“( ) Before a house, flat or room where a person is living is used as a place of safety the patient must first be offered one of the following locations as an alternative place of safety—
(a) a residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948 or under paragraph 2 of Schedule 8 to the National Health Service Act 1977;
(b) a hospital as defined by the Mental Health Act 1983; or
(c) a mental health care home.”
This amendment would require that a patient was offered a health-based place of safety as an alternative to their, or someone else’s, home being used as a place of safety.
With this it will be convenient to discuss the following:
Amendment 159, in clause 61, page 69, leave out lines 31 to 38 and insert—
“the point at which the decision is taken to remove a person to a place of safety, or keep them at the current place of safety.”
This amendment would mean that the permitted period of detention started when the decision was taken to remove a person to a place of safety, rather than the point at which they arrived at the place of safety.
Amendment 158, in clause 61, page 69, line 31, leave out “24” and insert “12”.
This amendment reduces the permitted period of detention to 12 hours.
New clause 11—Detention in places of safety: annual reporting—
“(1) Police forces in England and Wales must publish an annual report containing statistics on the usage of the power to detain a person in a place of safety.
(2) This report shall contain, but need not be limited to, information on—
(a) the number of detentions;
(b) the age of detainees;
(c) the length of detention; and
(d) the location of the detention.”
This new clause would require police forces to report annually on the number of detentions in places of safety, including information on the age of the detainee and the location and duration of the detention.
New clause 12—Access to Independent Mental Health Advocates—
“(1) A person detained in a place of safety under section 135 or 136 of the Mental Health Act 1983 shall have the right to an independent mental health advocate (see section 130A of the Mental Health Act 1983).”
This new clause would extend the right to an independent mental health advocate to those detained under sections 135 or 136 of the Mental Health Act 1983.
New clause 50—Powers under the Mental Health Act 1983: reporting and review—
“(1) One year after section 59, 60 and 61 of this Act come into force the Secretary of State must lay before parliament a report on the impact of the changes to powers under the Mental Health Act 1983 on mental health assessment and outcomes.
(2) This report shall contain, but need not be limited to, information on—
(a) length of time taken from commencement of mental health assessment of an individual under sections 135 or 136 of the Mental Health Act, to either the discharge, admittance to hospital or extension of period of detention of these individuals,
(b) availability of trained medical professionals to carry out assessments, and
(c) availability of hospital beds for persons deemed to require inpatient care.
(3) In producing this review the Home Secretary must consult the Secretary of State for Health.”
This new clause would make it mandatory for the Home Secretary to report on the impact of Section 59, 60 and 61 on mental health assessment and outcomes. This would allow for scrutiny of whether the proposals improve the outcomes for those subject to police detention and mental health assessment, and whether health providers have the capacity to carry out timely assessments and provide any necessary inpatient care.
It is a pleasure to serve under your chairmanship, Mr Howarth. I have said in Committee, and on the Floor of the House, that I recognise that the Government are trying to make progress on ensuring that the way in which people with mental illness are treated by the police is both compassionate and secures them the help that they deserve. The problem that is evident today, and will be as the Bill continues its journey through this House and the other place, is that although the Home Department is trying to improve the situation, the elephant in the room is the resources and activities of the Department of Health. This is an area in which two Departments are intertwined, because the issues are quite clearly not, in essence, a police matter, although the police are left to resolve the problem.
Amendment 157 recognises that the Government have tried to emphasise that a police cell is the worst place for not only a young person but an adult. I commend the Government’s initiative in trying to ensure that few adults, and certainly no children, are detained in a police cell. We have to ask why they are currently detained, which is—I am going to be very political—because of the reduction of beds and facilities by the Department of Health. I have tabled amendment 157 because the Government, quite helpfully, have no objection to a place of safety, under the Mental Health Act 1983, being someone’s flat or home, because that is a place in which those individuals can be supported by mental health services and other agencies. That is important. The problem is that it might become the default position that people are forced to stay in their homes if an alternative is not available. I put it to the Committee that most of us, given the choice between staying at home or being in a police cell, would stay at home. However, that does not guarantee that home is the best place of safety.
The aim is to help the Minister put some pressure on health service colleagues to ensure alternative provision. It is no good if those individuals are clearly in crisis and the only option is to stay at home, which might be unsatisfactory for the individual and family members, or go to a police cell, which nobody wants. It is a probing amendment, hoping to get some joined-up thinking.
As the Bill proceeds through this House to the next, we need some movement from the Department of Health on how they will join up with the initiatives that the Minister has rightly taken to ensure that people with mental illness do not end up in police cells.
The hon. Gentleman makes a good point and speaks with authority on the subject. Does he recognise that there are some excellent local examples of clinical commissioning groups working well with the police? In Kingston we have a new project where the mental health trusts, the clinical commissioning group and the Met police have come together to provide just the kind of facility we are talking about. Although there is more to do nationally, there are some good local examples of the policy working.
I agree with the hon. Gentleman. One of the few good things that came out of the Health and Social Care Bill was that it allowed local providers to develop contracts out of the box, perhaps with the third sector and others, to provide good local services. I am on record as having said that. I have to say that in my own area and nationally that has not happened in practice because unfortunately the default position is that the contracts that have been awarded are so large that a lot of small, good voluntary organisations that could provide those services are not getting a look in.
The hon. Gentleman makes a good point about the project in his constituency, but we need to ensure that there is uniformity across the piece. If we have a situation where the only option is for people to go to a police station or stay at home, that is not satisfactory.
Amendment 159 is also probing, aiming to explore and again bring pressure on the Department of Health. With regard to the time limits put in place around the place of safety, it is important that people are assessed quickly. It is no good waiting, in a police cell, hospital or any other facility, for a long time without assessment.
When being removed to a place of safety, it is important that the assessment is made quickly and undue time limits are not in place, for example, if someone has to travel a long distance to access a service. At the point of detention, a decision would start with the removal of the individual, certainly in terms of Lord Crisp’s report for the Commission on Acute Adult Psychiatric Care. That gives examples of people having to travel up to 50 km to access a mental health bed. If that were done in the back of a police car or van, it could take a long time and add to that individual’s distress. Again, I want to get the Minister’s thinking; I do not think for one minute that she wants anyone to be detained for an unduly long time without assessment. We are probing to find out what the Government are thinking in terms of trying to put pressure on the services that provide assessments. Can we get intervention at an earlier stage?
Amendment 158 is linked to the previous amendment and is another probing amendment. I welcome the reduction from 72 to 24 hours, showing again that the Government want to improve the situation. This probing amendment would further reduce the time from 24 to 12 hours. I would like to understand the Government’s rationale for agreeing to 24 hours. Under existing and proposed legislation, if someone is clearly incapable of assessment, that period can be extended. The Royal College of Psychiatrists has a target of three hours for someone to be assessed. I accept that there are difficulties: for example, if someone is intoxicated or has some other issue, with drugs or anything else, an assessment may not be possible for a long time, but I think that 24 hours is too long.
I have tabled these amendments to assist the Minister to press her Health colleagues to push the boundary. I accept what the hon. Member for Kingston and Surbiton said about some excellent local provision. We do need a uniform service, but it would be completely wrong for individuals to be detained longer than necessary. I would not, for one minute, suggest that any healthcare professional, police officer or the Government, for that matter, want to detain people. Early diagnosis and assessment are in the interest of the individual and help to ensure an efficient use of time.
Let me deal with new clauses 11 and 12. I may push new clause 11 to a vote because it is important. One fear I have is that we have before us a Home Office Bill which deals with the problem faced by police forces up and down the country of people being detained under the Mental Health Act. The right aim of the Home Secretary is to ensure that no one is detained in a police cell. Certainly, her target for young people is welcome and she clearly wants to get to a position whereby no adult is detained in a police cell either. The problem I have with that is that we may achieve the target in terms of the police—a police authority or a police and crime commissioner may be able to stand up and say, “We have nobody in police cells who has been detained under the Mental Health Act”, but unless we have some indication of what has actually happened to those individuals, it could mask a problem. It could move away from the clear spotlight that has been put on this, certainly in terms of young people being detained in police cells.
If the answer to the written question that we ask every year is that nobody is being detained in police cells, that is good, but if people are languishing in the community without support, or are unable to access the treatment that they want, that would let the Department of Health—again, not the Home Office—off the hook in terms of its responsibility to those individuals. It is important that we have reliable statistics, because we need to see where there are pressures, which there certainly are. Having talked to my local police force, I know that forces throughout the country are dealing with a lot of mental illness problems that they are not qualified to deal with. The system has failed when people with such problems turn up in police cells, so we need to address that.
I feel passionately about new clause 12, because, very strangely, the only people who are not allowed advocates under the Mental Health Act are people who are sectioned under section 135 or 136. I am not sure why that was agreed when that Act passed through this place. It may have been to do with cost, and I understand that if we offer everyone who is sectioned an advocate, costs will be incurred, but we are talking about ensuring that people with mental illness are given the right approach and support. If someone is arrested for any other crime, they should have an advocate to speak on their behalf. Many people think that those with mental illness will have family members or others to help them, but there are clearly individuals who do not, so there is no one there to speak on their behalf. There are also individuals who go into crisis whose family members have never experienced anyone with mental illness and so will not know the right questions to ask or the rights of the individual.
The need for an advocate is particularly relevant to the issue I mentioned earlier: the home becoming a place of safety. Is someone really going to object to their home becoming the “place of safety” if they have no one to advocate for them or understand their position? I do not think they would. The default position would be that the easiest option is to stay at home, even though it might not be the best option for some individuals, so advocacy is very important.
As I said on Second Reading, sections 135 and 136 are unique powers that are, quite rightly, not used lightly. They are used to protect either the individual themselves or the people who might be in danger from their actions, but that still leads to people’s liberties being taken away from them. If the default position in this country is that someone who is arrested for a crime is entitled to legal representation, it is not too much to ask in this day and age that people who are detained—we are not talking about a massive number of cases—should at least, within a permitted period, be allowed an advocate to speak on their behalf and advise them. Properly done, that may well save time and money by ensuring that the individual takes the advice they are offered and by allowing the system—the police and health services—to ensure that that person is directed to the help they require.
I pay tribute to my hon. Friend the Member for North Durham, who is a brave and doughty champion of those who have suffered from mental illness. There is no question but that real progress has been made in recent years, and he can take credit for the outstanding role that he has played in that process, which we see the benefits of in our constituencies and across the country.
I have seen non-custodial places of safety at the Oleaster suite in Birmingham and in the form of street triage arrangements around the country, including one team of three outstanding police officers in the east midlands. One of them took me to one side and said, “I’m passionate about what I do because my brother was diagnosed as a paranoid schizophrenic eight years ago. I’ve supported him; I now want to support others like him.” The Home Secretary is absolutely right to say that a police cell is no place for an ill person. I therefore completely support everything that my hon. Friend the Member for North Durham has said.
I want to speak only to new clause 50, although we support what has been said in respect of new clauses 11 and 12 and I will briefly refer to them. In our country there is a right to be represented, and that is all the more important in circumstances where there is a vulnerable individual—often one who is going through a terrible trauma in their life—who requires the support and advice that an independent representative or advocate can give. We therefore strongly support what my hon. Friend has said in respect of new clauses 11 and 12.
Returning to new clause 50, I will take this opportunity to repeat the concerns that were expressed across the House on Second Reading—the debate on these issues was excellent—and the concerns of medical professionals and the police. Although we welcome the objective of the proposals, the combination of the changes could put professionals in a difficult position. Assessments of those detained under the Mental Health Act 1983 cannot be completed until a bed has been identified. Professionals should not have to choose between breaking the law by exceeding the 24-hour period if a bed cannot be identified and not breaking the law but releasing someone who should be detained. Yet HMIC has found that some of the most common reasons why the police used custody as a place of safety include
“insufficient staff at a health-based place of safety” and
“the absence of available beds at the health-based place of safety”.
I am sure that the Minister recognises that such problems will not be fixed by the Bill or even by the Home Office. It is therefore essential that, alongside the Bill, the Home Secretary and the Health Secretary work together to ensure that health service commissioners open sufficient beds and train sufficient professionals to deliver these welcome new commitments. New clause 50 would make it mandatory for the Home Secretary to report on the impact of the proposals in the Bill on mental health assessment and outcomes.
“We cannot make demands on the police to change the way they do things in providing places of safety unless we actually provide places of safety.”—[Official Report,
He is absolutely right. There are not enough beds in this country for mentally ill people who are suffering real crises and, as my hon. Friend the Member for North Durham has said, where beds are made available, long distances sometimes have to be travelled to take the individual in question to a safe place where they can be looked after. We therefore need cast-iron guarantees from the Department of Health that it is in a position to support police officers in treating those suffering from mental health crises with the dignity and support that they deserve.
The mental health crisis care concordat requires NHS commissioners to commission health-based places of safety for that purpose. It states:
“These should be provided at a level that allows for around the clock availability, and that meets the needs of the local population. Arrangements should be in place to handle multiple cases.”
However, there is not a specific statutory duty to commission health-based places of safety. In theory, the Mental Health Act could be amended to introduce a duty for clinical commissioning groups to commission suitable and sufficient health-based places of safety for persons detained under sections 135 or 136. Have the Home Office or the Department of Health considered that? We understand that, strictly speaking, such legislation is outside the scope of the Bill, but in parallel with the provisions here, the Home Office must have assurances from the Department of Health that they are going to make available the necessary capacity. That is why it is crucial to our amendment that the Secretary of State for Health is consulted. The Home Secretary and the Health Secretary should work together to ensure that the proposals improve the outcome for those subject to police detention and mental health assessment, and that health providers have the capacity to carry out timely assessments and provide any necessary in-patient care.
In conclusion, is there welcome progress in the right direction? On that there is absolutely no hesitation. However, on the issues that I have raised, the Government have yet to give assurances. I urge the Minister to act, to give Parliament, the public and the police whatever assurances are possible to ensure that the proposals in the Bill are not only brought forward with worthwhile intentions but implemented in practice, and that we avoid the possibility that in some cases they will do more harm than good.
It is a pleasure to serve under your chairmanship, Mr Howarth, and to be back from Easter recess; I hope you had a pleasant break. I also pay tribute to the hon. Member for North Durham, who has campaigned tirelessly on this issue for many years and who is known as a leading advocate for those suffering with mental health conditions, be they crises or long-term conditions. I respect him enormously; I look forward to meeting him soon to discuss the many points he has raised today and to ensuring that the Government take notice of his experience and expertise and that we can work together on these matters.
I also want to make a point about what we are dealing with here. In a section 135 or section 136 detention, we are not dealing with a long-term condition that is being managed; we are dealing with a crisis—with somebody who, for whatever reason, either for their own protection or that of others, needs to be detained under the Mental Health Act. This has to be a short-term detention, and it should be one in which they are treated with dignity and respect. Somebody who breaks their legs does not get taken to a police cell, and nor should somebody having a mental health crisis. They have committed no crime, but for their own safety and that of others, they need a short-term temporary detention. That is not the same as being sectioned long term under the 1983 Act; it is a short-term issue. It might arise, for example, as a result of alcohol or drug abuse, because of some personal issue that has happened, or—let us admit it—because there has been a failure, where something has been identified from a health perspective but without identifying that the individual may go into crisis. It is about the crisis.
I want to pay tribute to my own police and crime commissioner, Matthew Ellis in Staffordshire, who I think was the first police and crime commissioner to identify how much police time was being taken to deal with people in a mental health crisis. He estimated that it was 20%: one in five police days were taken up with dealing people in a mental health crisis. It says a lot about the system that was in place, in which it was easier for police to deal with this than it was for health workers. We know that we are dealing with a problem that has grown up over many years; we are tackling it and ensuring that it is dealt with appropriately.
I want to assure the Committee that this issue is not just dealt with by the Home Office. I work very closely with other Departments: not just the Department of Health, where my right hon. Friend the Minister for Community and Social Care is as absolutely determined as I am to ensure that this matter is dealt with, but the Department for Communities and Local Government, the Department for Education and others. We need to ensure that we are all working together to identify the signs of mental health issues and ensure they are dealt with so they do not lead to a crisis. That is the important point.
The crisis care concordat, a cross-Government initiative, has led to a halving of the number of people being detained in police custody, but that is not good enough. That is why we are taking the steps in the Bill. We want to see this practice as the very rare exception when somebody in a mental health crisis ends up in police custody. We want the vast majority, and certainly those under 18, to be in a health-based place of safety.
The shadow Minister made a point about the east midlands police officer’s family member. Since I took on this brief, a number of people have spoken to me about their personal experiences of mental health in their families. This is something we are all waking up to in many ways. The issue has not been recognised for many years and I am glad we are talking about it and recognising the scale of the problem and ensuring that support is available.
I will turn to the amendments tabled by the hon. Member for North Durham. As he said, amendment 157 seeks to introduce a requirement to offer a health-based place of safety before a private home is used. When a person is in a mental health crisis, it is important that they have access to the appropriate medical care at the earliest stage. I know we all agree on that.
In most section 136 cases people will be taken to a health-based place of safety, as is the case today. Usually, that will be a bespoke facility provided by the NHS that meets the national standards set out by the Royal College of Psychiatrists. The shadow Minister and I and my colleague who previously dealt with mental health have all visited health-based places of safety and been incredibly impressed by the work to provide somewhere safe and secure but also does not feel like a police cell. It feels like a medical setting and is comfortable. I visited one in Sussex—I know I have a Sussex MP behind me—where Katy Bourne, the excellent police and crime commissioner, has done incredible work on ensuring that there are sufficient and appropriate places of safety.
That facility at Crawley hospital has private access; the patient does not walk through the main hospital and A&E. The patient comes through a private door at the back into the mental health unit but in a secure section 136 facility where there is a bed, a private room and a bathroom. That is somewhere where someone can be treated with dignity while they experience the crisis, and can be diagnosed appropriately. Great credit should be paid to the many clinical commissioning groups and police and crime commissioners who are working together to ensure that those places of safety are there.
I am slightly concerned by Opposition amendments that want to create a national picture. Having a bespoke local model has meant that Sussex has gone from having one of the highest levels of detention of people in crisis to one of the lowest. That is working very well for the police, the health service professionals and, most of all, for the patients.
My hon. Friend, who represents her Sussex constituency extremely well, is right. When we looked at the figures, we asked why Sussex has a problem. It has Beachy Head and that is a particular problem. There is no Beachy Head in Staffordshire. There is a particular problem that the police and crime commissioner and the health services in Sussex have to deal with. The work that has been done there should be commended. Katy Bourne has worked not just to provide the health-based places of safety but with the Richmond Fellowship to understand the problems. That includes understanding why people are not always able to go to a health-based place of safety. It is shocking to discover that there are many health-based places of safety that will not take a person under the influence of alcohol.
We know that the majority of crises occur when somebody is under the influence of alcohol or drugs, so it is important to educate and have appropriate facilities. I visited an excellent facility in Merseyside where they are able to cope with somebody under the influence of alcohol, give them time to sober up and recover from the alcohol or drugs, and then assess them appropriately as to their ongoing medical care needs.
The Minister speaks with authority and sincerity, and we welcome the progress that has been made. Unusually, what we want to do on this occasion is strengthen the arm of the Home Office because, while it is true that there are excellent examples of good provision all over the country, it is uneven and patchy, and too many people who suffer mental illness are still being let down. The crucial point—she may be coming to this—is how the Home Office addresses the reality that, ultimately, it is the Department of Health that funds this provision. Unless the Department of Health is compelled to work with the Home Office, the Home Office will forever have problems.
I will deal first with whether a health-based place of safety is the most suitable place of safety in every case, which goes to the nub of amendment 157. As the hon. Member for North Durham knows, a private home can already be used as a place of safety for a person detained under section 136 of the 1983 Act if the occupier consents. Clause 60 will make it possible to use a private home as a place of safety after a section 135 warrant has been used to enter those premises.
Where consideration is given to using a private home, it should be because it is the most appropriate place of safety for meeting that person’s needs, and not due to a lack of better health-based alternatives. In determining which place of safety to take a person to, those involved will need to consider all the relevant circumstances in the round. However, if the person concerned is particularly frail or likely to be very distressed if away from familiar surroundings, removing them from a home setting may be judged to be, on balance, more harmful than helpful. Conducting the mental health assessment in the home may therefore prove both quicker and a more satisfactory experience for all concerned. Similarly, it may be preferable to take a young person to their family home, rather than detaining them in a strange place where they know no one.
There is no question of a person being taken to a private residence or forced to remain there against their will. The use of a private dwelling as a place of safety will require the active consent of both the person detained and the occupiers of the residence.
The shadow Minister talked of street triage. When I have met street triage teams across the country and seen mental health clinicians working with law enforcement, the best cases have been where the law enforcement officer has allowed the mental health professional to take responsibility for the necessary decisions. I have seen examples of the mental health professional, rather than the police officer, going into the place where the individual in crisis is, assessing them and determining whether they should be arrested or detained, whether at their own home, at somebody else’s home or in a health-based place of safety.
Anybody who has been in a police custody suite—I hasten to add that it was not as an inmate, in my case—will know that it is stark and brightly lit, with no shade and nowhere to hide. It is a horrible environment for somebody who is ill to find themselves in. Going to a health-based place of safety is a much better option, but it may be that some people can be treated better and get the appropriate care in their own home. I assure the hon. Gentleman that we are not saying that there is no need for health-based places of safety—absolutely not. We are determined that health-based places of safety will be available as they are needed, but for some people it is better to be treated in their own home. In the majority of cases I genuinely believe that the health-based place of safety is the best place, but for a small number that will not be the case.
The Bill is designed to increase the flexibility that police and medical professionals have to act in the best interests of the person concerned in a wide range of circumstances, while ensuring that appropriate safeguards remain in place to prevent abuses of such a system.
Amendment 159 seeks to provide that the period of detention would commence when a decision to detain was made, rather than on the person’s arrival at a place of safety. As the hon. Member for North Durham will know, sections 135 and 136 enable someone to be removed to a place of safety if that is required. Once they arrive at the place of safety, it is essential that the mental health professionals have sufficient time to conduct the assessment and arrange any further care and treatment that are required. Any individual in such a circumstance must have the opportunity to have a thorough assessment that is not driven by detention deadlines.
Amendment 159 would unfairly penalise both the people in need of care and the health professionals assessing them if the decision to remove them was taken in an isolated place and if getting them to a place of safety would take some time. I know from my constituency that in isolated rural constituencies, things just take more time. As it happens, one also cannot give birth in Staffordshire Moorlands because there is no maternity facility. If one goes into labour, it will take at least half an hour to reach a maternity hospital. That is the reality of isolated rural communities.
Similarly, what about situations in which removal is difficult and risky for all concerned—for example, when someone is threatening to jump off a bridge? An attending police officer would probably make the decision to detain very soon after arriving on the scene, but it might take time to get the individual off the bridge. Would it be reasonable to require the police officer, in that highly pressured situation, to think about the clock ticking towards a time when they would have to release the person, whether or not they had managed to get them to a suitable place for a mental health assessment?
I do not think that that is what the hon. Gentleman intends with his amendment. I think he intends to ensure that the person is transported to a place of safety as quickly as is reasonable. That can be addressed through guidance and the performance management of ambulance response times, rather than through legislation. Front-line professionals need to make the right decisions, taking account of the circumstances and the individual’s best interests.
Amendment 158 seeks to reduce further the permitted period of detention. As far as I can see, there is no disagreement among members of the Committee that the current period of up to 72 hours is much too long. It was put in place to take into account bank holidays, weekends and so on, but that is not good enough. We cannot have a situation in which, because someone has a mental health crisis on the Friday night of a bank holiday weekend, they find themselves in a police cell for 72 hours. That is simply unacceptable. It cannot be right to hold someone who is suffering a crisis and is in urgent need of a mental health assessment against their will for up to three days anywhere, not just in a police cell.
Clause 61 deals with that issue by introducing the concept of a permitted period of detention, and setting that period at 24 hours. We have also allowed for an extension by a further 12 hours if—and only if—the person’s clinical condition merits it. This is not a target time. Just as they are now, we expect that the vast majority of cases will be resolved much more quickly. The Royal College of Psychiatrists has recommended, as a matter of good practice, that the assessment should start within three hours of the person being detained, and that has been built into the Mental Health Act code of practice. I want to be clear that 24 hours is not a target. We do not expect that a mental health assessment will start at 23 hours. We want it to start as soon as is reasonably practical, to ensure that the person gets the assessment and treatment that they need as soon as it is required.
We have been told by stakeholders that there will be occasions when the clinical condition of the person is such that they simply cannot be assessed immediately—for example, because they are intoxicated through drugs or alcohol. We have listened to that advice, and the maximum permitted period of detention has been set at 24 hours so that time is built in for the effects of intoxication to wear off. Otherwise, we would risk creating a situation in which the assessment process was made difficult or impossible because the person was unable to participate fully.
Equally, a shorter maximum detention period would risk the person having to be released before they had been assessed because they were not yet clinically fit to participate. Clearly, that would be in no one’s best interests. For those reasons, we have set the permitted period of detention at 24 hours. In the Government’s view, that provides a good balance between keeping periods of detention as short as reasonably possible and making sure that the assessment can be carried out in the most effective way.
The provision for an extension of not more than 12 hours over and above the original 24 hours, is for the very rare cases where the clinician responsible for carrying out the assessment is satisfied that the person’s clinical condition is such that the assessment cannot be started or completed within the 24-hour period. I want to be clear here: the provision to extend beyond 24 hours will be based solely on the person’s clinical condition. There is no scope for it to be used in any other circumstance, such as staffing problems.
In practice, the average period of detention is now less than 11 hours. That time includes the person being detained, the assessment being made and any future care or treatment arrangements arising out of that assessment being put in place. In the majority of cases, the necessary processes are already completed well within 24 hours. Of course, we recognise that the reduction to 24 hours may represent more of a challenge in some areas than others, but the work that is going on across England to improve mental health crisis care services, backed by both the national crisis care concordat and the 94 local concordat groups, is helping to develop services that can respond to the changing needs of the areas they serve.
I hope that I have reassured the hon. Member for North Durham that the 24-hour time limit is not some arbitrary figure that has been chosen for convenience, but a deliberate decision that seeks to establish the balance between compulsion and care that I mentioned earlier.
New clause 11 seeks to introduce an annual reporting requirement in respect of detention in places of safety. The Government agree that the police should be transparent about the use of their powers under the Mental Health Act, so that we can see how often these sensitive powers are used, who they are used for and what further actions are taken. That will enable the changes being made through the Bill to be monitored effectively. It is only through looking at the data that we are in the position we are in. When my right hon. Friend the Policing Minister had responsibility for this area, he was determined to get to the bottom of what was and was not working well, and to make the decisions and changes that were needed to get to things working well across the country.
The Health and Social Care Information Centre and the National Police Chiefs Council publish annual data on detentions under sections 135 and 136 of the 1983 Act. For section 135, data are provided by health services covering the volume of detentions in which people are taken to a health-based place of safety. For section 136, the data include the numbers of people taken to police custody and health-based places of safety and are provided by the police and health services respectively.
However, we know that police data in this area have varied in quality. As a result, the Home Office is working with forces across England and Wales on a new data collection system for section 135 and 136 detentions to raise the level of consistency across the country. The new data set is voluntary in 2015-16, but will become a mandatory part of the Home Office’s annual data requirement for all forces in England and Wales from April this year—this month.
The annual data requirement will capture not only the number of detentions, but the age, ethnicity and gender of the people detained; the place of safety used, including, where applicable, the reason for using police custody; and the method of transportation and, where a police vehicle is used, the reason why. We intend to publish the data annually to ensure that there is full transparency, so I hope the hon. Member for North Durham will not need to ask written questions at that point.
I welcome what the Minister has said, as it goes to the core of what new clause 11 aims to achieve. In what format will those data be published? Will there be a consistent approach, as she suggests, so that areas can be compared? That is the other important point to consider as this legislation progresses: we must ensure that it is working, that people do not end up in police cells and that we have comparable data from different areas.
The hon. Gentleman is absolutely right. If we do not have comparable data, we cannot compare. My right hon. Friend the Policing Minister, who set this work in train, was adamant that we needed comparable, appropriate data, which would be available online, so that we could make a fair comparison.
It is a fair suggestion that the length of time for which people are detained should be recorded, but there are practical difficulties. It would be incredibly difficult for the police to keep such information, because, quite frankly, we do not want police officers to be part of the process once somebody has been detained under section 135 or 136 of the Mental Health Act, apart from in the very rare cases where a police station is used.
There will, I am afraid, be rare cases in which a police cell is the only place where the person can be kept, for their own safety. I know from speaking to chief constables and others that very occasionally that is so, but in the vast majority of cases, the person will be detained in a health-based place of safety. It will be difficult to ask the police to provide that information, but the Department of Health, NHS England and the Health and Social Care Information Centre are working together to develop and enhance the data that are collected across mental health crisis care. I am sure that they will consider what information should be captured in relation to the length of detentions. If it would be of further help to the hon. Member for North Durham, I will commit to making that point to my right hon. Friend the Minister for Community and Social Care, who I know will want to be as helpful as he can.
New clause 12 concerns access to independent mental health advocates, and I know that the hon. Member for North Durham feels incredibly strongly about that. We have spoken about it privately and I would like to discuss it further in a meeting in the next couple of weeks. I entirely understand his motivation in tabling the new clause. It is right that if someone is in such a serious mental health crisis that they need to be detained, they should be given the help and support that they need to understand what is happening to them.
However, I am not sure I agree that that would best be achieved by extending the statutory independent mental health advocacy service. Independent mental health advocates serve a specific purpose in the context of safeguarding and advising people who have been sectioned under the 1983 Act and subjected to detailed assessment or treatment under compulsion. They help such patients to understand and exercise their rights under the Act, such as their right to make an application to the mental health tribunal appealing against being sectioned.
Although it is true that someone who has been detained under section 135 or 136 is technically being held compulsorily, it is not of the same order as being formally sectioned under, say, section 2 of the 1983 Act. Nor does the detention last anywhere near as long as being sectioned under sections 2 or 3 might last. Moreover, the person concerned would not receive compulsory treatment during a section 135 or 136 detention. Unlike other forms of detention under the 1983 Act, a section 135 or 136 detention does not confer on the person detained statutory rights of a kind that mean independent assistance might be required to assist in understanding or exercising them. For example, there is no right of appeal to the mental health tribunal.
It is important to consider the priorities in a section 135 or 136 situation. For someone in the midst of a frightening mental health crisis, the first priority must be getting them to a place where they are safe and can be looked after by appropriately qualified staff, in a calm and quiet environment. I have to question whether at that point in the detention process it would be helpful or practical to have to identify an independent mental health advocate and obtain their attendance at the place of safety.
The hon. Member for North Durham suggested that it was a question of cost, but it is not. It is about the practicalities of getting someone to the right place of support and help. Detentions under sections 135 or 136 might last only a few hours. If it were mandatory to provide anyone so detained with access to an independent mental health advocate, there would be a risk that advocates would have to prioritise them over patients who had been sectioned and subjected to compulsory treatment, because of the much shorter timeframe in which they would have to respond. That would inevitably have an unsatisfactory knock-on effect on the patients for whom the independent advocacy service was established.
I agree with what Dr Julie Chalmers said to the Committee in her evidence: that the mental health professionals looking after the detainee at the place of safety are best placed to provide the support. They have the skills and expertise to help the person understand and participate in what is happening to them immediately, without having to wait for an independent mental health advocate to arrive.
That is the point that I would like to discuss with the hon. Member for North Durham. He made the analogy when we spoke privately with someone who is arrested and is thereby entitled to a phone call and access to a solicitor. I understand that point, but this is about the practicalities of how we deal with someone in a crisis who needs urgent attention. We must ensure that we do not delay that urgent attention by putting an additional, mandatory burden in place. I would be grateful if we could discuss this matter further because, while I have sympathy with the proposal, I think that, practically, it may cause more problems than it solves.
New clause 50 seeks to introduce another reporting requirement to measure the impact of the changes we are proposing. We all share a common goal of improving the outcomes for those who find themselves experiencing a mental health crisis. We believe that the changes we are introducing will achieve that, particularly by ensuring that there is less reliance on police cells as places of safety and that people instead have prompt access to proper medical care and support. I do not believe, however, that this new clause would prove to be an effective way of measuring the impact of our changes.
Every person is different and the length of time that an assessment may take, and the outcomes that may flow from it, depends on the individual circumstances and what is in the best interests of that person, not solely on where they happen to be or the route by which they came to be there. The vast majority of persons detained or assessed under sections 135 and 136 do not require in-patient care. When they do, relevant provision will be made for them, as it is at present. That remains unchanged by the provisions in the Bill.
The shadow Minister talked about potentially putting a statutory duty on CCGs and commissioners. There is already a great deal of work going on. Last year, we announced £15 million to support the development of more health-based places of safety, in line with our manifesto commitment, but it is for local commissioners to make decisions at a local level—we do not want blanket, national decisions. As I mentioned earlier in relation to new clause 11, the Government are planning to publish new data annually on the use of sections 135 and 136, which will provide much greater transparency about the use of those powers and be a good indicator of the direct impact of this legislation.
I hope that I have been able to reassure the hon. Member for North Durham in respect of the many thoughtful points he has raised, and that he will be content to withdraw his amendment.
Finally, Government new clause 28 relates to protective searches. The key issue is ensuring that the police can, in all circumstances, search a person who is subject to section 135 or 136. It is important that the police are able to protect all concerned: the person experiencing the mental health crisis, health and police professionals, and others, including family members, who may be present during the execution of a warrant, the removal and the period of detention at a place of safety. Currently, the police are able to search a person under section 136(1) of the 1983 Act, which relates to the removal of a person from a public place, because it is a preserved power of arrest under schedule 2 to the Police and Criminal Evidence Act 1984. However, section 135 does not constitute a preserved power of arrest, nor does the remainder of section 136.
We want to ensure that search powers can be used at any place of safety. As the Committee is aware, there are provisions in the Bill to enable a wider range of places of safety to be used for the purposes of an assessment where a person is subject to either section 135 or 136—namely, any place that is considered suitable and safe, and where those who are responsible for the place give consent. Many such places, including private homes, are unlikely to be covered by the existing powers of search. New clause 28 therefore complements the existing provisions in the Bill by enabling officers to search a person for their own protection and the protection of others.
I emphasise that where the place of safety is a hospital or other health setting, new clause 28 will not prevent health professionals from using their general powers to search patients when it is appropriate to do so. We recognise that search powers are a sensitive area, particularly where vulnerable people are concerned. For that reason, I want to be clear that the power will be limited, proportionate and used solely to maintain the safety of all concerned. It will be executable only when officers have reasonable grounds to believe that the person has an item concealed on them that could be used to injure themselves or others.
New clause 28 requires that a search is carried out only to the extent that is reasonably required to discover the item. It does not authorise a constable to require a person to remove anything except his or her outer clothing. It would allow a search of the person’s mouth, but not an intimate search. Those safeguards are consistent with the existing search powers under PACE. The new clause will therefore support the other mental health provisions in the Bill by enabling officers to protect all concerned, while ensuring that appropriate safeguards are in place.
I apologise to the Committee for the length at which I have responded to these points, but I think it is incredibly important that what the Government are trying to achieve is well understood and that we all share the aims of the Bill. I commend new clause 28 to the Committee.
As I said, my amendments are probing amendments. I thank the Minister for the full way in which she has responded to them. I know, and I want to put it on the record, that she, too, has a genuine interest in this subject and wants to do the best for individuals who suffer mental health problems.
I welcome the Minister’s response to new clause 11. The data are going to be very important, because they will attest to whether the changes are working. By comparing areas with one another, local scrutiny will allow areas to improve their situations and to learn from best practice. As she said in response to an intervention, what happens in one area can be transferred to another.
I hear what the Minister says about new clause 12. I accept her point that this situation is very different from being sectioned under section 2 of the Mental Health Act, but for people to be detained without any right to advocacy is unique. Like her, I do not want to overburden or inhibit the system, but there needs to be a basic right for individuals to have access to information. Given her commitment to further discussions on new clause 12, I shall not press it to a vote, but we may come back to it on Report. I beg to ask leave to withdraw the amendment.