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.

Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

“…Companions and PMI described distress, fear, confusion, humiliation and trauma caused by a large police presence, disproportionate use of S136, involuntary transport and physical restraint18 22–32: “You’re confined in this tiny, small box and you go, ‘what’s happening to you?’ They don’t speak to you, and the only time they do, they’re barking orders at you” (PMI) 33. FRs were sometimes perceived as threatening: “I said I am going to call 911, and he said: ‘no don’t, if you call 911 they are going to kill me’” (companion) 22.…”

“…I feel no empathy for such people” (paramedic) 34. However, FRs also described PMI being frequent users of emergency services due to ineffective health systems overusing services as a ‘band aid approach’ 18 27 30 36 37 48 51 52 54 56. PMI were often released from hospital the same day police transported them, leading to future crises requiring police response: “vicious cycle…you are exposed to that cycle so many times of taking people in, nothing happens, they get released, taking people in, nothing happens, they get released” (police officer) 36.…”

“…Negative interactions with FRs caused PMI and companions to be reluctant in seeking help. Being treated with force and physical restraint, or at worst the PMI being killed during an encounter with FRs, led to many regretting having called for emergency help27 30–32 40 46 48 49 54 57: “I am afraid to call them. They have exasperated traumatic events.…”

“…FRs felt unequipped to respond to MHC due to their lack of knowledge, resources and time constraints25–27 31 34 37 40 44 45 52–54 56 57 63 64: “ training makes it look straight forward and it’s dead simple…and then you go out and it’s just a different game” (police officer) 45. Police described their past reluctance to ask PMI direct questions, thinking they would distress them, and instead asked vague questions that overwhelmed and confused PMI 40.…”

“…Evident in the majority of studies was that while many FRs engaged meaningfully and empathetically to resolve crises, a significant number of interactions involved excessive force, physical restraint and stereotyping, which often humiliated and traumatised PMI and their companions 18 22–24 27–32 34 35 37 38 40 42 45 53 54 69 70. Previous reviews71–73 reported FRs’ reasons for force, such as their duty of care, bystanders and themselves, and that PMI are likely to be resistant and this would require proportionate force.…”