Operational partnerships - Mental health - escalation process (O18e)

O18e Mental Health Escalation Process

1. Security protective marking

1.1 Not protectively marked.

2. Summary of changes

2.1 This Standard Operating Procedure (SOP) has been reviewed in August 2024 - no amendments to content made. 

3. What this Procedure is About

3.1 This standard operating procedure (SOP) is published to provide operational officers with clear guidance on using the Escalation Process to resolve problems involving mental health patients and external agencies.

Compliance with this SOP and any governing policy is mandatory.

4. Detail the Procedure

4.1 Introduction

4.1.1 The Escalation Process allows employees of Kent Police, the Approved Mental Health Practitioner Service, Kent and Medway Partnership Trust, North East London NHS Trust and the South East Coast Ambulance Service, to access successive levels of management to tackle unresolved problems.

4.2 Structures and Participating Agencies

4.2.1 The structure of ‘Mental Health Services’ in Kent is complex and not provided by a single, cohesive body. Understanding the respective roles of the separate bodies that contribute to mental health services will assist officers, staff and managers to resolve problems more effectively.

4.2.2 NHS England provides government funds to Integrated Care Boards (ICBs) to contract medical and mental health care. There is one central ICB in Kent.

4.2.3 The Service Provider for adult mental health services is the Kent and Medway Partnership Trust (KMPT), and Children and Young People's Mental Health Services (CYPMHS) are provided by the North East London NHS Foundation Trust (NELFT). A number of charities also provide mental health services but do not provide S136 Detention services. Both adult and child mental health services include their own respective Crisis Teams which are the first point of contact for the Police.

4.2.4 The Kent and Medway Partnership Trust (KMPT) and the North East London NHS Foundation Trust (NELFT) are separate entities with no mutual responsibility. These two service providers cover differing geographic areas and have different contact arrangements for in-hours and out-of-hours services.

4.2.5 KMPT’s facilities include: Section 136 Suites at Little Brook Hospital, Priority House and St Martins Hospital; the Bracton Centre; Crisis Teams; Kent Forensic Psychiatry Service; Tarentfort Centre and the Trevor Gibbens Unit. KMPT employ the Community Psychiatric Nurses (CPNs) that work in custody and Consultant Psychiatrists to give expert advice.

4.2.6 The North East London NHS Foundation Trust does not have a Section 136 Suite for children and adolescents in Kent and such a Suite within Kent geographic boundaries has not been commissioned by the ICBs.

4.2.7 The Approved Mental Health Practitioner Service is an independent service provided by KMPT. An Approved Mental Health Practitioner (AMHP) has a unique position in law. Their duties include among others: statutory responsibility for the care of a patient, preserving their rights, applying for a warrant under Section 135(1) Mental Health Act, convening a Full Mental Health Act Assessment for people detained under Section 136, completing "applications to section" a person following assessment and arranging their conveyance to a mental hospital.

4.2.8. Kent Police has negotiated an agreement with the South East Coast Ambulance Service (SECAmb) to transport patients detained under Section 136 Mental Health Act.

4.3 Issues for Escalation

4.3.1 It is anticipated that certain problems will naturally invoke an intervention requiring contact with a manager with the relevant partner agency. This is a reciprocal process providing the same mechanism for all participating agencies. The timescales shown in the MH Escalation Process document are suggested and are not mandatory. Managers retain the flexibility to escalate this process sooner than the suggested times where this is necessary. A problem could also be a critical incident and treated accordingly.

4.3.2 Examples of issues that must be escalated immediately include:
• Where a person detained under Section 136 is taken to a Crisis Team nominated Place of Safety, other than a Police Station, but is refused admittance on arrival;
• When a child or young person has been detained under Section 136 and a Place of Safety in Kent has not been identified within two hours of contacting the North East London NHS Foundation Trust;
• After 4 hours having elapsed between requesting attendance at the Custody Suite of a Police Station for a Mental Health Professionals’ Assessment or a full Mental Health Act Assessment of a detainee and the requested agency has not attended;
• Where an AMPH has requested assistance from the Police under Section 6 Mental Health Act and the requested service is believed to have been unreasonably declined.
• Where an ambulance has been requested to convey a person detained under Section 136 to a place of safety and the requested service is believed to have been unreasonably declined or there is an excessive delay in attendance.

4.3.3 Police officers and staff should be aware that before invoking the Escalation Procedure, they are in a position to account for their actions. Expect the manager/Gold working through the Escalation Process to require a comprehensive briefing and may ask intrusive questions to satisfy them that police actions were appropriate and have been completed.

4.4 Contact Telephone Numbers

4.4.1 The Escalation Process shown in the MH Escalation Process document provides the contact telephone numbers for manager to manager and executive to executive level conversations to tackle a problem front-line staff have not been able to resolve. All partner agencies have agreed to update Kent Police to any changes to points of contacts and in addition Kent Police will conduct an annual review.

4.5 Post Incident Investigation

4.5.1 Some incidents or service failures are so serious that post incident they warrant raising as an Adverse Incident using the Adverse Incident Report form for formal investigation.

5. Equality Impact Assessment

5.1. An Equality Impact Assessment 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.

6. Risk Assessment

6.1. This SOP has been subject of extensive consultation with senior representatives from the AMHP Service, Integrated Care Board, Kent and Medway Partnership Trust, North East London NHS Foundation Trust, SECAmb and with health and police officer practitioners over the past year.

6.2. Further corporate consultation has been carried out with HR, Finance, Legal, Health and Safety.

7. Monitoring and Review

7.1. 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.

7.2. The next review of this SOP will take place in August 2025.

8. Other Source Documents

• Mental Health APP
• Mental Health Act 1983
• Mental Capacity Act 2005
• Mental Health Code of Practice
  
  

9. Security

9.1. Kent Police have measures in place to protect the security of your data in accordance with our Information Management Policy (Policy W1000 – Information Management).

10. Retention and Disposal of Records

10.1. Kent Police will hold data in accordance with our Records Review, Retention and Disposal Policy (Policy W1012 – Records Review, Retention and Disposal).