Cynulliad Cenedlaethol Cymru	National Assembly for Wales
Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon	Health, Social Care and Sport Committee
Ymchwiliad i iechyd meddwl yng nghyd-destun plismona a dalfa’r heddlu	Inquiry into Mental health in Policing and Police Custody
HSCS(5) MHP21
Ymateb gan Fwrdd Iechyd Prifysgol Betsi Cadwaladr	Evidence from Betsi Cadwaladr University Health Board

1. Whether there are sufficient services (i.e. health and social care services) available to support police officers in Wales to divert people with mental health problems away from police custody.

There are currently some opportunities to provide support and/or guidance to North Wales Police officers, who can then make informed decisions regarding diverting a person with mental disorder from police custody. Across North Wales, BCUHB currently operate a dedicated telephone number to enable access to a mental health practitioner who can consult with officers prior to use of S136. This consultation is available 24 hours a day, 7 days a week.  

However, there is scope to build on this availability. Therefore, it is pleasing to report that BCUHB have been successful in being awarded funding from Welsh Government to develop, with North Wales Police (NWP), a mental health telephone triage service within the Joint Communications Centre. BCUHB have also provided an additional mental health triage resource across the region as part of the Health Board’s annual Winter resilience planning, and for large public events (Armed Forces Day 2018) in partnership with NWP and WAST. 

As part of our wider 2018/19 Winter resilience planning, BCUHB provided a mental health practitioner in a dedicated police vehicle to support the emergency services across the region, to provide the right response in the right place at the right time. During the eight nights, practitioners responded to 38 incidents, undertaking 21 face-to-face assessments and 6 incidents through effective collaboration in the police control room. Whilst the activity is low, importantly some conveyance and application of S136 was prevented.  We will continue to explore such opportunities with partners when operational pressures indicate a perceived need, as the service user experience of being detained under a S136 can have a significant impact on individuals.   

 We are also working with the Third Sector to provide support to people who may ordinarily access the local emergency departments for emotional and welfare support.  The ICAN Centres have now been operationalised across each BCUHB district general hospital, and are staffed by volunteers to support individuals in need of non-medical support.

During the setup of the centres, which was in a short time scale, 200 volunteers have been recruited, which demonstrates the commitment of our North Wales population to support such initiatives.  Dependant on evaluation we believe there is significant further scope to scale up this project and to replicate this approach in local communities. North Wales’ Together for Mental Health Partnership Board will continue to oversee future developments in terms of developing a range of alternative crisis response initiatives in line with our strategy. The CALL Helpline is also available to members of the public and police staff to provide advice and guidance on how best meets the needs of people in distress, or seeking support 24/7.  BCUHB and NWP are also piloting an approach to reduce the number of vulnerable people informally conveyed by police to local ED, who subsequently leave without an assessment. This approach will be evaluated in July 2019.

2. The number of people arrested under section 136 of the Mental Health Act 1983, and the extent to which police custody is being used as a place of safety for people in mental health crisis.

Between January and December 2018, North Wales Police utilised powers under S136 on 719 occasions (10.27 per 10,000 population). On 8 occasions police custody was used as a place of safety (1.1%). Further detailed data for all S136 activity is available, broken down by area if required.  All of BCUHB Mental Health Act data including S136 is scrutinised at our Mental Health Act Committee which is chaired by our Vice Chair. Unlike other areas, there has been an historic culture of not utilising police custody for S136 in North Wales, and numbers have always been very low.  However, our S136 activity remains high and places significant operational pressures on both BCUHB and NWP, which is why crisis development is one of our strategic priorities for mental health developments in North Wales.   

3. Whether local authorities and health services are meeting their duties and complying fully with legislative requirements to provide appropriate places of safety to which the police may take people detained under section 136 of the Mental Health Act 1983.

BCUHB currently provides three health based places of safety across the region. Each facility is a dedicated and purpose built room that meets the requirements for the detention of a person under S136ⁱ (National Institute for Clinical Excellence 2005 and Royal College of Psychiatrists 2013). There are occasions when demand for access to these facilities exceeds capacity and this presents operational challenges for both organisations, and is managed jointly via our on call and escalation procedures to keep the person safe and provide dignified care. We have recently experienced a significant reduction in under 18s S136 activity, from 52 in 17/18 to 20 in the comparable period for 18/19. However, this remains an area of concern for both BCUHB and NWP, especially in relation to detention of young people under 16. We continue to work proactively with partners, particular Social Services, to improve our joint offer to young people who are in distress but who may not have a mental disorder and therefore do not meet the criteria for detention under the Mental Health Act. We are striving to develop alternative pathways and options, hence our joint Parliamentary Review bid with our six Local Authorities, which focuses on out multi agency response to young people who are on the edge of care.    

4. Adherence to the Code of Practice to the Mental Health Act 1983 which requires that people detained under that Act should always be conveyed to hospital in the manner most likely to protect their dignity and privacy, taking account of any risks (i.e. by ambulance which should be made available in a timely way, as opposed to police transport).

Our Mental Health Act data reports that North Wales Police conveyed people detained under S136 on 96.6% of occasions (January to December 2018).  Part of the explanation for this is likely to be delays in accessing ambulance services.  BCU has been working as part of our plan to improve urgent care services to reduce ambulance delays and have delivered sustained improvement.  For example, comparing Feb 2019 to February 2018 delays have reduced by just over 72% 

5. How effectively police forces in Wales work with partners (such as health or social care services) to safeguard vulnerable people in police custody, and how well the police themselves identify and respond to vulnerable people detained in custody, specifically those arrested under section 136 of the Mental Health Act 1983.

North Wales Police work positively with BCUHB to meet competing and shared operational challenges with a shared strategic view (Together for Mental Health in North Wales).  During 2018 BCUHB funded and seconded a full time mental health practitioner to work with NWP on a range of joint initiatives.  This is an example of our will to address the ongoing operational pressures that both organisations face from this agenda and to improve the experience for our service users.  This post has now been made substantive and will oversee the development of future initiatives such as the provision of mental health practitioners in the joint control room and the significant training agenda for frontline police staff. 

 NWP have also recruited a mental health lead working with all partners to improve the response to vulnerable people who encounter the police. As part of the Day in Their Shoes programme North Wales Police have released officers to spend time shadowing mental health practitioners. North Wales Police are also active members of the Local Implementation Teams, exploring local solutions to community based challenges   North Wales Police identify vulnerable people within police custody and access custody nurses to provide a physical health check. Police will identify when a person may require a face to face mental health assessment and will access appropriate mental health assessment, either through Psychiatric Liaison, S.136 or requesting a formal assessment under MHA in custody. Re-launch of our Criminal Justice Liaison Service will provide additional resources to provide primary mental health care assessment in custody. In addition, BCUHB and NWP have jointly developed a mental health training programme that will be jointly delivered to improve the competencies of frontline police officers in a range of mental health topics.

6. The effectiveness of multi-agency care planning for people with mental health problems when leaving custody, specifically for those detained in police custody under section 136 of the Mental Health Act 1983 to help to prevent repeat detentions.

As previously indicated following a review of S136 use over four years in North Wales (2018) there is evidence that very few people are detained in police custody under S.136. Of those people detained under S.136, on average, 26% of people detained under S.136 require inpatient admission following assessment, 15% of people do not have a mental disorder and 59% of people had a mental disorder and required referral or follow by mental health services. The developments described previously and our future actions planned with partners, under our joint mental health strategy, are all designed to have a positive impact on the regions use of s136 and improve the experience for our service users and staff across both organisations.  

7. Whether effective joint working arrangements are in place, with a specific focus on implementation of the Mental Health Crisis Care Concordat, including whether the Welsh Government is providing sufficient oversight and leadership.

In relation to implementation of the Mental Health Crisis Concordat the approach adopted in North Wales is to embed this activity within the governance of our Together for Mental Health Partnership Board.  This demonstrates an efficient use of resources, and ensures all our regional developments and policy drivers are aligned.  

Yours sincerely

Gary Doherty

Prif Weithredwr

Chief Executive