metpolice

Too Long and Too Complex

The Metropolitan Police have set up an independent commission to examine issues around policing contact with people in mental health crisis.  The only police representation on the group will be Chief Constable Simon Cole, the ACPO Lead of Mental Health and Chief of Leicestershire.  Otherwise, there will be various mental health professionals.  There has been some disquieted reaction by organisations such as Inquest and Black Mental Health UK and today the Deputy Commissioner, of the Metropolitan Police, Craig Mackay, appeared before the London Assembly with regard to this review. 

This post focusses upon a remark by the Deputy Commissioner, the second most senior police officer in the Metropolitan Police:

“The standard operating procedure is over 100 pages long and individual officers don’t have much chance of being able to understand the complexity of it.  This is why we wanted an independent commission to do a root and branch review.”

SIMPLIFY!

It got me thinking about this whole blog – now approaching 200 articles and 160,000 words, which is roughly two PhD theses.  On just s136 Mental Health Act alone, there are 23 articles covering various issues.  They were deliberately written as explanatory pieces, not operational guidelines to be accessed in a crisis.  Such posts came later in the form of the Quick Guides, in order to simplify, simplify, simplify.

We can see from just overlooking s136 how complex a subject it can be.  It is often said when I’ve done training or inputs on this stuff, that it is complex and this is right.  We are talking about police responses to legally demanding situations, involving medical complexity, often in an emergency.  Therefore we all know, that to give any operative a chance, we have to simplfy, simplify, simplify.

We should also bear in mind the frequency with which operational officers deal with different mental health jobs.  In my force there are around 8,000 officers and we detain around 1,000 people a year under s136 MHA.  Bearing in mind that the number of officers who are likely to come across a scenario where s136 would be exercised is approximately 4,000 is still means the hypothetical ‘average’ cop doing this stuff once every Olympics.  How many MH assessments in a private dwelling – well my borough does about 1 MHA assessment a day and far fewer than half of those involve the police.  So there are about 125 cops likely to attend and these jobs happen about once or twice a week – could you remember the legal complexities of such things – bearing in mind that AMHPs can’t always agree – if you’re doing it about once every two years?!  Simplfy, simplify, simplify.

How easy is it to recall even simple operating models on MH jobs, if you’re doing it once in a comparative blue moon? … and let’s be frank: it is made more complex than it needs to be by the NHS -

  • Some will deny officers access to a PoS for children – others won’t.
  • Some operate a zero tolerance to drugs and alcohol – others don’t.
  • Some will deny anyone who is resistant – others won’t.
  • Some will demand officers stay after arrival, even if the patient is calm – others won’t.
  • Some will say ‘excited delirium’ is a real, life-threatening medical emergency – others will say it’s been made up by the police to justify killing people through the excessive use of force!

These are just some of the things I could list … so how do we make it simple for cops?

This is where the Quick Guide series of posts comes in: written to make operational reference tools from the larger, substantive posts which tries to explain backgrounds, problems, solutions and provides links to case-law, guidance and other relevant news articles or material.  The Quick Guides are more about “Consider this; bear these things in mind; take a good faith decision according to what you know and act in the person’s best interests.  Now: crack on.”

SIMPLICITY

But actually, s136 and Places of Safety is EASY.  All of the above complexity and debates about exclusion criteria can be summarised into one brief model and this model can be applied to EVERY NHS AREA, whether or not they provide their Place of Safety services in accordance with guidelines.

This is crucial >> if they DO provide PoS services properly, it will work well and we’ll all be happy.  If they do NOT, then application of the model will make the NHS part of the decision-making around where someone ends up and they will be professionally and legally obliged to account for this in the event of untoward events:

  • Arrest – under s136 MHA
  • Ambulance – called every time
  • Assess – the clinical needs of the patient
  • RED FLAGS to A&E
  • No RED FLAGS to the psychiatric place of safety – it is for them to determine how much alcohol or resistance is too much, not the police.
  • Police station as a last resort – if you can’t improvise around it. << Yes, improvising solutions is legal as long as it is assessed carefully.

It is therefore my view that police officers can and should apply this model, irrespective of their local arrangements because to do so would always be to act legally, against laws, codes of practice, guidelines and to act morally correctly.

Other debates about whether or not the police service could / should be involved in issues which are principally health and / or social care matters can be determined with reference to another, even simpler model – Are there any “RAVE Risks“?

  • Resistance
  • Aggression
  • Violence
  • Escape

Where there is “Resistance or Aggression”, we’re helping the NHS achieve their objectives to prevent crime and a breach of the peace, where there is “Violence and Escape” risks, we’re leading the operation with NHS support.  This stuff isn’t actually hard.

These things can combine, for example if Mental Health Act assessments on private premises:

  • Do we get involved in such assessments? >> Only if there are RAVE Risks or a s135(1) warrant.
  • Having got involved to ensure safety against such risks, someone is detained under a s135(1) warrant for a place of safety?  Ambulance – Assess for RED FLAGS and then one of three things … etc..
  • Having got involved in MHA assessment without a warrant and someone is then ‘sectioned’ – do we convey? >> We’ll support the NHS in doing it if the RAVE Risks continue to be relevant.

Of course, senior officers need to accept that this is complex business and the breadth of incidents which fall under the “policing / mental health” banner is very wide.  Professor Jill PEAY commented in her book “Mental Health and Crime” (2010) that work at the interface of mental health and criminal justice is the most complex that either set of professionals will ever undertake.

I would encourage everyone connected to this work or this debate to read Professor PEAY’s book if they get the opportunity.

I would respectfully suggest senior officers also need to reflect upon whether there force has a co-ordinated strategy around simplfying and improving policing responses in partnership, along the lines envisaged by the ACPO / NPIA Guidelines on Police Responses to Mental Ill-Health and Learning Disability (2010).

COMPLEXITY

Of course, one of the reasons that police services find that mental health is made complicated, is that we deliver far less training on mental health issues in relation to the proportion of our work that this business represents, than in other areas of policing.  That this remains the case is surprising for a few different reasons.  If for no other reason, we know that many very high-profile tragedies in policing have involved issues around mental health matters:  these have included the deaths of patients during police responses to mental health emergencies as well as the deaths of members of the public and of police officers from offenders who have mental health problems and relevant risk histories.

I remain convinced that our society’s response to the diversion of offenders (whatever that means) can unwittingly ‘stack the deck’ towards the building of hidden risks because we still have not defined what ‘diversion’ is and what we’re trying to achieve.  We still see official reports talking about “appropriate diversion” without defining it.  This is a problem.

It is also true, that forces which maintain partnership arrangements with several mental health trusts and local authorities often acquiesce to often to individual mental health trusts preferred arrangements which are overly localised.  The law on s135(1) is the same in Bristol and Birmingham; the law on s136 is the same in Newcastle and London.  So why the differences?  I don’t mean differences in local arrangements, I mean why do trusts maintain differences which imply differences in law?  It self-evidently obvious that the law is the same.

So we need models that take this business and simplify, simplify, simplify.  This blog contains many … we can make more.  The Quick Guide Series of posts turns most MH issues into a series of bullet points in under 300 words. If I can work out how to fund it, we need to develop a SmartPhone app with this material on it – meanwhile, why not save blog pages to your homepage?  I’ve got stories now of cops waving iPhones at NHS staff to “oil the wheels of partnership!”

This stuff is there to be used / adapted / improved upon.  Fill your boots.

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5 thoughts on “Too Long and Too Complex

  1. Good post as usual and not much here that i could disagree with. However the problem is how you can enforce a uniform policy no matter how good it maybe, on the hundreds of separate NHS Trusts and Local Authorities, which seem from the frontline to be looking at how they can foist responsibility on to someone else, mainly as they focus on short term cuts/ savings rather than longterm projects which could bring savings to all and improve outcomes for the people who matter whatever you call them i.e.service users, patients, clients.

    Oh and by the way it’s possible to think that Excited Delirium is a possible condition that has not yet been scientifically proven and not an excuse used by the police when things have gone sadly wrong.

    1. I’m not advocating the foisting of a specific policy uon all trusts, bearing in mind different demographics, geographies, etc., but what insistent is foisted upon them is the law of the land – as you and I have discussed before. And this extends to the excited delirium debate and things that sound and look like it.

      If failure to remove someone to emergency medical care will be wilful neglect by officers – regardless of any ongoing aetiological debates – then that also is an aspect of law. Coroner’s have ruled on this – that is a form of law. So what I’m advocating is the rule of law. Nothing more. Laws can be made, developed, etc., by the courts or by Parliament legislating after appropriate drafting and consultation processes. That is what we must all assume has happened so far and we should keep it in check in light of developments and expansions of knowledge.

      But, that many things are legally black and white is well established – what I cannot stand being foisted upon the police is suggestions of legal shades of grey where no such shades exist, bar two. Does that make sense?!

      1. It does make sense, what i want to see in my area and across the country is someone with the will and power to ensure that the law is followed in policy’s and local protocols at implementation, rather than individual workers from any organisation having to point it out after the fact.

  2. Another blog that is clear and informative as ever. Non-NHS or non-emergency service staff may wonder why it even needs to be written – the rest of us are grateful that it is. “InspectorBrown” or “MentalHealthCop” are terms that have become shorthand among enlightened MH and emergency service staff often used in the context of needing to employ commonsense, properly apply the law, treating people with dignity and respect, overcoming interagency disputes around acute MH situations,etc. In my experience, informed frontline staff are pleased to have your resources available to back them up when challenging “local” policies or their application by less-informed staff or management. I wholeheartedly agree that there should be national policies with local implementation guidelines and that these should not be difficult to devise.

    All that said, as the previous response points out, local services (MH, Ambulance, A & E, GP, general medical health) are often inappropriately and possibly illegally going to default gate-keeping strategies for any number of reasons, not the least of which is cost. My fear is that increasing privatisation of some or all of NHS services, including MH, the negotiation of “partnership” policies with ever increasing numbers of agencies will create even more obstacles to doing the right thing in the right way in acute and complex circumstances, e.g. managing risk, balancing risk and clinical need, sharing appropriate information, .. wasting also diminishing police resources?

    The really good news, as you have shared, is the rapidly decreasing numbers of people in the West Midlands being detained in police cells unders136. What a shame that it seems to be as a result of dedicated and persistent PCs and Custody Sergeants rather than MH professionals and organisations. Nonetheless, thanks and congratulations to you and WMP personnel in achieving this.

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