About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

52 Med. Sci. & L. 1 (2012)

handle is hein.journals/mdsclw52 and id is 1 raw text is: Review Article Emergency department as a 'place of safety': reviewing the use of Section 136 of the Mental Health Act 1983 in England Dorothy C Apakama FRCS(Eng) FCEM Consultant Emergency Medicine, Emergency Department, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands CV2 2DX, UK Email: dotapax@googlemail.com Abstract Section 136 provides the lawful authority for the removal, by the police, of the person to whom the provision applies, from a place to which the public have access. There has been a longstanding debate as to the most appropriate place of safety for these patients. The aim of this article is to review the literature and determine the ideal place for the detention and assessment of these patients and clarify the responsibilities of the staff of the agencies involved in the detention. It concludes that there is no single most appropriate place of safety for all groups of patients. Rather, there should be a range of options to enable the assessment in the most suitable environment for individual cases according to their needs at the time. Med Sci Law 2012; 52:1 -5. DOI: 10.1 258/msi.2011.010154 Introduction Section 136 (S136) of the Mental Health Act 19831 (the 1983 Act) gives a police officer the power to remove persons who appear to be mentally disordered from a public place to a place of safety (POS). In practice, psychiatric units, police stations and emergency departments are commonly used in the UK, although the 1983 Act does allow other options. There has been a longstanding debate between the police force and the emergency physicians as to the most appropri- ate place of safety for these patients.2-5 Unfortunately, those left in the middle of the debate are the junior doctors and police constables, usually outside normal working hours. Several studies have shown that about 77% of cases invol- ving S136 take place between 18:00 and 09:00 hours.6 A study done by the Independent Police Complaints Commission (IPCC)7 concluded that a hospital emergency department (ED) provides a better environment than police custody for these patients. The Royal College of Psychiatrists working group8 recommends that police stations should only be used as the POS on an exceptional basis and there should be sufficient places of safety in psy- chiatric facilities to meet foreseeable local needs without recourse to police stations as a convenient local option. However, in practice, where such facilities exist, they are regularly full and the patients end up in the ED. Since the last review article on the use of S136 in the ED (2002),9 there have been several amendments to the mental health law, which have implications for the use of this power. The most recent review article6 focused on the socio- economic status and demographics as well as the diagnostic profiles of individuals detained under S136. The studies indicated that S136 is inconsistently implemented and monitored across the UK and that differences exist between rural and urban areas. The review revealed a high prevalence of schizophrenia, personality disorders, mania and drug-induced psychosis in individuals detained under S136 and an over-representation of black detainees. This and similar studieso'11 have been dedicated to investi- gating 'who' is detained under this section and 'how' it is implemented. This article, however, is about 'where' these patients should be detained and assessed. It aims to provide evidence-based recommendations as to the ideal POS for different patient groups. Joint training and locally agreed protocols as rec- ommended by the Code of Practice12 are needed for police officers and health and social care staff. The aim is to clarify the responsibilities of the staff of the agencies involved in the detention to maximize safety of staff and ensure that patients are treated with dignity and respect and according to their needs. Where the ED is used as the POS, a quick refer- ence guide for all staff is shown in the Appendix of this article. Changes to the 1983 Act Below are the relevant 2007 amendments to the 1983 Act, which may impact on the use of S136. (1) Single definition for mental disorder: Mental disorder is defined as 'any disorder or disability of mind'. This extended definition encompasses people with personality disorder more readily than before. There is potential for increase in the number of people detained under the Mental Health Act generally and S136 in particular. (2) Introduction of 'Supervised Community Treatment': Supervised Community Treatment allows some individuals previously Medicine, Science and the Law 2012; 52: 1-5

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most