It occurred to me recently that the actions of the police can have the effect of appearing to create a mental health patient where none really exists. This can become a self-fulfilling prophecy of repeated interventions which creates a lot of failure demand, for both policing and health services. Let me explain! -
EVER DECREASING CIRCLES
Once upon a time, the police detained a man who was on the wrong side of a road bridge, expressing suicidal ideas and threatening to jump. The road has been closed, officers starting to try and persuade the man not to jump and a negotiator was called. After a protracted discussion to persuade and influence this guy back over the railing, he was detained under s136 MHA – because suicidal ideas, hanging off a bridge may indicate the presence of mental disorder, right? And the interaction with officers may lead to further suspicion that the man was mentally ill. Following assessment at the “136 suite” the man was neither admitted to hospital under the Mental Health Act nor referred for mental health care or support to anyone. << I have known this outcome from such incidents many times in my fifteen years’ service. The person then having been released from section 136, the police resume and the person goes about their life.
What happens if we attend a similar job in the future? – maybe a different bridge in a different area and almost certainly different police officers; but background circumstances broadly the same. Did the MH assessment first time around get it wrong; do the officers even know that outcome or are they simply aware from intelligence systems that the person was previously detained by the police under the MHA? Maybe they are aware of nothing at all and simply start from the basis that the first officers did … suicidal ideas, bridge, communications and perceptions so there is a mental disorder and when they person is persuaded back over the rail, they will be detained under s136 MHA for assessment at the PoS and an outcome. Guess what it is? Not “sectionable” so no admission and maybe a referral to GP or CMHT; or maybe not – all depending on circumstances.
REVOLVING DOORS
We can see where this is going can’t we? My police area are currently attempting to manage two people who fit this category and on a recent early shift one the men rang the police from his flat at 9am having been drinking heavily and as part of our response to what an officer described as “that regular mental health patient who is constantly ringing” I rang the Crisis Team to find out more about him. Their answer motivates this blog because it suddenly occurred that we – the police – have “created” this mental health patient.
The Crisis Team had assessed this man for the first time about two years previously and had assessed him several times over that two-year period. Every single time they assessed him, it was following a police intervention: either detaining him under s136, including whilst hanging off bridges expressing suicidal ideas; but also following him being arrested for minor offences. They always, always found him to lack any obvious mental disorder and either released him from s136 or advised us to do what we wanted with any criminal allegation against him. Yet look up this guy and several like him on PNC and police intel systems and you couldn’t fail to think he had a mental health history.
It becomes the “obvious” to do – to attempt to involve mental health services in the police response and think about diversion from justice and so on. But he’s not mentally ill, except to the extent that we regard anyone who drinks a lot to be mentally ill. He has been repeatedly offered support for alcohol related issues by both the police and the health system and declined to take up those offers.
CRIMINALISATION
The first time I came across a similar case, was about seven years ago: a female drug user who often brought the M5 to a standstill (at massive economic cost, I might add) because of her obsession with a certain bridge and the adverse of its parapet. Repeated s136 interventions led to some frustration being expressed by the mental health trust that the police kept perpetuating this revolving door when a better approach may not involve s136 being used at all. When we asked what they thought would be better they emphatically said, “Prosecution!” Simple when you know how, isn’t it?!
And so we did.
Few people realise that it is an offence under s22A of the Road Traffic Act to place something (including yourself) “on or over a road” in circumstances where it causes a danger to road users. Obviously, someone falling from an M5 motorway bridge onto a 70mph triple carriageway would be horrendously dangerous. So after something like five s136 interventions in a short period of time – all by different officers acting in good faith – we made it more widely known that s22A was the way to go, secure MH assessment in police custody as part of the investigation if that were thought to be necessary and take a broader view than whether it is a “health or justice” issue. It could well be both.
In these cases, criminal sanction for behaviour has been shown to be effective – at least in terms of a short-term solution. All the mental health assessments and the criminal investigation considered the issue of drug use for the woman mentioned and alcohol support for the man. The female drug user was prosecuted, remanded to prison (because of various other criminal justice antecedents) and subsequently found guilty. It brought an immediate end to incidents on the bridge. Maybe she found another bridge, some may ask how effective this strategy was in the longer-term. All fair points, but not issues that prevent us prosecuting those who commit street robbery where we think they’ll take the consequences and just commit more robbery elsewhere on different victims.
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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.”
It seems to me that there just is no positive intervention which is both fitting and available here. Prosecution, while removing the possibility of these guys holding up traffic for the foreseeable future, fails to address the underlying disease and may just mean the revolving door takes longer to spin . Sooner or later, because their cries for help have largely gone unheard, they will be hanging from some other bridge.
Posted by Janette Leigh | February 20, 2013, 10:26 amYou mention cries for help! – unfortunately the care is so appalling and is only about drug pushing by so called professionals. When the drugs do not work and someone like my daughter is diagnosed as being “chronic treatment resistant” the answer is more and more drug pushing and to just continue with it. The problem will not go away as the drugs mask the problem not deal with it and what should have been given to my daughter, a victim herself was counselling instead of mind altering LSD-like serotonin reuptake inhibiting drugs that lead to suicide and aggression. I and other mothers of sons/daughters who are on never ending treatment orders would like to see humane care and proper assessments. What underlying disease! The worst thing they could have done is come up with one diagnosis after another which shows they do not know – the answer is drug pushing as it is easy to control someone when they are like zombies and then they are dumped back into the community in schemes like my daughter who is so vulnerable that have led to her being further abused and living in dreadful conditions – rotting food in the fridge, sitting alone in a dark room as the light bulb had gone, ending up in a crack den as the latch on the door was broken. Some of the patients were crying to go to prison as it is better in prison than on the wards! Perhaps the answer is a complete review of the current “care”. Projects like Chy Sawel, Soteria and Root and Branch set up. for £800 a week my daughter needed more support and did not get it and was isolated in the community. I ended up having to go round and do housework and shopping for her. They allowed her to spend all her money on a tattoo and a phone she did not need leaving nothing for food. It is no wonder there is constant revolving doors in the mental health. The drugs cause the suicide – prescribed drugs given by the psychiatrists that are passed in such a dubious way (Prof David Healy – Pharmageddon) and cause no end of side effects – who can blame a patient for not wishing to take them. There are no places for someone to safely come off these chemicals unlike illicit drugs and when a patient does it, skips a tablet this can cause psychosis however you can also suffer from a condition called Akathisia whilst on the drugs and other serious side effects that are all ignored by these so called professionals. There is nothing but manipulation and control and abuse of the law going on under the mental health where psychiatrists play on capacity and when someone does not have the capacity their Tribunals are held up and they are deprived this right – I believe there is a shortage of suitable housing and support in the community and so these poor patients are held forever on Enforced Treatment Orders. I am disgusted along with a group of other mothers and former patients who I am in touch with with the shocking care in the UK. Quite often people like my daughter are discharged into the community, not kept an eye on by Crisis Team and left without enough support when they cannot cope. It is very sad what is going on .
Posted by susan Bevis | February 22, 2013, 12:18 amThere have been many times when I myself have been put on a 136 taken to hospital and released same day ….i think the police just make the situation look worse ….but that is just my opinion ….
Posted by imtakingcontrol | February 20, 2013, 10:47 amI think it would depend on the situation – police often have little choice but to use s136, although I accept that this is not always the case.
Posted by mentalhealthcop | February 20, 2013, 10:48 amA revolving door scenario but for who? The individual, the police or mental health services. I’ve been present in many s136 assessment whereby the use of s136, given the individual’s behaviour when the police intervened, was wholly appropriate. I wonder if the creation of the patient is more down to the NHS and how they respond? I’ve seen many s136 assessments end in discharge with no mental or behavioural need or disorder but yet a referral to a CMHT is an action ‘for further assessment’ or to a crisis team for immediate follow up despite the assessed absence of need. I think that mental health services allow the door to revolve all too often.
Posted by mrajbridge | February 20, 2013, 11:28 amThere are times when I have been in my own home, minding my own business and my CMHT have expressed concern for me and sent the police around to do a welfare check, the police have come, found me sitting quite happily watching TV or whatever and decided to take me to the police cells to ‘Prevent a breach of the peace’. This basically creates a lot of work and wastes a lot of time and resources when I was absolutely fine and created a mental health patient.
Posted by Emma | February 20, 2013, 11:57 amUnderlying issue for me is two similar sounding but very different terms … ‘mental health problem’ and ‘mental disorder’
Someone who is using drugs/alcohol, who is having problems meeting their basic economic and social needs, who is deeply distressed is (rightly) seen by lay people, including the police, as having a ‘mental health problem’
But that’s NOT the term used in the mental health act. To put someone on, example, section 2 of the mental health act is about ‘mental disorder’ as defined in the act, and detailed in the code of practice. That actually excludes drugs/drink, lifestyle etc.
Personally I would really like to see seriously mentally ill people have more access to hospitals, but I wouldn’t be keen on seeing the definition of who can sectioned broadened.
Posted by MHAcademic | February 20, 2013, 12:55 pmHospitals are not always the answer and it has been proven that patients recover more quickly in their own homes, hospital treatment should only be used as an absolute last resort where nothing else is available or appropriate. I think they need to concentrate on improving community services and make them more accessible.
Posted by Emma | February 20, 2013, 1:46 pmTotally agree that hospitals are not always the answer – indeed they are only helpful for a small minority. Unfortunately for those people who desperately need that care, beds are often not available. Those are frequently the people this blog writes about.
Posted by MHAcademic | February 20, 2013, 2:51 pmI totally disagree – hospitals are not the answer and can lead to some patients becoming even more disturbed. The care is just drug pushing on the part of so called professionals even if someone is treatment resistant. I have seen what goes on in those hospitals. What is needed is Open Dialogue 85% success rate in Finland, Soteria, Chy Sawel and Root and Branch Projects – I feel so sorry for these patients.
Posted by susan Bevis | February 22, 2013, 12:20 amI wish we knew more about the female who appeared to stop the bridge behaviour. It piques my interest as I’ve had numerous detentions under s136 in the past (a few involving various bridges). Being arrested and charged etc for an offence wouldn’t have stopped me from doing that (or other ways). In fact, it would have compunded the situation as the shame etc of being now deemed a criminal would have intensified my need to harm myself or commit suicide.
I’m not sure about the police creating patients. From the circumstances laid out in the blog, the police were correct in detaining the persons for assessment. What the services do afterwards to help (or usually not) is not the fault of the police correctly detaining someone.
Posted by Carrie Quinn | February 20, 2013, 12:56 pmhello,
my understanding of s.22 of the RTA is to do with leaving vehicles in a dangerous position etc. and wouldn`t fit the attempt suicide on a bridge scenario.
What`s the wording of your version of s.22 of the RTA,Please?
Posted by Joshua | February 20, 2013, 2:55 pmSection 22A of the Road Traffic Act 1988 -
“A person is guilty of an offence if he intentionally and without lawful authority or reasonable cause—
(a)causes anything to be on or over a road, or
(b)interferes with a motor vehicle, trailer or cycle, or
(c)interferes (directly or indirectly) with traffic equipment,
in such circumstances that it would be obvious to a reasonable person that to do so would be dangerous.”
Posted by mentalhealthcop | February 21, 2013, 12:44 amCan you give me some advice? My mate hates the police and when we met up at the pub a few weeks back he said that he’s sent a couple of threatening emails to the police. What would be the consequences of his actions and will the police be able to trace him (he’s made a fake email address). I’m worried for him, he has a few mental health problems
Posted by David | February 25, 2013, 3:45 pmI would advise him not to be so silly – fake email addresses can be traced; threats can be non-criminal, but sometimes slip over the threshold and he could, in theory, find himself investigated. If he has issues with the police, he could ask to speak to a police supervisors like a sergeant or inspector; or complain to the IPCC.
Posted by mentalhealthcop | February 26, 2013, 7:11 amWhat would the police do to him?
Posted by David | February 26, 2013, 1:48 pmIt depends on the nature of the threats and the method and the impact: impossible to be precise without knowing details. It’s just best, as a general rule, not to go around threatening people, regardless of who they are because it can have unintended consequences or unexpected reactions.
Posted by mentalhealthcop | February 27, 2013, 2:11 pmwhat sort of details do you need to know?
Posted by David Dodds | March 7, 2013, 9:15 pmHi do u know how long it wud take for ones wrists to go down on the swelling after being put in a pain compliance hold alot of times in one day? And the general pain of moving them?
Sent from my iPhone
Posted by sheepmouse | March 18, 2013, 6:48 pmI don’t know specifically, it would all depend on various things. Can only suggest you see your GP to have it properly examined.
Posted by mentalhealthcop | March 19, 2013, 6:51 amThey used the pain compliance hold via hamdcuffs – does tht make any difference?
Sent from my iPhone
Posted by sheepmouse | March 19, 2013, 11:18 amNot in terms of injury impact or how any injuries caused may heal. Can only recommend you seek medical advice. If you are concerned about the force used in the circumstnaces, write or speak to the duty inspector in the police area where it occured. You can ring 101 to get put through to the correct police force area whose switchboard will then handle the call.
Posted by mentalhealthcop | March 19, 2013, 12:56 pmAlso still hvnt got the feeling back into the underside of my hand between where the thumb starts and the wrist…. Was put into this hold alot on saterday
Sent from my iPhone
Posted by sheepmouse | March 19, 2013, 12:10 pmI think they need to improve community mental health care, I believe that is where the problem lies, if there arent enough beds (which there clearly arent) available in hospitals then more needs to be done to successfully help and treat people in the community. Out of hours police are going to be the people who deal with mental health crisises, but these mental health crisises could be reduced if more was done to help in the community.
Posted by Emma | February 20, 2013, 3:04 pmNot disagreeing with your point – certainly if people get better care in the community then some will not deteriorate to the point of needing hospitals (or police).
Unfortunately some people will not cooperate with that. If someone just plain says ‘NO’ then that may well be insurmountable in the community. Even the recent ‘community treatment’ orders are not an answer if the person is still determined that treatment is not them. In most cases the person in the community has every right to say no.
Again, a minority but thats the minority that do need hospital care. (and often don’t get it)
Posted by MHAcademic | February 20, 2013, 3:36 pmI am currently in my third formal complaint against my CMHT, and this one has been accepted by the ombudsman. The care currently available in the community is simply not adequate for someone with acute mental health problems, this is someone who does not need to be hospitalised but needs help, the CMHT offer next to nothing, this causes me to be frequently be one of the section 136 statistics, and I am always discharged and referred back to my CMHT who offer next to nothing …. definately a revolving door.
Posted by Emma | February 20, 2013, 3:42 pmSorry to hear that – but it doesnt surprise me. Definitely agree with you on the need for good community service.
We are only apart where I have some passion about the needs of a minority of individual people who really do need hospital care.
Posted by MHAcademic | February 20, 2013, 4:00 pmThere are times when I have begged my CMHT to admit me to hospital, only to be told to have a hot bath or read a book, something wrong there.
Posted by Emma | February 20, 2013, 4:15 pmThis is when police often get involved, people know if they draw police attention it is likely they will be able to access treatment. Sadly a lot of the people I have dealt with know they need it and are pleased when police turn up.
Posted by Northmead01 | February 20, 2013, 8:46 pmIn all honestly, yes. There are times when I have been at rock bottom and the police are the only people who are available to turn up at my front door. It’s not to draw police attention, it’s because they know they are the only service who will turn up swiftly.
Posted by Emma | February 20, 2013, 8:49 pmIts a shame it has to be that way somtimes, but the police will look to help any way they can.
Posted by Northmead01 | February 20, 2013, 9:00 pmI have actually found the police to be the most caring and sympathetic out of all the professionals and I am very grateful for that.
Posted by Emma | February 20, 2013, 9:08 pmIm proud of that
Posted by Northmead01 | February 20, 2013, 9:18 pmAre you a police officer?
Posted by Emma | February 20, 2013, 9:20 pmsomthing to do with it! And have seen many detained s136.
Posted by Northmead01 | February 20, 2013, 9:27 pmI am very grateful to the police as they have been the only ones who have been there when I have been at rock bottom and mental health professionals have been nowhere to be seen. They treat me with respect.
Posted by Emma | February 20, 2013, 9:32 pmI think it can end up being a difficult cycle. Because the police are on the frontline, they are the people who are having to deal with a person who is very distressed and at crisis point. Taken to hospital, then potentially an 11 or 12 hour wait to be assessed (that was the norm in my uni city at least). 11 or 12 hours sitting in a room with nothing in it keeps you safe in that immediate time, but it does nothing to help your mental health and the reasons for ending up in that situation, and it gives a long amount of time for that initial ‘crisis’ to become calmer, potentially more rational and then the mental health team who carry out the assessment potentially see something completely different to when first admitted. Then it seems common for people to get discharged to no further support or referrals, and so the next time the person ends up in a crisis point, potentially the same situation happens.
There isn’t really a ‘winning’ situation for the police I suppose, but there’s only so much that can be done if someone is consistently refusing help and criminalisation is a way to stop the situation reoccurring. From my experience though, it was very very difficult to get support from mental health services following a 136, definitely room for improvement.
Posted by L | February 21, 2013, 12:02 amI think at the times the police are responsible for escalating a mental health crisis, someone could be struggling and needing help but by locking them in a police cell for 12 hours or more, that is only going to make them feel worse and show more signs of severe mental distress which werent present previously.
Posted by Pete54 | February 21, 2013, 12:23 pmI understand that remark and I don’t disagree – it’s only fair of me to point out that in many circumstances of people being locked in cells for 12hrs, it comes about not because of a police decision that the custody is a great place to hold someone, but from the fact that they have no alternative options whatsoever.
There are still too many areas where PoS services either don’t exist or operate such exclusions criteria as to ensure that as many as 50% of the people detained in that area will not be able to access it. So we also need to look at the NHS for the fact that people end up in a cell.
Your point is still correct though – on occasions the police do get it wrong and they sometimes misuse s136 for the want of better training.
Posted by mentalhealthcop | February 21, 2013, 12:32 pmCrisis teams need to attend at the point of crisis, not hours later when the situation has calmed.
Posted by Pete54 | February 21, 2013, 12:45 pmDealing with a very similar set of circumstances today, man over the other side of a multi story carpark above a road in town…. Like the thought process boss.
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Posted by chris.spellerberg@hampshire.pnn.police.uk | February 23, 2013, 9:16 pmI’m (very!) late into the discussion here, but couldn’t let this pass without comment.
I think you need to be VERY careful about this train of thought/action. We know how rubbish the MH services can be about helping people… so it’s not inconceivable that their assessment of someone as ‘not suffering from a diagnosable mental disorder’ may be wrong. After all, if they admit the person needs help, they might have to find a bed for them! (A side issue here is that the exact phrasing might be “a diagnosable mental disorder” or similar, yet many fall between diagnostic cracks whilst stil clearly needing help.)
I feel desperately sorry for the woman who was criminalised for repeatedly crying out for help in the only way she knew how. Had she been offered treatment by services? Help and support to cope with her distress? A route out of drug abuse, focussing on dealing with the problems that had led to it? Or was she refused treatment because she had a so-called ‘personality disorder’ which didn’t used to be treated by the NHS? (Despite basically being a form of PTSD – the backgrounds of those so diagnosed are heartbreaking).
I was arrested, charged and criminlised as a vulnerable teenager with mental health problems for which I had tried to get help. I had been refused help, not only by mental health services (who instead verbally abused and bullied me) but by council/homelessness services – all this meant I was living desperately, in accomodation where I was being threatened by another tenant, with no way to escape. I was also trapped in an abusive relationship because I had no-one else to turn to. I was frequently sectioned by police and dragged to A&E to be told I was a waste of time by staff there. I literally begged for help to relieve the pain I felt inside and received nothing.
When I finally told them what I thought of them – including the phrase “I could kill you!” – I was criminalised, despite the nurse in question stating he knew it wasn’t a serious threat. (A similar case in the news this weekend had triggerd a lot of painful memories.)
My future was ruined as they withdrew my nurse training place years later due to this. I now struggle daily with nightmares, flashbacks, and hopelessness – ironically I am about to start NHS therapy and they have recognised the trauma caused by my previous treatment.
Posted by odetopsychiatry | April 28, 2013, 4:03 pm