WYE3

999 What’s Your Emergency?

There was quite a debate about the above programme when it was aired on Channel Four last night – you can watch it for a limited period of time on the Channel Four ‘catch up’ website.  Last night, it all focussed upon people’s “state of mind”, ie mental health issues and it was all set in Blackpool, covered by Lancashire Police and the North West Ambulance Service.

Using the hashtag #999whatsyouremergency there were various comments flying around the Twittersphere.  Some warmed my heart – a combination of people expressing sympathy for some people who came to the attention of the 999 services in a variety of formats and some who quite obviously did not believe the kinds of mental health demands that hit the ambulance and police services on a daily basis.

I was amazed that at no stage in the programme did the editors attempt to signpost people in crisis to support, to prevent things getting to the stages shown in the programme.  Any number of organisations could have been mentioned.

I had a few observations:

  • Listening to call handlers using terms like “fruitloop” wasn’t very helpful for me – unprofessional.
  • I could do without hearing that someone who has taken an overdose has “been stupid”.  Do people really overdose “for a laugh”?!!
  • I could do without hearing “These people” to refer to everyone (in the country or the world?!) with mental health problems.
  • There also was an underlying assumption that many demands were not really police business and if only the police and the paramedics didn’t have to respond to mop up after other, often unmentioned agencies who were absent …

I’ve written before on this blog, that mental ill-health incidents are core police business – where people’s safety is at risk or where crimes are being committed.  Notwithstanding that one guy in the programme was mentally ill, the fact that he was seen with two knives means it is perfectly proper to seek police involvement – possession of knives is a criminal offence, even if you are possessing them in order to harm just yourself because of a mental illness.  It doesn’t mean the police will automatically prosecute and criminalise him, but it does mean we have a role to “make safe and signpost”, if nothing else.

Policing is only necessary at all because some people don’t self-police.  The existence of an alcohol industry and many of our fellow subjects’ inability to drink and behave responsibly forces untold costs upon the public purse and causes mass demand for policing and emergency medical services.  We’re not banning pubs or alcohol, though, are we?  We’re not talking in terms of locking up drunken offenders for inordinate periods to ensure they are not free to drink again next weekend.  Yet more harm and cost is caused to our society from drunk young men and, increasingly, women.

Why not just lock up all of “these people”? – is it because we, ourselves, along with most people are or have been in this group and we know general labels around alcohol related violence and disorder do not apply to us?!  << Stigma in operation.  We do actually know that the relationship between alcohol and crime is far more direct than the links between mental illness and crime and that the costs – measured in lives lost and money – are far greater.

MENTAL HEALTH CRISIS IN PRIVATE PREMISES

I also want to focus on something specific: watch the programme from around 27 minutes – they are following a particular job from 999 call to police attendance where a man rings up to say he’s taken a “massive overdose”.  After officers force entry to the premises they find him in a private dwelling committing no offence, having potentially taken over 40 tablets.  I’m not sure whether these tablets or the quantities involved were potentially damaging but the paramedic immediately says, “We’re going to take you to hospital”.  The man refuses to go.

Remember the law in this situation?

  • This man is presumed to have the capacity to take his own decisions, including about medical care.
  • The taking of an unwise decision does not, of itself, render him without this capacity.
  • The police have NO powers in a private dwelling to act under mental health law unless there is an attempted or actual criminal offence – there isn’t – OR unless they anticipate a breach of the peace.
  • (Remember: a breach of the peace is an imminent risk of violence following the judgement of R v HOWELL [1981].)
  • Did we anticipate an imminent risk of violence when he’s slumped on the sofa declining treatment ?
  • I’m not sure I did - not for a minute.

In these circumstances our colleagues in green should have been invited to undertake a mental capacity assessment and start making decisions.  Remember - he is presumed to have capacity unless demonstrated otherwise in an appropriate assessment.  As paramedics are there, on hand, it is their responsibility to undertake this.  Should they feel that he lacks capacity, given that the ingestion of tablets that could have profound health consequences, it could be argued he can be removed under the MCA to hospital but only where this is the least restrictive option, to the medical threats faced.  This lack of capacity would need to be demonstrated.

(Incidentally, once arrested, did you notice the ambulance service trying to back off from this non-criminal healthcare situation at a rate of knots?!  Quite rightly, a paramedic was persuaded into the police vehicle to accompany the officers and the patient but in reality, he should have been primarily in the care of the paramedics being accompanied by the police, if need be.)

If this whole blog is about anything at all, it is about educating officers who attended these incidents not to put their “arm in the mangle“.  Attend to ensure protection of life, by all means.  Force entry, by all means.  Once you’ve established that you are in his house with paramedics and he is alive and not committing an offence, we should then look to assist our ambulance colleagues to take over the lead decisions.

We need officers who can remind them that the clinical decisions around this man’s capacity to take drugs and kill or harm himself is theirs.  This is not my personal view, this is the law of the land.  The decision about what to do with him, if they feel they cannot leave him there because of any lack of capacity is theirs and we can help them, if they need it.

Given that upon arrival in Accident & Emergency, he is being uncooperative with nursing staff attempting to triage him but not actively trying to leave, I’m wondering why we are devoting a police officer to sitting with him?  For those who would argue that we might as well stay because otherwise we’ll have a high risk missing person I would ask this: following this logic, why do we not just put a police officer in every single psychiatric hospital in the country to stop missing persons, otherwise we will end up with a high risk missing person?

The police have finite resources and they must be targeted against public priorities.  What I saw in the second half of this programme was the police failing to distinguish between the necessary initial response we MUST provide, the support to our ambulance colleagues that we SHOULD provide and the ongoing healthcare issues which then become NHS responsibilities.  Of course, because the man had been arrested for a breach of the peace, we got our arm caught in the mangle, right up to the shoulder and ended up “policing a patient” … again.

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21 thoughts on “999 What’s Your Emergency?

  1. One of the issues for me is that the time and outcomes we spend/provide dealing with MH issues are not measured, and therefore not regarded as important by senior officers.

    You cannot reach your detection target when you are sitting with an MH patient for hours. You get in trouble for not reaching your detection target. Thus, PC’s who don’t want to get in trouble, and remember, under Winsor II they can make you redundant for not ‘performing’, will never like being involved in issues which do not provide them with a performance outcome they can show their bosses.

    This is clearly wrong, and it stems from Theresa May saying over and over that our mission is ‘to cut crime, nothing more’.

    Most PCC candidates are also obsessed with cutting crime. The culture then becomes one of ignoring any other kind of task. Sad, sad times for a service now run by accountants.

  2. Very interesting post Boss. As always, your professional knowledge and analysis of the situation is impressive. However, I have a question veiled in the cloak of “playing devils advocate” :

    Let`s suppose that the officers arrive, and request that the subject attends hospital. The suspect refuses. I absolutely agree that there is no breach of the peace, so as you suggest the officers request the ambulance service conduct an assessment under the Mental Capacity Act.

    The Paramedics undertake the assessment – and state the subject HAS CAPACITY.

    What then ? Or rather, what practically then ?

  3. Interesting blog as always mhc! When I saw the arrest for breach of the peace I was somewhat surprised. Not sure where any violence would have come from… Is arresting for a breach of the peace following refusal for medical treatment a policy decision?

    In my opinion, any arrest needs to be proportionate, lawful, accountable and necessary. I am struggling to see where the arrest was lawful or necessary in that instance. After he had been thrown around and the cops restrained him, he seemed fairly passive. I thoroughly agree to your points as regards mental capacity – I think this is an area of law which seems to be oftentimes shyed away from.

  4. I agree with some of your points.we would normally take the patient accompanied by a police officer if we deemed it necessary through threat of violence. I have never ridden in the police waggon?!
    I thought the entry into the home of chap overdosing was very gungho, also there was no obvious capacity assessment. Playing for the cameras? Perhaps. Or, sensational editing.
    It did portray the type of jobs we get though.

  5. well written and insightful blog, yet again!

    I’m glad I’m not the only one shocked by this programme. according to other tweeters I ‘misinterpreted’ the whole thing. and then received a torrent of abuse as did a few of my followers.

    I felt so strongly about this programme that it actually prompted my to complain. something I’ve never felt the need to do before.

    I agree, at no point, not even after the show, did the makers of the programme or channel4 offer any information or support for people who had viewed it.

    I also felt that the programme itself possibly breached broadcasting guidelines in regard to suicide.

    I feel that the response on Twitter leaves a lot to be desired about public attitude and understanding of MI and did little to challenge stigma worth the attitudes of the ‘Professionals’ shown.

    I have spoken to many people since the show aired and they have all said that they would not consider contacting the emergency services in a MH crisis situation. myself included.

    I hope that any other complaints made about the show allow channel4 to realise that it wasnt a well thought out show, and that it has affected many people. and then maybe the next time they consider something like this, they make it more effective and maintain a view of helping people rather than a ratings grabbing poor portrayal of people and MH problems. maybe even showing the people with MI who manage to lead their lives without to many crisis situations and advising others what to do to avoid a situation where they have to rely on a service like Blackpool appears to have.

    I’m trying to hold onto hope that West Midlands emergency services are nothing like that.

  6. I’m reluctant to come to any conclusions after watching highly edited extracts from a television show whose main aim is to entertain. That aside, I thought it was good and … entertaining, it certainly made me glad I no-longer police in the UK.

    You ask, ‘ Do people really overdose “for a laugh”?!!’ Had you have seen the first episode, you would have seen the youngster who overdosed on valium. When asked why he’d taken this drastic step, he replied, ‘Somefing to do, innit?’ A sentiment that many of my current customers would identify with.

  7. I have to say that yes, some people do OD for a laugh. Perhaps not 40 asprin, but a mix or pills and alcohol, yes, absolutely. Happens a lot. We do deal with people that stupid and that in to drugs and a heightened ‘high’. I also agree that a police cell is NOT the place for someone with MH issues. Nor do i think putting a police officer (usually two where I work) with someone in A&E is a very bad use of their time. Especially when we think how often and how regular some people ‘claim’ to have ODd because of other issues – often to get away from a boring cell and kill time. Whilst I don’t think it showed the police in a good light in MH care regards, why should it? They are cops, they are not trained in dealing with MH, so what are we expecting? They are providing the level of care they can and even, in some cases shown, going outside the law (the arrest for BOP) to ensure that care is sought. I think actually they showed that we aren’t the right people to be dealing get with it, but we are all that there seems to be. I think the NHS need to step up and remember that this is their remit. Where I work there is one room we can take people for MH assessments. That’s one person a day. Everyone else gets a cell. That’s just not right.

  8. Very interesting points well raised, but I feel that some people are missing the point. The programme very clearly showed that there is not enough of the right kind of help for people suffering from MH, and the emergency services are struggling every day to do what they can. As a call handler and dispatcher I have to speak to them every day, yet I’ve never had the right training, how can I be expected to get it right? Perhaps calling them ‘fruit loops’ is the wrong idea, but we all know that all workers working for emergency services have a rather cynical view on life and strange sense of humour to get through what we deal with day in day out. I think the real issue isn’t the comments staff made, or the way the programme portrayed things but more the reality that we’re all left looking after people without the skills or resources required! And as for the guy arrested for BOP, I speak to people like him every day, you say he has the capacity to make his own choices but I can guarantee the first people questioned if e was later found dead would be the officers who left him there.

    1. I said absolutely nothing of the sort – I said that the law presumes capacity, unless established otherwise. No-one tried to establish anything, they just illegally arrested him in ignorance of law. We all know what happens when the public defend illegal actions by claiming a lack of knowledge about the law.

      As for broader training, you are quite right – we need more of it. Far, far more of it.

      But on the subject of language and attitude – the fact that people didn’t think twice about the language employed just shows how much work there is left to do. I know 999 workers are cynical and enjoy banter but we just would not have heard such stereotyped generalisations on a fly-on-the-wall show about most other important policing subjects like DV or Hate Crime. Imagine if we’d heard “these people” and equivalent jokes about seat-belting people as the paramedic who said “both of you” to the man with schizophrenia?!

      1. Please please don’t get me wrong, I fully support what you’re saying. As a MH sufferer myself I know only too well how it feels to be subject to those generalisations. All I meant was people seem to be focusing on what the controllers said that was wrong and the actions taken were wrong, when the real reason it was all done wrong is through lack of training on everyone’s part

  9. I agree with a lot of what you said but not the bit about police officers staying with unco-operative patients. It’s reasonable to expect a psychiatric hospital to have adequate staff and security measures to keep their patients safe without police presence. Plus their patients have been fully assessed and a plan is in place. It is not reasonable to expect clinical staff in a busy Emergency Department to be able to do the same with unpredictable, unknown patients.

    1. I heard about your blog at an event about mental health and missing people. Interestingly, some forces are trying exactly the approach you mention, and putting officers in mental health units to help reduce patients absconding. Some have done the same with children’s homes too..

      Very interesting blog, thank you.

  10. Not sure how to reply to this post…..I am in the process of writing a written complaint to Channel 4 out lining most of the “issues”that have been raised in your post and also a couple of my own. TBH I still can’t believe that there was no helplines etc given at the end of the programme…an advert for donations to Cancer Charities but no contacts for Samaritans, Mind etc.

    On the plus side I am happy I watched it and get into the massive fallouts that took place on Twitter as I would never have come across your blog. As a person with severe Mental Health problems where unfortunately memeber of my family have “required” the help of the 999 services in the past….your blog gives an insightful view of the law etc especially in relation to Sections ie 136/135 and taking people to a place of safety. So yeah…thanks to the show I have come to your blog. :-)

  11. I took over our block this weekend as a chap was being booked in. He is going through a difficult period in his life and went to a minor casulaty unit for help. I’m not sure what transpired there but he left and police were called because there was concern for his safety. Officers found him and arrested him S.136, he was drunk so the local suite wouldn’t accept him so he came to my block. He started by being disruptive in his cell, nothing especially violent just extremely upset. He told me he had been walking home when he was approached in a dark alley by men in black who told him to stand still. As a martial arts ‘expert’ he took his top off to allow him to fight more freely and was Captored.

    I had a 20 minute chat with him, explaining why I though he was there and mollified him so he had a good nights sleep for assessment in the morning. He was released for community care.

    The next day I came in and he was back. This time he had called ambo to try and speak to a MH councellor (I don’t know if this was suggested to him by the MHT). They couldn’t get him back on the line so a unit was despatched with police support. Because of his martial arts experience and ARV was called. He was seen pacing around his house and then he opened a door holding a samuri sword. Holding, not waving/pointing/posturing. He called police as he thought someone was in his back garden…. Yes, more police.

    A challenge was put in and he fully complied with instructions. He was arrested for “Mental Capacity” and affray – not surprisingly he was refused charge….

    This could easily have gone horribly wrong because officers do not understand the Mental Capacity Act or even S.136. Perhaps we should avoid training by powerpoint and email and invest in officers!

  12. A glaring omission from the show, I thought, was that it never showed MH professionals calling the police (do they have a different line?). It implied that the callers were either time-wasting/attention seeking and as such probably not bothering to engage in treatment, or complete “fruitloops” who needed locking up in hospital 24/7. There was no mention of the fact that people can be aware (most of the time) of their problems and seek help but not receive it, or not receive adequate, ongoing support.
    Many of those callers, if they’d called the MH ‘crisis team’ first, would have been told to call the police or had the crisis team call the emergency services themselves. The alcoholic chap was particularly interesting as he’d probably not have access to the crisis team (they can refuse to speak to people who haven’t been referred to them), and if he’d gone down the MH channels to get help he’d be waiting several days to see a GP to get referred on. Yet he clearly needed help and those kind words of the ambulance crew right then.
    Of course, when the person is then seen in A&E (after lengthly wait), they are seen by the crisis team who appear to have used the police as a taxi service. In addition, it strikes me that some MH professionals urgently need to learn de-escalation techniques, or even basic ‘don’t-be-a-patronising-git-and-provoke-people’ techniques to avoid many situations that end up requiring police.
    It would have been interesting to see the kind of help offered after A&E attendances for MH too. There was a comment about the man who’d overdosed and is apparently a ‘regular’. The officer mentions seeing people like him again and again and that “they’re crying out for help… we’re offering that help… and they’re not accepting it”. I would love to know what help that man has been offered, and whether it has been offered respectfully, compassionately, and ‘on a level’ with him – or whether he has fallen between diagnostic cracks and been passed from pillar to post, spotted a mile off as a ‘difficult’ or ‘complex’ service user and excluded by any means possible, and been spoken to condescendingly (and if he showed his annoyance at this would be swiftly bundled off as ‘agressive/violent’)…
    The part with the lady who committed suicide was heartbreaking, and again I wonder what kind of help she had been offered/would have been offered. (The fact that she was struggling to find work didn’t escape me either – a failed Atos medical assessing her as ‘fit-to-work’? Accompanied by Mail headlines about benefit scroungers?…)

  13. I watched this program on catch up tv being unaware of the subject. I was horrified. I’m a mental health patient and yes I have been in contact with the emergency services over the last few years. I felt guilty about ‘wasting their time’. I know I should have stopped watching but I couldn’t. Yes there should have been contact details like the Samaritans at the end of the program . I was so deeply affected and racked with guilt. Yes the mental health services do ‘pass the buck’ and tell us to ring the police rather than help. The services have nothing to offer me at times of crisis which can be quite frequent and I am now determined not to waste police time either. Anyway the police can only take me to the mental health services for help and I end up going round in circles. No help there back off in crisis and so on.

    A while back there was a program following a local ambulance service and you should have heard the comments made by the paramedics about attempted suicides that they were called to. Thank goodness there are some programs out there that deal with the issue more sensitively.

    Anyway the upshot is that watching this program tipped me over the edge in to attempting suicide the following day – I was teetering on the brink.. I made very sure that I would not inconvenience the police in any way. Yes I am still alive to tell the tale but it was not attention seeking etc.

    Program makers please be careful.

  14. I have watched this programme tonight I found the way call handlers and paramedics spoke about mental health very offensive and indicitive of the many socially stigmatising view people in society hold. The 999 services are for emergency s feeli g suicidal or experiencing serious mental health problems IS AN EMERGENCY the staff Di not have to fix the person their role is to take them to a place of safety and help them access the right support

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