Today Parliament is debating the Policing and Crime Bill which contains provisions to end the detention of children with mental health problems in police cells. These measures are welcome and long overdue. Whilst our understanding of mental health may have grown in recent years, there remains many elements of mental health care that have no place in the 21st century; locking up a very ill child in a police cell is one of them. Yet despite these welcome proposals, changing the law alone will not be enough to put a stop to this practice.
The Bill, if passed, would ban the use of police cells as places of safety for children with mental health problems, and will prescribe that they are only used in exceptional circumstances for adults. It also proposes to reduce the maximum length of time a person can legally be detained whilst waiting for a mental health assessment from 72 hours to 24 hours.
These changes look good on paper but they will not solve the problem of why professionals are often left with no other option but to detain sick people in police cells or why assessments take so long in the first place. To tackle these challenges, the Government must address the lack of appropriate alternative places of safety for children and young people, the shortage of trained professionals to carry out the assessments, and the severe pressure on hospital beds for those that need inpatient care.
The choice of places of safety that can be used for a mental health assessment is incredibly limited and does not reflect the diversity of the communities they serve. Despite being over represented in detentions under the Mental Health Act, there is a lack of culturally sensitive places of safety for black African Caribbean men; and many places are not able to accept under-18s due to safety and safeguarding requirements. The Care Quality Commission has reported that there isn't a single health based place of safety that can be used for under 16 year olds in many local authority areas including Devon, Norfolk, Lincolnshire, Bristol and Bath.
Likewise, reducing the time limit for a mental health assessment will not guarantee that there will be enough trained professionals to complete the process within 24 hours. The CQC's review of crisis care in 2015 found that the most common reason for delayed assessments was the lack of specialist doctors, nurses or Approved Mental Health Practitioners (AMHPs) to carry out an assessment. An FOI request in 2013 found that the number of AMHPs had fallen in almost half of councils.
If a person does need to be admitted to hospital then current guidance states that the assessor should not complete their assessment until they have found a bed for the person to go to. Yet, as pressures on the system grow, this is becoming more and more difficult. It is estimated that around 500 people with mental illness have to travel over 50km to be admitted into hospital every month, a figure which has risen in recent years. Last year leaked emails revealed that hospitals were being advised to adopt emergency procedures and admit young mental health patients to adult wards because of a national shortage of places for children. 391 children were placed on adult mental health wards last year alone, an increase of 10% on the year before.
Without reforms to tackle the root of the problem - lack of capacity - there is a risk that the proposals in the Policing and Crime Bill will add pressure to an already pressured system and bring unintended consequences. Professionals may be forced into the impossible situation of having to choose between sending someone who needs inpatient care home or breaking the law because they haven't been able to find them a bed within the 24 hour window. The CQC has recently warned that the burden already placed on AMPHs could be leading to people being detained unnecessarily under the Mental Health Act because it's the only way to guarantee a patient will get a hospital bed.
The changes we are debating today have the potential to make a big difference to some of society's most vulnerable people. However for this to be achieved, the Government must show they have a plan to translate this legislative change into reality on the ground. How many additional places of safety will the Government commission and how will they be paid for? How many AMPHs will be needed to meet these new requirements and will the Government commit to funding them? What action are Ministers taking to ensure that we have enough inpatient beds and what are they doing to improve outreach and triage support in the community to ease the pressure on the beds we do have? These are the questions that the Government must answer robustly. Otherwise, they are in danger of making yet another promise on mental health that they are not able to keep.
Luciana Berger is the shadow minister for mental health and Labour MP for Liverpool Wavertree