Agenda item - Sussex Police & Crime Panel Letter to Sussex HOSCs: Sussex Police and Mental Health

Report of the Executive Director, Governance, People & Resources (copy attached)

HOSC 18 Oct 2023 Excerpt from UNCORRECTED draft minute

18.1    This item was introduced by John Child, Chief Operating Officer, Sussex Partnership NHS Foundation Trust (SPFT). Mr Child presented to the committee on the current challenges within the mental health urgent and emergency care pathway in Brighton & Hove and across Sussex. Mr Child outlined that the request to present to the committee was a response to correspondence between Sussex Police commissioners and HOSC Chairs outlining Sussex Police's concerns as to the impact on their operational policing capacity as a result of supporting increasing numbers of members of the public with mental health needs. Issues of concern included people requiring a mental health admission having to wait for long periods of time in the Royal Sussex County Hospital emergency department for a bed to be found; police time being taken up supporting people detained under Section 136 (S136) of the Mental Health Act because there is no free capacity in a local Health Based Places of Safety (HBPOS) (and linked to this, the police’s move away from supporting mental health crisis as set out in the Right Care Right Person national guidance) .

18.2    Mr Child outlined the Mental Health Urgent and Emergency Care Improvement Plan informing the committee this was a health and care system plan, rather than a Sussex Partnership plan to improve these matters via a wide set of initiatives, some of which are already active and others in an advanced stage of planning. Mr Child described developments including the Havens, Blue Light Triage, Text Sussex, Blue Light Line, Staying Well Cafes, Sussex Mental Health Line and plans to remodel crisis teams. Mr Child outlined the root causes of the current challenges as additional need within the mental health urgent care pathway since the Covid pandemic but primarily as an issue of flow through the pathway, particularly in terms of the timely discharge of patients from acute psychiatric hospital into supported housing, residential and nursing care- those patients who are classified as being medically ready for discharge.

18.3    Cllr Nann asked who or what would fill the gap if the police were no longer fully using their S136 powers. Mr Child noted that the use of S136 has been fairly static in recent months, but had dropped appreciably in the past few years because alternative services such as Street Triage had been introduced. Given that only around 60% of patient subject to S136 detentions end up with admission to an acute mental health bed, there is considerable scope for the system to do more to find alternative ways of supporting people in crisis, as outlined in the improvement plan.

18.4    Cllr Nann asked whether the police were being irresponsible in seeking to withdraw from mental health incidents. Mr Child replied that he did not believe that the police intended to withdraw totally from supporting people in acute mental health crisis, but that they were understandably concerned about the time officers had to spend staying with people they had detained under S136 because those patients cannot access a HBPOS. Mr Child said the police rightly believe that available, timely support should typically be provided by mental health professionals in a clinical setting.

18.5    The Chair asked whether there was confidence that the system could cope if the police withdrew support. Mr Child responded that sometimes S136 detention is absolutely the right action, and the police should and would continue to support this. Mr Child outlined that on occasion the police use S136 because people have not been able to access alternative services whilst in a crisis to prevent their mental health problems escalating and the improvement plan described was seeking to address this issue.

18.6    Cllr Shanks asked about numbers of acute mental health beds available within Sussex. Mr Child replied there are challenges for people accessing acute psychiatric admissions and as a result people are having to wait an excessive length of time in hospital emergency departments. Mr Child explained that was due to Health Based Places of Safety being occupied with patients waiting onward acute admission or for an alternative community placement. The root cause of the challenge was described not primarily as a lack of acute beds but rather issues with the timely discharge of people into community settings, who are waiting for supported accommodation, residential and nursing care and that if discharge pathways were improved there would be better flow and less pressure on urgent and emergency services supporting patients in mental health crisis. Mr Child gave examples of the length of delays in acute psychiatric beds across Sussex.

18.7    Cllr Robins voiced concerns about police withdrawal from mental health emergencies, noting that families typically only call the police when they have no one else to turn to and there is immediate life-threatening concern to the safety and welfare of family members. Mr Child responded that he was unable to speak for the police, but that he was confident that they would continue to respond to threats to life. Mr Child reiterated the greatest challenge outlined by the police is the time they spend with people after they have intervened, and the time they spend dealing with lower level mental health related incidents- not necessarily for people known to mental health services. Mr Child said that people should continue calling the police if they believe that someone’s life may be in danger.

18.8    Cllr Nann stated that the police would be happy to continue with their S136 role if they could then pass people on to a place of safety. However, mental health services are themselves in crisis, and the structures to better support people are just not there; it is wishful thinking to believe that they can be transformed at short notice.

18.9    Cllr Hill asked a question about local place of safety capacity. Mr Child responded that there are 5 Health Based Places of Safety across Sussex which includes one at Mill View Hospital in Brighton. He outlined the 5 Havens across Sussex which are also used as Alternative Health Based Places of Safety. Mr Child clarified all hospital accident & emergency departments are also deemed to be health based places of safety. He was happy to provide precise figures in writing.

18.10  Cllr Asaduzzaman asked what was done to support people waiting in the hospital emergency department for a mental health bed. Mr Child responded that SPFT has a mental health liaison team (MHLT) working at the Royal Sussex (in keeping with all acute hospitals across Sussex) that provides assessment and treatment for patients presenting with mental health needs. The MHLT also provide specialist support and advice to A&E staff in caring for patients waiting for acute psychiatric admission. University Hospitals Sussex employs additional mental health nursing staff to provide care to people with mental health issues. Mr Child described the steps taken to support alternatives for patients waiting for acute admission, for example if there is capacity, people waiting for an acute mental health bed will be transferred to the Haven to wait there instead, if clinically appropriate.

18.11  The committee discussed what to do next with this issue, as a number of members were not assured that there are adequate measures in place to deal with the police changing their role in relation to mental health crisis, and more generally to deal with problems in emergency care caused by issues accessing acute mental health beds. Members were also unhappy that they had not been given the opportunity to question Sussex Police. Members were advised by the Policy, Partnerships & Scrutiny Team Manager that the report in front of them was to note, leaving them little scope to amend it, but that they could request an update report at a later meeting, or they could refer the matter to another Council committee.

18.12  Resolved that the report be noted and that the report be referred to the Health & Wellbeing Board for attention.