THE issue of mentally ill children and adults being initially detained in police custody due to a shortage of hospital beds, is nothing new, with 750 people detained last year in Devon and Cornwall – 28 of them children.
Figures released to the Echo by Devon & Cornwall Police reveal that in the 12-month period between October 2013 and September 2014, 28 children, those aged 17 and under, were arrested under the Mental Health Act in Devon, with 27 detained; five in Exeter, one overnight. All cases were this year.
In the same period the year before, there were a total of 31 children detained.
The issue was propelled into the spotlight last weekend when Devon and Cornwall's Assistant Chief Constable Paul Netherton raised the alarm on Twitter that a 16-year-old girl from Torbay had to be detained in police custody for three nights in Exeter, because there were no free hospital beds in the country for her.
Inspector Paul Morgan who works in the Local Policing and Partnership Dept at police headquarters in Exeter, branded it one of the "biggest issues" facing Devon and Cornwall Police.
The Echo first highlighted the double issue of the two-year wait for some mental health therapies, and a lack of funding for adult mental health services, which in Devon is provided by the Devon Partnership NHS Trust, in February.
The trust only receives seven to eight per cent of the total NHS budget in Devon for mental health services, which is allocated by the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG).
In response to the Echo's reports, MP Ben Bradshaw raised his concerns in Parliament and has now raised the issue of the lack of funding for mental health services and mentally ill people being kept in custody beds in Parliament with Health Secretary Jeremy Hunt.
In response, Mr Hunt said: "I have been putting in place a strategy that will see over the next few months a reduction of 51 per cent in the number of mental health patients who use police cells."
Mental health services for those aged 17 and under are provided by Child and Adolescent Mental Health Services (CAMHS) in Exeter.
Virgin Care is responsible for Devon Integrated Children's Service, which has been responsible for providing CAMHS since April 2013.
But although CAMHS is responsible for the first three levels of a care, mild – severe, it is not responsible for tier four, emergency cases.
While CAMHS professionals respond to emergencies, NHS England is responsible for finding beds for the patient.
The Northern, Eastern and Western Devon Clinical Commissioning Group commissions Virgin Care for tier three, but was unable to confirm how much of its budget it provides to CAMHS when the Echo went to press.
Reacting to the chief constable's concerns, an NHS England spokesperson confirmed that as a result of expanding mental health crisis services, the number of people ending up in police cells is down, but added: "Clearly more needs to be done."
The police have the power to detain any person in a public place who they believe may have a mental disorder and be in immediate need of care and control, under Section 136 of the Mental Health Act 2007.
The patient may be held until the assessment of an approved mental health professional and either one or two doctors, for up to 72 hours.
Under the Act, people presenting with a mental disorder must be taken to a place of safety – the majority of the time, the only place available for emergency cases is police custody.
Insp Morgan explained that the issue of police officers having to provide the front line response to mentally ill people, has been prevalent for decades but has been exacerbated by the lack of NHS funding allocated to providing alternative places of safety.
Devon & Cornwall Police was identified around 18 months ago by the Home Office as having one of the highest Section 136 detention rates in the country.
In response, there has been a national attempt to increase police awareness, and extra training has been given to officers to understand the needs of mentally ill people.
Since a successful bid to the Department of Health, Devon & Cornwall Police launched a night time street triage project, in conjunction with the Devon NHS Partnership Trust whereby three mental health professionals worked alongside officers in the control room.
Since the year-long pilot ended in March, professionals have continued to work alongside officers on Thursday, Friday and Saturday nights.
This initiative is in addition to the force's daytime Liaison and Diversion Service which injected additional support for mentally vulnerable people in police custody.
But Insp Morgan stressed that mental health care is an "under invested area" with a knock-on effect on police forces countrywide. "We are frustrated by the situation – police custody centres are not the right place for initial care," he said.
"There are three issues here – the appropriateness of using police custody centres as a first point of call for a potentially mentally ill person requiring an assessment in their greatest hour of need, the length of time people are detained while medical professionals arrive, and the difficulty in finding them beds to move in to."
Insp Morgan said negotiations are ongoing with partners to ensure appropriate initial places of safety instead of custody beds.
"But this has been a very slow process," he added. "Investment should be in prevention, so less people present in this way.
"We all recognise that public services are being cut across the country, but the financial situation shouldn't be compromising the wellbeing of people with mental health issues.
"If someone presents to Accident & Emergency with a physical injury, they are accepted, but if someone goes there with a potential mental disorder and then becomes upset at the wait, we are called.
"It's not fair on the police officers, but more importantly, it's not fair on the person who is in need of care.
"And the plea from the police service is, and has always been, for there to be a focus on the needs of the person over the needs of organisations."
Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, denounced the situation of mentally ill people being detained in custody due to a lack of beds as "appalling".
He said that despite a 30 per cent rise in demand for beds, there has been a drop of more than 3,300 mental health nursing posts and a loss of 1,500 available beds.
Mr Bradshaw said: "What's happening is an illegal breach of the Mental Health Act, while the NHS is falling apart over it. And unless this issue is taken seriously, people will die."
MOST mental health services for those aged 17 and under are provided by Child and Adolescent Mental Health Services (CAMHS).
Virgin Care is responsible for Devon Integrated Children's Service, which has been responsible for providing CAMHS since April 2013.
The Northern, Eastern and Western Devon Clinical Commissioning Group (CCG), allocates a budget to CAMHS services in Devon at tier three level commissioning Virgin Care in Devon and Plymouth Community Healthcare in Plymouth.
But the CCG does not commission care at the most severe tier four level; this more specialist children's mental health inpatient service is commissioned by NHS England's specialised commissioning team.
The CCG was unable to confirm how much it allocated to CAMHS services in Devon.
A spokesperson for Devon Integrated Children's Service said that the CAMHS team has seen 24 per cent more referrals in the last year as well as increasingly complex cases. And CAMHS has seen 20 per cent more children than last year within their existing budget. However, he said that CCGs have provided short term funding to further increase capacity to meet this increased demand and bring down waiting times. He said the NHS has also agreed to fund a new Assertive Outreach Team, which will support young people with severe mental and complex illness at home.
Paul O'Sullivan, managing director at the CCG responsible for commissioning of children's services, said: "There has been an increasing demand for child and adolescent mental health services in Devon and Virgin Care has responded by increasing the productivity of the service to enable more children to be seen.
"In addition the CCG has invested additional funding to support an increase in capacity for 2014-15 and the development of a targeted service for those with more complex needs."
