This is a picture of my son playing about with bits of my uniform: potentially, he’s the best human being ever to live, just like everybody else’s kids. Definitely, the best thing about my life on earth – getting to be his Dad.
I want to tell you a story about someone else’s child – because I admit that it got me quite upset bordering on angry and I often think about children’s mental health issues through the prism of being a dad. Wondering what I would do, how I would feel.
I went to work a while ago to find an email from an Acting Inspector, in the north of England, who had queries. His officers had been to a domestic address to support social workers who were present with a child / adolescent mental health nurse as part of routine community care and the child (10yrs old) had become aggressive. They had suggested the child with autism needed a mental health act assessment and called the police. There entailed a story that had me sitting staring into the mid-distance wondering what on earth we think we’re doing.
The police were asked to remove the child to A&E. Of course, there is no power whatsoever to do this as the child is in their private dwelling so s136 MHA cannot be used and no-one has sectioned the child. Parliament’s intentions around this scenario are that a s12 DR and an AMHP attend the home address and use s4 MHA for emergency assessment / admission. I suspect a reason why this was not done which I’ll leave until further into the story. So the social worker and CPN set about ‘persuading’ the parents of the child that he needed to go to hospital and they should take him to A&E. Quite why this is right, I’m not sure – the child was not physically injured or suffering from any obvious RED FLAG, they were ‘just’ perceived to be in need of MHA assessment. I can imagine if the child had been removed to A&E as a place of safety by the police, they would have been denied access to it. This has happened to countless cops over the years.
Nevertheless, the officers at the scene were implored to accompany them on the journey because of the violence exhibited and they agreed to do so. This is the first ‘error’ in my view, where they offered their arm to the mangle and started to get sucked into a nightmare. As I read the email telling the story, I got to this point and thought a certain thought, which I’m still keeping to myself until later.
Upon arrival at a busy A&E, the child was triaged and not turned away – social workers and psych nurses can get non injured MH patients into A&E, it’s only the police that struggle – and he was put into a normal cubicle that had been cleared of all equipment, including the bed. They were supplied with a chair and various ‘fitness mats’ for the floor. The A&E staff insisted that the police to stay because they had been told by the social worker of the previous violence at the home address. Standard warnings to the officers about the A&E not being able to detain or restrain were administered and they agreed.
We can all understand why they did: child in A&E who has been violent, who is upset and volatile and may run off, of course the police should stay!? That all having been said, we’re only in A&E in the first place because we haven’t put a legal framework around the child at their address and we’ve removed them to A&E despite them not suffering from any condition which would prompt removal there if they had been arrested under s136. I wonder why?!
A&E asked the s136 question at some stage, assuming that police plus volatile child with mental health problem and when they learned that the child was not so detained, they requested it. Officers had to explain that the legal criteria were not met, because the child had not been found in a place to which the public have access so an arrest now would still be illegal.
It was over twelve hours after initial attendance and a change of officers because of shift changeover before the AMHP and a CAMHS psychiatrist got there. The child was still volatile, despite his mother’s reassurances and a good manner by the officers. A&E were expressing frustration at everyone, some 8hrs after expiry of their 4hr target, that we still were relatively nowhere in bringing this process to an end. Assessment of the child led to a conclusion that they needed admission to hospital, detained under s2 of the Mental Health Act because they were a risk to themselves or others, volatile and unwilling to undertake voluntary admission. And here is the kernel of the story: where do we find a CAMHS bed? – nowhere. There are none.
BINGO! – this was coming from the minute we attended the house. We think the child needs admission; we know we haven’t got access to a CAMHS bed and it will be difficult (it usually is); we got to do something, this is ‘something’, so we’ll do this.
As the AMHP and the psychiatrist waved goodbye to the police and A&E staff saying, “We’ll identify a bed and get back to you” they left these emergency services with a nightmare. This child, in need of compulsory admission under the Mental Health Act, is in an A&E department with one of their parents, two cops and some A&E staff without a condition of legal detention around them as they have not been detained s136 and are not (yet) detained under s2 because no application has been completed and no other legal ground for detention exists. Personally, I’d have taken my son home at that stage as both I and he were legally free to leave. However, it had been implied that the boy could not leave because he’d been ‘sectioned’ … which of course he hadn’t, because no application had been made. (Article 5 ECHR anyone – detained by a process not prescribed by law?)
This saga continued with various protests and escalation of concerns around bed access. Vicious rumour emerged at one stage of a CAMHS bed 100 miles away … but that faded amidst the AMHP not being able to square an out of area admission. Overnight, the child slept well enough with two cops still stood around them. Doing what, I’m not quite sure … it was insisted by the A&E nurses involved that only the police had any power to restrain the boy. Quite why they’d think this and tell the cops what legal authority they had I’m not sure – I don’t tell nurses when / how to provide medical care? <<< This could be me being sensitive about the appalling position everyone was left in. Reality is, no power whatsoever to restrain the child, unless they offend or start actively attempting to serious hurt themselves or others. Should they try to leave, s136 is still highly questionable as the whole story began with removing the child from a dwelling … the passage of many hours doesn’t change the fact that the police did not find him “in a place to which the public have access.”
The officers at one stage were so frustrated – the inspector acknowledges that he and his officers were starting to get very grumpy indeed – they decided to try to improvise a better, temporary solution. They established of themselves that the local s136 place of safety was empty. They tried to encourage the AMHP to have the child removed from A&E, admission made to that PoS hospital and the boy temporarily held there where he could at least be in a more secure location, with better facilities for him in terms of bed, shower, toilet, etc.. Denied. “That’s not what it’s for.” But what do we think A&E is for? Surely not for providing a poor quality sleeping area for held-but-not-held children who need MHA admission so they can sleep on a floor and struggle to get drinks, toilet access and have no access to proper cleaning facilities.
Read that paragraph again: we will continue to ‘hold’ a autistic child in an A&E without a clear legal authority to do so; where access to basic facilities is made complicated by a department full of drunks, road traffic collision victims and other members of the public with injuries whilst a mental health facility with CAMHS staff just a few miles away has a Place of Safety (the clue is in the name) which is currently empty and which is not used very often. I know it’s not in the textbook or the guidelines, but is it legal? Which is better for the child? Is it even in doubt?
Thirty Two Hours
Eventually, the child was admitted to children’s ward in a general hospital with two-to-one nursing and the police were ‘allowed’ by the NHS to leave (thanks). Illegal detention of the child over, he was seen by a CAMHS psychiatric consultant on the first morning after admission. Released from detention under the MHA after about 9 hours.
Read that paragraph again! After nearly a day and half of effort, resources and frustration he was released after fewer than nine hours. Great.
I’ve asked this before, but I’ll do so again – if any person who has been volatile and aggressive is assessed as being in need of admission to hospital and is a vulnerable condition of non-legal detention in an A&E department with two cops who cannot legally prevent them from leaving unless they commit a criminal offence – of what application to this scenario is s13 MHA, s140 MHA and the MHAC (now CQC) guidance. If these things are utterly meaningless, can we please see the guidance retracted and the law changed. And if they mean anything at all, can we please see the organisations who administer MHA admissions at least knowing about it and acknowledging it, potentially with regulators and inspectors doing their bit.
Meanwhile, the police officers involved are raising formal representations. It is not legally correct to say “If there are no beds, there are no beds.” It is self-evidentally obvious and yet legally irrelevant all at the same time. Whenever I read s13 MHA about the duties of the AMHP to make applications, I note it does not contain anything about beds, hospitals, willingness, etc.; we have legal duties here. It’s almost like saying “Teh cells are full, so we can’t arrest this bloke despite the fact he’s stabbed you.” I know it’s better to ensure a smooth run following application for admission and that the Code talks about this in Chapter 4, but if a smooth run is not possible and the only other option is a situation such as this and it’s glorious illegality, should we not try the bumpy route? As long as we get there in the end, with the patient’s interests first?
I couldn’t help but think: do this to my son, and I’ll be speaking to a solicitor in the morning.
The Mental Health Cop blog won
- the Mind 2012 Digital Media Award, in memory and in honour of Mark Hanson.
The Awards celebrate the “best portrayals of and reporting on mental health in the media.”
- a World of Mentalists 2012 #TWIMAward for the best in mental health blogs.
It was described as “a unique mix of professional resource, help for people using services and polemic.”