Forensic Mental Health Studies

This assignment will critically analyse a group of mentally disordered offenders, in the context of the relationship between mental health and legal provisions for care under the Mental health Act of 1983 Section 136. The layout for this assignment will be broken down into sub headings ranging from the clarification of professional roles to suggested changes and improvements for future practice.

Case studies will be utilised giving different scenarios for practitioners and other agencies being faced with the requirements and understanding of implementing Section 136 appropriately. A uniform procedure for ‘good practice’ has been set under the MHA 1983 Code of Practice, in terms of compliance from Police, Health and Social Care involvement incorporating the Human Rights Act and Data Protection Legislation (Code Of Practice, 1999). The main emphasis will be of those individuals placed ‘arrested’ on Section 136 MHA’83 rather than those mentally disordered offenders who may be arrested on suspicion of an offence, as they are assessed separately for mental health needs via the courts while in custody.

Statement of the Law

Firstly it is important to clarify what is meant by the term Section (s136), and the criteria for the detention. The Section 136 of the MHA’83 states, “If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interest of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135” (Jones, 1999).

“A person removed to a place of safety under this section may be detained there for a period of 72 hours for the purpose of enabling him to be examined by a Registered medical practitioner and to be interviewed by an Approved Social Worker and of making any necessary arrangements for his treatment or care” (DHSS, 1983). The meaning place of safety is defined in subsection 6 of Section 135 as follows:

“Residential accommodation provided a local social services Authority under part III of the National Assistance Act 1948 or under paragraph 2 of schedule 8 of the National Health Service Act 1977, a hospital as defined by this Act, a Police station or Mental Nursing Home or Residential Home for the mentally disordered persons or any other suitable place, the occupier of which is willing, temporarily to receive the patient” (Royal College of Psychiatrists, 1997.)

Criteria for Detention To detain a person under Section 136 of the MHA a constable will carefully consider the following criteria to satisfy the law and best practice. 1. A Public Place- this is where the public has access and not private premises. 2. Evidence of Mental Disorder- the officer should note what is said and done by the person, together with their appearance and demeanour. The officer should rule out alcohol or illicit drug use first before looking at mental state. If there is clear evidence to show the person needs to be seen by a doctor or other health care professionals then this should be sought. (Rodgers & Faulkner, 1987).

One of the main reasons for officers placing individuals on s136 is that of there being clear evidence that removal to a safe place is in their own interest or to protect others. Nominated places of safety Individuals who are detained under s136 MHA should be taken to a nominated place of safety, which is nearest to where they are found. This ensures that appropriate assessment and medical assistance is made available as quickly as possible which reduces the time the individual is held in police custody. In Coventry, police stations are classed as nominated areas of safety. However, the Code of Practice states that “as a general rule it is preferable for a person thought to be suffering from a mental disorder to be detained in a hospital rather than a police station” (Code of Practice, 1999).

Ambiguity still remains about the legal interpretations of the provisions of s136, which needs to be rectified (Ogundipe & Knight, 2001). One particular survey found that in six police force areas there were 200 incidents involving people with mental health problems every day, however, the exact figures are unknown due to the lack of adequate recording (Mental Health and social Exclusion Unit, 2004). According to the independent police complaints commission (IPCC) about half of deaths in custody involve people with mental illness, according to a report by Community care “a disturbing figure given that 38 people died in custody in 2004” (Community Care, 2005). Problems arise as police officers do not have the experience and training to deal with this situation and police cells are not designed in such a way as to provide a suitable or therapeutic environment. (MIND, 2003).

Professional roles The Police The police respond initially to concerns raised by members of the public regarding to an individuals disturbing behaviour in public places. Once the individual is in custody his/her own Doctor (GP) or Forensic Medical Examiner (FME) will be contacted. The Police officer should then complete form A of the monitoring form, which records details of the individual and the circumstances in which they were found. The form should be handed over to an ASW to complete if the FME requests input. The police are involved in many mental health referrals, not just those involving Section 136 of the Mental Health Act ’83, which allows them to arrest disturbed people in public places.

Research has shown that the police are inconsistent in their use of this section and detain a higher proportion of Black people under it (Bhui & Sashidharan, 2003). When asked about African-Caribbean people’s entrance into hospitals on a section, in a minor survey carried out, consultants responded that it was usually either through contact with the police, a general practitioner or the casualty department, indicating that they would be placed on either a Section 136 or Section 4. In contrast, Cole et al (1995) found that ethnic status did not determine whether the police were involved. The significant factors associated with compulsory detention in this study were as follows:

Living alone the absence of GP involvement and the lack of a relative /friend discussing access to appropriate services. Under Section 95 of the Criminal Justice Act 1994, the Home Secretary has a duty to publish annually any information that will enable criminal justice agencies in England and Wales to help prevent racial discrimination. Ethnic monitoring of key police activities e.g. arrests, stop and search, became mandatory for all police forces Commission for Racial Equality (1997).

In the 1980’s several studies showed that Black people were more likely to be detained under section 136 of the Mental Health Act (DoH, 1992). By the late 1990’s, research carried out in terms of both race and gender, discovered that these similar worrying patterns are still continuing. The Mental Health Task Force Project reported that African Caribbean males were over-represented amongst those formally detained in acute in-patient units and were more likely to be ‘taken to a place of safety’ under section 136. It was also found that they were up to three times more likely to be sectioned than their white counterparts (Smaje & Heath, 1995). Black women also fare extremely badly, with a staggering 18 per cent likely to be held under this particular section, compared with just 2 per cent of their white counterparts (Browne, 1997).

Once arrested Black adults were less likely to be cautioned; more likely to be remanded in custody; to plead not guilty; tried at Crown Court and more likely to be acquitted. However where they were found guilty they were more likely to receive longer custodial sentences than their white counterparts (Fitzgerald, 1993). The author Fitzgerald notes: “The decisions of criminal justice agencies (and other relevant bodies including the legal profession and forensic “experts”) interact and compound each other. None can be viewed in isolation; for if there are even small ethnic differences in the key decisions taken by each, their cumulative impact may be very large indeed” (Fitzgerald, 1993 pg 34-36).

A report by the Department of Health on Black and Minority Ethnic Communities concludes that ethnic minorities are likely to be worst affected by any increase in the use of compulsory powers (Bennett, 1998). The draft Mental Health Bill further increases the possible abuse of powers enabled under the current Act in terms of the black and ethnic minority populations. Previous research has shown that black people are more likely to be perceived as dangerous; brought into hospital by the police under Section 136,detained prescribed higher doses of medication and older forms of major tranquillisers kept in secure, locked wards prescribed anti-psychotic drugs and less likely to receive non-drug therapies.

Any expansion of the grounds for compulsion is a cause of concern for minority ethnic people and the extension of compulsion into community settings is likely to exacerbate this situation (McNeil et al, 1995). Therefore, any individual of an ethnic background may suffer due to reports through the media and other sources making them less likely to accept medical care and treatment. This in itself can be a cause for concern as the issue may be far from resolved.

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