National Preventive Mechanism Eighth Annual Report 2016–17 resource being shared across a wider force area or the lack of approved mental health professionals. This, alongside the lack of suitable accommodation, had a detrimental impact on how quickly detainees were transferred out of police care into health settings. These type of schemes aim to ensure that appropriate mental health assessments are conducted at the earliest possible opportunity, to divert those with mental health issues away from the criminal justice system and ensure they receive appropriate mental health support in police custody and beyond. NPM concerns A lack of suitable places in health establishments (for example place of safety availability in hospital emergency departments or places in mental health hospitals) was a frequent barrier to effective and efficient pathways out of police custody, though available data does not shed light on the extent of this problem. NPM members’ monitoring identified several problems arising from the lack of available places in health care establishments to receive those in police custody: delays in having the individual transferred out of police custody, the negative impact of time spent in police custody on the individual held (including exacerbating their mental health issues), and a lack of proper mental health assessment and appropriate mental health care. In addition, difficulties arose when the detainee was under the influence of alcohol and/or drugs as health professionals could be reluctant to accept the individual, particularly if they were violent. It could also be difficult for police to ascertain if the individual had a mental health issue or if they were under a drug-induced psychosis. A lack of police 38 training or awareness about mental health issues contributed to this. Finally, NPM members were concerned that the number of individuals being brought to custody suites could delay the process of identification of mental health issues and the need for input from mental health services. Conclusion There has been significant attention in recent years to the situation of detainees in police custody who have serious mental health problems. Though some improvements have been made in relation to the reliance on police custody as a place of safety in England and Wales, and numbers in Scotland and Northern and Ireland appear small, further attention is needed to strengthen the availability and efficiency of pathways out of police custody. The lack of places in mental health establishments to which detainees can be transferred is a significant problem, and NPM members have also identified issues around the willingness of health care providers to receive individuals suffering mental health issues who have ended up in police custody. It is of concern that there is a widespread lack of data about mental health need in police custody to inform the need for mental health provision. Although data is available in relation to the use of police custody as a place of safety, there is apparently no data on the wider issue of detainees in police custody who require a full mental health assessment or to be transferred to a mental health establishment. Without this data police forces cannot challenge health care providers or their commissioning bodies about the perceived lack of provision, and steps cannot be taken to address this.