A retrospective cohort study describing the characteristics of patients under 18 years old in one section 136 suite

Abstract

Section 136 of the Mental Health Act 1983 is an authority allowing police officers to remove a person ‘who appears to him to be suffering from mental disorder’ from a public area. There has been much media coverage regarding the inappropriate detention of minors under section 136 and the suggestion that many were taken to police cells, as there were no suitable places of safety. Although previous studies describe characteristics of a typical individual detained under section 136, few distinguish the differences between adults and adolescents. Profiling these adolescents can help to identify adolescents at risk, allowing for earlier intervention and prevent the inappropriate detention of individuals. Data were collected retrospectively for all patients under 18 years of age who were brought to a section 136 suite in south-west London over a five-year period. The typical profile of an adolescent presenting to this suite was a 16-year-old female of white ethnicity who was sectioned in a public area due to attempted suicide or deliberate self-harm. The individual is more likely to have mental or behavioural difficulties, a history of abuse, be under the care of local authorities and have had previous convictions compared to adolescents in the general population.

Keywords

Forensic psychiatry section 136 Mental Health Act adolescents

Introduction

Section 136

Section 136 (s.136) of the Mental Health Act 1983 (MHA) is an authority allowing police officers with no medical training to remove a person ‘who appears to him to be suffering from a mental disorder’ from a public area, if need be by force. This is done in the interest and safety of that person and others around the individual and, if needed, to arrange measures regarding the person’s care or treatment. The individual is moved to a designated place of safety defined as ‘residential accommodation provided by social services, a hospital, a police station, an independent hospital or care home for mentally disordered persons or any other suitable place’.¹ The Policing and Crime Act of 2017 has reduced the time that one can be detained from 72 to 24 hours at the time of this study.² During this maximum period in which a person can be held under s.136, an approved mental-health professional (AMHP) should interview and determine a suitable plan for treatment, if required. A person subjected to s.136 can be detained further under sections 2 or 3 of the MHA, be informally admitted to a ward when they agree to their treatment in a hospital, be referred to health-care or social services or be discharged home. If the detainee is a minor, an AMHP with experience of caring for this age group or a Child and Adolescent Mental Health Services (CAMHS) consultant should undertake the assessment.

There has been much media coverage regarding the detention of minors under s.136 after the publication of a 2013 report by Her Majesty’s Inspectorate of Constabulary which suggested many were detained at a police station, as there were no suitable places of safety when ideally they should have been taken to a s.136 suite.³ This caused considerable concern, as although detainees did not face criminal charges, the stigma of having these was attached. Nonetheless, increased cooperation between the National Health Service (NHS) and police services to organise suitable places of safety has resulted in fewer minors being detained in police stations.⁴

There has been a rise in the number of people being detained under s.136, with 1959 detentions in 1984, 14,111 in 2011/12 and an increase of 37.5% to 19,405 in 2014–2015 in England.⁵ Statistics suggests that only 17% of those detained under s.136 and brought to a hospital-based place of safety are placed under sections 2 or 3 of the MHA once assessed.⁶

Previous literature in this field describes characteristics of a typical detainee as a single white male in his 30s who is often unemployed, homeless, not registered with a GP and with a history of mental illness.^7,8 Studies also suggest the over-representation of black ethnic groups in comparison to the general population.⁷ According to a 2001 study, the most common presenting problem leading to detention was threatened or actual violence, followed by the threats or acts of deliberate self-harm (DSH).⁹ However, it should be noted that young people with mental-health problems present differently from adults,¹⁰ and few studies distinguish these differences, leaving a gap for research into the characteristics of minors who are admitted under s.136.

The data published by Health and Social Information Centre from the Mental Health Minimum Data Set showed that in 2013–2014, 753 people under 18 years of age were detained under s.136.¹¹ However, recent data from the National Chiefs’ Council Lead for Mental Health suggests this has increased to 947 adolescents in 2014–2015.¹²

Places of safety for juveniles

Data from 2012–2013 suggest 263 children, 45% of those who were detained, were taken to police cells as a place of safety.¹³ The MHA Code of Practice stresses the importance of local services cooperating to establish a policy which provides sufficient ‘safe and secure health-based places of safety, including for people under the age of 18’.¹⁴ As of this 2015 policy, police stations should not be used as the designated places of safety for children and young adults unless there are no alternatives. The Policing and Crime Act of 2017² now states that a police station should never be used as a place of safety for children, but until recently, minors were often turned away from appropriate places of safety and consequently taken to police stations due to limited staffing, closing times and beds already being occupied. However, the main reason has been due to policies in these places excluding minors, people who are intoxicated or those presenting with bizarre or disorderly behaviour.¹⁵ The Care Quality Commission’s 2017 map of health-based places of safety found that of 161 health-based places of safety, there are only seven in the UK that cater specifically to those under 18 years of age. Additionally, 24 specifically did not accept patients under 16 years old, and a further 31 did not accept young people under 18 years of age.¹³

In 2013, the Department of Health launched a street triage scheme¹⁶ which involves the collaboration of mental-health nurses and police officers in attending situations in which they are possibly dealing with people with mental-health conditions. This is to ensure that those who require treatment receive appropriate and timely care and are referred to health and social services efficiently, ultimately reducing the use of police cells as places of safety and aiming to reduce s.136 rates. An evaluation of the scheme in 2016 found that of the nine areas in which the scheme was piloted, seven saw a reduction in the use of s.136, and overall, more people were brought to a health-based place of safety instead of police cells.¹⁷

Mental health and the law

Mind UK documented that of the one in four people who will suffer from a mental-health problem in the general population, many will encounter the police as either witnesses or suspected offenders, but typically as victims of crime or when detained under s.136.¹⁸ Police are often the first to respond to situations involving people with mental-health problems in crisis, and they need to be able to assess the situation and the needs of the individuals. Being able to recognise those people at risk is crucial.

It has long been established that young people who come into contact with criminal justice systems are a vulnerable group who are not thriving socially, emotionally or physically and hence have complex psychosocial needs which are not met.^19,20 A study for the Office of National Statistics found that 95% of imprisoned young offenders aged 16–20 years have a mental-health disorder.²¹ Where poor mental health is coupled with offending behaviour, interventions often focus on offences rather than treating the underlying triggers, potentially losing opportunities to prevent further improper behaviour.¹⁸

Young people and mental health

One study suggested that 1 in 10 children and young people aged 5–16 years suffer from a diagnosable mental-health disorder.²² Another study suggested that half of all lifetime cases of psychiatric disorders start by the age of 14 and three-quarters by the age of 24.²³ The most common mental-health problems in this cohort include anxiety and depression, eating disorders, conduct disorders, attention-deficit/hyperactivity disorder (ADHD) and self-harm.²⁴ Despite all children experiencing difficulties as they grow up, several studies have shown that children belonging to an ethnic or cultural minority, with a history of being bullied, coming from difficult families and particularly those that are in the care of local authorities have an increased risk of developing a mental-health problem.²⁵

Mental health plays a large role in various aspects of young people’s lives, particularly as they grow into adulthood; it impacts constructive social interactions and the ability to engage with education and other activities.²⁴ More than half of adults suffering from mental-health problems were diagnosed in childhood, but less than half were treated appropriately at the time.²⁶ Not only are untreated problems expensive for health services, they are also associated with poorer physical health, education and life satisfaction.²⁷

It has been suggested that there is greater diagnostic uncertainty in adolescents with regards to mental health in comparison to adults, and this often results in children slipping through services. Spooner et al. describe how it is difficult to decide whether challenging or odd behaviour seen in young adults is a symptom of a mental-health condition or in fact associated with the normal development of personality. Adolescents are most likely to use health services in times of crises rather than in primary or preventative ways. Therefore, when young people are detained on such occasions, it provides services with an opportunity to recognise individuals with problems.

This study’s aims were to describe the characteristics of adolescents who are detained under s.136 of the MHA and brought into one London s.136 suite and, in particular, to outline the demographics of these individuals, including age, sex and ethnicity, as well as recognise the primary reasons for their admission. Another aim was to establish whether demographic and clinical presentation factors were associated with time for assessment and their outcomes after assessment, especially whether they were admitted to hospital or discharged.

Being able to profile a minor typically detained under s.136 may allow us to identify adolescents at risk and allow for early intervention.

Methods

Data were collected retrospectively by accessing patient notes via an electronic care record system known as RiO. All patients under 18 years of age who were brought under s.136 of the MHA 1983 to a single south-west London and St George’s Mental Health Trust (SWLSTG) 136 suite between 1 May 2011 and 30 April 2016 were included. This single s.136 suite serves more than one million ethnically diverse people living in the London boroughs of Kingston, Merton, Richmond, Sutton and Wandsworth. There were no exclusion criteria.

Only the first encounter of any patient who was detained more than once in this five-year period was included when analysing demographic data in order to prevent double-counting and skewing of the results. Data were extracted from case records and clinical documentation and were entered into a Microsoft Excel spreadsheet.

Basic demographics of all detainees were collected, including date of birth, age, sex and ethnicity. Data regarding the detainee’s housing (i.e. home with two guardians, home with a single guardian, foster care or other) and education status (i.e. school or college, working, suspended, excluded or medical leave) were also included. Details were recorded about the admission, including the date and time the subjects arrived at the suite and length of time taken between admission and being assessed under the MHA. According to the SWLSTG policy, the assessment of a minor should happen within four hours of admission. Causes for s.136 were grouped into the following categories: self-harm or attempted suicide, verbalised ideation of suicide or self-harm, disorderly behaviour and harm to others.

References to intoxication at time of detention and any notes mentioning misuse of alcohol or illicit substances within the year preceding admission were also noted. Any notes that included details of conviction or charges of criminal offence were recorded, and safeguarding and risk-assessment tools were reviewed to find any previous records of the patients’ risk and history of harm. Whether the detainees were in contact with CAMHS and the reason they were being supported prior to admission were documented. Finally, the outcome of the assessment was recorded to identify if the patients were discharged home, detained under the MHA or informally admitted.

The collected data were coded and analysed using IBM SPSS Statistics v24 (IBM Corp., Armonk, NY). Descriptive statistics are reported using means, standard deviations, frequencies and percentages. Statistical analysis carried out explored how demographic and clinical presentation factors were associated with: (a) time to assessment (<4 hours/>4 hours); and (b) outcome of assessment (discharged home/admitted to hospital). Chi-square and Fisher’s exact tests were used as appropriate. No adjustment for multiple testing was conducted.

The study was conducted per ethical research guidelines; data were collected retrospectively and did not alter any normal clinical management. The researcher was given permission to access the data by the clinical service to facilitate the service evaluation. Mandatory training was attended to ensure secure access and storage of data. Patient data were anonymised and treated securely throughout, ensuring details were kept confidential. Hence, ethical approval was not necessary.

Results

During the five-year period investigated between 2011 and 2016, there were 104 admissions comprising 85 people under 18 years of age to the s.136 suite. Fourteen individuals were admitted more than once; the maximum number of repeat admission during this period was four, which was seen in three people. There were a greater number of females (n = 51; 60%) than males (n = 34; 40%) assessed. Age ranged from 8 to 17 years, and the mean age of the sample was 15.69 years (SD=1.53 years).

The sample included people from nine ethnic groups. The majority of patients were white (n = 67; 78.7%) followed by black (n = 7; 8.2%) and Asian (n = 7; 8.2%) individuals. Those who fell into ‘other’ (n = 4; 4.7%) were all of mixed ethnicity.

Within the sample, the majority of adolescents were in education at the time of detention (n = 70; 82.4%). Eight (8.2%) individuals were suspended or expelled. Looking at the residence of individuals in the sample, most were living at home with two guardians (n = 32; 37.6%) or with one guardian (n = 28; 32.9%). Twenty-two (25.9%) individuals were under the care of the local authority, either in foster care (n = 16; 18.8%) or living in hostels (n = 6; 7.1%).

Most admissions were seen on Tuesdays (n = 22; 21.2%) and Saturdays (n = 16; 15.4%), with more than half occurring during the day (n = 59; 56.7%), defined as 6am to 9pm. The most common reason for adolescents to be placed on s.136 was due to attempted suicide or DSH (n = 59; 56.7%). Other reasons included verbalised ideation of suicide or DSH (n = 28; 26.9%), disorderly behaviour (n = 13; 12.5%) or harm to others (n = 4; 3.8%; see Figure 1).

Figure 1.

Bar chart showing the reason for s.136 detention by police.

Among the 85 minors admitted, most were already known to CAMHS (n = 67; 64.4%). Thirty (28.8%) individuals had not previously been in contact with CAMHS, and seven (6.7%) had been referred to the services but were yet to be seen or did not attend a scheduled meeting. Many of those known to CAMHS were being seen in relation to a mental-health problem (n = 48; 71.6%). Others were supported for challenging behaviour (n = 16; 23.9%) and DSH (n = 9; 13.4%). The 48 (56.47%) adolescents with a mental-health problem had varying disorders, including mood disorder (n = 14; 35.9%), autism spectrum disorder (n = 6; 15.4%), psychotic disorder (n = 3; 7.7%) and ADHD (n = 8; 20.5%). Some individuals had been diagnosed with more than one disorder (n = 8; 20.5%).

Safeguarding and risk-assessment tools completed by health-care professionals identified that a large proportion of the adolescents had a history of self-harm (n = 53; 62.4%), but fewer had a history of harm from others (n = 32; 37.6%) or harm to others (n = 20; 23.5%). Prior to admission, nine (10.6%) adolescents had been convicted or charged with a criminal offence. The reasons for this included theft, destruction of public property and assault. Among the 85 adolescents, notes indicated 10 (11.8%) individuals had misused illicit drugs, and five (5.9%) had misused alcohol in the year prior to admission. Four individuals had a history of misusing both illicit drugs and alcohol. Of the 104 admissions, 11 (10.5%) were of individuals intoxicated at the time of being placed under s.136 or admission to the s.136 suite.

Despite the SWLSTG policy aiming to assess minors within four hours of admission, this limit was exceeded on 40 (38.5%) occasions. The mean time individuals were waiting for assessment was five hours and 20 minutes (SD=5 hours and 12 minutes), failing the trusts four-hour target. There was a statistically significant association between the reason for admission and time taken for assessment to occur (χ²=8.69; p=0.034l see Table 1). All the adolescents who were admitted for harm to others and more than half of those admitted for disorderly behaviour had to wait more than four hours for a mental-health assessment. On the other hand, only one-third of those who were admitted due to an attempt or verbalised ideation of suicide or DSH had a waiting time of more than four hours for assessment. Chi-square tests also showed a statistically significant difference between individuals who had or did not have a history of harm to others and time taken for a mental-health assessment to take place (χ²=9.724; p=0.002; see Table 1). More than half of those with a history of harm to others had to wait more than four hours for an assessment, whereas less than one-third of those without a history of harm to others waited longer than the target time limit.

Table 1

Variables assessed for affecting the time to begin mental-health assessment.

	Time taken for assessment
	<4 hours until assessment	>4 hours until assessment	Pearson chi-square test or Fisher’s exact test* value	p-Value
Sex
Male	27	14	0.532	0.466
Female	37	26	0.532	0.466
Ethnicity
White or white British	50	33	0.505*	1.000
Black or black British	5	3
Asian or Asian British	6	3
Other	3	1
Age group
<13 years	3	4	1.372*	0.563
14–15 years	18	9
16–17 years	43	27
Education
In education	54	33	0.664*	0.846
Suspended or expelled	4	4
Other	6	3
Residence
Home with two guardians	26	11	1.901	0.593
Home with one guardian	18	13
Public care	18	16
Other	2	0
Day
Monday	5	7	3.449	0.751
Tuesday	14	8
Wednesday	6	5
Thursday	10	4
Friday	10	4
Saturday	10	6
Sunday	9	6
Time of presentation
Day presentation	35	24	0.238	0.595
Night presentation	29	16	0.238	0.595
Reason for admission
Attempted suicide or DSH	39	20	8.691	0.034
Verbalised ideation of suicide or DSH	19	9
Disorderly behaviour	6	7
Harm to others	0	4
CAMHS
Known to CAMHS	41	26	0.214*	1.000
Not known to CAMHS	19	11
Referred to CAMHS	4	3
Known mental-health problem
No	33	23	0.349	0.555
Yes	31	17	0.349	0.555
History of harm to self
No	25	11	1.454	0.228
Yes	39	29	1.454	0.228
History of harm from others
No	35	29	3.300	0.069
Yes	29	11	3.300	0.069
History of harm to others
No	52	21	9.724	0.002
Yes	12	19	9.724	0.002
Contact with criminal justice system
No	57	31	2.528	0.112
Yes	7	9	2.528	0.112
History of drug misuse
No	50	32	1.677*	0.662
Alcohol	4	2
Illicit drugs	8	3
Combination	2	3
Intoxicated at presentation
No	59	34	1.344	0.246
Yes	5	6	1.344	0.246

DSH, deliberate self-harm; CAMHS, Child and Adolescent Mental Health Services.

Following assessment, most patients were discharged home (n = 70; 67.3%). Of the remaining individuals, most were placed under sections 2 or 3 of the MHA (n = 21; 20.2%), and others were informally admitted to the ward (n = 13; 12.5%). Whether there was a relationship between clinical and demographic variables and these outcomes was investigated (see Table 2). Fisher’s exact test revealed a significant difference within ethnicities (10.86; p=0.006) and age groups (7.04; p=0.023) in producing different discharge outcomes. Analysis shows that around three-quarters of people of white ethnicity were discharged home in comparison to people of black ethnicity of whom only one-quarter were discharged home. Around one in four adolescents aged 16–17 years were admitted to the hospital rather than discharged home, whilst half the individuals aged <13 years and between 14 and 15 years were admitted to the hospital.

Table 2.

Variables assessed for affecting the outcome of mental-health assessment.

	Outcome of assessment
	Discharged home	Hospital admission	Pearson chi-square test or Fisher’ exact test* value	p-Value
Sex
Male	28	13	0.030	0.863
Female	42	21
Ethnicity
White British or white other	62	21	10.854*	0.006
Black British or black other	2	6
Asian British or Asian other	4	5
Other	2	2
Age group
<13 years	4	3	7.039*	0.023
14–15 years	13	14
16–17 years	53	17
Education
In education	58	29	0.258*	1.000
Suspended or expelled	6	2
Other	6	3
Residence
Home with two guardians	21	16	4.649	0.199
Home with one guardian	25	6
Public care	22	12
Other	2	0
Day of admission
Monday	8	4	1.895*	0.946
Tuesday	15	7
Wednesday	6	5
Thursday	11	3
Friday	9	5
Saturday	11	5
Sunday	10	5
Time of presentation
Day presentation	39	20	0.090	0.764
Night presentation	31	14
Reason for admission
Attempted suicide or DSH	35	24	6.981*	0.060
Verbalised ideation of suicide or DSH	24	4
Disorderly behaviour	9	4
Harm to others	2	2
Time taken for assessment
<4 hours until assessment	41	23	0.796	0.372
>4 hours until assessment	29	11
CAMHS
Known to CAMHS	44	23	0.255*	0.941
Not known to CAMHS	21	9
Referred to CAMHS	5	2
Known mental-health problem
No	40	16	0.936	0.333
Yes	30	18
History of harm to self
No	24	12	0.010	0.919
Yes	46	22
History of harm from others
No	47	17	2.842	0.092
Yes	23	17
History of harm to others
No	47	26	0.952	0.329
Yes	23	8
Contact with criminal justice system
No	59	29	0.018	0.894
Yes	11	5
History of drug misuse
No	51	31	5.787*	0.096
Alcohol	6	0
Illicit drugs	8	3
Combination	5	0
Intoxicated at Presentation
No	61	32	1.177	0.278
Yes	9	2

Discussion

Between May 2011 and April 2016, there were 104 admissions into one s.136 suite by 85 adolescents under 18 years of age. A study previously conducted in the same Trust identified 43 admissions from 40 adolescents in a three-year period from 2007 to 2010,²⁸ suggesting that number of admissions by adolescents may have increased within this Trust over the past few years.

Older children have a greater prevalence of mental-health disorders than younger ones. A 2004 survey recorded the proportions of children with any mental disorder as 12% in 11–16-year-olds but 8% in 5–10-year-olds.²² It appears that the older subgroup of adolescents (those aged 16–17 years) were likely to be discharged home, whilst those who were younger were more likely to be admitted. It may be suggested that the older group are more comparable to the general adult population, and younger patients are considered more vulnerable or associated with greater diagnostic uncertainty, thus needing further assessment or care.

Most adolescents who presented at the s.136 suite in this study were white Caucasian (n = 67; 78.7%). We found a slight under-representation of ethnic minorities in this study in comparison to Wandsworth (one of five boroughs under SWLSTG) and London, in which 28.6% and 40.2% of the population, respectively, are an ethnic minority.²⁹ These results contradict previous research which suggest the over-representation of ethnic minorities being detained under s.136⁷. Although results suggest that people of black ethnicity are more likely to be admitted to hospital than discharged home, the cohort was so small in comparison to those of white ethnicity that firm conclusions cannot be made.

Fourteen individuals were admitted more than once. It can be noticed that repeat admissions are often clustered together, typically within days of each other. People who are repeatedly detained under s.136 are vulnerable and require attention. However, there are currently no data regarding this subgroup and their outcomes. This is a possible area for future research.

The main reason for admission under s.136 in this cohort was due to attempted suicide or DSH (n = 59; 56.7%) followed by verbalised ideation of suicide or DSH (n = 28; 26.9%). This is in keeping with another study in a rural county in which acts or threats of self-harm were seen in 55% of their admissions.³⁰ However, another study conducted in the same south-west London Trust found 40.8% of people over a six-month period presented due to threatened self-harm.³¹ It is notable that females accounted for most of the admissions in this adolescent group (n = 63; 60.6%), whereas male participants accounted for between 50% and 60% in other studies focussing on adult populations.³² A study assessing mental-health disorders in children identified that while boys are more likely to have a conduct disorder, they were less likely than girls to have an emotional disorder, including depressive disorders.²² A recent large survey by the Department of Education concluded that there was a surge in emotional problems in girls, with more than one in three girls aged 14–15 years showing signs of depression or anxiety.³³

At the time of admission to the s.136 suite, 22 (25.9%) individuals were under public care, including those in foster care and those living in hostels. As of March 2015, a total of 69,540 children were looked after by local authorities in England, a rate of 60/10,000 (0.6%) children under 18 years of age.³⁴ The rate of those detained under s.136 who are in foster care is therefore more than forty 40 times that of the general UK population. This can be explained by children under the care of the local authority having a greater prevalence of mental-health and behavioural disorders. The NSPCC suggests that children under care are four times more likely than their peers to have a mental-health difficulty.³⁵

Among the 85 minors admitted, most had prior contact with CAMHS and were being supported by the service in relation to a diagnosed mental-health problem or challenging behaviour. This is concerning and may indicate a need for future studies to review the management of active cases.

A review of s.136 admissions found between 75% and 84% of individuals had a previous psychiatric history.³³ It is likely that our results are lower than these, as we assessed a younger cohort for whom disorders may not yet be apparent. Still, the results are consistent with previous studies which suggest that people with mental-health conditions or behavioural difficulties are more likely to encounter the criminal justice system.²¹ Prior to admission, nine (10.6%) adolescents had been convicted or charged with a criminal offence. This is three times the peak national rate for offences in those 16 year of age in 2010.³⁶

Of those who presented at the s.136 suite, 37.6% had a history of either physical or sexual abuse as reported by safeguarding and risk-assessment tools. An NSPCC survey reported 18.6% of those aged 11–17 years disclosed severe maltreatment.³⁷ This study discovered that the adolescents who were admitted under s.136 are twice as likely to have a history of abuse in comparison to those in the standard population. Numerous studies have identified the increased risk of mental-health problems in an individual with a history of abuse from others. This may contribute to the admissions seen in our study.^38,39

Although most adolescents were assessed by AMHPs within four hours of admission, the Trust’s target duration for those under 18 years, a significant proportion (38.5%) still were seen beyond this time. Furthermore, the mean time that individuals were waiting for assessment was 5 hours and 20 minutes, failing the Trust’s four-hour target. In this study, all adolescents who were admitted for harm to others and more than half of those admitted for disorderly behaviour had to wait more than four hours for a mental-health assessment. A previous study of s.136 detention found that in cases where time taken for assessments exceeded the Trust’s target timeframe, the most common reason was due to intoxication of the patient.³¹ However, this was not reflected in this adolescent population. In fact, only 1/10 admissions were of individuals who had misused drugs or alcohol, which is much lower than other studies which have reported 22–29% of cases having drugs or alcohol contributing to s.136 detention.³³

Following their assessment, some were placed under sections 2 or 3 (20.2%) of the MHA or admitted informally (12.5%). The percentage of adolescents who are further detained under the MHA is comparable to the national average reviewed in hospital-based places of safety (17%).⁶ These findings raise a worrying question surrounding how appropriate the use of s.136 is, particularly with regards to adolescents for whom detention is likely to be a traumatic event. However, 56% of those who were admitted to the s.136 suite had an identified mental-health problem, more than five times the national average,⁴⁰ suggesting that it may not be such a large issue of the police in identifying those with mental-health problems, but also an interplay with the inability of AMHPs in organising their management. If individuals are identified as not requiring hospital-based care, it may be unnecessary for them to be detained by police. Mental-health resources are scarce and underfunded, particularly for children and young adults.⁴⁴ Hence, the use of s.136 inappropriately only disadvantages those who require access to mental-health services in a time of crisis. Alternatively, the low rate of hospital admissions may in fact reflect the sparsity of adolescent mental-health facilities. Reports have stressed the lack of adolescent inpatient beds.⁴¹

Profiling those detained under s.136 can act as a useful recourse to quicken the route to treatment of vulnerable individuals in the future. However, the limitations of profiling should also be considered. There is a chance of targeting individuals who may not need intervention and putting them through a process that can be considered traumatic, but conversely, it may also result in missing those at risk who do not fit the profile. These risks can arise with any generalisations, so the features we identified should be used with caution.

Strengths and limitations

The data collected over a five-year period were representative of patients from diverse ethnicities and socio-economic backgrounds. Despite the long period assessed, a large enough sample size did not arise to investigate certain variables. Furthermore, only patients who were admitted to a single s.136 suite were considered in this sample and may not reflect that in practice, which includes those seen in other places of safety including hospitals and police stations. Data were collected in a busy suite, situated in an ethnically diverse area which serves the needs of more than one million people. Hence, the generalisability of these results to other areas, particularly those which are non-urban, is unclear. A further limitation is that this was a study based on electronic case records of varying detail. Data regarding drug and alcohol and forensic history particularly relied on the standard of record keeping. However, this is the largest UK study exploring the characteristics of adolescents detained under s.136 of the MHA and second to another conducted in the same trust.

Conclusions and prospect for future research

The typical profile of an adolescent that presented to this south-west London s.136 suite was a 16-year-old female of white ethnicity who was detained from a public area due to attempted suicide or DSH. It is clear that the adolescents detained under s.136 are vulnerable. Consisent with previous studies that largely focus on adult populations, they are more likely to have a history of mental or behavioural difficulties, including a history of self-harming, have a history of abuse, be under the care of local authorities and have had previous convictions compared to adolescents in the general population.

We hope that greater resources can be allocated towards the management of crises in this vulnerable group to avoid dependence on the police for access to care.

It is hoped that this description of a ‘typical’ adolescent who is placed on s.136 will allow for better recognition of those most vulnerable to detention. Emergency crisis provision for this vulnerable cohort needs to be considered. There is a need for the collection of qualitative data to evaluate the process of detention of adolescents from the perspective of patients, AMHPs and police officers.

Footnotes

Acknowledgements

We thank Dr Sarah White (Biostatistician, St George’s University of London) and the IT Department and library staff at Springfield Hospital for their assistance during the data-collection process.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

References

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