Detainees and carers would like to see the provision of a place of safety other than emergency departments or police stations, and this study reinforces the Mental Health Code of Practice 2008 which states that police stations should only be used on an exceptional basis.

The small number of published studies on the use of Section 136 (S136) of the Mental Health Act 1983 may reflect neither the current situation nor the true national picture as most of the research comes from large urban centres and was published before 1997. We studied the use of S136 between 2002 and 2006 in Gloucestershire, a rural English county with a population of approximately 585,000, by analysing data held by the police and local mental health services. On average 192 subjects (range 176-203) were detained each year under S136, equating to a population rate of 32.8 S136 detentions per 100,000 per year in Gloucestershire. In contrast to other published studies, ethnic minorities, particularly Afro-Caribbean males, were overrepresented only in a minor way. Of those individuals detained, about a third were admitted, a lower rate than in other studies. Acts or threats of self-harm were common (55%), but acts or threats of violence (28%) and evidence of intoxication (16%) were present in a minority, suggesting that detainees are more likely to pose a risk to themselves than others.

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Complex partial seizures are a form of focal epilepsy associated with impairment of consciousness. The clinical presentation of such seizures is diverse, which can lead to misdiagnosis. We describe the case of a 17 year old woman who was referred to our service for treatment of panic attacks. Case reportThe girl was referred to our department with a two year history of panic attacks. She complained of recurrent episodes of acute anxiety accompanied by palpitations, hyperventilation, fuzziness in the head, butterflies in the stomach, tightness in the chest, nausea, urgency to micturate, and a choking sensation. During these attacks she would scream and run about in an agitated state. The attacks were short and occasionally occurred at night (she woke up before the attacks started). She was described as being "distant" during the attacks but said that she was aware of her actions. She would quickly come round when held still. She also mentioned outbursts of anger and physical violence, including assaulting a bystander and putting her hand through a window. The precipitants to these outbursts were trivial and she was alarmed at both the extent of her anger and her lack of control over it. She was taking a contraceptive pill and denied misusing drugs. The mental state examination and a physical examination showed no abnormality.Between the ages of 2 and 5 she had had episodes of disturbed behaviour during sleep. A paediatrician had diagnosed these as night terrors. She was first referred to our department aged 14 years, when she had behavioural problems at school, short bouts of deep depression, and outbursts of temper. She was counselled by an educational psychologist and her condition rapidly improved. She was referred again a year later with similar problems. Her threshold for anger and frustration was low and she had once slashed her wrist.She failed to attend follow up and was discharged. There was a family history of generalised anxiety (father) and epilepsy (paternal grandmother and paternal aunt).We were concemed that some of the features of her panic attacks were atypical, particularly the short duration, prominent motor activity, and nocturnal occurrence. These coupled with the family history of epilepsy prompted us to investigate with electroencephalography.

There is a gap in the expectations of the different agencies involved in the S136 process, which have the potential to be divisive if interagency pathways and agreements are not in place.

The Maxwell Centre, a health-based place of safety (POS) adjacent to a psychiatric hospital, was opened in Gloucestershire in February 2009. It provides a POS for people detained under Sections 135 and 136 of the Mental Health Act 1983 as amended in 2007. Prior to the opening of the Maxwell Centre, police cells were the only designated POSs. To assess the impact of the opening of this new facility, we undertook a service evaluation. In the five years (February 2009 to December 2013) following the opening of the Maxwell Centre, the use of Section 136 increased by more than 60%.

Weapons and other items with potential to cause harm are usually prohibited in mental-health hospitals and other psychiatric facilities. Detecting such prohibited items (PIs) can be problematic, particularly if concealed, and metal detectors are commonly used to search for such items. Our study compared two types of metal detection: continuous wave detection (CWD) by hand-held metal detector (HHMD) and magnetic anomaly detection (MAD) by a static pole device. In the study, real and dummy PIs were hidden on test subjects and in a simulated body cavity. The results showed MAD to be significantly superior to CWD in detecting small concealed PIs containing ferrous metal. The MAD pole found 100% of the real PIs on the test subjects and in the simulated body cavity. The CWD HHMD found only 5.2% of the real PIs, and these were limited to those on the test subjects, as it detected none in the simulated body cavity. In addition, the time taken to search by MAD pole was shorter than time taken to search by CWD HHMD.

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