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Personal and Public Safety: Mental Ill Health and Learning Disability Awareness

Version 2.2

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Page 2 of 17 Mental Ill Health and Learning Disability Awareness Version 2.2

© College of Policing Limited 2015

© - College of Policing Limited (the College) June 2015

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Version 2.2 Mental Ill Health and Learning Disability Awareness Page 3 of 17


Contents

1. Introduction ..................................................................................................................... 5

2. Partners: Statutory Services .......................................................................................... 5

2.1 Some ways to help you communicate effectively ........................................................ 6

3. Mental Health 1983 ........................................................................................................ 10

3.1 Power to remove a person to a place of safety ......................................................... 10

3.2 Transferring a person from one place of safety to another ........................................ 11

3.3 Entry to Premises with a warrant .............................................................................. 12

3.4 Section 135(2) of the MHA 1983 ............................................................................... 12

3.5 Detention in a psychiatric hospital ............................................................................ 13

4. Mental Capacity Act 2005 ............................................................................................. 14

4.1 Compelling a person to attend hospital against their wishes ..................................... 14

4.2 Wilful neglect or ill treatment ..................................................................................... 15

5. Revision Questions ....................................................................................................... 16

6. Key Legislation ............................................................................................................. 16

7. E-learning ...................................................................................................................... 16

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Authorised Professional Practice

These notes are aimed at learners completing their Initial training to meet the learning

outcomes specified on the National Policing Curriculum. The primary source of content is the

Authorised Professional Practice (APP) and the supporting evidence based research of

“what works” in policing.

APP can be found at: http://www.app.college.police.uk/

http://www.app.college.police.uk/

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1. Introduction

These notes have been written to support the ‘Mental Ill Health and Learning Disabilities’ e-

learning. They have been developed as an aide memoir of the key areas of legislation and

the powers covered by the e-learning with regards to the Mental Health Act (MHA) 1983 and

the Mental Capacity Act (MCA) 2005

The roles of other statutory services within the health and social care agencies with whom

you may work closely with are also looked at. The notes also outline a range of practical

strategies to help you communicate effectively, to minimise the potential for confusion or

agitation, in situations involving people experiencing mental ill health.

These notes are for Pre-Join, Police Officers, PCSOs, and IL4SC Phase 2.

2. Partners: Statutory Services

Police officers need to be aware of relevant roles within health and social care agencies. The

main services operating in a statutory framework, from a policing point of view, are:

Mental Health Duty Teams (MHDT)

Community Mental Health Teams (CMHT)

Accident and Emergency services (A&E)

All of these are part of the NHS.

Mental health duty teams

These are responsible for responding to mental health crises. They are staffed by Approved

Mental Health Professionals (AMHP) who are responsible for making arrangements for the

assessment and compulsory treatment of individuals experiencing acute mental ill health.

This may be the team that is called out to conduct a mental health assessment of a detainee

in police custody. Either this team or the CMHT are the people who are called upon to deal

with people having mental health crises at home.

Community mental health teams

CMHTs are responsible for the day-to-day treatment and support of people diagnosed with

mental ill health who are living in the community as distinct from a hospital environment.

They can carry out non-urgent assessments, usually during office hours, and sometimes

urgent ones too. Either CMHTs or the MHDTs are the people who are called upon to deal

with people having a mental health crisis at home. It is essential that officers on

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Neighbourhood Policing teams establish strong links with staff on CMHTs for advice and

referral when they encounter people experiencing mental ill health.

A&E services

Some A&E services have duty psychiatrists from whom you may be able to seek advice in

relation to people experiencing mental ill health. A&E departments may also act as places of

safety for individuals being detained under section 136.

Multi-agency protocols

Most areas have local multi-agency protocols for guiding police actions when dealing with

section 136 Mental Health Act 1983 (MHA) and assessments on private premises, many of

which are carried out using section 135 MHA 1983.

Officers should be aware of the contents of these local agreements and, if in doubt, should

speak to their local mental health liaison officer. The protocols should cover, for example, the

length of time that officers are expected to wait at the place of safety and how police will

work with CMHTs when responding to people experiencing a mental health crisis.

The structure of the working relationship between the police and other agencies (i.e.

arrangements for accessing and liaising with these services) varies from force to force so it

is essential to know what is in your area.

In most cases when you attend the scene of a crime you will be the Investigating Officer

(IO). However, on occasions the investigation will be taken over by another officer so it is

important that whoever the IO is they have as much information as possible to help them

identify potential witnesses and suspects and thereby solve the crime.

A key source of information is your initial gathering of information at the scene and the crime

report you will have completed. If you are aware of the options available to an investigator

you will be able to follow, or suggest to others, the areas of investigation that are worth

pursuing. The key is information and below are ways of obtaining it.

2.1 Some ways to help you communicate effectively

You will need to consider effective communication skills and strategies to break down

possible barriers and identify individual needs of people who may be experiencing mental ill

health within a variety of policing contexts.

Here are some ways to help you communicate effectively.

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Your Position

Do not touch the person unless you are sure that they do not feel threatened by you.

Give the person space and room to breathe.

Approach in a non-threatening, cautious manner.

Maintain a safe distance and position yourself defensively.

Tell the person what you are doing.

Repeat yourself, as the person may not hear you if their thoughts are being distracted - by

voices, for example.

Your Behaviour and Appearance

If possible remove your helmet or hat because it can seem threatening.

Do not rush into anything or make hasty judgements. A careful assessment of the initial

situation will ensure less difficulty later.

Do not stare at the person.

Do not humour a person with schizophrenia by pretending to agree with their delusions.

(Even if this seems the best thing to do at the time, it could rebound on you later).

Make it clear that although you do not accept their beliefs, you accept that they feel that way.

Be respectful, do not ridicule.

Remain alert and cautious, recognising that their behaviour can be unpredictable.

Be aware of your own non-verbal behaviour, as people who experience mental ill health,

enhanced by voices and thoughts, can be very sensitive to your actions.

Communication

Never leave someone who may be experiencing mental ill health to guess your intentions.

Explain simply and clearly what is happening.

Do not try to contradict or reason logically against a delusion, but do try to protect the person

concerned from its consequences.

Do not use your Airwave unless you have to.

Establish communication and work at maintaining it until the person is out of danger.

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Call for further assistance.

Look for a Medic Alert bracelet, some people who experience mental ill health wear one. Do

not try to take it off them, ask them about it.

Repeat why you are there, and tell the person that you are trying to keep them safe.

Speak calmly in a low-pitched voice and reassure the person.

Factors that can lead to agitation or aggression from people experiencing mental ill

health

Fear - Possibly of noise or people, which leads to desperation and the feeling that the only

way out is to fight. The person may also be frightened of what is happening inside them,

particularly if they recall previous aggression in past situations.

Confusion - Confusion about the situation can be very frightening for a person experiencing

mental ill health.

Paranoia - Feelings of being persecuted. The feelings may be directed towards society in

general or specific individuals or groups (for example, the police).

Anger - May be provoked by other people.

Voices - This is rarer, but the voices heard by a person with schizophrenia may sometimes

tell them to injure others. Mostly these voices are not acted upon but the increase in anxiety

and tension they create in a person reduces their ability to understand the situation.

Frustration - May stem from not being able to communicate clearly.

Warning Signs of Aggression

Some possible warning signs include:

Sweating.

Clenched fists.

Eyes darting about.

Frowning.

Increased reaction to sound (both external and internal).

Voice becoming louder.

Threats being made.

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Note - This is not an exhaustive list or a definitive guide to the signs of aggression.

Some useful ways to help reduce the possibility of aggression

Do not stare at the person.

Do not shout.

Do not whisper to colleagues.

Do not look aggressive.

Do not use your Airwave unnecessarily or have the volume turned up too loud.

If with a colleague, do not surround the person and make them feel trapped.

Do not stand face on: turn so that you are more side on.

Try not to feel aggressive yourself.

If you have assistance coming, try to warn them not to use flashing lights and two-tone

horns: unless it is absolutely necessary.

Regularly tell the person what is happening and what you are doing.

Keep your movements to a minimum.

Keep your hands in view, if you are not holding anything, make the fact obvious.

Make a visual check for weapons.

Several things that you can do to calm the situation down

Think about removing any audience from the scene as their presence may add to the

tension and anxiety of the situation.

Take a pace backwards to let the person know you are giving them space.

Talk calmly and evenly. Try to think how you sound and appear to the person.

Make sure that the person knows that you do not mean them any harm.

Ask the person why they are upset, there may be a simple solution.

Tell the person what you are going to do. If they are already feeling persecuted it will not

help at all if they have to try to guess what your next move will be.

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Ensure that only one officer talks at a time. This particularly applies to people with

schizophrenia because they may be hearing other voices as well.

Take the person out of a noisy environment.

Continue to reassure them.

Reduce your own body height by sitting down or squatting at the same height. Always

keep a safe distance between you and the person.

Use non-threatening body postures.

Remove anything dangerous (particularly sharp objects) that could be used against you.

3. Mental Health 1983

These notes deal with mental disorder which is the term used in the Mental Health Act 1983.

Outside of legislative use, the term ‘mental ill health’ is preferred.

The notes support the ‘Mental Ill Health and Learning Disabilities’ e-learning and the notes

are designed as an aide memoire of the key areas of legislation and powers covered by that

e-learning relating to the Mental Health Act (MHA) 1983 and Mental Capacity Act (MCA)

2005. The e-learning contains the full wording of the relevant legislation along with the Code

of Practice for the Mental Health Act.

PCSOs should complete this chapter for information and raising their awareness as it will

assist in identifying when to call for a warranted police officer.

3.1 Power to remove a person to a place of safety

Section 136(1) Mental Health Act 1983

This provides a police officer with the power to remove someone from ‘a place to which the

public have access’ to a place of safety if:

The person appears to the officer to be ‘suffering from mental disorder’ (this doesn’t mean

the police officer can diagnose mental ill health but that he or she believes, in good faith, that

the person is experiencing mental ill health).

The person appears to the officer to be in immediate need of care or control.

The officer considers it necessary to remove the person in their own interests or for the

protection of others.

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Example:

An officer attends a high bridge that spans a local river following calls from members of

the public concerned about a person in a distressed state. The person is agitated and

says they want to kill themselves and they are going to jump off the bridge.

A key question for an officer is:

“Based upon the individual’s current behaviour and what is known about them, what is the

risk of harm, to themselves and others, if they are not detained?”

Definition of a ‘Place of Safety’

The definition of a place of safety as referred to in section 136 MHA actually comes from

section 135(6). A place of safety means:

“Residential accommodation provided by a local social services authority under Part 111 of

the National Assistance Act 1948, a hospital as defined by this Act, a police station, an

independent hospital or care home for mentally disordered persons or any other suitable

place the occupier of which is willing temporarily to receive the patient”.

Section 136(2) of the MHA 1983

Once a person with mental ill health has been taken to a place of safety, section 136(2)

provides the power to detain them. It is important to understand that the power to detain the

person at the place of safety is given to all individuals who are party to the detention. This

means that, in law, hospital staff as well as the police have the power to detain the person.

3.2 Transferring a person from one place of safety to another


Section 136(3) allows a person detained in a place of safety to be transferred to another

place of safety.

While the police are empowered to make the transfer, any other person authorised either by

the police or an Approved Mental Health professional (AMHP) can also carry out such a

transfer. Unless it is an emergency, a person should not be transferred without the

agreement of an AMHP, a Doctor or another healthcare professional who is competent to

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assess whether the transfer would put the person’s health or safety (or that of other people)

at risk.

3.3 Entry to Premises with a warrant


Section 135(1) of the MHA 1983 allows an AHMP to apply for a warrant at a magistrates’

court so that, in certain circumstances, police can gain entry to premises (if need be by

force) where a person with mental ill health is believed to be.

The circumstances in which a warrant will be considered often include where the person with

mental ill health is having a crisis and is unwell. The warrant allows police to gain entry and

support a Community Mental Health Team (CMHT) or other health and social care

professionals to conduct an assessment.

A section 135(1) warrant provides a power additional to the power to enter as follows:

Remove the individual to a place of safety for 72 hours and assess them at that place

instead of their own home.

3.4 Section 135(2) of the MHA 1983

Whereas section 135(1) is geared towards obtaining a warrant to enter premises for the

purpose of assessment, section 135(2) is designed to enable a warrant to be obtained to

enter premises and remove an individual who is already absent without leave or liable to be

detained under the MHA 1983.

Examples:

People who have been detained by the police using section 136 and who escape while on

route to a place of safety and are found inside their home address and refuse entry. In

these circumstances section 138 MHA 1983 provides a power to detain and take the

person to a place of safety but a section 135(2) warrant would be required to enter the

premises by force and without consent and use section 138 to detain the person.

Detained patients within a psychiatric unit who absent themselves without leave from the

hospital either by escaping or by failing to return after their authorised leave has expired

and are found inside their home address. In these circumstances section 18 of the MHA

1983 provides a power to detain and take the person back to the hospital but a section

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135(2) warrant would be required to enter and use section 18 MHA 1983 if the person

refused entry to the police.

Patients on a community treatment order who are recalled to the hospital by their

responsible clinician and are found at their home address. As above Section 18 of the

MHA 1983 provides a power to detain and take the person back to the hospital but a

section 135(2) warrant would be required to enter and use section 18 MHA 1983 if the

person refused entry to the police.

3.5 Detention in a psychiatric hospital

Section 2 and 3 of the MHA 1983

For practical policing purposes, section 2 enables an AMHP to request that a person be

detained in a psychiatric hospital for the purposes of assessment. The detention lasts for 28

days, after which it expires and the person must be released, unless their further detention is

authorised under a different section (for example section 3).

Section 3 enables an AMHP to request that a person be detained in a psychiatric hospital for

the purposes of treatment.

Section 20 outlines the duration of the detention which lasts for 6 months after which it

expires, unless their detention is renewed for a further 6 months. After 12 months detention

can be renewed at intervals of one year.

The application forms for sections 2 or 3 must be supported by two doctors who must agree

that the person is ‘suffering from mental disorder’ warranting detention in hospital and that

detention is necessary in the interests of the patient’s own health or safety or to protect other

people.

Taking a sectioned person to a psychiatric hospital

Section 6 of the MHA 1983 allows for an AMHP to take, by force if necessary, someone who

has been sectioned (for example, using sections 2 or 3 of the MHA 1983) to a psychiatric

hospital.

It also allows an AMHP to authorise any other person to carry out the same function. This

means that police officers may be authorised to take and convey patients in this situation.

Such authority does not need to be in writing and the police cannot be compelled to use the

authorisation even if it is given. The decision about whether police will use the designated

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authority, once given, rests with the officer. Local guidance may help officers apply this

provision.

4. Mental Capacity Act 2005

4.1 Compelling a person to attend hospital against their wishes

Powers under sections 5 and 6 of the MCA 2005

The majority of the Mental Capacity Act (MCA) 2005 is not relevant to policing and is used

more by health and social care professionals and people with care responsibilities and

functions. Sections 5 and 6 operate together and are relevant in high risk situations in public

or private where officers need to intervene with someone who is not capable of making

rational decisions and is a risk to themselves or others.

In cases where someone reasonably believes that someone else lacks mental capacity to

make rational decisions, they will not incur any liability if they perform an act in connection

with the care and treatment of that person, where they reasonably believe that it is in that

person’s best interests.

Under these circumstances they will not be liable for prosecution if they restrain that person

so long as any restraint used is proportional to the likely harm to the individual they were

trying to prevent.

If the situation is urgent and no other professionals are present, officers may rely upon

sections 5 and 6 to compel an individual with a life threatening condition, or someone who is

at risk of serious harm, to attend hospital against their wishes.

The following is an example of a scenario where an officer may consider using powers under

the Mental Capacity Act 2005.

An officer comes across a person who is highly intoxicated in the street and sees they have

fallen and sustained a nasty injury. The person refuses to accept help and the officer is

concerned for their welfare. The officer can consider the ‘test of capacity’ and if the officer

decides that at that particular time, the person lacks capacity, the officer can act in their best

interests.

Restraint is only permitted if:

You believe that it is necessary to prevent harm to the incapacitated person, and

The restraint is a proportionate response to the likelihood and seriousness of the harm.

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Harm is not restricted to physical harm.

Officers should record their decision making and if restraint has been used or not and ensure

that this is documented appropriately.

PCSOs who take action to protect someone who they think is vulnerable and lacks capacity

are also protected from liabilities by section 6. This may include, for example, protecting

someone experiencing an epileptic seizure or preventing someone with dementia from

wandering onto a road. Police officers and PCSOs are not trained to assess mental capacity

and should defer to health or social care practitioners whenever possible.

Note that sections 5 and 6 of the MCA 2005 do not confer on police officers authority to

remove persons to hospital or other places of safety for the purposes set out in sections 135

and 136 of the MHA 1983.

4.2 Wilful neglect or ill treatment

Section 44 Mental Capacity Act 2005

Section 44 of the MCA 2005 makes it a criminal offence for a person who cares for someone

who lacks capacity to wilfully neglect or ill-treat them. This is a serious offence that is

punishable by imprisonment.

Wilful neglect may involve, for example, deliberate decisions by carers to deny food,

medication or heating; ill-treatment includes physical, mental, emotional, sexual or financial

abuse.

This offence may be encountered in a care-home setting or in circumstances where

someone is cared for in their own home. The offence may be committed by professional,

employed carers or by relatives and others who have formalised care obligations towards

someone who lacks capacity.

Example:

A concerned window cleaner contacts the police as they have seen an elderly person

through the window of a dwelling who appeared to be inappropriately dressed for a cold

day and who was tethered to a bed by a strap tied around their wrists.

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5. Revision Questions

Which statutory partner roles, within health and social care agencies, are relevant

to mental ill health?

What are the key skills and strategies that may enable effective communication

skills with a person who may be experiencing mental ill health?

Where may be deemed a place of safety under section 136 of the Mental Health

Act (MHA) 1983?

Who must apply for a warrant at a magistrates’ court under section 135(1) of the

MHA 1983 so that police can gain entry to premises where a person with mental

ill health is believed to be?

What is the maximum period a person can be detained in a place of safety under

section 135(1) to assess them at that place?

What actions or omissions may be deemed as wilful neglect or ill treatment of a

person who lacks mental capacity by their carer under Section 44 of the Mental

Capacity Act 2005?

6. Key Legislation

Key pieces of legislation applicable to this topic are:

Sections 2, 3, 6, 135 and 136 of the Mental Health Act 1983

Section 44 of the Mental Capacity Act 2005

7. E-learning

In addition to this book the following e-learning is available via the College of Policing

Managed Learning Environment (MLE):

Mental ill health and learning disability awareness. The e-learning contains the full

wording of the relevant legislation along with the Code of Practice for the Mental Health

Act. The part of the Code which has particular interest to the police service is that which

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deals with entry to premises under the Mental Health Act and powers to temporarily

remove people who appear to be experiencing mental disorder to a place of safety.

The MLE is regularly updated with new learning programmes and materials.

Personal and Public Safety - Enlighten Training · Personal and Public Safety: ... arrangements for accessing and liaising with these services) ... horns: unless it is absolutely

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