The Angiolini Report: Guarding the vulnerable

Deaths in custody

The Angiolini report formally titled Report of the Independent Review of Deaths and Serious Incidents in Police Custody and published on Monday (30 October 2017) was ordered by Theresa May in 2015 while she was home secretary. It was published 15 months late (the front cover is still dated January 2017), is 292 pages long and contains 110 recommendations for overhauling the way in which the police and health authorities deal with vulnerable people, and how the police complaints watchdog investigates such incidents when they occur. Much of the report is concerned with the role of the Independent Police Complaints Commmission and how it can investigate deaths in custody while maintaining the confidence of the bereaved person’s family.

This blog post, however, focuses on a section in the report entitled “Guarding the Vulnerable”.

Guarding the vulnerable – drugs and alcohol

During the 11 years 2004/05 – 2014/15, 82% of people who died in or following police custody had some link to alcohol and/or drugs. Overall, 49% of those who died had alcohol and/or drug related factors identified specifically as a cause of death in a postmortem examination.

Dame Eilish Angiolini makes two key points:

  1. These figures highlight that drugs and alcohol remain a significant factor in deaths in police custody, and indicates that this is as much a public health issue as a policing issue. The adherence to policies designed to protect the health and safety of detainees is fundamental. The need to effectively implement observation regimes for severely intoxicated detainees is therefore of manifest importance.
  2. The viability of drying-out centres as a potential alternative to either police custody or Accident and Emergency (A&E) departments for those under the influence of drink and/or drugs and who require specialist supervision needs to be reconsidered. This report recommends that the Government should consider piloting a centre or centres in large urban areas where it is most likely to be cost-effective, and linking such centres to existing A&E departments. An alternative would be the fundamental redesign of A&E departments to take into account this challenging situation.

Guarding the vulnerable – mental health

This report explores the link between mental health and deaths in police custody. Much of 21st Century police work involves dealing with mental health issues. IPCC statistics on deaths in police custody show a significant proportion of deaths involve people with mental health needs. Figures published for 2015/16 show that 7 out of 14 people who died that year in police custody had a mental health issue.

The report highlights a number of key issues, four of which I reproduce here:

  1. Mental healthcare facilities may refuse to accept people detained under section 136 of the Mental Health Act 1983 if they are intoxicated. Clinical staff are subjected to the problem of violent and drunken behaviour on a regular basis. However, the refusal to accept people who may be at their most vulnerable and suffering from mental ill health, exacerbated by intoxication, poses great danger to the life of these individuals. Without proper medical assessment it is not always obvious if there is a serious medical condition over and above the dangers posed by severe intoxication.
  2. An NHS initiative therefore is required at the national level to examine whether to prohibit the refusal of access to A&E or to health-based places of safety on the basis of severe intoxication. It should also consider the redesign of A&E facilities to allow for safe areas, to protect the safety of other patients and staff from the disturbing or abusive behaviour of those suffering from intoxication but whose lives may also be in grave danger.
  3. It is recommended that there should be national, comprehensive, quality assured mental health training for all officers in front-line or custody roles. Training should be interactive and should involve mental health users to help break down potential fears and assumptions of detainees with mental ill health. This report also discusses the use of Section 136 of the Mental Health Act 1983, and supports the urgent phasing out of police stations as a designated place of safety.
  4. Successful local mental health policing pilots and initiatives, particularly street triage and liaison and diversion schemes should be funded on a sustainable basis for national roll out so that, as far as possible, those in mental health need are dealt with through medical and community based pathways and not through police detention.

Other issues

The report recommends that police vehicles and cells should not be used to transport or hold those detained under mental health powers, unless in exceptional cases. It also says the detention in police cells of those believed to have mental health issues should be phased out completely.

Responding to another key recommendation, the home secretary, Amber Rudd, said the starting presumption would now be that the bereaved should have legal aid-funded representation at an inquest following a suspicious death or suicide in police custody or in prison.

Conclusion

This is an extremely far-reaching and authoritative report. The police would be delighted to not have to continue to be the prime emergency service responding to mental health issues (see Inspector Michael Brown’s blog for in-depth discussion of these issues and/or follow him on Twitter @mentalhealthcop).

The challenge, of course, is whether the government will find anywhere near the resources needed to make a proper response to Dame Eilish’s 110 recommendations.

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