This is a guest post from a police inspector in England. You can follow blogger and tweeter NathanConstable and he has been kind enough to give feedback that he’s putting this blog to good use. Here are some of his observations from the frontline of UK policing – right where the rub is:
I have finally reached the position where I just want to hold my head in my hands and weep. Several months ago I had to deal with incidents involving people with apparent mental health problems which have taxed my brain to exhaustion and where the outcome of each case has made me despair.
Each of these has taken significant time, thought and resources to try and manage and in each case it has fallen to the police to effectively shoulder responsibilities that should be spread or best burdened elsewhere.
REMAND FOR FORENSIC ASSESSMENT – ALMOST
The first case involved a man who had been making disturbing comments about wishing to undertake terrorist acts. It had also been reported that he had assaulted another family member. The family rang the police not knowing what else to do. The first call to the crisis team was met with resistance. They had dealt with this man before and practically told us that if we did arrest him they wouldn’t come out and assess him because the outcome was that he wouldn’t be sectioned. They were asked how they could possibly pre-determine the end result in that way and it took a couple of calls to persuade them otherwise.
We did arrest the man for the assault and had him initially checked by the FME who was sufficiently concerned about how he was presenting to suggest he be fully assessed under the Mental Health Act. The same people who had initially told us that they wouldn’t section him then came out and assessed him. Having done so they then decided that he was displaying disturbing behaviour and appeared mentally ill however, they chose not to section him! Apparently he was too dangerous for the local psychiatric hospital and needed a full forensic psychiatric assessment. According to them, the only way this could be achieved was if he was presented before the court for the criminal offence and then ordered to hospital by the court. They would be able to send him to a more secure and appropriate hospital. (Note from MHC : this what I call the “Criminalisation Contingency“.)
Call me a cynic but this sounded like nonsense to me: either he was ill or he wasn’t. Surely the easiest option was to simply section him and get him to where he needed to be? Surely the system allows for this type of situation?! Even his solicitor was concerned for his mental health but all protests fell on deaf ears. The assessment team wrote a lengthy letter to the Magistrates which was to accompany the file and would outline what action they needed to take at Court. Clearly they have no experience of dealing with the criminal justice system. The man was then interviewed and charged. He was apparently well enough for this but still needed to be detained for a forensic examination. I couldn’t work that out either.
Officers accompanied the man to court the next morning armed with the letter which was presented to the prosecution solicitors. The assessment team were utterly confident that the Magistrates would do as they suggested. Predictably, they did not. The man had admitted the assault and was therefore dealt with there and then and given a conditional discharge. He walked free from the court and received absolutely no treatment and no forensic psychiatric assessment despite being in need of it and “too dangerous” to be sectioned under s2 or s3. Tell me again why you can’t be sectioned under s2 or s3 to a medium secure unit? (MHC: you can be.)
THREATS TO KILL – BUT WHO?
The second incident involved a call from a concerned Housing Officer who had spoken with one of her tenants by telephone. During the course of this call he had made a number of alarming comments about feeling the need to kill people and started to praise a number of high-profile murderers. Naturally, she felt the need to call the police.
I contacted the Crisis Team and discovered that they had a history with this gentleman. He is being treated for a personality disorder and has a long record of not engaging with mental health care or self-discharging from hospital. It would seem that he made similar such comments during a meeting with mental health workers about a month ago and this was all recorded on file. At no point had anyone referred him to MAPPA. It also transpired that the Housing Officer had called the Crisis Team that afternoon and expressed her concerns to them. All that had happened was that a note was put on the file. If I hadn’t made contact it would have just sat there.
I asked the Crisis Team to contact the Emergency Duty Team. I felt if they went in sideways as fellow mental health practitioners it was more likely to get a positive result. I believed that the intervention needed to be clinical rather than criminal. Guess what? … EDT refused to assist. I had suggested they obtain a section 135 warrant and we, the police, could meet them at the address to assist if needed. No – apparently they couldn’t get a 135 warrant because no-one had tried to get the man to voluntarily submit to treatment.
This was utter nonsense and I knew it. They even kindly suggested that police attended and arrested the man. When I asked the Crisis Team operative “Arrest him for what?” – I was told “the threats.”
There followed, after a brief period of choking, a lengthy explanation into the definition of threats to kill. There was no offence here: the threats were general and non-specific. The danger was to the public at large and quite vague but police had no power to pre-emptively arrest for that. Again I stated that the need for intervention was clinical not criminal. The way to neutralise or properly assess the threat was to assess HIM.
A different Crisis Team operator called me back a couple of hours later. They weren’t going to come out tonight. Instead they were going to get the morning staff to try to contact the man by phone. I had no choice other than to go along with this. They did try to contact him but couldn’t get through. They made an assessment based on what they already knew about him and concluded that he had made this kind of threat before and was therefore no risk. When asked to provide a written rationale for us they refused quoting data protection. He is still unseen.
Believe it or not these examples have been cut back and edited. There are other factors involved in each of these scenarios which make them all worse and more complicated than I have presented them. A few things have struck me:
- The complete lack of knowledge of legislation displayed by some MH professionals
- The expectation that the police will just arrest, irrespective of whether there is a power under which we can
- The complete unwillingness for them to bend from rigid protocols to work with what is actually happening
- The almost total reluctance to take ownership or take charge
- The fact that they seem to think that I am stupid.
- That there is a prevailing attitude that they can refuse to help, put the phone down and, as far as they are concerned, the problem has gone. Leaving the police to reach for the rule books wondering how they can bend legislation to make things work and provide some duty of care.
Each of these people needs MEDICAL intervention. Police cells are not the place to have detained them – they need help. Instead we have met resistance, inaccurate information, differing medical opinion, lack of co-operation and a “not my problem” attitude.
Each of these people presents a threat to themselves or others – in every case the mental health side of business has effectively turned them away, either citing process or “lack of bed space” as the reason. They have not helped one little bit.
It really shouldn’t be this difficult – but it clearly and evidently is!
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.”