Section 136 of the Mental Health Act (MHA) (1983) enables police to detain an individual experiencing a mental health crisis in any public place, such as on the streets or in a shopping centre. This is implemented when the individual is a risk to themselves or others, and is in need of immediate mental health care. Police and ambulance workers will transport detainees to a place of safety for an assessment, which could be a police station, hospital or the person’s own home.
Despite recent efforts, the number of people being detained under the MHA continues to increase (NHS Digital, 2020). Read Kevin Stone and Vishal Bhavsar’s previous blogs for more information.
Research has identified concerns from police officers about accessing inpatient care for individuals detained. However, there has been limited investigation into the experiences of emergency workers implementing section 136. Genziani and colleagues (2020) set out to address this gap with this study.
Genziani and colleagues (2020) provide a novel insight into the experiences of ambulance workers and paramedics implementing the Mental Health Act section 136, aiming to bridge the gap in research.
This study used Interpretative Phenomenological Analysis (IPA) for an in-depth qualitative exploration of emergency workers’ experiences of implementing section 136.
A small number of emergency workers were purposely sampled. This included three police officers, one police mental health liaison officer, two ambulance workers, and one paramedic. Participants did not know one another.
Interviews (~50 minutes long) were conducted at participants’ workplaces between 2012 and 2014, audio-recorded and transcribed. The interviews used open-ended questions and prompts to invite participants to tell their stories. For example, police officers were prompted to think about their decision-making process.
The analysis was guided by two specific questions:
A theme identified in a third to half of the interviews was considered a ‘prominent theme’. Themes were randomly quality checked against the participant’s quotes after analysis.
Three prominent themes were identified:
It takes a good few hours to build rapport with her, which can be difficult if someone is going through an episode. You don’t want them to feel humiliated or mocked. Because you want them to know you are there to help – PO1
Participants wanted to make it clear that they are not just enforcing the law, but are there to support the individual being detained. The participants recognised the conflict between building trust and detaining someone, and the feelings of betrayal this may invoke. How the participants approached and communicated with individuals was discussed to be important in building a rapport, for example taking off their hat and turning down their radio in an effort to ‘make themselves human’.
I find once you get to [hospital X], I’ve waited 2 hours before to get into the 136 suite and that can cause issues with the patient – AMB2
This is a designated place of safety and transition point into inpatient mental health care. Participants spoke less favourably of their experiences with the suite, with only one participant expressing a positive experience. Ambulance workers were concerned with the welfare of detainees when held for long periods in emergency vehicles when there are delays accessing the suite, and wondered what actually happened to individuals once inside. Police are able to liaise with staff inside the suite, and spoke about blurred boundaries around responsibility and feeling overwhelmed with a lack of clear answers regarding care decisions.
There is no training on what you might want to look for, how it might present itself and different types of mental health, erm, issues. I don’t think there were any role-plays or anything like that, which I think could possibly be helpful – PO3
Participants held the unanimous view that training was limited. In particular, participants wanted a better understanding of mental illness and substance misuse. Practical suggestions were made to develop a more collaborative approach and minimise waiting times for detainees, such as a bed management system. Some participants demonstrated a commitment and willingness to go beyond the remit of their roles for the individuals detained.
Police officers, paramedics, and ambulance workers seek more mental health training and systemic changes to protect the well-being of individuals detained under section 136 of the Mental Health Act.
Ambulance workers, paramedics, and police officers are often the first to respond to mental health crises in the community. However, this research has highlighted the difficulties and barriers that emergency workers face when implementing section 136 of the MHA.
Building trust is a crucial first step to engage an individual to access mental health care. Emergency workers express the challenge of achieving this trust with someone when they are there to detain them, possibly against their will.
Frequent delays gaining access to the place of safety, the 136 suite, means that emergency workers are forced to hold detainees in emergency vehicles for a long period of time. Not only do emergency workers feel unprepared to deal with mental health crises, but also express significant concern for the welfare of detainees in this situation.
It is clear from this research that possible systemic changes could be made to improve the quality of the experience for both individuals being detained under section 136 and the emergency workers involved.
There are a number of difficulties and barriers that emergency workers face when implementing section 136 of the Mental Health Act.
This study provided a valuable insight into the experiences of emergency workers implementing section 136, but there are some methodological limitations that future research can resolve.
This study highlights the challenges to emergency workers associated with implementing section 136 of the MHA. Sufficient mental health training for emergency workers involved at each stage of this process is imperative, and warrants review. This is essential to protect the wellbeing of both detainees and emergency workers.
One of the more prominent concerns discussed was holding detainees in emergency vehicles for extended periods of time. Improvements in the procedures and transition into mental health care are necessary. However, in a society where resources are extremely stretched these situations may not always be avoidable. Realistic consideration of this study emphasises the need to assess the training and support of all emergency services staff involved in this process, including ambulance staff and paramedics.
Further research is necessary, particularly in light of the limitations of this study. It would be valuable to explore emergency workers’ experiences of section 136 in different regions. In doing so, the extent to which resourcing constraints impact challenges and distress for emergency workers, as well as the individuals being detained, can be explored.
Emergency workers implementing the Mental Health Act call for more mental health training and a more collaborative approach among mental health professionals and emergency workers.
