My first ever mental health research job was for Mind in the 1980s, investigating section 136 of the Mental Health Act. It was funded by the then GLC (Greater London Council) Police Committee. It was fairly groundbreaking in its time: examining the outcomes of three different ‘places of safety’ used under the Act in the London area. It was also a huge learning experience for me: just a few years previously, I had myself been picked up by the police and taken to hospital. The research placed something of a mirror up to my face. I had never been inside one of the old-style psychiatric hospitals until then, plus I was given the opportunity of observing activities in a police station in north London for several days.
Section 136 of the Mental Health Act 1983 allows police officers to remove a person from a public place to a place of safety if they believe that person has a mental disorder and is in urgent need of care or control. This power is used to facilitate a mental health assessment and ensure the safety of the person and others.
You can be held for up to 24 hours until assessed by a doctor and an approved mental health professional. This can be extended to 36 hours if it is felt that it is not possible to assess you properly because of physical health concerns.
Now, several decades later, I am working with a research team at the University of York looking at mental health emergencies from a rather different standpoint. Our plan is to build a research proposal together with people who have direct experience of mental health emergencies. Earlier this year, we put out a call through the NSUN bulletin for people to come forward and share their personal experiences of good practice in a mental health emergency. We heard from over 20 people and held two focus groups and four interviews to understand more about what people find helpful at this profoundly difficult time.
It may not surprise you to hear that many people found it hard to identify good practice other than in its absence. So many experiences were both distressing and traumatising. We summarised what we were told as follows:
- Control and autonomy: people spoke about the importance of having some measure of control over how an emergency was handled. This could emerge through the way in which people are treated: professionals asking permission to contact services, keeping you informed of what is happening, having an agreed crisis plan or mental health alert card to share relevant information.
‘I spoke to my therapist about my suicidal ideation and her response was to be very gentle and containing and ask for my permission to speak to my GP to refer me onto to psychiatric services.’
- Respect, understanding and trust: much of what people talked or wrote about concerned the attitudes displayed by the various professionals involved – whether police, ambulance or healthcare practitioners. Examples included: being included in conversations rather than being talked about; being treated with humanity, respect and open-mindedness; asking ‘what do you need from me?’. Many people talked of the importance of professionals remaining calm, of not ‘feeding the fire’ of the crisis. One policeman played music on his phone while they waited in a police car:
‘I think it was a really kind way to respond, because it showed he was calm. It showed that he was not judging me. It showed that he saw me as a human and not a problem.’
- Society, systems and services: a core problem at the heart of the way in which mental health emergencies are both experienced and reported is the placing of blame with the individual. Several people talked of the system and service failures that result in the amplification of their mental health emergency. Examples included being signposted from one service to another, with no service apparently able to help. Good examples in this category are significant: a quiet space in a hospital; a dedicated space designed for section 136 referrals; a ‘decisions unit’ with low lighting and pictures showing care for those taken there.
‘…having a separate place felt like, ‘Oh, I am in the right place. I’m supposed to be here’. Whereas I always feel a little bit here, like it’s like I’m kind of secondary to everything else that’s going on in the A and E department. I kind of shouldn’t be here.’
So often people are given anything but a ‘place of safety’ in a time of crisis, making a mockery of the wording in the Mental Health Act. But, through this consultation, we heard how it can be possible to respond well to a mental health emergency. We would like to see this happen much more frequently, and so we are developing a research project that we hope will lead to real change by working with people who have experienced mental health emergencies to show what good care looks like. We also heard about some schemes that sounded very promising and want to investigate these further.
How to get involved
If you have any experiences that you would like to share – or would like to get involved – please get in touch with me alison.faulkner2@btinternet.com. We would be particularly interested to hear from you if you have any examples of professionals (not necessarily mental health) intervening in a helpful way.
We are a group of researchers interested in police, health and social care responses to mental health emergencies — urgent mental health related situations that police (or ambulance) might be called to respond to.
Alison Faulkner is a survivor researcher with experience of working with mental health service users and survivors over many years. She has personal experience of mental health crises and of using mental health services in the past.
Claire Warrington has a background working in the criminal justice system (probation and prison) and has spent the last 11 years researching people’s lived experience of police Mental Health Act detention, especially repeated detention.
Martin Webber is a registered social worker and leads the Mental Health Social Care Research Centre at the University of York. His research explores mental health social interventions.