Part of: Mental Health and Illness

Related to: Anxiety and Depression, Personality Disorders, Psychosis, Postnatal Depression. Wellbeing, Emotional Health and Wellbeing of Children and Young People, Self-Harm, Suicide and Mortality of Undetermined Intent, Dementia, Eating Disorders, Patient Experience, Adult Social Care, People with Multiple Needs, Alcohol, Substance Misuse

Key facts

  • In the UK in the financial year 2012/13, there were 21,814 reported uses of Section 136 of the Mental Health Act (taking people having a mental health crisis to a safe place), of which 7,761 involved the use of a police cell.
  • In Bath and North East Somerset in Q1 of the financial year 2013/14 there were 28.5 detentions under Section 136 as an admission to hospital per 100,000 of the 18+ population. This was significantly higher than England with 15.5 per 100,000 of the 18 + population.
  • In 2014 there were 164 safe places in health-based settings for people experiencing a mental health crisis in England, the majority of these were rooms/wards/areas in a mental health hospital, accepted patients of all ages, but only had the capacity for one patient.
  • One of these places of safety in a health based setting serves Bath and North East Somerset (Mason Unit, Southmead Hospital). In 2014 it accepted patients aged 16 years and over, and had the capacity for four patients.
  • The Care Quality Commission’s 2014 review of places in health-based settings for people experiencing a mental health crisis in England, found that too many health-based places of safety were turning people away because they were already full, and some were refusing to help people who are intoxicated or exhibiting disturbed behaviour.

Section 136 of the Mental Health Act 1

Section 136 of the Mental Health Act allows for someone believed by the police to have a mental disorder, and who may cause harm to themselves or another, to be detained in a public place and taken to a safe place where a mental health assessment can be carried out.

A place of safety could be a hospital, care home, or any other suitable place where the occupier is willing to receive the person while the assessment is completed. Police stations should be only be used in exceptional circumstances.

Health-based places of safety are most commonly part of a mental health unit on a mental health hospital or acute hospital site, or part of an accident and emergency department in an acute hospital.

Unless the place of safety is an A&E department, it will not usually be available to people who have not been detained by the police.

What does the data say?

Use of Section 136 of the Mental Health Act 2

The Care Quality Commission’s report on the Mental Health Act 2012/13 notes that the Act was used more than 50,000 times in the UK during the year to detain or treat people and the total number of people who have been subject to the Act has risen by 12% over the last 5 years.

The Health and Social Care Information Centre’s Mental Health Bulletin for 2012/13 reported that 45.6% of all patients who spent time in a mental health hospital were subject to the Mental Health Act at some point during the year.

In terms of the use of Section 136 of the Mental Health Act specifically (to take people to a safe place), in the UK in the financial year 2012/13, there were 21,814 reported uses, of which 7,761 involved the use of a police cell. 3

CQC’s work with HM Inspectorate of Constabulary, HM Inspectorate of Prisons and Healthcare Inspectorate Wales in May and June 2012 found that some of the most common reasons for the use of police custody related to the lack of staff or beds available in health-based places of safety. 4

Use of Section 136 in Bath and North East Somerset 5

In B&NES in Q1 of the financial year 2013/14 there were 28.5 detentions under Section 136 of the Mental Health Act as an admission to hospital per 100,000 of the 18+ population. This was significantly higher than England with 15.5 per 100,000 of the 18 + population.

Are we meeting the needs?

Safe places in health-based settings 6

In January and February 2014, the CQC collected information via an online survey from 56 mental health trusts and two community interest companies responsible for the health-based places of safety in local areas throughout England. 7

The CQC requested details on their location, opening times, capacity and usage, any exclusion criteria, staffing and training, multi-agency working, and the support received from the police. They received a 100% response rate from the organisations they surveyed. 8

The Care Quality Commission review identified 164 safe places in health-based settings for people experiencing a mental health crisis in England.

The map showing the location of health-based places of safety in England can be found at www.cqc.org.uk/hbposmap.

Types of safe place -The vast majority of these safe places, 77% (126) were rooms/wards/areas in a mental health hospital, followed by 14% (23) that are places allocated in accident and emergency departments.  The other types of safe places in England made up the remaining 9% (15): mental health ward in a general hospital, section 136 suit, annexe to mental health hospital, area in a mental health hospital, bespoke room, bespoke unit, room in a hospital ward, section 136 suite in the mental health unit, section 136 suite in the urgent care centre, and stand alone unit in the hospital grounds. 9

Capacity - The majority of the 164 safe places in health-based settings for people experiencing a mental health crisis in England in 2014, 75% (123), only had the capacity for one mental health patient, 15% (25) had the capacity for two patients, 3% (5) for three patients, 2% (3) for four, and 5% (8) had no limit on the number of patients. 10

Figure 1: Safe places in health-based settings for people experiencing a mental health crisis in England in 2014 – capacity and ages accepted 11

Ages accepted - The majority of the 164 safe places in health-based settings for people experiencing a mental health crisis in England, 65% (106), accepted all ages of patient, 17% (28)  accepted patients 16 and over, 15% (24) accepted patients 18 and over, and the remaining 4% (6) either accepted patients under 16, under 18, or aged 18-64. 12

Safe places in health-based settings in Bath and North East Somerset 13

In 2014 there was one place of safety in a health based setting serving Bath and North East Somerset local authority:

Mason Unit, Southmead Hospital

Southmead Road, Westbury-on-Trym, Bristol BS10 5NB

(0117) 3238933

The Mason Unit is a room/ward/area in a mental health hospital, and in 2014 it had the capacity for four patients, and accepted patients who were 16 years and over.

The 2014 Care Quality Commission review  14

The Care Quality Commission has called for urgent action to continue to improve access to and the operation of health-based places of safety for people experiencing a mental health crisis.

CQC found that too many health-based places of safety were turning people away because they were already full, and some were refusing to help people who are intoxicated or exhibiting disturbed behaviour.

Overall, CQC’s findings suggested that while some health-based places of safety were effective, others were less responsive to people’s needs and require far reaching improvements.

CQC’s key findings were:

  • Too many health-based places of safety were turning people away or requiring them to wait for a long time with the police because they were already full or because there were staffing problems.

  • A quarter of providers told CQC that they did not believe that the provision of health-based places of safety in their locality was sufficient.

  • Too many providers were operating restrictions which exclude some people from specific groups from accessing a health-based place of safety. This included young people, people who were intoxicated, and people exhibiting disturbed behaviour.
  • Too many commissioners were not adequately fulfilling their oversight responsibilities.
  • Too many providers were failing to monitor their service effectively, making it difficult to assess whether provision of health-based places of safety was meeting the needs of their localities.
  • Many health based places of safety were unable to provide CQC with basic data about the use of their service or how often people were turned away or excluded.

Crisis Care Concordat 15

The Mental Health Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis.

In February 2014, 22 national bodies involved in health, policing, social care, housing, local government and the third sector came together and signed the Crisis Care Concordat.

It focuses on four main areas:

  • Access to support before crisis point – making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously.
  • Urgent and emergency access to crisis care – making sure that a mental health crisis is treated with the same urgency as a physical health emergency.
  • Quality of treatment and care when in crisis – making sure that people are treated with dignity and respect, in a therapeutic environment.
  • Recovery and staying well – preventing future crises by making sure people are referred to appropriate services.

What can we realistically change?

Care Quality Commission review 16

The 2014 Care Quality Commission review made a number of recommendations aimed at providers and commissioners based on its findings, including that:

  • Providers should identify areas in which national standards are not being met, working with local partners to address these shortfalls. This includes making sure appropriate arrangements are in place for young people, people who are intoxicated, or people exhibiting disturbed behaviour.

  • Providers should improve data collection on how health based places of safety are used.

  • Providers should ensure that appropriate levels of adequately trained staff are available to receive an individual brought to the place of safety at all times.
  • Commissioners should establish whether local capacity is sufficient, and take action to drive improvements by the commissioning of services or specifying interventions that may prevent or reduce the use of Section 136.
  • Commissioners should ensure they are fulfilling their responsibilities around multi-agency groups and policies relating to health-based places of safety.
  • Commissioners should ensure that ambulance arrangements for transporting people experiencing a crisis are appropriate and timely.
  • Health and wellbeing boards should assess local need for health-based places of safety as part of their Joint Strategic Needs Assessments.
  • Multi-agency groups should develop and monitor an action plan to address any shortfalls identified, including agreeing alternative arrangements when the place of safety is occupied, and auditing local intelligence on the operation of places of safety, promoting improvements in data quality where required.
  • Organisations responsible for the availability of professionals to carry out MHA assessments should take action to minimise delays.
  • NHS England should consider the use of capacity management systems to include real-time information on the availability of health-based places of safety, in order to help streamline the process for police and ambulances to access a place of safety.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • 1. Care Quality Commission (2014) Map of health-based places of safety, http://www.cqc.org.uk/content/map-health-based-places-safety-0#howto (viewed on 27/02/15)
  • 2. Public Health England (2014) Bath and North East Somerset Clinical Commissioning Group, Community Mental Health Profile 2014, http://www.nepho.org.uk/pdfs/cmhp/E38000009.pdf (viewed 21/11/14)
  • 3. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 4. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 5. Public Health England (2014) Bath and North East Somerset Clinical Commissioning Group, Community Mental Health Profile 2014, http://www.nepho.org.uk/pdfs/cmhp/E38000009.pdf (viewed 21/11/14)
  • 6. Care Quality Commission (2014) Map of health-based places of safety, http://www.cqc.org.uk/content/map-health-based-places-safety-0#howto  (viewed on 27/02/15)
  • 7. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 8. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 9. Care Quality Commission (2014) 20141104 CQC health-based places of safety map data, http://www.cqc.org.uk/content/map-health-based-places-safety-0#howto, In house analysis, Research and Intelligence Team at Bath and North East Somerset Council (downloaded on 27/02/15)
  • 10. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 11. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 12. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 13. Care Quality Commission (2014) Map of health-based places of safety, http://www.cqc.org.uk/content/map-health-based-places-safety-0#howto (viewed on 27/02/15)
  • 14. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 15. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC
  • 16. Care Quality Commission (2014) Email correspondence - Under embargo until 00:01, Wednesday 22 October 2014: Better access to safe places in health-based settings for people experiencing a mental health crisis is crucial, urges CQC