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Community Health Services

Ref No CP-048-07

SECTION 136 POLICY MENTAL HEALTH ACT 1983

(AS AMENDED BY MENTAL HEALTH ACT 2007)

AREA: Trust Wide POLICY SPONSOR: Mental Health Act Legislation Manager

IMPLEMENTED: January 2005

REVISED: December 2007 April 2008 July 2015

DUE FOR REVIEW: July 2017

Date Approved

APPROVED BY: Strategic MHL Multi-Agency Group MHL Assurance Committee Dorset Police South Western Ambulance Service Foundation Trust (SWASFT) Borough of Poole Bournemouth Borough Council Dorset County Council

DISSEMINATED TO:

Operational Directors Consultant Psychiatrists Hospital / Unit Managers Modern Matrons / Senior Clinical Nurses Ward Managers MHA Administration Team CMHT Managers Dorset Police SWASFT Borough of Poole Bournemouth Borough Council Dorset County Council

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Context

The Code of Practice requires Dorset Healthcare University NHS Foundation Trust, NHS Dorset, Dorset Police, Dorset County Council, the Borough of Poole, Bournemouth Borough Council, Dorset County Hospital, Royal Bournemouth Hospital, Poole General Hospital and SWASFT to establish a clear policy for the implementation of Section 136 Mental Health Act 1983 as amended by the Mental Health Act 2007.

This document contains the local multi-agency procedural guidelines and has been prepared and agreed by staff from the agencies above.

The “place of safety” will be St Ann’s Hospital except in circumstances where the person’s behaviour is so extreme, they cannot otherwise be safely managed. Then a police station will be used as the place of safety.

A glossary of terms and acronyms is included at the end of this policy to assist all agencies in understanding terms and / or roles associated to this policy.

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CONTENTS

PART 1 Introduction 4

PART 2 General Procedural Guidelines 4

PART 3 Policy/Procedural Guidelines (Hospitals) 6

PART 4 Procedural Guidelines (Police Stations) 9

PART 5 Assessment Procedure 9

PART 6 Terminating Section 136 12

PART 7 General Issues 12

PART 8 Monitoring and Review 13

PART 9 Contact Information and Addresses 14

Appendix A Dorset Police Form A375 Section 136 MHA –Your Rights 16

Appendix B Patients Information Leaflets – Hospital Forms 17

Appendix C Section 136 Monitoring Form 20

Appendix D Handover and Risk Assessment Form 22

Appendix E Guidance notes re Handover Risk Assessment Form 25

Appendix F Glossary of terms 26

Appendix G Dorset Healthcare NHS Foundation Trust Equality Impact 28

Assessment Form

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1.1

PART 1

Introduction

1.2 This policy relates to Section 136 of the Mental Health Act 1983 (2007)). It does not apply where a person has been arrested for an offence and subsequently thought to be mentally disordered. The policy is in place to ensure that such persons are dealt with appropriately in accordance with the Police and Criminal Evidence Act 1984 (PACE), the Human Rights Act 1998 (HRA), and the Mental Capacity Act 2005 (MCA).

1.2 To provide appropriate safety and security to persons detained by a Police Officer under Section 136 of the Mental Health Act 1983 (as amended) until the medical examination and Approved Mental Health Professional (AMHP) interview have taken place and any necessary arrangements for the person's treatment or care have been made.

1.3 Aims of the Joint Policy To ensure that:

a) The principles of the Crisis Care Concordat are adhered to b) A person detained under Section 136 receives the attention and the most

appropriate form of care he/she needs while respecting his/her rights as an individual;

c) That assessments are responsive to individual needs in terms of equal opportunities

d) That the safety of all involved in Section 136 detentions and assessments is maintained

e) Attention and care are provided in the most appropriate place and by the people best qualified to provide it;

Procedures will be responsive to the diverse needs of individuals and recognise the impact that social exclusion, deprivation and racial abuse can have on the mental health of people.

1) Whilst recognising ethnic, cultural and religious background, assumptions will

not be made on the basis of these characteristics. 2) All agencies share a commitment to improving service user experience and

service outcomes for people from black and ethnic minorities who experience mental health problems.

3) The attention and care is provided as soon as possible with the minimum of

disruption and stress to the person concerned. PART 2

2.0 General Procedural Guidelines

2.1

When a police officer decides to detain a person within the provisions of Section 136, the officer will contact the ambulance service who will aim to respond in the 30 minute timescale agreed, to screen the person for other potential causes. The Police and Ambulance service will decide, following a joint risk assessment and in accordance with joint Police/Ambulance Service mental health protocols, whether the person concerned should be conveyed directly to the psychiatric hospital or to another location, only using a police station in extreme circumstances.

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2.2

Transporting to a place of safety The Ambulance Service will aim to respond to the scene within 30 mins of a s136 request. As required by the Crisis Care Concordat, the responsibility for providing the patient with transport for definitive care lies with the ambulance service. However, when high risk is identified, measures may need to be taken to ensure the safety of the patient, ambulance staff and police officers. The provisions of the Crisis Care Concordat always need to be a consideration in these circumstances; patients with mental health needs must be provided with health services that provide parity with patients whose need is purely medical in nature. The other options to be considered are: • Police officer to travel in the ambulance with patient and ambulance staff. • Police vehicle to follow the ambulance and be in a position to assist if necessary. • Patient to be transported in a police vehicle only in exceptional circumstances with ambulance staff observing in a safe position within the police vehicle or an ambulance travelling behind the police vehicle and in a position to assist if necessary. Ambulance staff will be responsible for the initial screening and subsequent transport of the detainee. The final destination and mode of transport will be dependent on the outcome of the initial screen and the joint risk assessment.

2.2

Procedures when the place of safety is at the psychiatric hospital

(a) Prior to arrival at the hospital the police officer will, via the Force Control Room, inform the duty nurse that a person detained under Section 136 is being brought to the hospital and will provide any available details. The escorting/detaining officer will make every effort to ascertain as much information about the detainee as possible to pass to the duty nurse via the control room, including the place of arrest, estimated time of arrival, name and date of birth.The patient must be searched by police prior to being taken to a hospital and this recorded on the monitoring form.

On notification from the police the duty nurse will request the attendance of an Approved Mental Health Professional. The allocated AMHP will inform the hospital of the estimated time of arrival.

(b) On arrival, the police officers will provide information using a Section 136 Mental Health Act Handover and Risk Assessment Form (appendix D). Ambulance staff will complete a full clinical record (paper (PCR) or electronic(ePCR) and will ensure records are handed to hospital staff.

The AMHP will organise the attendance of medical personnel at the assessment, as required.

(c) The ambulance crew will depart the hospital once the clinical handover has been completed and be available to Ambulance Control in a time not exceeding 20 minutes of arrival

(d) The duty nurse will organise transport to return the person to the community, if they are not admitted to hospital.

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2.3 Police officer’s responsibility at the hospital: -

Where the detainee has been subjected to PAVA incapacitant spray, remain and carry out decontamination until the effects have dissipated.

If the person becomes aggressive or threatening once the decision not to admit is

communicated, the police will attend and manage as appropriate.

2.4 Use of Emergency Departments / General Hospitals

Those detained under section 136 will be taken to the emergency department of a general hospital if ambulance staff have assessed the detainee and believe there is a physical health issue which requires assessment and or treatment before assessment under section 136 can commence. This includes cases of acute alcohol intoxication, where ambulance staff will follow guidance in the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), and in the joint Police/Ambulance protocol for the “Health Assessment of Adults under the Influence of Alcohol and Incapable”. Such guidance requires that any adult who is incapable (i.e. Glasgow Coma Scale of 13 or less) is assessed at an emergency department.

2.5 Where a detainee is taken to the emergency department the police should remain with the patient in accordance with this local policy. The ambulance staff will complete the clinical handover including written or electronic documentation and clear from the department as per normal SWASFT procedure.

2.6 As soon as the assessment and or treatment of the physical health has been completed a decision will be made by emergency department staff regarding whether the detainee can be :

discharged from their service and moved to a place of safety; or

admitted to a ward within the general hospital

2.7 If a detainee is admitted to a general hospital ward for medical treatment the section 136 will continue. Where the detainee is in the A&E environment (i.e. not admitted to a ward), officers will remain at the hospital subject to a jointly agreed decision informed by the joint risk assessment process, see appendix D.

2.8

If a detainee is admitted to a general hospital ward the general hospital staff will be responsible for informing the AMHP via the contact details at part 9 of the policy.

2.9 The receiving hospital staff will be responsible for the completion of 136 monitoring form (appendix C) PART 3

3.0

Procedural Guidelines (Psychiatric Hospitals)

3.1

Procedure

(a) Nursing staff will be clear that the request for a place of safety is a request for an assessment and will not be dependent on the availability of a bed at that site.

(b) The duty nurse will immediately establish via the records systems whether

the detainee is known to the service. All information, i.e. case notes, will be

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made available to the professionals involved in the assessment. (c) The duty nurse will ensure that the designated 136 room is ready to receive

the detainee (d) The duty nurse will meet the police officer and the detainee and immediately

escort them to the 136 room and make them aware of health and safety issues and welfare facilities.

(e) The duty nurse will make an initial assessment of the detainee with regard to:

Mental state

Physical state

Security needs

Safety needs

Cultural needs

Any risk issues

and ensure that the appropriate level of nursing supervision is provided. At this stage a documented risk assessment must be carried out jointly with the escorting police officer(s) to determine whether the police officer(s) are required to remain on the grounds of safety.

(f) The duty nurse may need to make preliminary arrangements to prepare for the possibility of admission following the assessment.

(g) Under no circumstances will the duty nurse authorise admission to the

hospital of the detainee until a formal Mental Health Act assessment has been completed and a decision has been made unless an examining doctor has agreed to an informal admission.

(h) The duty nurse is responsible for issuing the detainee with a rights leaflet

(see Appendix B) and the completion of the appropriate Section 136 Monitoring Form (see Appendix C) which when completed should be sent to the MHL Office (St Ann’s Hospital) who will collate and send to the Performance Review section, Social Services Directorate, County Hall, Colliton Park, Dorchester DT1 1XJ.

(i) The mental health assessment of a person who has been detained under

Section 136 is to be considered by each agency as a priority. Co-ordination of the assessment must commence immediately upon notification. The assessment must take place within 3 hours or as soon as is reasonably possible.

3.2 Consent to Treatment

Detaining a person in a place of safety under Section 135 or Section 136 does not confer any power under the Act to treat them without their consent.

3.3

3.3.1

Restraint A person detained under section 136 cannot be restrained using the Mental Health Act 1983, as amended as he is in legal custody. He can however, be restrained by:

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Any person using powers under Section 3, Criminal Law Act 1967 and police officers using Section 117 of PACE where it is necessary to prevent a crime.

nursing staff or police using common law

3.3.2 If police officers have left the hospital following a risk assessment and an incident occurs where the detainee requires the use of restraint nursing staff are able to restrain on the following basis: Appendix A to the Mental Health Act Manual 17th Edition advises that: “Where a patient has been detained under the Mental Health Act, there is an implied power for staff to exercise a degree of control over the activities of the patient”….. “Both statute and the common law provide further powers that can be used to restrain and / or detain both detained and informal patients. They are:

1) In R. (on the application of Munjaz) v Mersey Care NHS Trust [[2003 EWCA Civ 1036; [2003] MHLR 362, Hale L.J. said, at para. 47 that:

“there is a general [common law] power to take such steps as are reasonably necessary and proportionate to protect others from the immediate risk of significant harm. This applies whether or not the patient lacks capacity to make decisions for himself”. 2) If the patient is mentally incapacitated, s.6 of the Mental Capacity Act 2005 enables

the patient to be restrained when (1) the person using the restraint reasonably believes that its use is necessary to prevent harm to the patient ; and (2) its use is proportionate both to the likelihood and seriousness of the harm and is in the patient’s best interests”

3.3.3 Other case law is listed at Appendix A to the Mental Health Act Manual 17th Edition,

however is not applicable to section 136 and restraint. These details can be found on pages 1095-1097 of the Manual.

3.3.4 Where police officers have left the hospital premises and the detainee has required restraint, the nurse in charge of the assessment should contact the police and request urgent police support (see paragraph. 2.6 c of this policy).

3.4 Communication

a) All professionals involved in the assessment should ensure that everything possible is done to overcome any barriers to communication.

b) Specialist help should be obtained if communication difficulties arise due to

hearing or visual impairment or learning disability.

c) Where the individual who has been detained does not speak English, or if s/he does not appear to understand, or if s/he requires an interpreter, this should be arranged. The patient’s relatives and friends should not normally be used as interpreters. The responsibility for arranging this, rests with the psychiatric hospital, or where detained at a police station, the Custody Officer.

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3.5 Detainee's rights

A person removed under Section 136 is deemed to be “arrested” for the purposes of the Police and Criminal Evidence Act 1984 (PACE). This means police officers have the power to search a person they detain under Section 136, as they would in the case of a person arrested for an offence. Under Section 54 of PACE, the custody officer at the police station has the power to ascertain what items the person has on them, to remove items (where permitted) and to search a person as necessary for these purposes.

Where a hospital is used as a place of safety, the nurse in charge will ensure that the detainee is made aware of his / her rights under this Section and is handed a copy of the Patient Information Leaflet (Appendix B) which provides information relating to Section 136. The detainee is entitled to have another person of his or her choice informed of the detention or whereabouts and they have a right of access to legal advice (Section 58 of PACE). This will be facilitated whenever it is requested.

PART 4

4.0 Procedural Guidelines (Police Station)

4.1 In those extreme circumstances where a police station is used as a place of safety, the normal procedures for dealing with detained and arrested persons will be followed.

4.2 On arrival at the police station the Custody Officer must: -

a) Open a custody record and fully comply with the conditions of PACE 1984 relating to detained persons;

b) Where the detainee has been exposed to PAVA spray put decontamination arrangements in place;

c) Hand the detained person the form at Appendix A (Dorset Police Form A375) “Section 136 Mental Health Act – Your Rights " and ensure as far as possible that the detainee is aware of his / her rights;

d) Liaise with Custody Mental Health Professional when available to make the

necessary arrangements. A doctor / duty psychiatrist must not, except in exceptional circumstances, discharge the detainee or informally admit them to psychiatric hospital without liaison with the AMHP.

e) The Custody Officer should commence the completion of the Section 136 Monitoring Form (Appendix C)

PART 5

5.0 Assessment Procedure

a) The purpose of the legislation is to enable a person to be both medically examined by a doctor and interviewed by an Approved Mental Health Professional (AMHP), and for an assessment to be made of the person's total situation as quickly as possible, in his/her own interests and/or for the protection of others, so that any necessary arrangements can be made for ongoing treatment and care (see 5.1c). The Mental Health Act 1983 Code of Practice 2015 states that a doctor and AMHP should jointly assess a person. Further detention may be necessary if the mental disorder is of a

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nature OR a degree that warrants detention in the interests of the person’s health OR safety OR for the protection of others.

b) The Mental Health Act Code of Practice 2015 states that the doctor examining the

patient should wherever possible be approved under section 12 of the Act. The examining doctor should discuss the case with the relevant Consultant Psychiatrist or senior doctor on call before any decision is made regarding the patient’s care. Where this is not the case the examining doctor should record the reasons on the Section 136 Monitoring form found at Appendix 3. However ultimately the decision is that of the assessing doctor.

c) In order to ensure a full assessment of the patient has been undertaken it must be a

joint assessment by an AMHP and the doctor. If there are exceptional reasons why this cannot occur, the reasons must be detailed on the monitoring form or, if at the hospital, on the incident form. In either case the forms must be copied to the Mental Health Legislation office, St Ann’s Hospital. If the assessing doctor who examines a person detained under Section 136 fails to detect any form of mental disorder whatsoever; the person should be discharged from detention under Section 136 immediately, as there can be no reasonable legal grounds for the holding power to continue. In this situation there is no requirement for the person to be seen by an AMHP, however good practice indicates there should be a joint assessment. If the person has a mental disorder, but the doctor believes is not detainable the patient cannot be released, but must wait for the AMHP to attend.

d) The doctor and the AMHP have a separate function to carry out. The contribution of

each should complement that of the other in the interests of formulating a plan of action that can be jointly agreed and implemented.

e) If it appears that the detained person has a Learning Disability it is good practice,

where practicable for a section 12 approved medic and / or an AMHP with experience of working with Learning Disabilities to be available to make a joint assessment.

f) If the person detained is under 18 years old it is desirable for a section 12 approved

clinician from the Child and Adolescent Mental Health Service (CAMHS) to be involved. Where this is not possible, a CAMHS clinician should be consulted as soon as possible. In particular, where a young person is being admitted to hospital either formally or informally, it is the responsibility of the managers to ensure there is access to / consultation with a suitably experienced CAMHS specialist It is also considered necessary that if they are to be provided treatment for mental disorder, it is important that accommodation in an environment that is suitable for their age (subject to their needs) is available in such cases.

g) The assessment under S136 is not solely for detention; AMHPs have a duty under

S9 of the Care Act to consider whether the detained person might be in need of Community Care Services.

5.1 All persons involved in the process must expedite actions in order that the assessment

takes place as soon as possible, and accurately record timings on the Section 136 Monitoring Form. There is a locally agreed target of 3 hours for both AMHP and section 12 clinician to attend the assessment, where possible.

5.2 The purpose of the examination and interview is to assess the needs of the person, which may result in that person's admission to a psychiatric hospital. The Mental Health Act 1983 Code of Practice 2015 lists a number of guiding principles which should be taken into consideration when an assessment is being undertaken. It is acknowledged that obtaining

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detailed information may present difficulties, particularly at night and at weekends.

5.3 Responsibilities of the Approved Mental Health Professional (AMHP)

Although the assessment process should, where relevant, be undertaken jointly the AMHP has a particular role, which includes:

a) Overall responsibility for co-ordinating the assessment of a person for possible admission to hospital under the Act.

b) Ensuring before the assessment process starts that the detained person is aware of his/her situation and why he/she is being detained.

c) Contacting nearest relatives, other relatives/friends.

d) Ascertaining whether there is a psychiatric history, the nature of any illness, and including an assessment of risk to himself/ herself or to others.

e) Ensuring that any possible alternatives to hospital are considered.

f) Ensuring that any other necessary arrangements are made to help the person concerned.

g) To ensure the assessment is carried out in accordance with principles of the Mental Health Act 1983 Code of Practice 2015.

5.4 Transfers from one place of safety to another place of safety

5.4.1

5.4.2

A person removed to a place of safety under Section 136 may be moved to a different place of safety before the end of the maximum 72 hour period for which they may be detained. The maximum period of detention begins from the time of the person’s arrival at the first place of safety to which they are taken and cannot be extended if the person is transferred to another place of safety. The revised Code of Practice 2015 states, a person held in police custody should be transferred to a health based place of safety within the first 20 hours where appropriate. Unless in an emergency, the detainee should not be transferred without the agreement of the AMHP, a doctor, or another healthcare professional competent to assess whether the transfer would put the detainees health or safety (or that of other people) at risk. It is for those professionals to decide whether they first need to see the detainee personally.

5.4.3 In deciding whether a transfer from one place of safety to another is appropriate, the doctor and AMHP would be well advised to make this decision based on the following list of particular considerations:

a) How would the planned transfer be to the detainee’s benefit?

b) How would the transfer protect the public?

c) How would remaining in the current place of safety either help the detainee or protect the public?

d) What are the views of the detainee and, if available, their family?

e) Are appropriate resources available to facilitate the transfer?

f) How does the choice of place of safety affect the detainee’s freedom of action?

g) Who is the most appropriate agency to convey? 5.4.5

If a police station must be used, the AMHP and doctor / psychiatric hospital staff must work with the police to support the care and welfare of the detainee and assist in arranging where appropriate, the transfer to a more suitable place of safety

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5.4.6 If a police station must be used as the place of safety, early assessment is essential to

determine if the detainee should be transferred to another place of safety.

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

PART 6

6.0 TERMINATING SECTION 136

6.1 There are five possible outcomes of a section 136. The outcome will be one of the following:

a) Compulsory admission to hospital under the appropriate section of the Mental Health Act 1983.

b) Where the assessment occurs at a police station as the "place of safety" any

subsequent compulsory admission to the psychiatric hospital can only occur after another section of the Mental Health Act (usually Section 2 or 3) has been implemented.

c) When the psychiatric hospital is being used as the “place of safety” only a Section

2 or 3 may be used to admit the patient compulsorily beyond the 72-hour time limit or once the formal assessment has been completed.

d) Admission to hospital as an informal patient (Section 131) e) Release from the place of safety with or without the offer of follow-up care and

support in the community. However, if follow up care is deemed appropriate and accepted by the individual then the AMHP is responsible for co-ordinating any follow-up care and support in the community.

PART 7

7.0 GENERAL ISSUES

7.1 Arbitration

7.1.1 The overall management of Section 136 involves discussion and planning across disciplines and agencies. This may occasionally give rise to differences of opinion, which will need to be resolved.

a) The Force Incident Commander (FIC), the Nurse in Charge or Duty Manager of the relevant hospital, Social Services Duty Manager and the Ambulance service’s Bronze Commander (contactable through Ambulance Clinical Hub) will be responsible for the resolution of immediate problems and difficulties on a 24-hour basis.

b) If agreement cannot be reached between the parties indicated above the matter

should, in due course, be brought to the attention of the relevant personnel listed below:

Acute Services Manager, St Ann's Hospital

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Dorset Police Mental Health Coordinator

Clinical Development Manager (East) South Western Ambulance Service

Service Managers / Head of Service, Social Services c) Where the issue is strategic and or persistent the matter should be brought to the

attention of the following group:

Mental Health Act Strategic Multi-Agency Group

7.2

Monitoring

7.2.1 Collection and analysis of information for monitoring purposes are addressed at 8.1.1 of this policy.

7.2.2 7.2.3

There is a local target time of professionals attending within three hours of the detainee arriving at the place of safety and compliance with this will be monitored through the use of the Section 136 Monitoring forms (Appendix C) in line with 8.1.1 of this policy. The Ambulance Service will aim to respond to all s136 requests within 30 minutes in accordance with the Crisis Care Concordat

7.2 Complaints

7.2.1 In the event that the detainee should wish to make a complaint, the complaints procedure from the appropriate agency should be followed, for example if the complaint concerns police actions the police complaints procedure will be followed.

7.3 Deaths

7.3.1

7.4

7.4.1

In the event that a patient dies within 36hrs of police contact the police must be informed immediately. This should be through the section commander of the relevant locality police involved in the Section 136. AWOLs For patient’s who absent themselves from the place of safety or during the 136 process, Trust staff should follow guidance within the Missing Persons policy.

PART 8

8.0 MONITORING AND REVIEW OF S136 POLICY

8.1

The effectiveness of this policy will be monitored regularly by the Mental Health Act Strategic Multi-Agency Group as a standing agenda item to be reviewed bi-monthly. This group is made up of representatives from Bournemouth Borough Council, The Borough of Poole, Dorset County Council, Dorset HealthCare NHS Foundation Trust, NHS Dorset, South Western Ambulance Service Trust, Poole General Hospital, Royal Bournemouth Hospital, Dorset County Hospital and Dorset Police.

8.1.1 The procedures for implementing Section 136 will be further monitored and audited through completion of the Section 136 Monitoring Form. This record must be forwarded to Performance Review section, Social Services Directorate, County Hall, Colliton Park, Dorchester DT1 1XJ. A six monthly audit will be completed by the Performance Review section and compliance with this policy monitored as above. A monthly 136 report is also produced and distributed to the MHA Strategic Multi-Agency group.

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8.2 Training / Awareness

8.2.1 All agencies should ensure that their staff are familiar with their relevant Mental Health Act

policies and procedures.

9.0

PART 9 CONTACT INFORMATION & ADDRESSES

Hospitals St Ann's Hospital 69 Haven Road Canford Cliffs Poole, Dorset (01202) 708881 South Western Ambulance Service Clinical Development Manager (East) Wynford House Lufton Way Yeovil Somerset, BA22 8HR 01935 381991 Dorset Police Dorset Police Mental Health Coordinator Criminal Justice Division Bournemouth Divisional Headquarters Bournemouth BH1 1QQ (01202) 220616 Custody Centres – All 24hr Centres Bournemouth Police Station Madeira Road Bournemouth Dorset, BH1 1QQ (01202) 222222 Weymouth Police Station Radipole Lane Weymouth Dorset DT4 9WN (01305 222222) Poole Police Station (Used when Bournemouth or Weymouth custody Wimborne Road suites are closed) Poole Dorset BH15 2BP

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(01202) 222222 Social Services Social Services Care Direct Borough of Poole Bournemouth Borough Council Civic Centre Annexe Town Hall Park Road St. Stephens Road Poole Bournemouth (01202) 633600 (01202) 458000 Dorset AMHP Service Hub Forston Clinic Herrison Road Dorchester Dorset DT2 9TB 01305 361300 OUT OF OFFICE HOURS Out of Hours Social Services 01202 657279

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APPENDIX A

Section 136 Mental Health Act

YOUR RIGHTS

Name: Date of Detention: Time of Detention: Why you are being held You have been brought to …………………………Police Station within the provisions of Section 136 Mental Health Act 1983. The reason for this is because a Police Officer saw you in a public place and you appeared to the officer to be suffering from mental disorder and to be in immediate need of care or control.

You can be detained here for up to 72 hours in order to allow a doctor to examine you and for you to be interviewed by an approved mental health professional (AMPH). The doctor and the approved mental health professional (AMPH) will consider what arrangements, if any, are necessary for your treatment or care. This could include admission to a psychiatric hospital if this is appropriate. The examination by the doctor and the interview by the approved mental health professional (AMPH) will take place as soon as possible and we do not wish to keep you in the Police Station for any longer than is absolutely necessary. If you have any questions or complaints If you wish to ask something, or to complain about something, talk to the Custody Officer, doctor or approved mental health professional (AMPH). If you are not happy with the answer you may write to the Chief Constable. You may do this even after the 72 hours is over. The address is: Dorset Police Headquarters, Winfrith, Dorchester, Dorset DT2 8DZ If you are still not happy with the reply you are given you can ask the Mental Health Act Commission to help you. You can also write to the Commission even after you have left hospital. The Care Quality Commission The Commission was set up specifically to make sure that the mental health law is used properly and that patients are cared for properly while they are kept in hospital. You can ask them to help you by writing to them at: Care Quality Commission, The Belgrave Centre, Stanley Place, Talbot Street, Nottingham, NG1 5GG Your nearest relative Your nearest relative, who we have told is: ________________________________ will be told of your detention unless you advise that you do not wish them to be informed. If there is anything in this leaflet you do not understand the Custody Officer, doctor or social worker will help you.

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APPENDIX B

ADMISSION OF MENTALLY DISORDERED PERSONS FOUND IN A PUBLIC PLACE

(Section 136 of the Mental Health Act 1983)

1. Patient’s name

2. Name of hospital and ward

Why am I in hospital? You have been brought to this hospital by a police officer because they are concerned that you may have a mental disorder and should be seen by a mental health professional. You are being kept here under section 136 of the Mental Health Act 1983 so that you can be assessed to see if you need treatment. How long will I be here? You can be kept here (or in another place where you will be safe) for up to 72 hours so that you can be seen by a doctor and an approved mental health professional. An approved mental health professional is someone who has been specially trained to help decide whether people need to kept in hospital. If the doctor and the approved mental health professional agree that you need to remain in hospital, a second doctor may be asked to see you to confirm their decision. During this time you must not leave unless you are told that you may. If you try to go, the staff can stop you, and if you leave you can be brought back. If the doctors and the approved mental health professional have not seen you by the end of the 72 hours, you will be free to leave. You may decide to stay on as a voluntary patient. But if you do want to leave, please talk to a member of staff first. In your case the 72 hours end at:

Date Time

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APPENDIX B (contd)

What happens next? When the doctors and an approved mental health professional have seen you, they may say that you need to stay in hospital for longer. They will tell you why and for how long this is likely to be. You will be given another leaflet that explains what will happen. If they decide that you do not have to stay, someone will talk to you about what other help you should have. Can I appeal? No. Even if you do not agree that you need to be in hospital, you cannot appeal against the decision to keep you here under section 136. Will I be given treatment? The hospital staff will tell you about any treatment they think you need. You have the right to refuse any treatment you do not want. Only in special circumstances, which would be explained to you, can you be given treatment you do not agree to. Letting your nearest relative know A copy of this leaflet will be given to the person the Mental Health Act says is your nearest relative. There is a list of people in the Mental Health Act who are treated as your relatives. Normally, the person who comes highest in that list is your nearest relative. The hospital staff can give you a leaflet which explains this and what rights your nearest relative has in connection with your care and treatment. In your case, we have been told that your nearest relative is:

If you do not want this person to receive a copy of the leaflet, please tell your nurse or another member of staff. Changing your nearest relative If you do not think this person is suitable to be your nearest relative, you can apply to the County Court for someone else to be treated as your nearest relative instead. The hospital staff can give you a leaflet that explains this. Your letters All letters sent to you while you are in hospital will be given to you. You can send letters to anyone except someone who has said they do not want to get letters from you. Letters to these people can be stopped by the hospital staff.

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APPENDIX B (contd)

Code of Practice There is a Code of Practice that gives advice to the staff in the hospital about the Mental Health Act and treating people for mental disorder. The staff have to consider what the Code says when they take decisions about your care. You can ask to see a copy of the Code, if you want. How do I complain? If you want to complain about anything to do with your care and treatment in hospital, please speak to a member of staff. They may be able to sort the matter out. They can also give you details of the hospital’s complaints procedure, which you can use to try to sort out your complaint through what is called local resolution. They can also tell you about any other people who can help you make a complaint. If you do not feel that the hospital complaints procedure can help you, you can complain to an independent Commission. The Commission monitors how the Mental Health Act is used, to make sure it is used correctly and that patients are cared for properly while they are in hospital. The hospital staff can give you a leaflet explaining how to contact the Commission.

Further help and information If there is anything you do not understand about your care and treatment, a member of staff will try to help you. Please ask a member of staff to explain if there is anything in this leaflet you do not understand or if you have other questions that this leaflet has not answered. Please ask if you would like another copy of this leaflet for someone else.

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APPENDIX C

Section 136 Monitoring Form

This form is used to evaluate the use of Section 136, Mental Health Act in Dorset. This form should be completed in the

first instance by the supervising Police Officer making the detention. IF THEY ARE UNABLE TO STAY FOR THE

DURATION OF THE ASSESSMENT THE FORM SHOULD BE PASSED TO EITHER:

0 Nurse in charge of overseeing S136 (when Place of Safety is a Mental Health Unit) OR

0 Custody Sergeant in custody suite (when Place of Safety is a Police Station)

The Approved Mental Health Professional (AMHP) & Section 12 Doctor should attend to undertake a joint assessment.

A second medical opinion will be requested if an application under the Act may be required. The additional notes must

be used to record exceptional circumstances (e.g. the AMHP & police doctor completing assessment to avoid

unreasonable delay) or any unusual circumstances or irregularities, or where a professional takes a particularly long

time to arrive at the place of safety.

Ethnic Origin Key (appropriate number to be used in ethnic origin column overleaf)

White Black or Black British Asian or Asian British

British 01 Caribbean 12 Indian 08

Irish 02 African 13 Pakistani 09

Other White 03 Other Black 14 Bangladeshi 10

Other Asian 11

Mixed Chinese or other Ethnic Group

White & Black Caribbean 04 Chinese 15

White & Black African 05 Other 16

White & Asian 06 Not stated 17

Other Mixed 07

PLEASE COMPLETE BOTH SIDES OF THIS FORM

Was Street Triage consulted?

Yes If ‘Yes’ state time HH : MM No Are they presenting either of the following:

Influence of drugs or alcohol Violent behaviour

Method of transportation to first place of safety:

Ambulance Police vehicle Other health vehicle Other N/A

Reason for a police vehicle being used: (please tick all that apply)

Ambulance not available within 30 minutes Ambulance crew refused to convey

Ambulance not available within 60 minutes Already at place of safety

Risk assessment (behaviour) Ambulance re-tasked to higher priority call

Ambulance not requested Not known

Additional notes:

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Section 136 Mental Health Act

Custody Record Number (if applicable):

First place of safety: Time rights given HH : MM

Second Place of Safety if moved during assessment:

Time rights given HH : MM

Name of Person:

Date of Birth: DD / MM / YYYY Gender : Female Male

Address: Dorset Poole Bournemouth Postcode :

Ethnic Origin of Detainee (see box overleaf for codes)

Area of Detention: Dorset Poole Bournemouth

Detaining Officer’s Number:

State actual date

State actual 24 hour time

e.g. SUN 16 08 15 15

2 1 : 3 0

Date Time of detention :

Date Time arrived at place of safety :

Date Time Crisis Team called :

Date Time AMHP called :

Date Time AMHP arrived :

Date Time Section 12 Dr called (see below) :

Date Time Section 12 Dr arrived :

Date Time Consultant called :

Date Time Consultant arrived :

Date Time assessment completed and decision made :

Date Time Police Officer no longer needed :

Date Time all assessments complete and S136

discharged

:

Outcome of the Assessment (to include any decisions to transfer from one place of safety to another)

If a Section 12 Doctor was NOT called please state why: No Admission

St Ann’s Forston

Clinic Informal Admission Formal Admission – Section 2 Formal Admission – Section 3 Other – please specify:

Form completed by: Date: / /

When complete please send form to the Mental Health Act Office, St Ann’s Hospital. Please return forms immediately on completion – this will allow us to make further enquiries where necessary.

22

APPENDIX D Police remaining with the individual at the Place of Safety

S.136 MHA allows a Constable to remove an individual found in a public place who appears to be suffering from a mental disorder and appears to be in immediate need of care or control to a place of safety, however the powers of detention given by S.136 (2) MHA 83 are not conferred expressly on the police, but are given to any person who is party to the detention of the disordered person, once he/she has been brought to the place of safety. It will be the responsibility of the Critical Incident Inspector to decide if officers will remain with the individual detained under S136 MHA 83 at the place of safety. The Critical Incident Inspector will be contacted by the detaining officer who will outline the circumstances of the detention and the demeanour of the detained individual. Upon arrival at the place of safety, the detaining officer will take into account the environment and nature of the place of safety, will request any relevant information from staff at the place of safety regarding the individual that will inform the Critical Incident Inspector’s decision. This information along with information from police systems will be considered using the table below to inform the joint decision. Low (not requiring police presence) – upon arrival after completion of 136 form, the officer will inform the nurse in charge, that the police will not be remaining with the individual. Medium (requiring police presence) -- that the police will be remaining with the individual for a maximum of 2 hours. High (requiring police presence) – Police MUST remain with the individual for the duration of their assessment under 136 MHA or until their risk status determines the police can leave.

Section 136 Mental Health Act – Risk Assessment Tool for determining the need for continued Police Support within Place of Safety

Low Risk Medium Risk High Risk

To be managed within hospital Place of Safety – Continued Police support is NOT necessary.

To be managed within the hospital Place of Safety – Continued Police support MAY be required.

To be managed within the hospital Place of Safety with CONTINUED Police support or in exceptional circumstances, Police Custody

Current / recent indicators of risk

Current / recent indicators of risk

Current / recent indicators of risk

No current or historic behavioural, criminal or medical indications (other than mild alcohol or substance use) that the individual is violent OR poses a risk of absconding OR is an imminent threat to their own or anyone else’s safety. OR

Some currently presented or recent behavioural indication which is more than just verbally abusive. AND/OR Some recent criminal /medical indications that the individual may be violent or poses a risk of absconding or is a threat to their own or anyone else’s safety. BUT

Currently presented or recent history of behavioural, medical or criminal indications (including significant substance intoxication) that an individual is violent and/or poses a high risk of absconding or is an imminent threat to their own or anyone else’s safety. OR

Previous indicators Previous indicators Previous indicators

Which are few in number and Limited in number or historic or Include violence graver than

23

historic or irrelevant: BUT Excluding violence graver than ABH and not involving weapons, sexual violence or violence towards NHS staff or vulnerable people.

irrelevant: including violence graver than ABH or involving weapons, sexual violence, violence towards NHS staff or vulnerable people. OR LOW RISK persons who have disengaged from treatment and where there are MEDIUM RISK threats when disengaged.

ABH or involving weapons, sexual violence, violence towards NHS staff or vulnerable people. OR LOW or MEDIUM risk persons who have disengaged from treatment and where there are HIGH RISK threats when disengaged.

The level of risk and the reasons for determining that level will be fully documented on the relevant Police Command and Control log. The Nurse in charge at the place of safety will be informed of the decision. Details of the person informed and their response will be documented on the relevant Police Command and Control log. Low (not requiring police presence) – Inform the nurse in charge, that the police will not be remaining with the individual.

Patient should be located in full view of staff and if nurse in charge considers it appropriate, one to one (Security/Nurse)

Consider a member of family or friend to attend and wait with the patient.

Command and Control log number to be provided to nurse in charge, advising that if patient absconds/becomes violent or threatening contact police (999) without delay.

Command and Control Log should remain open, in case of recall from place of safety.

Medium (requiring police presence) - Inform the nurse in charge, that the police will be remaining with the individual for a maximum of 2 hours.

After 1 hr – Request an update from the nurse in charge as to what preparations are in place for the hand over from police remaining with individual to health/security staff. Document their response on Command and Control log.

After 2 hrs – Critical Incident Inspector to re-evaluate 136 risk assessment to determine if the individual is presenting as Low, Medium or High risk.

Document decision making & result on relevant Command and Control log.

If individual still presenting as Medium risk - Inform the nurse in charge, that the police will be handing the responsibility for the individual to the nurse in charge.

Document details of nurse in charge accepting responsibility on Command and Control log.

Patient should be located in full view of staff and if nurse in charge consider it appropriate, one to one (Security/Nurse)

Consider a member of family or friend to attend and wait with the patient.

Command and Control log number to be provided to nurse in charge, advising that if patient absconds/becomes violent or threatening contact police (999) without delay.

Command and Control Log should remain open, in case of recall from place of safety.

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High (requiring police presence) – Police MUST remain with the individual for the duration of their time at the place of safety or until their risk status determines the police can leave. Lengthy delays regarding assessment should be escalated via the relevant organisation’s managerial structure.

Disputes Regarding Level of Risk/Officers Remaining with the individual In the event of a disagreement regarding the determined risk level and officers remaining in attendance;

Attempts should be made to resolve the dispute at a local level by those present at the assessment.

If a dispute cannot be resolved at this level then it should be referred to the Force Incident Commander (FIC)

The reasons for the dispute and all relevant staff member’s details should be recorded on the Command and Control log and forwarded to the Force Mental health Coordinator (Simon Thorneycroft 7461) to raise at the local partnership136 Monitoring Group meetings.

Any issues that cannot be resolved, will be raised by the Chief Inspector Custody to Senior Managers within partner agencies.

Not Protectively Marked

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APPENDIX E

Guidance notes for the Section 136 Mental Health Act

Handover and Risk Assessment Form

This form is intended to assist both Police and Hospital staff in the formal process of handing over Sec 136 detained persons. The form is to be completed jointly by the police officers accompanying the person to hospital and the on duty nurse who the patient is handed over to.

I.D. confirmed and source – To establish that we have the correct details for the patient and by what method these were confirmed. This could be by documents found on the person, PNC ID markers or by a third party (i.e. relative etc).

Place of arrest – be as precise as possible i.e. on pavement, outside 43 High Street, Poole.

Circumstances of arrest – Provide as much information as possible. If necessary, continue on a second carbonated form. Include whether any violence experienced or threats issued, weapons seen, what was said by the person, any self-harming, behaviour of person at time of arrest, whether person wishes to be at the hospital etc.

Searched? – It is essential that the person is searched by the Police.

Physical condition of person – include injuries / cuts, any indications of drink / drugs and to what extent intoxicated (i.e. only smells of alcohol otherwise coherent or person is drunk with slurred speech etc). Also, if person is visibly distressed, dishevelled etc.

Relevant warning markers – i.e. recent markers for violence, threats, escaper etc.

Relevant history – Include information from CJS / PNC / family / friends / previous visit to the hospital. Information that is several years old with no further occurrence may not now be relevant.

Behaviour of person on arrival at the hospital, which may indicate a risk – describe person’s behaviour and highlight if there has been a change since arrest (i.e. if violent on arrest and now calm or vice versa) or other signs, which may indicate a risk…

Any other information – any information you feel is relevant and is not covered elsewhere on the form i.e. any treatment for injuries, home circumstances etc.

Not Protectively Marked

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APPENDIX F

GLOSSARY OF TERMS

AC Approved Clinician A doctor or other mental health professional who has undertaken specialist approval and section 12 training to allow them to detain and treat patients under the Mental Health Act 1983.

AMHP Approved Mental Health Professional

A Social worker or other mental health professional who has undertaken additional training to approve them to be able to make applications for detention under sections 4, 2 and 3 of the Mental Health Act 1983, as amended.

CAMHS Children and Adolescent Mental Health Services

A specialist team working with children and adolescents with mental disorders.

CJS Criminal Justice System The CJS is one of the major public services in the country. Across the CJS, agencies such as the police, the Crown Prosecution Service, the courts and the National Offender Management Service work together to deliver criminal justice the work of is overseen by the Ministry of Justice, the Home Office and the Attorney General's Office.

DPA Data Protection Act 1998 The Data Protection Act gives ever person in the UK the right to know what information is held about them, and sets out rules to make sure that this information is handled properly and only disclosed in certain circumstances.

HRA Human Rights Act 1998

The Human Rights Act 1998 came into force following the European Convention on Human Rights. Anyone who is in the UK for any reason has fundamental human rights which government and public authorities are legally obliged to respect.

MCA Mental Capacity Act 2005

An Act which makes provisions relating to how to assess capacity and what actions can be taken to protect people in the best interests.

PACE Police and Criminal Evidence Together with the PACE Code of practice

Not Protectively Marked

27

Act 1984 provides the core framework of police powers and safeguards around stop and search, arrest, detention, investigation, identification and interviewing detainees.

PAVA Pelargonyl Vanillylamide Incapacitant Spray

A hand held personal incapacitant spray used by the police in policy identified situations.

PNC Police National Computer It is a national information system maintained and delivered by the National Police Improvement Agency .PNC holds details of people, vehicles, crimes and property that can be electronically accessed by the police and other criminal justice agencies.

Not Protectively Marked

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APPENDIX G

DORSET HEALTHCARE NHS FOUNDATION TRUST

EQUALITY IMPACT ASSESSMENT FORM

Department/Service area:

Countywide / St Ann’s Hospital (DHUFT)

Policy Sponsor:

Mental Health Legislation Manager

Name of the policy/protocol: (please attach a copy)

Section 136, Mental Health Act 1983

Intended Outcome/s of Policy:

To ensure that those patients detained under Section 136 are assessed and dealt with in accordance with the statutory provisions of the Mental Health Act 1983 and the principles of good practice as defined by the Code of Practice 2015

This form is designed to be filled in using the Impact Assessment flowchart for guidance.

Please see appendix 1.

Groups.

Positive Impact

Negative Impact

Evidence/justification for your decision.

High Low High Low

Gender and transgender groups.

It is anticipated the impact of this policy will depend on its application across the Trust. It will be expected to comply with the legal requirements of the Mental Health Act 1983, as amended and adhere to the Guiding Principles outlined in the Code of Practice 2015. The impact of this policy will be monitored on an annual basis as part of the Trust internal audit cycle and assessed on a regular basis by The MHA Strategic Multi-Agency Group

People from Black and Minority Ethnic groups

People who have a disability

People who identify themselves as lesbian, gay or bisexual

People from different age groups .

People who belong to a religion or have particular beliefs.

.