The reach of the state into your home is severely curtailed compared to its reach into public places: the notion that an “Englishman’s home is his castle” is actually very real, in the sense that you can require the police to desist from certain activities in your house where you would have no comparable right in the High Street. This has implications for how the police response to mental health emergency in private places – whether it is a spontaneous incident as we had at work last night; or whether it is a planned incident where the police support health and social care colleagues in undertaking Mental Health Act assessments.
Yesterday – amongst the child rape allegations, firearms / armed robbery incidents and the predictable amount of domestic abuse – my officers had two different “mental health on private premises” jobs, both involving known mental health patients and both the result of 999 calls. Each involved community mental health patients who had self-harmed after abusing substances – one drugs, one alcohol.
One of my sergeants was supervising an incident where a community patient had self-harmed and taken an overdose of medication after drinking alcohol. She was presenting in exactly the way that I highlighted in a previous post about an episode of “999 What’s Your Emergency?” – she was not committing an offence or breaching the peace and was declining the paramedics’ offer of a trip to hospital for assessment. The Sarge shouted up to ask about the Mental Capacity Act angle, correctly recognising that we cannot use s136 in the woman’s house. As the paramedics were standing there, I suggested that they go about the business of assessing her presumed capacity to take her own decisions whilst attempting to engage the crisis team and the AMHP. After the crisis team and the AMHP declined to do anything which would have brought about an MHA assessment – as per the Judge’s reminder in the Sessey case where the police were criticised for ‘using’ the MCA – the officers and paramedics were able to persuade the woman to attend.
There was no response from the CrisisTeam because “you can’t do a Mental Health Assessment on someone who is intoxicated.” Well actually you can, if you absolutely have to – and I would have thought that attempting to do so, to keep someone safe where there are no other legal options for the police or paramedics to safeguard this vulnerable person might be just such a scenario. Maybe it’s just me – but the end result was 24/7 emergency mental health services were disinclined to agree they had a role with regard to their known patient. I was only grateful that they didn’t incite the illegal arrest under s136 Mental Health Act as I have known in the past, “Just get her outside and arrest her”, etc.. Err … no.
Of course, the fact that the police and paramedics had tried to engage community mental health services was an important part of contextualizing any subsequent decisions they took.
At the end of the shift, I led four officers and a sergeant into a building during a second incident where another known mental health patient had self-harmed, seriously injuring himself. He had a history of attacking paramedics with razor blades after getting into a psychotic state following the abuse of cocaine so when the 999 call went in to West Midlands Ambulance Service, they called for our support – quite rightly. We also had knowledge of the man and I arranged for the “riot police” as they are not called to start coming towards us just in case the six of us – two with ‘tazers’ drawn – were unable to quickly safeguard him. Fortunately, things went swimmingly and after some cracking team work with West Midlands Ambulance Service whose paramedics were absolutely brilliant with this guy – off he went to Accident & Emergency and we went home after filling the forms in.
The myths around section 135 continue to abound – including the debate about whether you can or cannot obtain a warrant. I spoke at an AMHP conference in Leeds last week where I rattled through some of my views on this and saw heads nodding throughout. But I have continue to hear internet forum objections and frustrations around police responses and queries for planned assessments, in particular when it comes to the subject of section 135(1) warrants -
I want to dispel (again!) some myths so that we stop making stuff up that affects decision-making and contributes to risks:
- There is absolutely no requirement whatsoever in law to try to secure access before applying for a warrant
- There is absolutely no requirement whatsoever to evidence why you think access would be refused.
- It is perfectly legal to apply for a warrant as a contingency “just in case”. The police routinely secure warrants “just in case” in many other circumstances.
- If an AMHP would apply for a warrant, they need only be able to evidence one or more of four things: neglect, ill-treatment, lack of control or the fact that someone is living alone.
- The warrant is not just about gaining access: it is also about the safe management of the assessment once you are in the premises.
Of course whether you apply for a warrant is a different thing altogether! …
It has been recently assumed that I am arguing here for a “no warrant, no police” approach to the planning of Mental Health Act assessments on private premises. I have repeatedly said that I am not – actually, I’m wondering how else to make this clear?! I am not saying “no warrant, no police”.
I am arguing for a proper consideration of how to safely manage the RAVE risks which caused the police support to be requested in the first place. Let us remember: in a private premises, without a warrant, the police service have absolutely no powers whatsoever to do anything coercive until there is an attempted criminal offence, a (real) breach of the peace or until the person being assessed is ‘sectioned’. Until one of those three things occurs, the police are simply without a coercive power to intervene. They are human beings with a mouth and a certain skill set that may persuade, influence or encourage. Whether this is sufficient to keep everyone safe, will vary from case to case.
Let me clear about a final point: I believe that I can identify at least four MHA assessments in private premises where the absence of a 135(1) warrant has led to the realisation of risks which would have been immediately preventable and they were risks that were forseeable in circumstances where the grounds for a warrant would be met. The risks were manifested in serious injuries to service users, mental health professionals and police officers – life altering injuries. I wonder what the Health & Safety Exeuctive would say? Actually, I’ve asked them: the warrant could be considered a necessary part of proper risk assessment and the absence of an obtainable warrant could be relevant to any of their investigations.
The fact that such events are rare would be fair enough if the realisations of the risks concerned had led to trivial consequences. But where we are talking about self-harm injuries to GBH standard or attempted murder, it seems fair enough to raise the issue for debate – if we are asking police officers to take risks on our behalf, to mitigate risks for us, we need to give them the tools to do the job properly wherever the law allows.
The castle analogy at the start lead to a gratuitous opportunity to post some great pictures of my favourite castle: Bamburgh in my home county of Northumberland. Believe it or not, Bamburgh was a key location in the medieval England and as the seat of the Kings of Northumbria, once rivalled London it its significance!
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.”