April 2001
Unnecessary delays in assessing the mentally ill in police custody in Scotland.
The mentally ill sometimes exhibit disturbed behaviour that brings them to the attention of the police. In addition, mentally ill people who commit offences are much more likely than healthy offenders to be apprehended by the police at the scene of a crime, or to give themselves up.1 Therefore, it is unsurprising that 7.4% of police detainees in a sample of London police stations in 1993 were acutely mentally ill.2
The Association of Police Surgeons report of 1994 described increasing numbers of mentally ill people being seen by its members in the cells and linked this to failures in community care.3 It is unfortunate then to learn that, until recently, it was routine and accepted practice for people arrested in the Highlands and showing signs of mental illness to be held overnight in police cells before being transferred to an acute psychiatric unit the following day.
This situation arose from the lack of an out-of-hours mental health service and delays in obtaining specialist ambulance transport.4 Such delays are undoubtedly detrimental to the health of the detainee. The 1997 case of William Duffy, detained in a Strathclyde police station over a weekend without medical attention while suffering delirium tremens and who went straight to his death in the river Clyde on release, serves to underscore this.5 Deaths in custody during the restraint of people in states of excited delirium have been reported and psychiatric illness is one of the common causes of such states. Concern has been expressed that disturbed detainees are being sprayed with CS gas.7 Neither are the delays in securing medical attention appropriate for the police who perceive the need for more training in dealing with the mentally ill.8
The police do have powers under Section 118 of the 1984 Mental Health (Scotland) Act to convey someone who appears to be mentally disordered to a psychiatric hospital. Police officers seem able to identify those for whom this legislation was intended: in a 1990 study the majority of those conveyed to hospital under similar provisions in England and Wales received a psychiatric diagnosis and were admitted.9 However, police officers feel on firmer ground using their familiar powers of disposal if an arrestable offence has occurred rather than acting as an agent of the Mental Health Act. Given a choice, they will use the former.2 Unsurprisingly, they consider the identification of the mentally ill a task best left to the discretion of the custody sergeant and police surgeon.2 However, the Police Complaints Authority 1998 survey of 620 custody officers across all 43 police forces in England & Wales found that 23% had not attended a custody officer training course.10
Last year the report of HM Inspectorate of Constabulary in Scotland on Central Scotland Police Force expressed concern that training for custody officers and for the officers who deputise in their absence was "very limited". Officers of this force spoken to by the Inspectorate had no custody handling training and no recent first aid training.11 The training of police officers in dealing with the mentally ill has been found to increase officers interest in and sympathy for psychiatric problems.12 The introduction of the "Appropriate Adult" scheme, ensuring independent support for mentally ill people when they are interviewed by the police, is an encouraging initiative.13 So too is the lay visitors scheme, recently introduced by some of Scotland’s police forces, whereby members of the public appointed by the Joint Police Board can appear unannounced at police cells to ensure the requirements of welfare and detention policies are applied.14
Both the police and the courts are well aware of the inappropriateness of custody for acutely ill people and make use of the avenues available to them to divert such people out of the criminal justice system.2 However, time is the crucial variable in this. The ‘Health., Social Work and Related Services for Mentally Disordered Offenders in Scotland" policy paper was published almost two years ago.15 It suggested that mentally disordered individuals in police custody ought to be examined by an experienced psychiatrist within 24 hours of the request being made and that there should be ready access to appropriate beds. Although such provision exists in some parts of Scotland, in others it does not.
This geographical lottery is unacceptable. Delays in diverting the floridly ill, particularly at weekends, need to be rectified. Otherwise, lacunae of danger for all involved, patients, police and doctors, will continue to exist well into the twenty-first century.