Safe Spaces Scoping Report

4. Psychiatric Emergency Plans (PEPs)

4.1. Introduction

PEPs are locally agreed arrangements and procedures outlining the role and responsibilities of police, health, social work, and other partner who might potentially be involved in responding to and managing a psychiatric emergency, with consideration for what support is available to prevent escalation to a detention. The aim of a PEP is to agree on procedures to manage the detention and transfer process in a way that minimises distress, disturbance and risk for the patient and others, and which ensures as smooth and safe a transition as possible when conveying an individual from the site of the emergency to the legal place of safety for a mental health assessment. The PEP should also define where the designated legal place of safety is in each board. Police Scotland’s SOP and the Mental Health Act Code of Practice recommend referencing this within plans.

Whilst the purpose of PEPs is to outline guidelines for responding to psychiatric emergencies, an important element is also ensuring support is available which could prevent escalation to a psychiatric emergency or for those in crisis but for whom detention isn’t appropriate.

4.2. Analysis of Psychiatric Emergency Plans

The MWC’s Review of Psychiatric Emergency Plans across Scotland^[12], published in 2020, highlighted several issues with PEPs. These include inconsistencies and variance across boards, lacking guidelines for collaborative working between partners to ensure a safe handover, and clear guidelines around roles and responsibilities in relation to substance affected individuals presenting in crisis and distress.

The MWC report confirmed that all 14 health boards have PEPs in place and all include specific designated locations for the legal place of safety which provides adequate privacy. However, there was insufficient information provided on how privacy was achieved. The report indicated that ED is frequently used as a place of safety, and it understood that achieving privacy in this setting can be challenging. The Scottish Mental Health Law Review and Mental Health and Wellbeing Strategy recognise the need for legislation and practice which increasingly promotes human rights and compassion. Further detail and evidence of the promotion of human rights will be necessary within the PEPs in future.

The MWC report also considered debriefing with partner agencies to promote information sharing, collaboration, and joined up working. No health board described a clear debrief facility within their PEP. One did describe a quarterly review of the PEP and one a biannual review which may have served the same purpose provided representatives from all professional groups were able to attend.

Both the MWC report and HMICS thematic review highlighted the need for PEPs to have clear guidelines describing when police could remove themselves as care has been transferred to the appropriate professional.

A national review of PEPs is underway to promote clear lines of communication, roles and responsibilities, governance, and information sharing to promote a collaborative response to unscheduled mental health.

4.3. Substance Affected

The MWC’s PEPs review also reported that four of the 14 PEPs contained clarity of responsibility for intoxicated patients in mental health crisis which includes a plan when an individual is too intoxicated to be assessed. In their report, the MWC highlighted that whilst individuals presenting as intoxicated may not be fit for assessment, it would nevertheless be important to ensure that when they are fit for assessment they can be offered appropriate supports. The report noted a gap in provision where they are aware there may not be a place for the individual to wait until they are fit and able to engage.

The report recognises there is a risk that this could lead to criminalisation of patients who are then taken to police cells in the absence of alternatives. This risk also exists for people presenting as intoxicated as a result of self-harm. Police Scotland’s SOP highlights that: “it may be difficult for police officers to know whether a person, under the influence of alcohol or other substance, has a mental disorder as intoxication may mask mental health symptoms, or the presenting behaviours appear as intoxication when the cause is a mental health condition. The SOP adds the final decision as to whether such an assessment will be conducted will be that of the health professional, which should be respected by officers.

The HMICS Thematic Review highlighted that intoxication is often an issue that can impact on the person experiencing distress or mental ill health and this can impact on police officers waiting with people for clinical assessment. They noted that this further highlights the need for safer, more dignified, and equipped environments where people can be safeguarded awaiting sobriety and mental health assessment.