Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

Abstract

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

Policing mental illness: Police use of section 136 – Perspectives from police and mental-health nurses

“…As Thomas and Forrester-Jones 36 explain, in matters of mentally ill persons, the nature of police detentions 30 years ago has significantly changed from dealing with predominantly aggressive behaviours to now focusing on self-harming or suicidal behaviour. And in line with previous findings, 23,[33][34][35]41 this study adds further insight into the police practice of riskaverse decision making in matters of threats to selfharm or suicide which has led to the rise in s136 detentions.…”

The prevalence of mental illness and unmet needs of police custody detainees

“…The reported community prevalence of common mental disorders in the UK in 2014 was 17%, and 0.7% for psychotic disorders (McManus, Bebbington, Jenkins & Brugha, 2016). Fewer studies have examined the prevalence of personality disorder, post‐traumatic stress disorder (PTSD) or attention deficit and hyperactive disorder (ADHD) amongst police detainees and these too may be relevant to management, including safety needs or capacity to be interviewed (Craster & Forrester, 2020; Warrington, 2019; Young, Goodwin, Sedgwick & Gudjonsson, 2013).…”

Section 136 assessments in the COVID‐19 pandemic

“…Prior to the COVID‐19 pandemic there has been a reported rise in section 136 detentions in England and Wales over a number of years, 2 with regional variation in its use and a lack of formal recording of outcomes 3,4 . An important link between Section 136 and suicide prevention has been highlighted with a large proportion of detentions related to concerns about risk of suicide rather than risk of harm to others 4 .…”

“…Prior to the COVID‐19 pandemic there has been a reported rise in section 136 detentions in England and Wales over a number of years, 2 with regional variation in its use and a lack of formal recording of outcomes 3,4 . An important link between Section 136 and suicide prevention has been highlighted with a large proportion of detentions related to concerns about risk of suicide rather than risk of harm to others 4 . Multiple factors related to the COVID‐19 pandemic such as social isolation, economic difficulties and anxiety/uncertainty are thought to likely lead to or exacerbate stress‐related disorders and suicidality in vulnerable people, 5 and thus may lead to a further possible increase in the use of Section 136 detention.…”