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，如果某人因精神疾病而有立即受到伤害的危险，警官可以拘留此人进行精神健康评估。英格兰和威尔士的S136拘留率持续上升，尽管有人试图扭转这一趋势，去年接近30，000人。尽管许多公众和学术评论都对警方进行了仔细审查，但仍然存在这样一个神话，即（错误）使用这种权力表明了一种社会控制手段，过去二十年的多项研究发现，大约80%的拘留与自杀预防有关[2，3，4]。因此，S136提供了一个令人震惊的代表性，目前社会对精神疾病的反应。建立在高度重视的S136在苏塞克斯研究[4，5]，我是研究助理和第二作者，我开发了我的博士学位提案，并从威康信托基金会获得资金，以追求对少数人的重复拘留的重点，我们先前的研究表明，这是导致当地整体高发病率的一个重要因素。我的博士研究已经证实，经常性拘留是一个全国公认的现象，在东南地区构成了所有S136使用的三分之一。通过研究苏塞克斯郡的数据，我的研究表明，在28个月的时间里，有155人被拘留了563次。超过90%的事件与自杀或自残有关，一名年轻女子在谈到她的慢性抑郁症和自杀企图时说：“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。我的研究考察了使这一小群人陷入反复自杀危机的恶性循环的交织因素的复杂性，这一小群人几乎完全由有创伤史的妇女组成。至关重要的是，我已经展示了心理健康专业人员如何无意中导致这些妇女再次受到创伤，进一步破坏了他们的信任，并让警察通过不断干预以防止他们的自杀企图来履行代理照顾者的职责。S136拘留涉及多个机构，给公众带来沉重的财政负担，每次拘留平均花费1,200英镑[6]。因此，从财政角度来看，我们有必要了解这一现象，从道德角度来看，我们有必要改善对这一群体的照顾，以减少反复出现自杀危机的严重程度和频率。我的一位合作者（保罗·詹宁斯，最初是一名警官）为根据S136被拘留的人创建了一个创新的辅导计划（SIM）。[7]他现在受雇于NHS英格兰建立SIM全国。这种高级别的国民保健服务支持警方制定的干预措施表明，与经常性拘留有关的问题是相互交叉的。博士后奖学金将为我提供机会，以加强我的个人资料作为一个ECR和领先的学术在这个重要领域的变化的关键时刻这一主题。尊重自杀痛苦的生活经历是我研究的核心，尽管重复拘留最近越来越受到关注，[8，9]但我的工作目前仍然是独一无二的，将深入的定性研究和联合制作的分析与定量数据相结合，以全面审查重复拘留从现实主义的角度来看。我的博士学位为理论化频繁拘留的机制和背景做出了重要贡献，并指出了可以安全减少自杀危机的有希望的途径。我现在正在努力巩固这项工作。这个奖学金将使我能够与从业者和政策制定者分享我的发现，无论是通过我已经建立的关系，还是通过利用当前的机会进一步扩展我的网络，例如与SIM一起。同时，通过进一步的生活经验参与来测试和完善我在论文中发展的理论。

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.