Frequently Asked Questions (FAQs)
- appear to be suffering from mental disorder
- appear in immediate need of care or control
- be found anywhere that is not a private dwelling.
- the person is discharged from Section 136 and is taken home (transport is provided). Advice and support is provided on seeking further help
- voluntary admission to an inpatient mental health bed
- detention under a further section of the Mental Health Act to an inpatient mental health bed.
- Online via the Have Your Say in Kent and Medway platform www.haveyoursayinkentandmedway.co.uk where you will find the consultation questionnaire.
- Attend a community meeting (in person or online). This is a sensitive topic, so voluntary and community organisations are hosting discussions at a series of small in-person and online meetings.
- Invite us to your group – if you are having an event where people might be interested in knowing more and sharing their views about the proposal.
1. What is mental health urgent and emergency care?
Mental health urgent and emergency care are a group of services to support people who are experiencing a mental health crisis and in need of immediate help.
2. What is a health-based place of safety?
Health-based places of safety (HBPoS) are the spaces NHS mental health service providers provide and manage for police officers to take people who have been detained under Section 136 of the Mental Health Act; people are taken to HBPoS for assessment by mental health care professionals. In Kent and Medway, our HBPoS for adults are provided and managed by Kent and Medway NHS and Social Care Partnership Trust (KMPT). A&Es can also be considered a health-based place of safety. This consultation is about proposals for KMPT health-based places of safety.
3. What is Section 136?
Section 136 of the Mental Health Act 1983 is the power that allows a police officer to detain and remove a person they believe to be suffering from a mental disorder and in need of immediate care or control. The officer must think that removing the person is necessary in the person’s interests or for the protection of others. The power requires three conditions to be met before police can act.
The person must:
4. What is the Section 136 pathway?
A pathway is the defined steps or route to care. For Section 136, this starts at the point police called to a person in distress are considering Section 136 – and the police officer believes removing the person from where they are is necessary in the person’s interests or for the protection of others.
In Kent and Medway, the next step would be for the police officer to call 836 for advice before they make the decision to detain a person under Section 136 of the Mental Health Act. If the decision is made to detain a person under Section 136, the person is taken by police or ambulance to a KMPT HBPoS. If the person also has a medical need requiring treatment, they will be taken to A&E (hospital emergency department [ED]).
A 24-hour detention period begins when the person arrives at the HBPoS or A&E. An initial assessment/screening takes place on arrival (no later than an hour after arrival) at the HBPoS/A&E. Ideally, a full Mental Health Act (MHA) assessment takes place within four hours. Any delays are documented.
When the assessment has been completed, there are three possible outcomes (places where the pathway ends):
Currently 80 per cent of those assessed return home for treatment within the community, while 20 per cent remain until an inpatient mental health bed is available.
5. Who do these proposals affect?
The proposals affect people who are taken to a HBPoS after being detained by police officers under Section 136 of the Mental Health Act. Between 2018 and 2021, an average of 1,494 people a year were detained under Section 136.
The number is decreasing as improvements are made through the wider Kent and Medway Mental Health Urgent and Emergency Care Transformation Programme. In the 12 months between December 2021 and November 2022, the number of people detained dropped to 697. Currently less than 50 people are detained under Section 136 each month.
The proposals also affect KMPT staff and Approved Mental Health Professionals (AMHPs) working with Kent County Council and Medway Council, who work in the HBPoS in Kent and Medway and partner emergency services – Kent Police and South East Coast Ambulance Service (SECAmb) – and teams in hospital emergency departments.
6. Why do you need to make changes?
Despite previous investment, current KMPT health-based places of safety struggle to meet modern standards and are no longer fit-for-purpose. Extra Care/Seclusion facilities are not available on all sites and sometimes assessment rooms are damaged and out of use. All have maintenance backlogs.
Finding people who want to work in the current Section 136 suites is difficult, making staff recruitment and retention challenging. Doctors and AMHPs not being together on the same site can create delays, due to availability, coordinating attendance, travel distances and competing work pressures. Delays in assessments impacts on assessment room availability and people’s experience of care.
NHS England has allocated £3.7m to make safety improvements to Kent and Medway NHS and Social Care Partnership Trust’s (KMPT’s) health-based places of safety buildings; to improve patient safety and experience for individuals detained on Section 136. The money is ‘ringfenced’, so it can only be used to expand or renovate an existing facility, build a new one, or buy major equipment.
7. Will it change the number of health-based places of safety people can be taken to?
There will still be five KMPT HBPoS assessment rooms but it is proposed they will be all on one site, instead of three. Having staff in one location should mean capacity will increase as people will be assessed sooner. With the spaces being fit-for-purpose, providing a therapeutic environment, with access to outdoor space, it is expected they will be out of action less often.
8. Will it change the location of where the health-based places of safety are?
Yes. Currently KMPT has five HBPoS spread across three sites: Dartford, Canterbury and Maidstone. The proposal is the five KMPT health-based places of safety will all be on the Maidstone site in the future, in a fit-for-purpose Section 136 unit that meets standards.
9. Will it mean people need to travel further?
People under Section 136 are taken to and provided with transport home from a HBPoS. Where people are taken to, and so how far they travel within Kent and Medway, depends on where a health-based place of safety is available, not which one is nearest.
The proposal to put the five health-based places of safety assessment rooms on to one site in Maidstone, will mean people will always be taken to Maidstone. A comparison of travel times between journeys to current KMPT Section 136 health-based places of safety (HBPoS) over a 12-month period and the same number of journeys made to Maidstone alone, shows less time spent on the road. Distanced travelled is also reduced.
10. Is this about saving money?
No, this about using government funding (£3.7m) allocated to KMPT to improve its health-based places of safety in Kent and Medway, so they meet standards, people’s experience when being assessed under the Mental Health Act is better and the working environment is better for staff.
11. How can I share my views or give feedback?
The public consultation runs for eight weeks from 21 February until 18 April 2023. During this time we welcome responses from both organisations and individuals. There are different ways you can get involved and share your views.
To find out more please email kmicb.engage@nhs.net.
People without access to email or the internet are invited to phone 01634 335095, select ‘option 2’, leave a message and we will call you back.
12. Who makes the decision about whether these changes will go ahead?
NHS Kent and Medway will make the decision. It is the organisation that plans and buys health services for our area. It will consider the feedback from this consultation along with other clinical evidence and information put forward before making a decision. The decision is expected in the autumn.
13. If the changes go ahead, when will the new health-based places of safety (HBPoS) be available in Maidstone?
If the new section 136 HBPoS suite at Priority House in Maidstone is given the go ahead, the design process is expected to take place between October 2023 and June 2024, with the building work starting in October 2024. The new HBPoS are expected to be ready to open in May 2025.
14. Why aren’t people’s families contacted and involved in their treatment?
If the person gives consent, their family can be contacted but it is not permitted for them to take part in the Section 136 clinical assessment process.
15. How do people get home safely?
Transport is arranged by mental health staff at the HBPoS. We intend to invest in a dedicated mental health patient transport provider to support Kent Police and the ambulance trust, to take people to and home from the HBPoS.
16. Will this mean people are no longer taken to A&E?
Improvements being made through the Kent and Medway Mental Health Urgent and Emergency Care (MHUEC) Transformation Programme should see fewer people going to A&E overall.
The proposal to create a fit for purpose Section 136 suite with five KMPT HBPoS rooms on one site in Maidstone, should increase the availability of a KMPT HBPoS, so see fewer people taken to A&E as an alternative health-based place of safety. If a person under Section 136 has urgent medical needs, they will still be taken to A&E because that is the place they need to be.
17. What about those people overwhelmed by circumstances, who become a risk to themselves without any previous experience of mental health services?
People can be detained under Section 136 if there is police involvement. Otherwise, they will be supported by those working with them or their families and loved ones to access mental health crisis support.
18. How long are people in a health-based place of safety for?
A person can be kept at a health-based place of safety (or in another place where they will be safe) for up to 24 hours so they can be seen by a doctor and an approved mental health professional. This can be extended to 36 hours if it is felt that it is not possible to assess the person properly because of physical health concerns.