The Politics of the Prison Cell: Mental Health Interventions and Imprisonment

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A Government Minister recently complained that there was no point going to Parliament these days, because they had run out of things to do. With only one Bill currently going through the House of Commons, and no announcements due before the Queen’s Speech in May, you could perhaps understand that frustration. But the truth is that there are many issues that Parliament could consider as a matter of urgency, and that the Government have already pledged to act upon but have done nothing about.

One such issue is the worsening crisis in the treatment of those with mental ill health, and the fact that more than ever, it is the police and not medical professionals who are engaging with them. Mental health interventions are now occupying nearly a third of all police time, up drastically from when the amended Mental Health Act was first passed in 1983. Even more worrying is the increased use of police cells as a place of safety. In 2012 around 11,000 people with mental ill health were held in police cells, including nearly 400 children.[1]

Both the Independent Police Complaints Commission and the Royal College of General Practitioners concluded that a police cell was arguably now the single worst place to use as a place of safety, especially for children. The facts are particularly depressing; 81% of those with mental ill health who were held in police-based places of safety became self-harming or suicidal.[2] Out of the 11,000 held in 2012, 65 took their life within a day of release. Of all deaths in police custody last year, half were attributed to mental health concerns. [3]

Over a third of all people now given a place of safety order end up in a police cell, for an average of over 10 hours. The overwhelming majority of these people have not committed any crime, but suffer from a confused process where the roles of the NHS and the police are ill-defined, and which results in them being placed in the worst possible place. It is not an exaggeration to say that the situation has effectively created a system that is institutionally discriminatory against those with mental ill health.

If a 12-year-old child suffered a broken limb, but was taken to wait in a casualty department due to a lack of surgeons to see them or facilities to assess them, there would be an outcry. And yet there have been nearly two dozen cases in the last year of 12-year-old children with mental ill health being held for hours in police cells.[4]

Since being granted extraordinary powers in the Mental Health Act 1983, the police have increasingly been used as a point of first contact for those undergoing mental ill health. The Act was a tremendous improvement on its 1959 counterpart, made at a time when the asylum was still rife in Britain. Thankfully that is not the case today, but despite the improvements, the Act’s focus on the police has created this unintended consequence: the role of first responders to those undergoing mental ill health is one which the police have neither been suitably trained nor adequately prepared for.

Chief Constables across the UK have reported that their forces are struggling to cope with these responsibilities and that if rules and practices are not changed soon, the situation will only get worse. They have also reported breakdowns in their system of managing those with mental ill health, saying that their ill-defined role as first responders is making liaising with NHS professionals nearly impossible. It seems remarkable that, given the figures above, nothing has yet been done to prepare the police for the role they increasingly have to fulfill.

Despite regularly stated cross-party agreement that the law must be changed to allow for greater police training, there has been absolutely no progress. Those undergoing a mental health crisis – defined by the Royal College of Psychiatrists as a situation “when the mind is at melting point” – are increasingly finding the police are their first point of contact, and a police cell their place of safety, and the system of cooperation between the police and the NHS nonexistent; we cannot accept this state of affairs.

These breakdowns in the system can lead to tragic consequences, as in the case of Christina Edkins, the girl murdered on a bus on her way to school in Birmingham last year. Her killer, Phillip Simelane, had already undergone prison psychiatric assessments, but these records were lost in a system that both the NHS and the police knew to be unmanageable.[5]

The Government has made it clear that it accepts the findings of the Bradley Review – which called for increased contact between the mental health and criminal justice worlds, and a greater focus on police procedures when dealing with mental health situations – early last year. [6]

Despite this, there has been no action taken to implement its recommendations, and there are no indications that the Government plan to bring any change in legislation forward before the next general election. Perhaps that same Minister who bemoaned the fact that Parliament had run out of things to do might consider bringing that up.

Written by Sam Mannion