Alan Bailey from Greater Manchester suffered from Alzheimer’s and was sectioned under the Mental Health Act in March 2011. He fell whilst in hospital in April 2011 and subsequently died – a true tragedy for him and for his family.
The manner of his being ‘sectioned’ under the Mental Health Act has featured in the Inquest into his death, which recorded a verdict of accidental death following his unconnected fall. The Coroner has criticised a decision by a police officer to handcuff him whilst being moved to the ambulance that would convey him to hospital. The officer claimed that he was attempting to undo the straps on the paramedic chair that was being used and that he had become resistant and agitated. The force subsequently offered evidence that the risks of handcuffing (and presumably the implications for dignity) were weighted against the alternatives, which broadly would have consisted of manually handling him.
This all re-visits the debate about the use of force on vulnerable people after the Coroner is quoted as saying, “This is totally ridiculous officer” and saying that the handcuffing decision “beggars belief”.
I’ve posted about this in the last few months and won’t repeat all of that again. Suffice to say, that I repeat my point about mental health professionals often stating that elderly adults are capable of inflicting serious injuries when they lash out or resist being compulsorily detained under the Act whilst suffering organic mental disorders like Alzheimer’s. I know of older adult professionals who will say they have lifelong visible injuries and the officer’s job was to prevent such things.
I will restate the bigger questions this further example raises – but they are generic observations, not specific to Mr Bailey’s case:
- Patients who are resistant, aggressive, violent or pose risks of escape (RAVE risks):
- If it is decided that alternatives to compulsory admission cannot be achieved and / or are less safe than pursuing (coercive) admission; if attempts to achieve admission without use of force have been tried and have failed, who should be deployed to use force to reinforce that legal decision to ‘section’?
- Some thoughts:
- Is it always a police role and if so, is police training fit for such purposes?
- If it should not always be a police role, who in the NHS is going to do it and when is the line crossed where it is argued it has become a police role?
- Regardless of who does it, how does one move an octogenarian from “here” to “there” when they are perceived as posing a ‘RAVE risk’?
- If the answer to the previous question should not include the word “handcuffs” or “proactive blanketting”, how does one move someone who does not want to be moved?
- Are the alternatives to handcuffing safer? – these would include things like doing nothing at all, using manual handling to control arms, or legs?
- What are the potential medical implications on the elderly of being manually restrained by a police officer?
- Are NHS personal safety techniques for restraint more appropriate?
- If so – why don’t the NHS deploy such staff to MHA assessments in support of AMHP?
- Some areas never do this and refuse to consider it, because they argue that force in the community is a police responsibility.
- They argue this, despite the fact that no such thing is written down in UK law.
- Do we expect police officers to keep filling gaps in NHS services, using their training as it is outlined to them by the Home Office and then to face criticism for doing so in courts?
I fully understand, frankly I support, the concern of Mr Bailey’s daughter, Sandra Coombes. She said, “I was particularly upset to hear the manner in which a frail, elderly man was handcuffed and held by straps to restrain him in an ambulance to hospital … not only the excessive use of force, but to send a policeman to accompany him was unbelievable.”
There we have it, and from the families of vulnerable patients – they would prefer the police not to be involved in the detention and admission of vulnerable people like Mr Bailey.
So how are we going to do it?! - especially against a backdrop of knowing that such escorting of patients is being looked at politically?
UPDATE >>> Since the original publication of the Manchester Evening News article, this has been picked up by the Daily Mail, also. Sir Peter Fahy has replied to the criticism of HM Coroner for Stockport, saying “This is a medical issue and not a police issue. Medical staff receive extensive training to deal with patients in this sort of situation and to recognise warning signs. There is no way we can replicate this level of training. Basically I do not want to have police officers trying to restrain elderly people in medical situations. We are presently negotiating a new protocol with the NHS on police being called to deal with mental health issues.”
I will be going to Greater Manchester Police on Monday to talk to them and their NHS colleagues about exactly this issue.