Section two Focus on detention issues Conclusion Although there is universal agreement across and within jurisdictions about the purpose of secure mental health care and that there should be clear pathways between levels of security and types of care, in many instances patients are not able to receive the right services in the right place at the right time. It is welcome that there has been increasing focus on developing standards, reviewing and improving the quality of care and treatment in secure settings, and that most of the challenges in the provision of services, including the lack of coordination in planning and commissioning, are recognised. However, the difficulties set out can have significant impact on individual patients, who become frustrated with delays, and may disengage from treatment when they are aware they should be moving on, with consequent risks that their mental health might deteriorate. Many patients end up far away from home as a result of ineffective or non-existent pathways, and this can compromise rehabilitation and discharge planning, especially when planning a move from secure care to community placement, which may be at some distance from the inpatient unit. Pathways from police custody arising from mental health issues90 NPM members considered the pathways from police custody that arise from concern by police (including, for example, arresting officers, custody staff and health care staff working within the custody setting) about the mental health of the detainee. NPM members decided to focus on this because their regular monitoring highlights an increasing number of detainees in police custody who are vulnerable due to mental health issues. There are two situations in which these pathways can be needed. Firstly, when a detainee is being held by police under relevant mental health legislation (as a ‘place of safety’) and, secondly, when a detainee has been arrested for a criminal offence and mental health issues are identified as a risk factor during the initial assessment by the custody officer, and a subsequent assessment by a forensic doctor or nurse raises further concerns. In both instances, police may seek to have the detainee transferred into a mental health setting for their own safety or to facilitate a mental health assessment. The pathway therefore usually occurs when the detainee is transferred from the custody suite to a mental health facility. The detainee may subsequently be transferred back into police detention (for example when an assessment has been conducted). A further pathway may also arise when a detainee is transported from police custody to court custody 90. Data and information on this topic was collected between September 2016 and April 2017 by ICVA, NIPB ICVS and CJI. Custody visitors from the NIPBICVS and ICVA collected data using a pre-defined data set which was collated by the Scheme Manager in the NIPB and the Office of the Kent Police and Crime Commissioner (OPCC) respectively during their regular visits to custody. Nine of the 42 ICV Schemes (and associated OPCCs) responded to the survey. CJI was not undertaking inspection work in relation to police custody so used information gathered during the 2015 inspection and via a focus group with custody officers. NPM members in Scotland (HMICS and the Scottish ICVS) had hoped to contribute but due to the custody legacy systems of Police Scotland were unable to obtain any meaningful data. 35