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Local policies on use of police powers and places of safety

16.30 Local authorities, NHS commissioners, hospitals, police forces and ambulance services should have local partnership arrangements in place to deal with people experiencing mental health crises. The objective of local partnership arrangements is to ensure that people experiencing mental health crises receive the right medical care from the most appropriate health agencies as soon as possible. The police will often, due to the nature of their role, be the first point of contact for individuals in crisis, but it is crucial that people experiencing mental health crises access appropriate health services at the earliest opportunity.

16.31 It is also important to ensure that a jointly agreed local policy is in place governing all aspects of the use of section 135 and section 136. Good practice depends on a number of factors. For example:

• local authorities, hospitals, NHS commissioners, police forces and ambulance services should ensure that they have a clear and jointly agreed policy for use of the powers under sections 135 and 136, as well as the operation of agreed places of safety within their localities

• all professionals involved in implementation of the powers should understand them and their purpose, the roles and responsibilities of other agencies involved, and follow the local policy

• professionals involved in implementation of the powers should receive the necessary training to be able to carry out fully the role ascribed to their agency

• the parties to the local policy should meet regularly to discuss its effectiveness in the light of experience and review the policy where necessary, and

• partner agencies should decide when relevant information about specific cases can be shared between them for the purposes of safeguarding the person and the protection of others, if there is thought to be a risk of harm.

16.32 The policy should define responsibilities for:

• commissioning and providing sufficient safe and secure health-based places of safety, including for people under the age of 18

• identifying and agreeing the most appropriate places of safety in local areas, including contingency arrangements for those cases where the preferred place of safety is not available. This should ensure that local agency boundaries are not an overriding constraint, and that there are arrangements to ensure children and young people can access a place of safety in their local area

• escalating and reviewing decisions, particularly in the event of disagreement

• providing prompt assessment (including how soon the doctor and AMHP should attend) and, where appropriate, admission to hospital for further assessment or treatment

Police powers and places of safety

• securing the attendance of police officers at health-based places of safety, where appropriate, for the patient’s health or safety or the protection of others

• the safe, timely and appropriate transport of the person to and between places of safety (bearing in mind that hospital or ambulance transport will usually be preferable to police transport, which should only be used exceptionally, such as in cases of extreme urgency or where there is an immediate risk of violence)

• deciding whether it is appropriate to transfer the person from the place of safety to which they have been taken to another place of safety (see paragraphs 16.53 – 16.58)

• ensuring that people who are intoxicated can be safely managed in any place of safety or an emergency department, and receive an assessment of both their physical and mental health needs. Intoxication should not be used as a basis for excluding people from particular places of safety, except in the circumstances outlined in the policy such as where the patient’s current behaviour clearly indicates that there may be a risk to their own safety, or that of the staff, which cannot be safely managed in the health-based place of safety.

• ensuring that people who are behaving, or have behaved, violently can be safely managed in a place of safety taking into account the needs of the person and the safety of staff and others

• arranging access to a hospital emergency department for assessment for

people who need it, and having an agreed list of circumstances when this will be necessary, such as where a person is self-harming, has a high body temperature or physical injury

• record keeping (see paragraphs 16.59 – 16.62) and monitoring (see paragraphs 16.63 – 16.65) and audit of practice against policy

• the release, transport and follow-up of people assessed under section 135 or 136 who are not then admitted to hospital or immediately accommodated elsewhere, and

• preparing multi-agency care plans for people who are repeatedly detained under section 136.

16.33 Responsibilities should be allocated to those who are best placed to discharge them, bearing in mind the different purposes for which health and social services and the police service exist. Local policies should ensure that police officers know who to contact prior to the removal of a person to a place of safety under section 136, in order to help secure their acceptance into a health-based place of safety. 16.34 Such policies should cover arrangements for police officers to remain in attendance

when a person arrives at a health-based place of safety. Healthcare staff, including ambulance staff, should take responsibility for the person as soon as possible, including preventing the person from absconding before the assessment can be carried out. The police officer should not be expected to remain until the assessment is completed; the officer should be able to leave when the situation is agreed to be safe for the patient and healthcare staff.

16.35 Such policies may be best maintained by the establishment of a liaison committee, which might also take responsibility for examining the processes in place for other multi-agency tasks, such as transport of persons under the Act and policies in respect of patients who go absent without leave.