Pathways from Repeated Detention (Section 136 of the Mental Health Act, Trauma and Frequent Suicide Attempts)

《精神健康法》第136条(S136)规定，如果一个人看起来因精神疾病有立即受到伤害的危险，警官可以拘留该人进行精神健康评估。尽管试图扭转这一趋势，英格兰和威尔士的S136人拘留率仍在持续上升，去年接近3万人[1]。尽管许多公众和学术评论对警察进行了仔细的审查，与(不当)使用这一权力证明了一种社会控制手段的神话有关，但过去20年的多项研究发现，大约80%的拘留与自杀预防有关[2，3，4]。因此，S136代表了当前社会对精神疾病的反应。基于苏塞克斯研究[4，5]中备受推崇的S136的发现，我是研究助理和第二作者，我开发了我的博士提案，并从Wellcome Trust获得资金，以追求专注于少数人的反复拘留，我们之前的研究表明，这是导致当地总体高发病率的一个重要因素。我的博士研究证实，经常性拘留是全国公认的现象，在东南地区占所有S136使用的三分之一。查看苏塞克斯的数据，我的研究显示，在28个月的时间里，155人被拘留了563次。在这些事件中，超过90%与自杀或自残有关。一名年轻女子在谈到她长期抑郁和自杀未遂时说：“警察救了我24次。”另一名妇女在过去五年中被拘留了100多次。我的研究考察了将这一小群人困在恶性循环中的复杂因素，这些因素几乎全部由有创伤史的女性组成，恶性循环中反复出现自杀危机。至关重要的是，我已经展示了心理健康专业人士可能会在无意中对这些女性造成再创伤，进一步破坏她们的信任，让警方通过持续干预以防止她们自杀，来履行代理照顾者的职责。S136拘留涉及多个机构，对公众造成沉重的经济负担，每个拘留的平均费用为1,200 GB[6]。因此，显然有必要在财政上了解这一现象，以及通过改善对这一群体的护理来减少自杀危机反复发生的严重性和频率的道德理由。我的一个合作者(保罗·詹宁斯，最初是一名警长)为频繁根据S136被拘留的人创建了一个创新的指导计划(SIM)。[7]他现在受雇于NHS英格兰，在全国范围内建立SIM。NHS对警方制定的干预措施的这种高级别支持表明了与经常性拘留有关的问题的交叉性。博士后奖学金将为我提供机会，在这一重要领域发生变化的关键时刻，加强我作为ECR和这一主题的领先学者的形象。尊重自杀痛苦的亲身经历是我研究的核心，尽管最近多次拘留得到了越来越多的关注，[8，9]我的工作目前仍然是独一无二的，将深入的定性研究和共同产生的分析与定量数据结合起来，从现实主义的角度全面审查多次拘留。我的博士学位在对频繁拘留发生的机制和背景进行理论分析方面做出了重要贡献，并指出了安全减少自杀危机的有希望的途径。我现在正在寻求巩固这项工作。这一奖学金将使我能够与从业者和政策制定者分享我的发现，既通过我已经建立的关系，也通过利用当前的机会进一步扩大我的网络，例如与SIM一起。以及检验和提炼我在论文中提出的理论，以及进一步的生活经验参与。

Section 136 (S136) of the Mental Health Act enables a police officer to detain a person for mental health assessment if they appear to present an immediate risk of harm owing to mental illness. The rate of S136 detentions in England and Wales has risen continually despite attempts to reverse this trend, last year nearing 30,000[1]. Although much public and academic commentary has scrutinised the police, relating to the myth often still perpetuated that (mis)use of this power demonstrates a means of social control, multiple studies over the last twenty years have found around 80% of detentions relate to suicide prevention[2,3,4]. S136 therefore provides a startling representation of the present social response to mental ill health.Building on findings from the highly regarded S136 in Sussex study[4,5] on which I was the research assistant and second author, I developed my PhD proposal and secured funding from Wellcome Trust to pursue a focus on the repeated detention of a small number of individuals, which our prior research had indicated was a significant factor contributing to the overall high rates seen locally. My doctoral research has confirmed that recurrent detention is a nationally recognised phenomenon that within the South East region constitutes a third of all S136 use. Examining Sussex data, my study showed that 155 people were detained 563 times in a period of 28 months. Over 90% of these incidents related to suicide or self-harm.Referring to her chronic depression and suicide attempts, one young woman stated: 'the police have saved my life 24 times'. Another woman had accrued over 100 detentions in the last five years. My research examined the complexity of interwoven factors that trapped this small group, almost exclusively comprised of women with histories of trauma, in a vicious cycle of repeated suicidal crises. Crucially, I have shown how mental health professionals may unintentionally contribute to retraumatising these women, further fracturing their trust and leaving the police to fulfil a position of proxy carers by consistently intervening to prevent their suicide attempts. S136 detentions involve multiple agencies and high financial burden to the public, with each costing on average £1,200[6]. There is hence a clear financial imperative to understand this phenomenon, as well as the moral case to reduce the severity and frequency of recurrent suicidal crises by improving the care of this group. One of my collaborators (Paul Jennings, originally a police sergeant) has created an innovative mentoring scheme (SIM) for people detained under S136 with high frequency.[7] He is now employed by NHS England to establish SIM nationally. This high-level NHS support for a police-developed intervention demonstrates the intersectionality of issues tied to recurrent detention. The Postdoctoral Fellowship will provide the opportunity for me to strengthen my profile as an ECR and the leading academic on this topic at a crucial time of change in this important area. Honouring lived experience of suicidal distress is central to my research, and despite repeated detention recently gaining increasing attention,[8,9] my work currently remains unique in combining in-depth qualitative research and co-produced analysis with quantitative data to comprehensively examine repeated detention from a realist perspective. My PhD has made an important contribution to theorising the mechanisms and contexts in which frequent detention arises and has pointed to promising avenues through which suicidal crises can be safely reduced. I am now seeking to consolidate this work. This fellowship will enable me to share my findings with practitioners and policymakers, both through the relationships I have already established and by capitalising on current opportunities to further extend my network, for example alongside SIM. As well as to test and refine the theory I developed in my thesis with further lived experience participation.