Operational partnerships - Mental health - detention under Section 136 (O18a)

1. Summary of changes

1.1 This standard operating procedure (SOP) has been reviewed in August 2024 - no amendments to content made. 

2. What this procedure is about

2.1 This standard operating procedure (SOP) is published to provide operational officers with clear guidance when considering detaining people under Section 136, Mental Health Act 1983.

Compliance with this SOP and its governing policy is mandatory.

3. Detail the procedure

3.1 Introduction

3.1.1 A police officer has a power under Section 136 (1)(a) to remove a person (adult or child) who appears to be suffering from a mental disorder and is in immediate need of care and control to a place of safety (or keep them at a place of safety). This power can be exercised where the person is in any place other than;

(a) any house, flat or room where that person, or any other person, is living, or
(b) any yard, garden, garage or outhouse that is used in connection with the house, flat or room, other than one that is also used in connection with one or more other houses flats or rooms

Where a person is in a place to which a and b above are applicable then legal powers are limited to using Section 17, Police and Criminal Evidence Act (1984) to enter private premises but only in urgent situations to save ‘life and limb’. Officers should consider force police O18b Execution of Warrants under Section 135 Mental Health Act if appropriate.

The legislation empowers an officer to take the detained person to a place of safety, so that ultimately health professionals would conduct a full mental health act assessment on the person with a view to determining whether or not they should be further detained under Section 2 (for further assessment) or Section 3 (for treatment) of the Mental Health Act.   

3.1.2. The power can only be exercised in custody where there is further difficulty justifying detention under PACE for someone who was originally arrested for an offence; and where their mental health problems are believed to be sufficiently serious in their own right to justify the use of s136 if they had been encountered outside of custody. The exception to this is where someone is so ill, it is a medical emergency and they are unfit, this is also discussed within the standard operating procedure O18c mental health patients in custody and allied matters paragraph 3.4.5 refers to the circumstances and process that needs to be followed in these circumstances.

3.1.3. Although the power exists to keep people safe, officers must consider other, less restrictive, means to de-escalate the person's crisis before detaining under Section 136.  

3.2 Consultation before use of Section 136(1)

3.2.1 A police officer is required to consult a healthcare professional where it is practicable to do so before deciding to detain the person and remove them to a place of safety or to keep them at a place of safety. In Kent officers can use the 836 number 24/7 to obtain this advice.

3.2.2 The police officer should seek to ascertain, and the health care professional should provide information and advice regarding;

• an opinion on whether this appears to be a mental health issue based on professional observation and, if possible, questioning of the person
• whether other physical health issues may be of concern or contributing to behaviour (e.g. substance misuse, signs of physical injury or illness)
• whether the person is known to local health service providers
• if so, whether it is possible to access medical records or any care plan to determine medical history and suggested strategies for appropriately managing a mental health crisis
• whether in the circumstances, the proposed use of section 136 powers is appropriate
• where it is determined that use of section 136 powers is appropriate – identification of a suitable health based place of safety, and facilitation of access to it
• where it is determined that use of section 136 powers is not appropriate - identification and implementation of alternative arrangements (such as escorting the person home, to their own doctor, to hospital, or to a community place of calm/respite)

3.2.3 The police officer retains ultimate responsibility for the decision to use their section 136(1) powers, having considered the advice given to them as part of any consultation. The police officer should ensure that any consultation is recorded –including who was consulted and the advice they gave.

3.2.4 Deciding whether it is practicable to consult. It is for the police officer considering using section 136(1) to determine whether or not it is practicable in the specific circumstances to consult a health professional. The officer’s judgement as to whether it is practicable to consult is likely to be informed by a number of potential factors. These will include:

• whether there are established local arrangements for undertaking such consultation
• the time it is likely to take to carry out the consultation
• whether the person appearing to suffer from a mental disorder is likely to remain cooperative and present during the time taken to undertake a consultation
• whether it is safe to undertake a consultation or whether the behaviour of the person requires immediate action in the interests of safety

3.2.5. Officers must consider using other powers such as: Common Law powers, the Mental Capacity Act and powers of arrest when it is not practicable to use S136 of the MHA. This will allow officers time to contact the health service via 836 to obtain advice.

3.3 Protective search power

3.3.1 Section 136C allows a police officer to search a person subject to section 135, 136(2) or 136(4) if the officer has reasonable grounds to believe that the person may be a danger to themselves or others and is concealing something on them which could be used to physically injure themselves or others.

3.3.2 The search power is designed to ensure the safety of all involved and should be used appropriately to support policing and health agencies to effectively care for and support the person. The new power does not include any restrictions around age or any other characteristic of the person to be searched. However, the power does not require a person to be searched. Any search conducted by the officer under Section 136C is limited to actions reasonably required to discover an item that the officer believes that the person has or may be concealing. The officer may only remove outer clothing. The officer may search the person’s mouth, but the new power does not permit the officer to conduct an intimate search.

3.3.3 Section 136C power does not affect the applicability of other existing search powers – including powers under sections 32 and 54 of the Police and Criminal Evidence Act 1984, and powers of health professionals to search patients detained in hospitals in some circumstances.

3.3.4 There is no power to search under the Mental Health Act if the individual is taken to hospital in a voluntary capacity. However, where a voluntary patient is dropped off, or where a search power under Section 136 or S135 has not been utilised, the fact that the person has not been searched should be communicated upon handover, and a written record of this made.

3.4 Places that can be used as a place of safety

3.4.1 Summary of provisions:

A place of safety is now defined in the Act as:-

• a hospital
• an independent hospital or care home for mentally disordered persons
• a police station
• residential accommodation provided by a local social services authority
• any other suitable place (with the consent of a person managing or residing at that place)

3.4.2 By virtue of Section 136A(1) a police station may not be used as a place of safety for a person under the age of 18 years under any circumstances. This means any part of the police station. There are no exceptions to this total ban.

3.4.3 A police station may now only be used as a place of safety for a person aged 18 and over in the specific circumstances set out in The Mental Health Act 1983 (Places of Safety) Regulations 2017, namely, where:

(i) the behaviour of the person poses an imminent risk of serious injury or death to themselves or another person

(ii) because of that risk, no other place of safety in the relevant police area can reasonably be expected to detain them

(iii) so far as reasonably practicable, a healthcare professional will be present at the police station and available to them

The authority of an officer of at least the rank of inspector must be given for the use of a police station in such circumstances. The inspector must be satisfied that no place of safety in the area other than a police station can reasonably be expected to detain the person in the light of the risk posed. Consultation with healthcare professionals, will serve to help officers identify the availability and capacity of places of safety, and will assist with facilitating access to them.

3.4.4. The inspector must satisfy themselves:

• a place of safety that could normally manage the person’s behaviour is not available (for example because it is temporarily out of commission or already fully occupied and cannot be cleared readily)
• a place of safety is available but is not reasonably able to manage the person – for example because of a lack of sufficiently trained and equipped staff, or because the physical characteristics of the facility, including security and the ability to safeguard other patients (for example in shared assessment areas), are inadequate in the circumstances

3.4.5. In Kent the only custody suite that will accept patients detained under such circumstances will be Medway. A forensic healthcare professional is required to conduct 30 minute health check observations on the patient during their time in cells. The practitioner is required to remain on duty if this detention takes place between 5am and 7.30am.

The custody officer must review at least hourly whether the circumstances which warranted the use of a police station still exist. If they do not, the person must be taken to another place of safety that is not a police station. A person does not however, need to be taken to another place of safety if this would cause a delay in carrying out a Mental Health Act assessment, which would be likely to cause them distress.

3.4.6. Lack of Kent and Medway Partnership Trust Section 136 assessment suite availability. Should there be no Section 136 assessment suite available to take the patient to, officers should take the patient to the nearest emergency department and wait with the patient there until a suite becomes available. Officers should inform supervisors of this so the escalation process can be commenced immediately. Officers should not wait in car parks outside Section 136 assessment suites.

3.4.7. Other suitable places. There are two principle requirements for determining whether a place (other than one specifically named) is a “suitable place” – and can therefore be used as a place of safety

1. the first is whether the place itself is suitable. This will involve evaluation of a number of inter-related factors including for example, the physical environment, the condition and behaviour of the person, and potentially any relationship between the person and that place. A suitable place of safety should, ideally, provide a therapeutic environment as part of, or associated with, local health and care services. Standards for places of safety are set out in guidance issued by the Royal College of Psychiatrists and considerations in relation to use of suitable places of safety are set out in the English and Welsh Codes of Practice.
   
   As a minimum, and when contemplating contingency arrangements, there should be a quiet, comfortable and private space for the person to wait, and potential physical risks should be identified and mitigated so far as is possible. When considering the suitability of a place, the behaviour of the person being detained is likely to be a key consideration. A temporary or ad hoc space such as a private dwelling, which is not inherently secure or professionally staffed, may not for example be suitable for someone who is unresponsive and unco-operative. In some circumstances a person may be less distressed if taken to or kept at a place of safety with which they are familiar. This may be particularly true for example, in relation to children or older people, or possibly those who have experienced mental health crises on several occasions and who may have a relationship with a particular support organisation. However no assumptions should be made about potential personal preferences. In addition, if contemplating using a private dwelling the police officer should have regard to any information – readily available to the police and their partner agencies – indicating that use of that address as a place of safety could be detrimental to the detainee’s welfare (for example, safeguarding concerns, or previous incidents at the address)
   
   
2. The second is that appropriate agreement is given to the use of the place as a place of safety

3.5 Periods of detention

3.5.1 The permitted period of detention, during which a person can be detained at a place of safety, under section 135 or 136, is 24 hours (reduced from a maximum of 72 hours).

The responsible medical practitioner can extend that period by up to 12 hours if a Mental Health Act assessment cannot be completed within the permitted period due to the person’s mental or physical condition. Where the person is being detained in a police station, a police officer of the rank of superintendent or above must also approve the extension.

3.5.2 Calculation of the detention period. The detention period for those detained under section 135 or 136 begins:-

(i) where a person is removed to a place of safety under section 135 or 136 – at the point when the person physically enters a place of safety. Time spent travelling to a place of safety or spent outside awaiting opening of the facility does not count

(ii) where the person is kept at the address specified in the warrant under section 135 - the time at which the police officer first enters the premises

(iii) where a person is kept at a place under section 136 – at the point the police officer takes the decision to keep them at that place. The clock continues to run during any transfer (if this is necessary) of a person between one place of safety and another.

If a person subject to section 135 or 136 is taken first to an emergency department of a hospital for treatment of an illness or injury (before being removed to another place of safety) the detention period begins at the point when the person arrived at the emergency department (because a hospital is a place of safety).

3.6 Transportation

3.6.1 Once the patient has been detained the officer must telephone 810 directly or call 836, select option 3 for ambulance transportation to a place of safety. The officer should explain that they have detained a person under Section 136 of the Mental Health Act. If any officer present suspects an individual is showing signs of acute behavioural disorder/excited delirium, which can be present whether the individual has been restrained or not, or there is a risk of positional asphyxia due to restraint, this must be communicated to the call handler/e-desk when an ambulance is requested. Any suspicion of acute behavioural disorder/excited delirium or positional asphyxia by any officer or health professional should be treated as a medical emergency, taken at face value until ruled out by a doctor. Kent Police and SECAMB have an agreement whereby the ambulance service will convey the patient to the first place by ambulance, be that to A&E or a S136 suite. The ambulance service operator will conduct a medical triage questionnaire over the telephone to rule out other medical complications or identify a medical need and prioritise the call accordingly. An ambulance will be despatched.

3.6.2 On arrival the ambulance paramedic will triage the patient before transporting them to the place of safety. A police officer must accompany the patient in the ambulance. The officer has a duty of care to the paramedic to communicate any known risks presented by the patient. When ambulances are stationary their doors cannot be locked to prevent egress from inside the vehicle. This may affect police containment preparations when police officers are escorting individuals for the purposes of Section 136 or 135 of the Mental Health Act. Officers must ensure the supervision, containment and if unavoidable, restraint of those detained where ambulances are used to convey patients to a place of safety. In law, conveyance by ambulance does not imply agreement to convey and detain unless expressly agreed otherwise and police officers remain responsible for the security of the detained person until handed over, usually at the place of safety.

3.6.3 A patient may only be transported in a police vehicle with the permission of an inspector. Ambulance transportation provides continuous medical monitoring, immediate medical intervention if the patient deteriorates and protects the dignity of the patient. The inspector must be satisfied that transportation in a police vehicle is necessary and appropriate in the circumstances and document their decision. Police vehicle transportation should only be considered if the officers have waited or are expected to wait longer than 60 minutes for an ambulance.

3.6.4 Where a patient is so violent that it is unsafe for them to be transported in an ambulance, they should be conveyed in a police vehicle containing an equipped paramedic and followed by an ambulance. These circumstances do not require the prior approval of an inspector and must be decided by the detaining officer.

3.6.5 In the event that the paramedic concludes that the patient needs urgent medical attention, the patient will be conveyed to an emergency department. Some medical conditions evidence symptoms that can be easily mistaken for symptoms of mental disorder. At the emergency department the paramedic will inform the clinician of their medical observations.

3.6.6. The officer must also provide a verbal account of the detention to the receiving clinician and provide a completed copy of the Section 136 record form, they should ensure that the name of the member of staff they handed the patient over to and the briefing they gave is also recorded in their PNB. The officer has a duty of care to the clinician to communicate any known risks presented by the detainee. At the emergency department the clinicians will concurrently stabilise and treat the patient’s medical condition and notify the hospital’s psychiatric team. Detaining officers should ensure that the Approved Mental Health Practitioner (AMHP) Service are aware that the patient is at the emergency department at the point of arrival by contacting them through the 836 number option four. If the AMHP/doctors do not accept handover of the patient (e.g. the assessment team lack the ability to take responsibility for the patients). The patient remains the responsibility of the detaining officers, and they need to remain until the assessment has taken place. If officers believe that our colleagues in the NHS or AMHP service are being obstructive, unprofessional or difficult, supervisors are encouraged to:

1. escalate at the time using the escalation processes
2. report the incident (with details of the relevant staff members) to Inspector Wayne Goodwin so it can be discussed at senior leadership level with partners
3. report any attempts to use the escalation process which fail (e.g. due to numbers not working)

3.6.7. Transfer of patients from one place of safety to another. If the patient is still the responsibility of Kent Police officers, SECamb are no longer able to provide transfers between places of safety. Officers will need to ensure that the person has been medically cleared and no restrain used prior to transportation. If these circumstances are met, officers can transport the individual between places of safety without the prior permission of a senior officer.

3.7. Arrival at a Section 136 Suite

3.7.1 On arrival at a Section 136 Suite the officer must escort the patient into the suite, provide a verbal account of the detention to the receiving clinician and provide a completed copy of the Section 136 record form. The officer has a duty of care to the clinician to communicate any known risks (Athena/PNC warnings) presented by the detainee to themselves or other patients or staff. There is a specific information sharing protocol in place between police and health providers for this purpose. If the person detained is a Registered Sex Offender, Section 325 of the Criminal Justice Act 2003 states that the police and mental health services should be sharing sufficient information with each other for the purpose of dynamic risk assessment as the point of admission. In all cases officers should record what information has been shared. Where a voluntary patient is dropped off, or where a search power under Section 136 or S135 has not been utilized, the fact that the person has not been searched should be communicated upon handover, and a written record of this made. The paramedic may inform the clinician of their medical observations.

3.7.2 The detaining officer will remain with the patient until the clinician is ready to assume responsibility for the patient, and if the patient is violent, to remain to prevent a breach of the peace, until the patient is no longer violent or the clinician is satisfied they have sufficient available staff to manage the patient safely. Officers remain responsible for the patient until the place of safety staff (or emergency department staff; or anyone else) agrees to take responsibility for the person in those circumstances, fully knowledgeable of any relevant risks that will need to be managed; full details of the handover need to be recorded in the officer's pocket notebook (PNB). If issues are raised around handover of responsibility the officers must ensure that this is escalated as already discussed in Section 3.6.6.  

3.8. Ending of a Section 136

3.8.1. Once instigated, section 136 only ends at one of two points – either a doctor says, “this person is not mentally disordered within the meaning of the Mental Health Act” or an AMHP says, “I have now made the necessary arrangements for this person’s treatment or care” and either admits them to hospital or releases them with referrals to appropriate places (GP, CMHT, etc.). Police officers cannot instigate section 136 and then end it without reference to Drs and AMHPs, with the exception of where it becomes obvious the power was instigated illegally.

3.9. Post assessment

3.9.1 When the full mental health act assessment has been completed the outcome section of the Section 136 report form will be faxed to the Force Control Room (FCR).

3.9.2 The mental health eform is to be completed throughout the S136 pathway by each officer who has contact with the individual in crisis. The mental health eform allows officers to save their details after their involvement has finished and to enter the force number of the officer taking over the S136 detention. All officers are reminded to ensure details added to their PNB are added to the eform accurately to ensure correct records of times, dates and the individual’s details are recorded in line with GDPR. At the conclusion of police involvement in a Section 136 detention, the officer must complete a 3x5x2.

3.9.3 When a person is detained under S136 of the Mental Health Act under circumstances relating to domestic abuse, officers should also record the incident in accordance with policy N07 domestic abuse.

3.10 Section 136 Mental Health Act 1983 or arrest for Criminal Offence

It is ultimately up to the discretion of the arresting officer as to whether to prioritise the offence or use Section 136 where both options exist however, it is best practice to choose one  option over the other. Consideration should be given, where the offending is low level, possibly 'victimless' and/or where the behaviour is most likely to be related to their mental health condition, to the investigation being paused for the purpose of the mental health assessment under Section 136. The investigation may be revisited after an assessment, especially if an officer's initial concerns about a person's mental ill health are not supported by medical opinion.

If you have decided to arrest and PACE Code G is complied with then an investigation should occur. A mental health assessment may be considered alongside the criminal investigation in police custody. If this is the case then early notification should be given to the community psychiatric nurses in custody so a mental health assessment can be undertaken.

If a person is about to be released from custody and there are concerns remaining around their mental health status consideration can be given to detention under Section 136 Mental Health Act and removing to a health based place of safety for assessment. Unless paragraph 3.4.3 applies the detainee should be removed from custody and immediately taken to a health based place of safety.

4. Equality Impact Assessment (EIA)

4.1. An EIA has been carried out and the potential for differential impact has been carefully considered. It is noted that the morbidity of mental illness is greater in those with a learning and/or physical disability and also in those with other protected characteristics (e.g. higher morbidity in ethnic minorities and LGBT+ communities and higher incidence of suicide in males.) For this reason officers enacting this policy/standard operating procedure are reminded to be particularly careful to ensure their decision making is evidence based and without cultural bias.

5. Risk assessment

5.1. This SOP has been subject of extensive consultation with senior representatives from the AMHP Service, Clinical Commissioning Groups, Kent and Medway Partnership Trust and North East London Foundation Trust and with health and police officer practitioners over the past year.

6. Monitoring and review

6.1. The force mental health liaison officer will monitor this standard operating procedure and conduct an annual review to ensure it is fit for purpose, reflecting changes in legislation, national police practice, the NICE guidelines and developments in local partner practice.

6.2. This SOP will next be reviewed in August 2025.

7. Other source documents

None listed.

8. Security

8.1. Kent Police have measures in place to protect the security of your data in accordance with our Information Management policy.

9. Retention and disposal of records

9.1. Kent Police will hold data in accordance with our Records Review, Retention and Disposal policy.