This week a man went to an A&E department to seek help in crisis. He is a known mental health service user and had become unwell after 3 weeks of not taking medication – he had run out. Arriving at A&E at 10am, he was triaged and they rang for the crisis team to come and assess him.
By 4pm, he was starting to get frustrated with the wait. He had already started protesting about the length of time it was taking and staff were becoming anxious about him and his behaviour. So they called the police claiming, “He’s threatening staff” and “about to kick off”. Five cops on a blue light run across the city later and they were there within 8minutes. The man appeared controlled and calm enough, albeit vocalising his frustration at the waiting times. He used a few naughty words, but not directed at anyone, just in the anxious parlance of someone who is fed up of waiting.
A&E staff indicated that crisis were on their way, that they want the man removed from the department. The attending sergeant asked who the man was fighting and what threats had been made. He indicated that he wanted to arrest the man for the threats and violence. No member of staff would confirm any threats or violence were made at all.
“So he’s frustrated with waiting and said so, perhaps in a grumpy or even belligerent fashion?” That appeared to be so. “and you want him arrested for this because he’s got mental health problems?” Yes. The police contacted the s136 suite: if they arrested him MHA would they assess him? No, apparently not. Why not? Because they wouldn’t, that’s why not. He should be removed to the cells and assessed there. Why?!! Because he’s been threatening and violent towards NHS staff. No, he hasn’t. Yes he has. NO – HE HASN’T. We’re not dealing with him.
The sergeant took the view that it was not necessary to detain the man s136. He wasn’t attempting to leave A&E; to the extent that a police sergeant can tell, he doubted whether the man would be sectioned; he wasn’t posing a risk to himself or others. The decision not arrest was treated with opprobrium by the NHS staff in both A&E and MH camps.
But the law requires that it be necessary, to exercise s136. If the detention is only going to coerce the man through a process with which he is willing to comply if only it gets realised this side of bed-time, then what is the utility? We are probably agreed that there is none.
So he went unarrested and I’m telling the tale of the man who the NHS wanted to see arrested because he vocalised his frustration at a six-hour A&E wait.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 
Well done that sergeant! He appears to have sussed that the NHS staff were refusing treatment (that’s what it amounted to) when all he actually need was some of the medication he had not been taking. What on earth do they think the crisis team is about? Poor bugger with the mental health problem label which once awarded is very difficult to lose. One of the problems I experienced and observed is that if some in a mental health team, they use whatever tricks they can to avoid having anything to do with or for an individual. The service user is not believed because s/he is mad and some MH staff know that they can get away with anything in the closed environment where they rule supreme. Not surprised by the collective opprobrium as ‘interference’ from an authoritative outsider is deeply resented particularly when he just won’t do what he’s told 😦
I believe MHC’s brilliant blog is a valuable resource for many….who dont understand Mental Illness, who need to know more re law and NHS Duty of Care and for patients left feeling even more angry and confused!
I suppose after 18 years seeking justice in case of Stephen Lawrence, the system flaws opened up could extend to MH services, will we finally see that “justice denied anywhere diminishes justice everywhere”
Not holding my breath though!
Agreed and well done to @Mentalhealthcop for brining this into the public domain!
Broadly there are two descriptions of organisations that serve the public.
1) Customer led – whereby the whole stimulus and drive of an organisation is geared to providing the best possible service that meets the needs of patrons thus causing them to want to use that service above all others in the future.
2) Service led – whereby the whole stimulus and drive of an organisation is geared to providing a service that is chosen by its staff and meets their own needs causing them to only provide a service that is also sought by its patrons when it suits them not the patron to do so.
1) Correlates with private industry and private sector services.
2) Correlates with public taxpayer funded services.
This is why maximum possible privatisation of the NHS is the only way to drive up standards in what is now a lamentable, overblown, wasteful and mismanaged service – as the narrative of the above blog amply demsonstrates.
Are you seriously suggesting that the police and mental health services would be better run by profit driven organisations like Halliburton, ATOS and Capita? Privatisation fails to deliver better service in the public sector, the only concern is the ROI for investors and the dosh that circulates to secure and keep contracts. You are of course free to buy your own security and private means of travel that you control completely and of course your own healthcare. Or buy your own country where you will not need any services whatsoever and declare UDI from any sort of society.
http://www.dailymail.co.uk/news/article-1269491/Daughter-psychiatric-patient-committed-suicide-wins-10-000-NHS-breached-mothers-right-life.html This case law set a precedent! Hopefully it will never be needed, somehow I doubt it!
Hooray indeed – I hope that when malpractice in the form of breaches a patient’s human rights is seen to coist money, the managers (and their insurers) will not be so ready to accept assurances that all is well in the dark and opaque world of closed wards.
Oh it’s used and needed OK – I have mentioned Savage v Essex numerous times whilst engaged in partnership discussions about MH services, AWOL cases and s136 stuff. There is a POSITIVE, ie a proactive, responsibility around Human Rights.
I’m looking forward to the outcomes of another Human Rights case which could blow things open too: MS v UK. Believe it’s due before European Court this year.
Hooray indeed – I hope that when malpractice in the form of breaches a patient’s human rights is seen to cost money, the managers (and their insurers) will not be so ready to accept assurances that all is well in the dark and opaque world of closed wards.
Naive in the extreme, I’m sure. But ‘crisis’??? Not much of a Crisis Team. Unless crises can be booked a few days ahead and an appointment made, of course. Shame on the that patient for not managing himself better, eh?! What the hell is the team for if not to respond at a moment’s notice. Crazy.
Who wouldn’t kick off after six hours?
What is most distressing is that this example is happening every day up and down the country. Healthcare Security Officers are regularly required to deal with people ” vocalising their frustration at the waiting times” and many will be very justified in that sense of frustration. Some will wish to leave and Healthcare Security Officers may be told “we (clinical staff) don’t want him/her to go”. I have personally questioned why a patient expressing a desire to leave and being quite confrontational about it to Healthcare Security Officers cannot be allowed to leave after 5 hours waiting to see a MH professional to assess them. After being told there were no plans to section the individual and it was obvious (in a calmer moment) that the individual who may well have needed to talk to someone about threats to self harm made over 5 hours previously was now purely fixated on why they should wait voluntarily any longer in a busy A&E Dept when no one had spoken to them since they had been admitted, I advised that security officers could not legally, prevent the individual from leaving and that in fact our presence was inflaming the individual. We withdrew, a MH nurse appeared within 5 minutes and the patient was assessed and discharged. Of course had the patient left the A&E Dept which of course is a safe place if not a place of safety, against clinical wishes the A&E staff would have been faced with a new question. What to do now? Many will resort to ringing their local police and asking for police officers to attend and arrest the patient under S136 or go to the person’s home and do a “safe and well” check. I know both of these topics are covered elsewhere in your blog so won’t pursue them here. Keep raising these issues. Too often they go unnoticed, unremarked and unresolved.
The triage system that operates in many hospital A&E departments provides little favours to the mentally ill – since they are breathing, their heart is beating, their pain is often not realised, they are often are bumped down the list whilst new patients arrive and are deemed more prority (… people with broken arms). Sometimes, because of the triage system, the urgent response mental health team isn’t contacted until a doctor prompts it.
An experienced doctor working in A&E could have asked him about his medication, checked the notes (if any existed at that hospital) and prescribed his old medication (at a lower dose) or some short acting antipsychotic medication to settle him a little whilst waiting for the mental health response team to do a full assessment. Calling the police, that’s very poor practice.
When mental health consumers have lost contact with a psychiatrist it can become very difficult to get access to treatment by going through the system: appearing at A&E. And sometimes appearing at A&E is the only way. Some (and families) wait for severe deterioration because they know it takes that to a response.
Poor practice indee, I know of a woman running supported lodgings in Gloucester who was very frustrated that the only way should could access services for her sometimes seriously ill clients outside normal office hours was by enlisting the help of the police. She was an expert at working any system: fortunately her police contacts understood the problem and were very helpful because they knew that she would not be bothering them until she’d exhausted the correct channels. The current actual practises rather than the theory need to be scrutinised and improved – this blog is very helpful in that it details what is supposed to be practice and the many failures out there in the real world. No recriminations of scapegoating here – this blogprovides a very factual statement of what is happening and bound to worsen as poverty increases while police, social services and mental health budgets are being cut
Delays in assessment can have serious consequences. A recent case in Leeds :
http://bit.ly/zDnitK
I thought the hospital came under the term ‘place of safety’ and as such you cannot use s.136 unless the person is outside and as such not in a place of safety.
That’s not correct, I’m afraid. The law on s136 makes no reference to whether the person is already in a place of safety and as most areas’ A&E departments are not established to act a place of safety there’s nothing that prevents the use of s136 in A&E as long as all the criteria are met.
Just like there is nothing that prevents its use in a police station front office and removal to the local psych place of safety or into the cells if appropriate.
The bigger question in this anecdote is whether it was ‘necessary’ to use s136 – and it wasn’t.