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© - College of Policing Limited (the College) June 2015
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Occasionally, to ensure clarity, it has been necessary to refer to an individual by gender.
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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/
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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) of the MHA 1983
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
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.