Maudsley Hospital: Care delays at place of safety revealed which staff warn is legal and safety risk

Josh Salisbury (25 November, 2020)

Maudsley staff have warned internally it is both a safety concern for patients and a legal risk

40548The Maudsley Hospital in Denmark Hill; inset: A warning to the hospital's board that Section 136 breaches are a legal risk

Patients taken to the Maudsley Hospital as a place of safety during a mental health crisis are facing delays in their care, according to data obtained exclusively by the News.

The hospital’s own staff warn it is both legally risky and a significant safety concern for patients.

Police can take those having a mental health crisis in public to a ‘place of safety’ unit at the Maudsley where they can be detained for their own welfare, under section 136 of the Mental Health Act.

 A person can only be detained for the purposes of a mental health assessment, and normally only for 24 hours, before either being admitted to hospital as an inpatient voluntarily, sectioned as an inpatient or discharged.

But according to data exclusively obtained by this paper, some patients have been in the place of safety for up to a week – well beyond the legal 24 hour standard. At least one person was there for a month.

READ MORE: South London and Maudsley Trust hospitals section highest number of patients in the UK, according to new data

The Trust has recorded at least 625 breaches of the 24-hour limit over the past three years to date, according to the FOI data.

The longest stay was for thirty days, in 2018. The Trust insisted to the News that it has other “legal and ethical frameworks” with which to detain patients past the 24 hour limit, but did not elaborate what those were.

But its internal documents admit a risk these breaches could “lead to a legal challenge from the patient” and “can mean a person is held ‘illegally.’” Staff add these breaches are a “significant safety concern, especially in COVID.” 

A lack of beds may mean a patient cannot be moved from the place of safety and admitted or sectioned as an inpatient.

Those admitted to the place of safety may also be too ill to be discharged.

Alarm over the phenomenon has been escalated to the top levels of the organisation, with chief operating officer Neil Robertson being asked this month to present at a Trust-wide meeting on the risks caused by the overstays.

Interim chief operating officer, Neil Robertson

The charity Rethink Mental Illness told the News our findings showed the urgent need for extra resources to improve the number of inpatient beds at the Maudsley Hospital.

“People experiencing a mental health crisis shouldn’t experience delays in their care while detained under Section 136,” said policy manager, Will Johnstone.

“Overstays are always of significant concern and this highlights the urgent need to improve both inpatient bed availability and crisis care, with alternatives to detention provided wherever possible.”

This paper unsuccessfully asked to interview a senior leadership figure within the hospital about our findings.

A spokesperson said people often stay at the place of safety for longer than 24 hours, but that the Trust would use different legal provisions in those cases.

The hospital inspector, the CQC, has said it is concerned about stays at a place of safety beyond 24 hours. The watchdog said it “would question the lawful basis for detaining people under these circumstances.”

The Maudsley Hospital in Denmark Hill

The Maudsley Hospital in Denmark Hill

“We recognise that the experience of being detained under the Mental Health Act can be a distressing, uncertain and difficult experience for people,” said a Maudsley spokesperson.

“Increased demand for mental health support across London means that sometimes patients have to wait.

“We monitor any breaches daily to be able to plan ahead and reduce any impact on people who use our services.

On the specific case of a person being in the place of safety for a month, the Trust said it could not comment on individual cases.

“But breaches with significant waiting times often relate to patients who come into our services with a specific set of circumstances which have to be investigated,” it said.

It added: “We have stepped up a 24-hour all age crisis line and we are working with the London Ambulance Service and Metropolitan Police via joint response vehicles and crisis assessment teams.

“We are also piloting the use of Advance Choice Documents, where clinicians carry out a therapeutic interview with people prior to discharge when they are well enough, which could help inform a care plan if it becomes necessary for a person to be detained again.”

How does the Maudsley Hospital compare?

According to previously unpublished analysis obtained by the News, the South London and Maudsley Trust compares poorly with other London mental health hospitals on its use of section 136.

A report written by a consortium of mental health trusts in London called the Cavendish Square Group, compares data from across the capital.

The group had refused to give a version of the report to the News, arguing “it was not intended to be shared with external parties.”

It states: “Many MHTs deal relatively quickly with s136 episodes with around half being processed within 12 hours of arrival.

“A large proportion of episodes within SLAM and SWLSTG [South West London and St George’s Mental Health NHS Trust] take longer than 12 hours.”

A five-year comparison of the ethnicity of those detained under S136 at the hospital reveals that Black people are more likely to be detained.

“The Asian category is under-represented, and the Black category is over-represented,” states an analysis of the patients admitted under section 136.

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