Operational partnerships - Mental health - transportation of patients (O18g)

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 on the appropriate means of transporting mental health patients.

Compliance with this SOP and any governing policy is mandatory.

3. Detail the procedure

3.1 Introduction

3.1.1 Kent Police has negotiated an agreement with South Eastern Coastal Ambulance Service (SECAmb) to transport patients detained under Section 136 Mental Health Act only. SECAmb response times to Section 136 patients mean that in the absence of physical medical emergency SECAmb aim to arrive within 30 minutes.

3.1.2. Transportation of patients who are detained under a Section 135 Warrant (as the AMHP will organise ambulance transportation), who are detained while AWOL or unlawfully at large are not covered by the agreement. These circumstances are described below.

3.2 Requesting transportation and medical clearance

3.2.1. Once the patient has been detained the officer must telephone 810 directly or call 836, select option three for ambulance transportation. Kent Police and SECAmb have an agreement whereby the ambulance service will convey the patient to hospital by ambulance within 18 minutes. The officer should explain that they have detained a person under Section 136 of the Mental Health Act. 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. If any officer present suspects an individual is showing signs of acute behavioural disorder and/or 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 and/or 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.

3.2.2. SECAmb should attend the scene and complete a physical health check to confirm/deny medical clearance for all S136s detentions. This is part of the police process, which they are aware of but may need reminding. If SECAmb do not deem someone to be medically fit, then this individual should go to A&E to receive treatment. For further details of medical clearance at a place of safety, please see the document ‘medical clearance protocol’.

3.2.3. 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.

3.2.4 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.

3.2.5 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. Whilst these circumstances do not require the prior approval of an inspector and can be decided by the detaining officer. Acute behavioural disturbance and or excited delirium can present as extreme aggression and officers should call an ambulance to screen out these issues.

3.2.6 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. If any officer suspects the individual is experiencing excited delirium and/or acute behavioural disorder or positional asphyxia, this would constitute a medical emergency until ruled out by a doctor. If there is a delay in ambulance transportation, officers should transport the individual by police vehicle prior to approval from a sergeant or inspector to ensure life sustaining treatment.

3.2.7 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. The officer has a duty of care to the clinician to communicate any known risks presented to or 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. Once the patient is medically safe the psychiatric team will begin their assessment. The officer’s supervisor must decide whether it is appropriate for the officer to remain with the patient or risk the patient absenting themselves from hospital and being reported as a high risk missing person.

3.3 Patients transported between places of safety

3.3.1. 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 restraint 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.

3.4. Patients detained under Section 135

3.4.1 Officers will not transport patients detained under a Section 135(1) warrant unless they are so violent that they cannot be safely managed by health professionals and ambulance personnel alone. Ordinarily the approved mental health worker (AMHP) who must obtain the Section 135(1) warrant will be expected to make transport arrangements (usually with SECAmb).

3.4.2 In the exceptional circumstances that an officer obtains a Section 135(2) warrant transport arrangements will be the responsibility of the police. SECAmb is not responsible for transportation.

3.5 Missing patients

3.5.1 Where a patient was missing or AWOL from a mental health hospital and has been retaken by the police under Section 18 Mental Health Act, the hospital from which the patient is missing should be contacted and requested to provide transportation. However, if the patient is violent or it is otherwise expedient to do so, the patient can be transported in a police vehicle subject to the approval of an inspector. SECAmb is not responsible for transportation.

3.6 Escapees

3.6.1 If a person is remanded by a court to a hospital or made subject of an interim hospital order and escapes and is later arrested, the person should be conveyed to a police station in a police vehicle. SECAmb is not responsible for transportation.

3.7 Use of cell vans

3.7.1 It is recognised that if the police transport a patient or detainee, unsupervised conveyance in a cell van presents significant risks to the health and safety of that person. In extraordinary circumstances subject to the approval of an inspector, a person can be conveyed in a van provided that the person is supervised by a police officer and a medical professional (e.g. a FHP, CPN, paramedic, doctor) and conveyance in this manner is necessary because the person requires restraint or is otherwise unsafe to transport in an ambulance or car.

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 minority 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 over the past years.

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 

• Mental Health APP
• Mental Health Act 1983
• Mental Capacity Act 2005
• Mental Health Code of Practice
• Information Sharing Protocol
• For further internal documentation please see section 8 of O18b

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.