl iant with

discretionaryconditions

RECALL BEINGCONSIDERED

Patient notcompl iant w i th

Mandatoryconditions

PatientRelapsing

Not compliantwith conditions

Patient Informal persuasion fails .remains Deadline for sectionwell? renewal or SOAD

Assessment du eDischarginq CTO not

Informalpersuasion .

Considerva ry ing

conditions?DischargeCTO if not

practicable .

Pat i ent relapsed .Inc i p i ent relapse .Risk behav i our .

Meets recall criteria

Refusing hospital

RECALL DECISION MAD E(by RC in consultation with CMHT keyworker

who co-ordinates the process. )

Serve Recall Notice

PATIENT CONTACTABLEArrange meeting & serve Not i ce

D irectly to pat i ent .Recall deemed served immediately .

Patient accepts Recall :Arrange HospitalBed .Transport to Hospitalin least restrictiveway possible bearingin mind riskassessment .

Patient goes AWOLfollowing Recall :

FOLLOW HOSPITALAWOL POLICY

Urgent cases : Hand-del iver Not i ce toPat i ent's last known address-Recalltakes effect the next day after delivery .

Patient does not comply with recall despitecontinued informal persuasion . (The time

period for persuas i on i s at the d iscret ion ofthe RC , rang i ng from one to several days

depend ing on the degree of cl in icalurgency ) .

Compliant withconditions

Requires hospitaladmission

Voluntaryadmissio n

PATIENT NOT CONTACTABLENon-urgent cases: send Not ice by 1Stclass post to pat i ent's last known

address- Recall takes effect two "workingdays" after posting .

Patient deemed AWOL .Arrange Hospital Bed .

FOLLOW CTO RECALL / AWOLFLOWCHART 2


Arrange bedUpdate :

Family/CarerKey worker

. GPSocial Worker

Pat i ent to be RECALLED anddeemed to be AWOL

Risk Assessment -Is th i s ` h i gh ' ?

NO

Is the patient's whereaboutsknown?

YES

ASSESS RISKagree pla ninform colleaguesarrange transport

request Police

C

Are there riskYES factors identified

for staff?

Is there need for Section 135(2)?

YES

Inform PoliceNO Complete

MissingPersons repor t

Liaise with

Liaise wit hNO Police

Convey urgencyandseriousness

Outcome and Resolutionreassess patient and review Care Planrecord outcom einform colleagues and carerscomplete documentationSee FLOWCHART 3

Are CMHT to bedirectly involved in

YES returning thepatient (le in office

hours)?

Inter-Agency Joint Protocol Mental Health (V2 . 0)

RECALLED PATIENT

Conveyed to Designated Placeof Recal l

(Sector Ward/Un i t)

ASSESSMENTMust take place within the 72hours Recall DetentionPeriod .

Carried out by CommunityResponsible Clinician (or byInpatient/other RC ifCommunity RC notavailable) .

Patient may be treated underPart d of 4hp At i f

PATIENT RELEASEDFROM RECALL.(RC makes decision)Consider va ry ingconditions .Considerdischarging CTO .

PATIENT RECEIVESTREATMENT & ISRELEASED FROMRECALL(Recallautomatically lapsesafter 72 hrs & treatmentcannot be enforcedthereafter) .

CTO ISDISCHARGED .(RC makes

Patient absconds :If deemedappropr i ate ,INITIATE HOSPITALAWOL PROCEDURE .Th is w i ll be therespons i b i l ity of the

PATIENT ACCEPTSVOLUNTARY ADMISSIO N

CONSIDER REVOCATION OF CTORequ ires RC & AMHPAssessment & agreement beforecompletion

AMHP does not support Revocation :Recall Notice expires after 72 Hrs .(Not appropriate to seek alternativeAMHP opinion)

AMHP supports Revocation : Liabilityto be detained under Section 3 or 37resumed .Ensure current valid Part 4Certificate! !

Inter-Agency Joint Protocol Mental Health (V2 . 0)

19 . EQUALITY IMPACT ASSESSMENT AND ANALYSIS FORM

Name of the policylservice development , strategy or plan being analysed :Inter-Agency Joint Working Protocol for the Management of Mental Healt h

Name and job title of the manager responsible for car ry ing out this analysis :Andrew Smith - Corporate Mental Health Law Manage r

Please summarise your policylse rvice development, strategy or pla nAn overarching protocol to ensure inter-agency joint working for the management of mental health with aparticular focus on those persons who are subject to the Mental Health Act 1983 and under the care of loca lagencies.

What are the main objectives or intended outcomes of the policy lserv ice development , strategy or plan ?

■ Joint working in respect to section 135 warrant s■ Joint working in respect to section 136 policy powers to remove a person to a place of safet y■ Joint working in respect to Missing Persons or those AWOL under the MHA 198 3■ Joint working in respect to conveyance (section 6) of patients subject to the MH A■ Joint working in respect to the management of patients recalled under section 17E of the MH A

1 . Please indicate the expected impact of your proposal on people with protected characteristics

Characteristics Significant +ve Some Neutral Some -ve Significant -+ve ve

Age :Disability:Ethnicity : ✓Gender re-assignment :Religion/Belief : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sex (male or female) ✓Sexual Orientation : ✓

✓_

Marriage and civi lpartnershipPregnancy and maternity ✓

The Trust is also concerned about key disadvantaged groups event though they are not protected by lawSubstance mis-users ✓The homeless ✓The unemployed ✓

2 . Consideration of available data , research and informatio nMonitoring data and other information should be used to help you analyse whether you are delivering a fair andequitable se rv ice. Social factors are significant determinants of health outcomes . Please consult these types ofpotential sources as appropriate . There are links on the Trust website :• Joint strategic needs analysis (JSNA) for each borough• Demographic data and other statistics , including census findings• Recent research findings (local and national )• Results from consultation or engagement you have undertake n• Se rv ice user monitoring data (including age , disability, ethnicity, gender, religionlbelief, sexual orientation

and )• Information from relevant groups or agencies , for example trade unions and voluntary/community

organisations• Analysis of records of enquiries about your se rv ice, or complaints or compliments about them• Recommendations of external inspections or audit report s

Inter-Agency Joint Protocol Mental Health (V2 .0) 1 00

Key questions

relate to the Trust's corporate equalityobjectives and the public sector duty ?

What are the relevant equalitiescharacteristics of the staff involved oraffected ?

wnat are the relevant equalitiescharacteristics of the service users andcarers involved or affected?

Reference data, research and information that you have reviewedwhich you have used to form your response

upon

A range of equalities characteristics relevant depending on theindividuals involved or affected at the time .

bull range of equalities cnaractenstics relevant depending onindividuals involved or affected at the time .

2 .4 What other relevant data do you have i n CQC reports on visits and discussions with staff and service users,terms of service users or staff? ( e .g . Joint Monitoring Group reports, databases of s135, s136 andresults of customer sat isfacti on Community Treatment Order data . Rio data on activity . Minutes ofsu rveys, consultation find i ngs, census JMG and MHA Committees .data , and health needs assessmentsetc).

3 . It is Trust policy that you explain your proposed development or change to people who might be affected by it, or theirrepresentatives . Please outline how you plan to do this .

Group Methods of engagemen t

Enfield Mental Health Users Email consultations , Members of the Inter-Agency Joint Protocol Monitorin gGroup (EMU) Group (JMG) , co-delivering staff training

Barnet Voice for Mental Health Email consultations , Members of the Inter-Agency Joint Protocol Monitorin g(BVMH) Group (JMG) , help delivering police training and section 12/AC training

Haringey Users Network (HUN) Email consultations , Members of the Inter-Agency Joint Protocol Monitorin gGroup (JMG)

Metropolitan Police Se rv ice 1 Active JMG membership , signed off by the organisation , delivery of trainin gBritish Transport Police and awareness within the organisatio n

Barnet and Chase Farm Active JMG membership , signed off by the organisation , delivery of trainin gHospitals NHS Trust and awareness within the organisatio n

London Ambulance Service Active JMG membersh ip , s igned off by the organ i sation , del i very of tra i n i n gand awareness w i th i n the organ isati on

North M i ddlesex Un iversity Active JMG membersh ip , s igned off by the organ i sation , del i very of tra i n i n gHospital NHS Trust and awareness w i th i n the organ isati on

The Local Author i ties of the Active JMG membersh ip , s igned off by the organ i sation , del i very of tra i n i ngLondon boroughs of and awareness w i th i n the organ isati onBarnet, Enfi eld & Haringey

4 . Equality Impact Analysis Improvement Plan

If your analysis indicates some negative impacts , please list actions that you plan to take as a result of thisanalysis to reduce those impacts , or rebalance opportunities . These actions should be based upon the analysisof data and engagement, any gaps in the data you have identified , and any steps you will be taking to address anynegative impacts or remove barriers . The actions need to be built into your se rv ice planning framework.Actionsltargets should be measurable , achievable , realistic and time framed .


Issues identified Actions required By who

None identified No additional actions require d6 . Sign off and publishin g

Once you have completed this form , it needs to be `approved ' by Serv ice Director , Clinical Director or a nExecutive Director or their nominated deputy . If this Equality Impact Analysis relates to a policy , procedure o rprotocol , please attach it to the policy and process it through the normal approval process . Following this sig noff by the Policy Review and Monitoring Committee your policy and the associated EgIAn will be published by th eTrust's policy lead on the website .If your EgIAn related to a se rvice development or business /financial plan or strategy , once your Director or th erelevant committee has approved it please send a copy to the Equalities Team (equalities (~beh-mht.nhs . uk ) , whowill publish it on the Trust ' s website . Keep a copy for your own records .

I have conducted this equality Impact analysis in line with Trust guidanceYour name : PositionAndrew Smith Corporate Mental Health Law Manage r

Signed : Date :

Smith 17 September 201 2

Approved by :

Your name : Oliver Treacy Position : Service Director (BEHMHT)

Sign :

Date :


CHECKLIST FOR THE REVIEW AND APPROVAL OF PROCEDURALDOCUMENTS

1 .

Title of document being reviewed :Yes/No/ CommentsUnsure

pl~

3

4 .

5 .

F6 .

7

TitleIs the title simple and clear toeveryone who reads it?Is it clear whether the document is agu idel ine , pol icy , protocol orstandard?Rationale

Are reasons for development of thedocument stated?

Development ProcessIs the method described in brief?Are individuals involved in thedevelopment identified?Do you feel a reasonable attempt hasbeen made to ensure relevantexpertise has been used?Is there evidence of consultationwith stakeholders and users?ContentIs the objective of the documentclear?Is the target populat ion clear andunamb iguous?Are the intended outcomesdescribed?Are the statements clear andunamb iguous?Evidence BaseIs the type of evidence to supportthe document identified explicitly?Are key references cited ?Are the references cited in full?Are local/organ isat i onal supporti ngdocuments referenced?ApprovalDoes the document identify whichcomm ittee/group w i ll approve it?If appropriate , have the jo int People& Organ isational Development /staffside commi ttee (or equivalent)approved the document?Dissemination and Implementation

Is there an outline/plan to identifyhow this will be done?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

YesYes

Yes

Yes

N/A

As agreed with Multi-agencyYes Joint Protocol Monitorin g

Group (JMG)


Title of document being reviewed :

Does the plan include the necessarytra in i ng/support to ensurecompl iance?

8 . Document Contro l

Does the document identify where itwill be stored?

Have archiving arrangements forsuperseded documents beenaddressed?

9 . Process for Mon itor ing Compl ianceAre there measurable standard tosupport mon itor ing compl iance ofthe document?Is there a plan to review or auditcompliance with the document?

10 . Review DateIs the review date identified ?Is the frequency of review identified?If so, is it acceptable?

11 . Overall Responsibility for theDocumentIs it clear who will be responsible for

L

coordinating the dissemination ,implementation and review of thedocumentation?

Yes/No/ CommentsUnsure

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

BEHMHT Intranet andorganisational policyrepositories

Corporate MH Law Manager

J MG (see above)


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