I can’t begin to imagine the gradual build up of distress and despair that must overwhelm a person who has to watch their nearest and dearest be gradually consumed by Alzheimer’s disease. To reach a point where one must wonder whether or not your parent or partner even still recognises you and the love you give them must be heartbreaking. If it were then learned that during a brief period of respite the police had attended a care home and restrained them using handcuffs, we can all agree we would have questions to which we would demand answers: from the police AND from the care home – and from appropriately senior managers.
It is for those reasons that I don’t want to focus on the reaction of relatives to the recent handcuffing of 76yr old Keith HYRONS in a Malvern care home. Mr HYRONS had been placed there to afford his wife a period of respite from being his full-time carer and I’m sure all we can do is wonder how traumatic it must be to have found out that within twelve hours the police had been called and handcuffed him. I’d be furious and have questions, too.
I am a front-line police officer leading a team that answers 999 calls and I would argue that my team alone, in just one UK police area, is called to a residential care setting once a week whilst being invited to use force on a vulnerable person because ‘agitated behaviour’ or a ‘behavioural disturbance’. In planning a recent contingency in a nursing home, I recently had to ensure that we had officers with both tasers and the police protective equipment which is better known as “riot gear”. Such was the nature of the episode. Whilst we thankfully resolved that particular incident without anyone using any force whatsoever by playing a waiting game, it has not always been possible to do so. On other occasions inaction would have meant the very real probability that someone would get hurt
I have written on this blog about how I have perceived in recent years an increase in dementia-related demands for the police, so these kinds of incidents will potentially recur and cause further debate unless we learn the lessons now from what has already occured. It is against these backgrounds that I want to take issue with just one part of the reaction to this sad case.
It is the reaction of the Alzheimer’s Society that particular engaged my interest when their West Midlands spokesman, David ASH, attacked the handcuffing incident. In fairness to them, they have published information about handling aggression in dementia patients and forewarned that introducing police officers to situations may exacerbate problems. They have also covered this issue in their magazine, arguing for a different approach and better training for officers. All of that said, the comment still bears scrutiny -
‘‘Any case of abuse against a person with dementia is absolutely appalling. The most vulnerable people in our society should be treated with respect and dignity. Our care system in the UK is broken and underfunded.”
Abuse? — can we agree on three things?
1. None of the people talking about this incident in the Birmingham Evening Mail were actually present in Malvern, so do not know, ultimately, what occurred? – if we are to reach a position where the officers’ handling of the situation is labelled “abuse” let it be following an properly constituted investigation which hears all sides.
2. Using force on anyone to prevent harm to others should be done only where it is necessary, as a last resort? – given it is established form, we should assume the officers at least attempted to communicate the situation into a safe position, before resorting to force.
3. Describing a use of force as “abuse” without knowing whether it was reasonable in the circumstances is premature? – and when one considers the magazine article which calls for any needed restraint to be done in another way, we start to see that it is not restraint per se, that is the issue.
I have met and interacted on social media with many people who think it is always possible to avoid using force when dealing with vulnerable people – it often emerges from discussions where they’re have been criticisms of the police for failing to de-escalate certain situations. Now de-escalation training, by that name, is not taught in police training. But the concept is and I’ve heard many people from health and social care backgrounds say that police de-escalation skills are usually first-rate.
It was recently a question on Twitter from a PhD researcher from a mental health nursing background – whether restraint could always be avoided? The consensus was that it could not always be avoided, but that we need a debate about whether we’re doing the most we can to avoid the need for it. Suggestions of where we could do better were in the arena of staffing levels, staff training (in police AND health / social care) as well as in access to relevant services and crisis support. If you read the Alzheimer’s Society’s full comments in the Birmingham Evening Mail, you see the attack is at the care system itself, into which the police were invited.
The above-mentioned magazine article calls for police officer to use velcro straps instead of handcuffs – presumably this means the leg restraints with which we are (mostly) already issued? And this moves the debate on to the more specific area territory of how dementia patients are restrained, if that is deemed necessary, rather than whether they are restrained whilst exhibited various kinds of challenging behaviour.
LAWS AND ETHICS
So I want to finish by highlighting the apparent clash of laws and morals in this kind of incident. West Mercia Police have publicly backed their officers using the language of law: highlighting risks and threats and having words like “rights” attributed to them. Meanwhile the remarks from the Alzheimer’s Society show the background factors of concern to his family couched in moral terms; as well as the proper assessment of needs we hear language like “abuse” and suggestions of treatment like a “common criminal” inflaming our emotions about what occurred.
The problem here, as with the Humberside ‘taser’ case and the Manchester ‘handcuffs’ case before, is that BOTH are right. It is an outrage that things get this far but those of us who police know that we are often demanded to instantly restore order to situations which took months or years to deteriorate. By the time we are making minute-by-minute decisions in the middle of the night involving risks and threats with people who we know little about, we are are not talking about precise, nuanced interventions – we’re talking blunt, crude options which may lack utility. This is the very real danger in these cases because the complaints the Alzheimer’s Society spokesman had after labelling the intervention as “abuse” we’re all about the care system: not the police. When the officers arrived, they had three choices: do nothing, do something without resorting to force, use force to prevent harm to those present and call for further medical assistance which we know was done, because Mr HYRONS was detained under the Mental Health Act in an older adults unit.
I’m sure we all wish him and his family well and regret the events, however necessary those involved may have considered them to be and I’m sure they would be further reviewed if that is what the family wish to see happen. But as with many incidents, the necessary actions to avoid the police use of force as a last resort, were things not in control of the police that needed to occur way before the 999 call was made.
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.”