Here is a profoundly important example in practice of some of the decisions facing operational, front-line cops about their duties and obligations with regard to mental health patients once they have had contact.
Nicola Edgington is currently standing trial for murder. It is relevant to point out that she had previously been tried for the murder of her mother in 2006 and was found guilty of manslaughter on the grounds of diminished responsibility. Having then been detained in a secure unit under a restricted hospital order, she was discharged from detention under s42 of the Mental Health Act into forensic community care. She was living in supported accommodation in Greenwich, London when the latest incident occurred in November 2011.
Last year I wrote a post about how the decision would be taken on whether or not to release a convicted killer back into a community model of care, when rumours floated about PC Nina MACKAY’s assailant being considered for release. The same legal and risk assessment process would have applied in the build up to Nicola Edgington’s release in 2009. I am interested in this post in neither the conclusion of the current trial nor in the whether the release decision in 2009 may or may not have been premature.
Prior to the attack, Nicola Edgington is known to have approached a taxi rank in Bexleyheath, south London and asked to be taken to the Queen Elizabeth Hospital. When it emerged she didn’t have the money to pay the fare, the taxi driver called the police and there have been various reports. They include that she was “pleading with the police to section her” and that she “begged him [a police officer] for help to get sectioned“. << Of course, there is a distinct difference between the two things.
The police have a power under s136 of the Mental Health Act and I’ll come on in a moment to whether it could or should have been used; but asking for help to “get sectioned” is different and does not necessarily mean via section 136 MHA. There are other routes to getting sectioned and in this particular example, the two officers took the lady to the Accident & Emergency Department of the QEH, without legally detaining her.
- Could they have detained her under s136 of the Mental Health Act 1983? – very probably; almost certainly.
- Should they have detained her under s136? – it is very far from clear.
Remember the grounds for detention? -
- A constable finds in a place to which the public have access – check.
- A person who appears to be suffering from mental disorder – check.
- And who is in immediate need of care or control – check.
- The constable may, if he thinks it necessary – hang on a minute
- In her own interests or for the protection of others – STOP RIGHT THERE!
Nicola Edgington wanted help, the police were willing to take her to a 24/7 medical facility with liaison psychiatric services who can call upon MH professionals to provide whatever assessment and admission she needs. So if she is willing to undertake the journey and engage with staff, is legally detaining her “necessary”? Strictly speaking, perhaps not. Why coerce someone through a process with which they are apparently willing to engage?
But doesn’t it depends what you mean by “necessary”? Although not necessary to detain her at the taxi rank in order to secure her attendance at a medical facility for assessment, was it ‘necessary’ to ensure that a patient who can now be seen as erratic and in crisis, remained engaged in that process? Earlier in the month, I wrote up a report after investigating a complaint against an officer where he was accused by a patient of failing to detain him MHA when at the time of this officer’s alleged neglect, the patient was busy getting into an ambulance to go willingly to A&E.
- So why would the officer arrest you, in order to force you to do what you’re already doing very willingly?!
- Should the police act to ensure that no matter what happens in the subsequent hours, the person remains to be assessed?
- If the officers don’t arrest now, could they arrest later? Yes – s136 may be exercised in Accident & Emergency if it becomes necessary to do so and the patient decides to leave.
SHOULD I STAY OR SHOULD I GO?
So what I am interested in is the debate about “should I stay or should I go?” Having arrived in Accident & Emergency with a patient who is not under arrest or in any condition of legal custody, the officers would have to think about whether they remain with the patient after arrival. On the face of it, there is no legal obligation to remain. Officers have exercised a duty of care in immediately removing the patient to hospital, but nothing explicitly demands their continued attendance.
Does it matter that the patient concerned was previously convicted of homicide – the manslaughter of her mother, committed whilst mentally ill? Some may well argue that it does. Certainly John COOPER QC put it to the police witnesses that they should have stayed there with the patient until she was assessed and he pressed them quite keenly about why no background check was done to establish previous risks. It also emerged during his questioning of the officers that at one particular point they began to leave and Nicola followed them claiming that she did not want to wait on her own. After sitting with her for a while further, the officers claimed to be satisfied that she would remain there and left.
Within a few hours she had been seen and arrangements were being made to admit her as a voluntary patient to a nearby mental health ward – so the officers were not the only people convinced that she was a willing participant in a process to arrange her admission. It has emerged during the trial on 24th January that whilst waiting for those arrangements to come into effect, she rang 999 and informed operators that she felt as she did prior to killing her mother. She subsequently left the unit and bought a knife, attacking the first victim who managed to resist and fight back, disarming her. She then stole a knife from a butcher’s shop and killed her second victim. To describe this as a tragedy for all involved, is to understate the matter enormously.
20 / 20 HINDSIGHT
This is exactly the kind of debate that gets police officers going. My sergeants and I recently discussed this at length having had three such cases on our team in the last week. “Did we PNC and FLINTS check any of them?” Apparently we did – all three. “Did we remain at A&E after arrival?” No, not in any case. What would have happened if any of those people had then committed a serious offence? Our approach would have been questioned, no doubt.
- Are we saying that all people removed to A&E by the police should be PNC checked? … or just the mentally ill?
- Are we saying that we should stay with all patients in A&E until the MH assessment process is completed?
- Do we do this every time – and even where this risks criminalising an 80yr old dementia patient?
- What are the dynamics here? - we wouldn’t do this with physical or medically unwell patients so is this a further example of stigma, discrimination and presumptions of violence in mental health care?
- If we are saying, “No, you don’t have to stay with all mental health patients”, how are defining the divide? Which ones are we staying with?
- Is it just those with a homicide conviction, or would GBH convictions also count towards attracting a police chaperone?
- What about violence to property or are we only interested in violence against people?
This situation is a tough judgement call. Once you hear that Nicola Edgington is a mental health patient with a previous homicide conviction, it is hard to countenance why the police would even think about leaving her unaccompanied. But at that time, she was engaging in something and not just because of the police being present. The officers formed a view and made a decision that they could leave and she remained there for a couple of hours. When she was formally assessed under the MHA, the AMHP and Doctors could have sectioned her and caused her detention to be framed by law. They did not.
Not only with police powers of arrest, but also with medical applications of the Mental Health Act, the law requires professionals to operate against ‘necessity criteria’, ‘least restrictive’ principles and the way in which these principles are explained and framed by guidance (usually in Codes of Practice – are not black and white. They are endless shades of grey.
So if we are going to trace history backwards to look for intervention opportunities ahead of this second serious offence, why go back to the officers at the taxi rank and not to the AMHP and Doctors who assessed her after the police had left and / or to the psychiatrists and officials from the Ministry of Justice who released her in 2009? Just asking.
* The Man in the Arena is the title given to an excerpt from a speech by President Theodore Roosevelt (a former Police Commissioner of the New York Police Department). The speech was made in the Sorbornne, University of Paris, in April 1910.
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”
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.”