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I Predict A Riot

riots3An article was recently published in The Voice, regarding a concerns about the deployment of police officers into a mental health unit “in riot gear“.  Apart from having various reservations about the article itself which I’ll come on to shortly, I wanted to more generally cover the subject of this from the point of view of being a police officer who has twice pulled on his “riot gear” to do exactly this.  I’ve also done it on another occasion to safely ‘section’ a young man in a community MHA assessment setting.  I have also been the duty inspector for an area who has asked officers to do this and in my ‘policy and partnership’ work on mental health, have been involved in numerous debriefs where mental health staff request the police to lead on the management of serious violence and aggression on psychiatric wards.

The article states that a local Councillor has called for an explanation of the reasons why officers were called, amidst concerns about previous events where police interventions in mental health crises were followed by disaster.  There is now an inquiry ongoing into the incident by the mental health trust concerned.  All of this is more than fair enough, because public services should be accountable and transparent about the work they do for us all.

Whilst this sort of thing is comparatively rare, it is not a one-off.

THE VOICE

Firstly, let’s deal with the article.  I have a few concerns about it -

  • It doesn’t even begin to explain why the officers were called:  Crimes can and sometimes are committed on psychiatric wards, including some serious ones. For all I know from this piece, the polcie response could have occurred following an armed threat where staff and patient’s lives or safety were at grave risk.  Such things have been known so it would have been helpful, not to say balanced, to have had the context to the incident.  “Riot police called for patient who broke tea mug” would also have been equally helpful, because it would then allow the reader to contextualize the concern because of a potential over-reaction.  <<  This is example is not flippant: my officers were once called – without their riot gear! – to staff complaining of criminal damage to a mug.
  • The Metropolitan Police do not appear to have been asked for a comment.  They are neither quoted, nor referenced as declining to comment.
  • It does not mention the reality of violence against mental health staff within the NHS:  67% of violence against the whole NHS was directed to mental health staff during NHS Protect’s last publication on the matter.  This includes grievous bodily harm and sexual violence, some of that involves weapons or improves weapons.
  • I’ve got about four more objections, but you get my point?

DOES JUSTICE STOP AT THE HOSPITAL GATE?

riots1During detailed discussions over many years with mental health professionals, a senior forensic psychiatrist asked whether “justice stops at the hospital gate?”  I don’t mind sharing that (NHS) healthcare appears to stop at the police station gate, but managed to focus just in time!  He’s quite right – as am I – that the core roles of the police don’t service do not entirely stop within hospitals, psychiatric or otherwise.  The police may be reluctant on occasion to respond to or investigate criminal offences within mental health units, but we should remember we are still in a period of transition where this might be expected.  When I joined the police, we simply didn’t get called to violence on wards to investigate / prosecute, merely to help to restore safety.

No-one, presumably, thinks that every single ‘offence’ by a mental health patient should be reported and the NHS Protect report shows that this is not what happens.  A major trust in my area reports 16% of its violence against staff and other patients to the police.  Other cases are handled as clinical issues or assessed by the staff as lacking a public interest or being cases where a suspect would be unlikely to be held responsible for their actions, because of their condition.  Contrary to some officers’ beliefs, there is no wholesale reporting of every misdemeanour for investigation – far from it.

So when NHS staff ring the police, they have often gone through the process of trying to decide whether the situation was clinically attributable, potentially in the public interest and potentially supported by admissible evidence.  After all, a victim of crime is still a victim of crime even if that offence was committed by someone whose mental disorder mitigates against their liability for that act.

SERIOUS AGGRAVATED RESISTANCE

riots2Where particular situations on psychiatric wards reach a point of crisis and weapons have been produced or used and / or where barricades have been erected in rooms, it doesn’t surprise me to learn that staff ring the police.  These were the two situations I was involved in as a police constable, but I would remind you that such occurances are rare.  Whilst in some hospitals, staff training is such as to afford the ‘deployment’ of nurses with control and restraint training, tackling armed patients threatening to kill is potentially on another level.  Mental health services, unlike the Prison Service, does not necessarily train and equip their staff to deal with the upper end of resistant behaviour – what the police would call ‘serious aggravated resistance’.  You may have a view on this, but I can understand why they don’t.

So if a decision has been taken to use force to resolve an armed stand-off, or a barricade situation, this is going to involve officers in protective equipment – sometimes called, “Riot Gear” – or officers equipped with tasers or in very serious cases, firearms.

I totally understand the intuitive that we don’t want “riot police” on psychiatric wards, but it needs to be understood that mental health professionals have been slashed with knives, punched to such an extent that their jaw or their eye sockets have been broken and they have been left with life altering injuries, arising from their work.  Not just physical injuries, but serious, debilitating psychological trauma.  Whether or not such events could have been prevented or their likelihood reduced through earlier intervention or better care planning, is arguably beside the point if you are the police officer called there.

The fact that tonight’s emergency may have been prevented by something else happening last Tuesday is irrelevant to the police officers who have to attend and prevent crime, bring offenders to justice, protect life and property and maintain the Queen’s Peace.  The predictability of the situation is immaterial to those officers – they must police what is in front of them.  We are where we are  …  and all that.

PREVENTION AND RESOLUTION

Of course, it is incumbent upon mental health professionals to prevent the escalation of situations which may, unchecked, become cases of the type we are talking about – cases which are quite rare, actually.  Naturally, we should be aware of the impact upon vulnerable patients of seeing “tooled up” cops running into their environment with shields, police dogs or tasers in order to forcibly subdue another patient, especially one who may already suffer from delusions or paranoia.

As with many of the debates around criminalisation of vulnerable people, I’m not sure I want a society where the reality that we are ‘policed’ is kept from some of our citizens, especially where the safety of our public servants is compromised.  As long as intervention is proportionate, I think there is much to be gained from acknowledging the reality that if you pose a serious risk to others, the police can or will be called.  If there is to be safe management of such events without resort to policing, then NHS managers will have to undertake considerable work to achieve this.  It’s do-able in theory; potentially more difficult in practice.

Of course, the officers weren’t in “Riot Gear”, they were in protective equipment.  Overalls are still overalls whether the purpose for wearing them gardening, decorating or repairing your car.  Language is important in mental health – as policing is a de facto part of our mental health system, this must extend to the officers, too.

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.”

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About mentalhealthcop

24/7 police inspector but blogging in a personal capacity. Interested in mental health issues and criminalisation but views do not represent those of any police force or police organisation.

Discussion

9 thoughts on “I Predict A Riot

  1. You have once again justified your recent award with this post that only you, as far as I am aware, seem to be able to write.
    The big question IMO is what you asked: why didn’t the article in question say why the police were summoned.
    Btw, several police officers were called to the ward because I refused extra medication.

    Posted by Adrian Cox | December 1, 2012, 3:34 am
  2. Another very good blog, and I write as a consultant psychiatrist. No we don’t WANT the police on wards but on very rare occasions there is no alternative.

    Posted by Robert H | December 1, 2012, 7:40 am
  3. Well done for award you deserved it, have had police in protective gear on ward on several occasions and have been really grateful for them very proffessional thet were,

    Posted by mick hopkins | December 1, 2012, 5:59 pm
  4. Your points are well made very few assaults are reported and even less threats and generally this is the right way to handle most incidents, but there there are times when a call to the police is the only option. The only time i’ve been involved was a MHA assessment on a ward where the patient barricaded their room, had made a weapon was threatening all staff and was literally bouncing off the walls and we still waited and tried negotiations and the waiting game before they were called. I would of had no concerns about explaining that call to anyone which is how it should be.

    Posted by bc (@444blackcat) | December 1, 2012, 8:13 pm
  5. And with the increasing assaults on NHS staff http://www.shponline.co.uk/news-content/full/increase-in-assaults-against-nhs-staff isn’t it likely that we’re destined to see even more police intervention within hospitals in the future?

    Posted by Dave Hasney | December 3, 2012, 5:36 pm
  6. one thing that does puzzle me and its in both the trusts and kent police guidelines is having the consultant certify if they have capacity following an incident, surely a crime has been committed and capacity is not relevant to investigation? have to say kent police have been fantastic in their response

    Posted by mick | December 5, 2012, 12:21 pm
    • I’d agree with you – asking questions about capacity is often to miss the point, as some offences require no specific mens rea at all, merely the completion of the relevant act. I’ve covered this on some other blogs about prosecution, but in short, I totally agree with you.

      What might be relevant to the investigation is concepts of intent, recklessness and so on … but these are legal concepts, not medical ones, so asking Doctors about them is to miss the point because we don’t ask lawyers about medication, do we?!

      Posted by mentalhealthcop | December 5, 2012, 10:54 pm

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