Item 7 on the agenda is a debate on the Health, Social Care and Sport Committee Report, 'Mental Health in Policing and Police Custody', and I call on the Chair of the committee to move the motion, Dai Lloyd.  

Motion NDM7233 Dai Lloyd

To propose that the National Assembly for Wales:

Notes the report of the Health, Social Care and Sport Committee: Mental health in policing and police custody, which was laid in the Table Office on 30 October 2019.

Motion moved.

Thank you very much, Deputy Presiding Officer. I'm pleased to take part and to open this debate today on the Health, Social Care and Sport Committee's report on mental health in the context of policing and police custody. 

During two Assembly committee inquiries, Assembly Members have heard from police representatives that an increasing amount of police resources are being used on managing mental health crises. The committee therefore agreed to hold a short inquiry with a focus on partnership working between the police, health and social care services, and others. We were particularly keen to see how effectively services are working together to prevent people with mental health problems from being taken into police custody, and to assure ourselves that vulnerable people in mental health crisis get the care and support that they need.

Sections 135 and 136 of the Mental Health Act 1983 give police officers powers in relation to individuals who have, or appear to have, a mental disorder. The Policing and Crime Act 2017 made some significant changes to sections 135 and 136. These were intended to improve responses to people in mental health crises who need urgent help with their mental health in cases where police officers are the first to respond.

Previously, section 136 applied to people in a public place, section 135 required a magistrate-issued warrant for a police officer to enter private premises to remove a person to a place of safety for assessment. The 2017 Act introduced changes that allowed for that assessment to take place in a person's home or private premises under certain circumstances, and removes the need to be in a public place.

The Act introduced a number of other changes, including that police stations cannot be used as a place of safety for people under the age of 18. In the case of adults, police stations can only be used as a place of safety in specific exceptional circumstances. Now, we recognise that the police frequently respond to people with mental health problems, but for the purposes of our inquiry we have focused on the use of section 136, because this is usually used when people are at their most vulnerable.

Too often and for too long, vulnerable people experiencing mental health crises, who have committed no crime, have found themselves in a police cell because there is nowhere else for them to go. We therefore welcome the assurances we received from senior police officers, inspectors and Welsh Government officials that police custody is no longer being used as a place of safety for those detained under section 136, apart from in exceptional circumstances.

Further, we were reassured to hear that there have been no cases of a police cell being used as a place of safety for a person under 18 in Wales since 2015. We were also pleased to hear that inspections of police custody in Wales have generally found that, where adults are detained in police custody for exceptional circumstances, the provision of mental health care is good.

While the number of people in mental health crisis being held in police custody has decreased, the number of detentions under section 136 appears to be increasing. Data published by the Home Office showed that there were 2,256 detentions in Wales under section 136 in 2018-19, compared to 1,955 in 2017-18. The police also report an increase in demand from people in mental health crises.

We recommend that the Welsh Government works with the police to seek evidence about why the number of detentions under the Mental Health Act 1983 is increasing, and to provide some analysis of national and local data to explain the regional variations. In his response to this recommendation, the Minister emphasises that seeking and analysing evidence about the number of detentions under the Mental Health Act 1983 and providing analysis of national and local data to explain the regional variations, is a core responsibility of the mental health crisis care concordat assurance group.

We were also told that provision of mental health triage services is variable and not consistently funded across Wales. Triage services can play an important role in reducing the use of section 136 detentions and police cells, and hospitalisation via the emergency department or acute mental health services. To that end, we have recommended that the Welsh Government works in partnership with the police to review the emerging evidence on the effectiveness of the different triage schemes in Wales.

The evidence we received was generally very positive about the contact people had with the police when experiencing a mental health crisis. We were told that individuals and their families who have called the police during a mental health crisis have been grateful for the support they received. This challenges the general assumption that people experiencing a mental health crisis have negative views of being detained by the police. 

We therefore recommend that the Welsh Government should work with Healthcare Inspectorate Wales to ensure the thematic review of crisis and out-of-hours care includes a review of the care pathway for people detained under section 136, looking at the quality, safety and responsiveness of the care provided to people detained under section 136.

Section 136 also allows for a person to be detained for assessment by a doctor and an approved mental health professional to enable arrangements to be made for treatment or care. We heard, however, that the majority of people detained under section 136 are discharged following assessment without further treatment. In figures provided by Mind Cymru, 68 per cent of those assessed in 2016-17 were not admitted to hospital for treatment. This accounts for two thirds of the overall number of section 136 detentions that year. It is worrying that the majority of people detained under section 136 are discharged following assessment because they do not need urgent mental health in-patient treatment. 

The code of practice to the Mental Health Act 1983 requires that people being detained under the Act are always taken to hospital in the manner most likely to protect their dignity and privacy—i.e., not in a police car. However, the evidence we heard suggested that this is not happening. In fact, the South Wales Police partnership group told us that

'the vast majority of S.136's are still being brought to place of safety by the Police.'

We also heard that operational pressures on the ambulance service and mental health services meant that the police are filling the gap, and police vehicles are consistently being used to transport people to mental health establishments.

We were told by the Minister that there are pilots under way in Aneurin Bevan and Hywel Dda health board areas to look at non-emergency conveyance. He has also asked the NHS collaborative commissioning unit to undertake a mental health urgent access and conveyance review to look at how and where access is provided.

We therefore recommend that the Welsh Government should, as a matter of urgency, implement its conveyance review. It should also state how it will ensure that alternative patient transport will be provided for individuals experiencing mental health crises, thereby limiting the use of police vehicles in the conveyance of individuals detained under the Mental Health Act to hospital.

While I welcome the Minister’s acceptance of this recommendation, it is disappointing that, despite the committee’s calls for urgency in this area, the findings of the mental health urgent access and conveyance review will not be available until April, with further action dependent on its consideration by the MHCCC assurance group.

In conclusion, I think we would all agree that it is unacceptable to hold mentally ill individuals in police custody, and that the practice of detaining people under section 136 of the Mental Health Act should only occur in exceptional circumstances. We welcome the progress that has been made to date but we believe as a committee that greater pace is now needed. Thank you.

Can I thank the Chair for his introduction and quite detailed explanation of the report? It doesn't leave us much to say. Can I also thank the clerking team and the witnesses who came before the committee? 

Dirprwy Lywydd, we regularly discuss in this Chamber the way in which Wales addresses mental health provision. In fact, we just had a debate that highlighted very much mental health and how we tackle that and the prevention of suicide. We often reflect upon the ability to deliver crisis care and care and treatment planning, sometimes linked to physical health care and sometimes, as well, to mental health care. Just look back at the debates of the past few years, both on the health and social care committee's reports and on the children and young people committee's reports. They've produced several reports around mental health in particular.

Now, we all know the figures. I know it's often quoted: one in four will suffer from mental health. And it's hugely frustrating that this still exists in society. There remains a stigma about mental health, and that, undoubtedly, stops people from speaking out and getting the support they need, though I am pleased to see action being taken to change that and I very much support all the steps being taken to do so. 

There are many recommendations in the report, and I'm pleased that the majority have been accepted by the Government or accepted in principle. However, I have concerns regarding the rejection of recommendation 11. I have had representations from many organisations in my role as chair of the cross-party group on mental health around crisis care and care and treatment planning and the pace at which previous recommendations and actions for their consequent delivery has been undertaken. 

Now, we all recognise that the mental health crisis care concordat is an ambitious agreement between Welsh Government and partners to improve the care and support for people experiencing or at risk of a mental health crisis. The concordat is underpinned by the following four core principles and expected outcomes: effective access to support before crisis point; urgent and emergency access to crisis care; quality treatment and care when in crisis; and recovery and staying well. Providing excellent crisis care requires a resolute focus on the person experiencing crisis, recognising them as an individual in need and responding in a person-centred way. The concordat makes clear that supporting individuals experiencing crisis is a multi-agency responsibility, which requires a joined-up approach, and we must not lose sight of the key issue: the needs of the person experiencing a mental health crisis.

The committee heard that since 2015, when the concordat was introduced, there has been a 90 per cent reduction in the number of individuals detained in police cells who are in mental health crisis, so it can help. Whilst this inquiry looked specifically at the use of section 136, recommendations, if implemented effectively and with pace, can have a broader impact and support the delivery of transformative change, which was the ambition of a crisis care concordat. The Twilight Sanctuary in Llanelli—the first of its kind in Wales—is an example of partnership working under the concordat with Dyfed Powys Police, Carmarthenshire County Council and Hywel Dda health board, having commissioned the service working with Mind and Hafal. I look forward to seeing the reflection of the good practice in Llanelli being introduced across Wales. 

I'd also like to discuss recommendation 8, which is based around care and treatment planning. Care and treatment planning is vital to people, irrespective of whether they're suffering with a physical health condition or a mental health condition. However, for those living with mental health illness, the failure to deliver a holistic care and treatment plan can be hugely detrimental, and we can see many getting caught in the revolving door of coming out, going back in, coming out, going back in and being detained. We've still not seen enough progress on care and treatment planning. Effective care and treatment plans are a great tool to prevent crises from occurring, as well as ensuring that people, whether it be those suffering with mental health or their carers and families, know how to access urgent support when they need it. However, there is significant evidence to show that care and treatment plans, in particular crisis plans, are not being used effectively. We are falling short in this area, and as a Welsh Government it's important that we must ensure that this is addressed as a matter of urgency. 

Now, I raised this during business questions back in November, and I raise it once more here: we must get the care and treatment plans right and we must ensure that those people using them have confidence in their care and treatment plans and don't feel that they're merely warm words that do not deliver for them. Dirprwy Lywydd, mental health care, whether it be in the community or in police custody, must continue to improve and we must do more.

I thank the committee for undertaking this report. Whilst the Welsh Government has accepted seven of its 11 recommendations, I urge the committee to monitor the actions proposed by the Welsh Government where it has only accepted recommendations in principle. 

Section 136 of the mental health Act is designed to allow police officers to remove from a public place, for their own or the public's safety, someone who they believe is undergoing a mental health crisis and to take them to a place of safety. As the report states, the use of police custody as places of safety has fallen significantly over the past four years. Additionally, the chair of the mental health crisis care concordat assurance group stated that there has been a 90 per cent reduction in the number of individuals detained in police cells who are in mental health crisis since the introduction of the crisis care concordat in 2015. As the report adds, this, and the subsequent passage of the Policing and Crime Act 2017, marks significant reductions in the use of police stations as places of safety, despite the general trend of rising section 136 detentions. However, as we've heard, the number of detentions in other units have gone up between 2017-18 and 2018-19. We therefore need a better understanding of why certain force areas saw differing rates of increase in these detentions and to see if lessons can be learned from police force areas such as Gwent, where figures actually fell.

The figures also demonstrated different approaches in the way that mental health triage schemes were implemented. These schemes are intended to bring police and mental health practitioners together to jointly assess a mental health incident in order to reduce the use of section 136. Although North Wales Police saw a 70 per cent increase in section 136 detentions between 2014 and 2019 to 795, mental health clinicians are working alongside North Wales Police to provide a new triage service based at the force control centre. This aims to help people identified as being in mental health crisis and to improve the flow of information between North Wales Police and Betsi Cadwaladr University Health Board.

The Welsh Government accepted recommendation 2, which states that better understanding is needed on which model of joint working between the police and health staff is helping to provide people in crisis with the right help and support, which can contribute to reducing the use of section 136 overall. The National Police Chiefs' Council evidence in the report suggested that provision of health-based places of safety is patchy across Wales, both in terms of geographical spread and times of access.

Health boards pointed out that many had suitable facilities but these were not adequately staffed or that their irregular use may mean that staff used in these facilities did not have the right skills to deal with complex cases involving patients presenting different forms of emotional distress. Evidence received by the committee detailed a range of good practice models such as the scheme in Aneurin Bevan University Health Board that had developed a single point of contact accessible 24 hours a day for individuals, family or professionals.

The Welsh Government accepted recommendation 5, which outlines the need for additional health-based places of safety to be developed where required. However, it is then relying on the health boards to provide assurance that their current capacity is meeting demand in order to help them and their partners understand which elements of the crisis pathway need to be strengthened. We therefore need assurance that the associated costs will be met should additional health-based places of safety be required.

Autism is not a mental health condition, but many autistic people develop separate mental health problems that stem from a lack of appropriate support and mean that autistic people can develop more significant needs. However, although the proportion of autistic people in UK prisons is thought to be more than double that in the general population, the UK Government strategy on autism includes prisoners, and HMP Parc prison has been awarded the National Autistic Society autism accreditation, I can find no reference to autism in this report. Worryingly, the Inns of Court College of Advocacy planning to question someone with an autism spectrum disorder, including Asperger's syndrome guidelines, applicable to both witnesses and defendants, are all too often ignored. But as these state—and a message for everybody—consideration must be given not just to the types of questions asked but also to the manner in which this is done. Thank you.

Thank you, Deputy Presiding Officer. I wasn't a member of the committee during this inquiry, and I look forward to rejoining the committee as I undertake my role as shadow Minister for health once again. But I am very grateful to the committee for producing a report that is exceptionally interesting and teaches us a great deal. The specific issue and what we're trying to achieve here is something where there is quite clear consensus and there has been over a number of years. But the actions that need to be taken in order to achieve that aim is one area where we may disagree in terms of the approach.

Nobody truly believes that it is appropriate for vulnerable people experiencing mental health crises to be sent to police stations, but far too often in the past, that is what has happened, and that was because there was nowhere else for the police to take those individuals. I was very pleased to read in this report that no-one under the age of 18 experiencing a mental health crisis has been sent to a police station since 2015, and the numbers of adults who find themselves in police stations is also reducing.

But we also see in this report that the number of cases of imprisonment under section 136 has increased, generally speaking, and the police told the committee that they felt that they were still being called too often to deal with issues that, in reality, relate to health and care or social care. What’s highlighted, if truth be told, is the fact that the kinds of 24-hour, seven days a week mental health services that we would like to see don’t exist, and people are still required to use the services that are available 24/7 and, of course, they are the police and emergency departments at hospitals, and so on.

So, we return to a theme that has emerged a number of times in a number of inquiries—I can refer back to our previous debate on suicide, for example—the feeling and the evidence that our health and care services are not fit for purpose, out of hours, certainly, and that that then places pressures on other services that are available 24/7.

Another general theme that emerges in the report is the fact that communication is inadequate between services, particularly between services that are devolved and those that are non-devolved. We must tackle that issue.

So there are themes there that are very familiar to us, if truth be told, and they are themes that I feel haven't been given the attention that they deserve in terms of the Welsh Government’s response to this report. So, I will finish by asking the Minister how this Government is going to improve the provision of crisis care, out of hours particularly, so that people who do experience a crisis or those who are looking after them will know who to contact and, more than that, will know that support will be provided to them when they make that call.

Thank you. Can I now call the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer. I'd like to thank members of the Health, Social Care and Sport committee for their work in producing the 'Mental health in policing and police custody' report. It's important to acknowledge the role of the police in helping people in mental health crisis. In many cases, the police are the first point of contact and the support that they provide to some of our most vulnerable people is critical.

The recommendations made by the committee look to further strengthen the approach we're taking to improve crisis care, which is one of the key priorities included in the Welsh Government's 'Together for Mental Health' delivery plan that I expect to publish at the end of this week. The recommendations made in the committee's report align with the approach we are taking with partners to support people experiencing crisis through the mental health crisis care concordat, and I was pleased that many people recognised the improvements that have been made in terms of the numbers of people being detained. That has not come by accident; that's come through partnership working across health, the police and other sectors.

But I do recognise the ongoing concerns raised by the police regarding officer time spent responding to issues where mental health is deemed to be a factor. Some of this demand will be a properly appropriate use of the police's role and time under current mental health legislation. But, it will also include making sure that vulnerable people can access the right support, and that is provided across a range of agencies. From an NHS perspective, I made improving crisis care a priority, supported by additional funding. However, I recognise that the NHS is just one partner in the crisis pathway. We work closely with a range of partners, including the police, local authorities and the third sector, to improve support and outcomes for people. I was therefore pleased to agree, or agree in principle, 10 of the 11 recommendations in the committee report.

I agree with the committee about the importance of robust data and evidence on outcomes. The mental health crisis care assurance group has developed a revised data set for section 135 and section 136 detentions, which was published for the first time on 5 December. The data provides more information than was previously published, for instance, with the inclusion of ethnicity and the type of conveyance, and will now be published on a quarterly basis. We plan to continue to work with partners to conduct further analysis of the data to help inform our approach and practice over time. All partners agree that, to improve the crisis care pathway, we need a system that is able to respond to the range of ways in which people experience personal crisis. A one-size-fits-all approach will not work. To do this, we need to better understand and have a shared understanding of the demand currently described as mental health demand within our entire system.

In response, we have commissioned the NHS national collaborative commissioning unit to conduct a mental health urgent access and conveyance review. That review is being overseen by a multi-agency steering group and is analysing data across a range of partners, including the police, local authorities, 111, and the wider NHS family, including the Welsh ambulance service. The review, which will report in April, as has been mentioned, will help us understand the current demand, for instance, if it is mental health illness or distress due to social factors. This will enable all partners to consider their role in ensuring that needs are met as we improve crisis care and outcomes for people.

I accepted recommendations calling on the Government to work in partnership with the police to review the emerging evidence on the effectiveness of the different triage schemes across Wales. A key aim of the concordat assurance group is to collectively understand which approaches are most effective in improving outcomes for individuals. Regional partners are required to report local developments and initiatives to the concordat assurance group to enable that learning and to share improvements. We are working with mental health clinicians, local health boards and 111 to identify opportunities to develop a mental health crisis pathway. That will allow us to identify which approaches could then be scaled up at a national level.

In line with the committee's recommendations, we are fully committed to investing in early intervention and prevention, to reduce the risk of mental health crisis in the first place. Both the 'Together for Mental Health' delivery plan and the mental health crisis delivery plan reflect that focus. All regional mental health and criminal justice partnerships will have local plans in place to deliver on early intervention and prevention.

So, crisis and out-of-hours care remains a priority, both for the NHS and in the new 'Together for Mental Health' delivery plan for the next three years. We will continue to work collaboratively with our partners to improve the response with and for people in mental health crisis, and I will of course keep Members up to date on progress as we make it.

Thank you. Can I now call on Dai Lloyd to reply to the debate?

Thank you very much, Deputy Presiding Officer, and thank you for your patience, because I understand that I have little time to respond to this debate. May I thank, therefore, in the time that does remain to me, everyone for their contributions? I think it’s relevant for us to pay tribute to the police’s work in this difficult context of responding to mental health crises in emergency situations. Over the years, I've been there with them, very often in the middle of the night. When there are crises in people's lives, the police are there to help us as medics to deal with the situation, as well as to help the family. So, I'm pleased to have this opportunity to pay tribute to the police for their work.

May I acknowledge the important contributions made by David Rees, Mark Isherwood, Rhun ap Iorwerth and also, of course, the Minister? May I also thank all of the witnesses that provided such excellent evidence to us during our inquiry as a committee? And, of course, I’ll take this opportunity to say thank you for the hard work of the clerks and the researchers on the health committee, because I don't always remember to do that. So, thank you very much to them.

To conclude, therefore, there are major steps that have been taken in this field. It does continue to be a very important, difficult and serious issue, because as we know, policing isn't devolved here, whereas health and mental health have been devolved, but experience increasingly shows that there is excellent collaboration that can happen. Having said that, a number of challenges remain in this area. Thank you.

Thank you. The proposal is to note the committee's report. Does any Member object? No. Therefore the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.