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.