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Half A Million Hits

Half A MillionThis blog has now been running for over two years and this post should be celebrating that fact and having moved past half a million blog hits.  (I just laughed out loud (again) writing “half a million blog hits” – a policeman banging on about out-dated laws and NHS guidelines.)

I started this blog because I found myself no longer working in the area of policing and mental health and felt there was still stuff to do and there were things to be said.  And as I sat thinking through what to put in this post to mark two years and half a million hits, I found myself just becoming really angry, if I’m frank.

Because this blog shouldn’t really need to exist – not at all.

MY ORIGINAL INTENTIONS

1. To promote a debate about the role of the police in the implementation of the Mental Health Act – the police do not have legal powers to resolve every type of MH crisis and this is not widely understood.

2. To promote debate about the investigation and prosecution of criminal suspects who are mentally ill – when / how should we divert from justice, who should take those decisions and how?

3. To provide practical advice and links to resources for front-line police officers on how to navigate through a legal and medical minefield.  Successful resolution of incidents involving mental health issues can involve “PlanA” when necessary partnership structures and responses are in place but “PlanB” needs to be understood for when they are not.

You tell me — job done?  My sense is that I and many others have said what can be said, but whether the right people are listening is quite another thing.  I’m not yet convinced but I’m also running out of ideas except to keep saying it: over and over and over again.  And again.

As forces realise what threat and demand mental health work represents, they are appointing sergeants and inspectors to lead on project work for their force.  It is obvious from the emails I get, that those officers are running up against the standard obfuscations that emerge when you first wade into this arena, intended to make progress difficult.  Things I started seeing ten years ago.  And of course, those officers are starting with the same knowledge base I had about ten years ago.  None whatsoever.

So they’re being told “A&E is not a place of safety”, “resistant detainees must be taken to the cells”, “you can’t get a s135(1) warrant unless you’ve already tried to get in”, “it is the role of the police to recover and repatriate all AWOL patients” and “you have to convey patients when AMHPs direct that.” << All wrong, just so you know.  But how would they know?  They’ve probably had the same 4hrs of training that I’ve had.

DRIPPING TAP

DrippingTapI have started to feel like a dripping tap, saying these same few things with an almost monotonous regularity.  Even very recently, following yet another death in custody after the use of section 136 of the Mental Health Act, I entitled a piece “Here We Go Again” and began by admitting I had cut and paste things from previous posts into the new one.  Nothing new in it at all:  just yet again pointing out that which has already been pointed out before – and not just by me.  Within that post, following the death of Leon BRIGGS, I wrote, “Let us be clear about this, yet again — another death in police custody or following contact could happen tomorrow in any area where the procedure followed by the police is not built to mitigate against unlikely but highly significant risks.”

And guess what; it did, didn’t it?

Ten days after the death of Mr BRIGGS in Luton, we learned of the death of Terry SMITH in Staines.  We have since learned of the death of Luftar COKU in Hereford, which occured in August this year.  Three section 136 inquiries from a four month period.  We also know that the CPS currently have investigation reports on their desks following deaths of Thomas ORCHARD and Kingsley BURRELL-BROWN; and that the IPCC have re-opened their investigations into the deaths of Sean RIGG and Seni LEWIS.  Add to those the ongoing inquiries from the deaths of Rafal DELEZUCH in Leicester in 2012; that of Toni SPECK in York in 2011 and of James HERBERT in Yoevil in 2010.  There is a lot going on there and we have over three dozen police officers being investigated and various health staff alongside them.  At least one of the police officers being investigated is a Chief Constable, for potential corporate liabilities.

And all because, we – the United Kingdom, a major first-world democracy and the world’s seventh largest economy – either don’t have adequate basic procedures for safe restraint, or for emergency mental health partnership working; or even a concord across our NHS as to what is needed.  Our NHS can transplant a human heart from a dead person to a critically-ill patient, extending their life by decades but it can’t agree where patients in mental health emergency should be taken by the police.

In chance conversation last month with someone relevant to this debate in NHS England (who carry commissioning responsibility for various offender health services and oversight responsibility for ensuring that CCGs commission correctly) I was told, “of course, where people are violent and aggresive, they’ll have to be taken to police custody.”

No, no, no – half a million times, no!  What hope is there if the people leading the way so fundamentally don’t get it after all the tragedies and enquiries.

Apart from anything else, NHS staff lack the legal authority to make this happen and if this blog has got any underlying message at all, it is this one and it is directed to frontline police officers: go and learn for yourself what you need to do to try your best to safeguard the vulnerable people for whom you become legally responsible: learn what this looks like in an ideal world and even more importantly, learn what this looks like in the world we work in because it doesn’t look like we will see an end to the situations in which you’ll be left with your first-aid certificate fending for yourself and a vulnerable person who has medical problems that no junior doctor would manage alone.

What will you need to say you’ve done or tried in order to look the family of a death in custody victim in the face and with your hand on your heart say, “I tried my best and did everything I could.”

There’s not really much more to say, is there? 

ARE WE GOING TO DO THIS, OR NOT?

ForkintheRoadWe know what needs to happen.  We know it is possible to do.

We know that if we don’t do it, the body count and the family trauma will continue to mount; the police will then cite things like the Adebowale Report to show that we’re left carrying the can and the Rocky BENNETT report to show what medical opinion states about restraint-rekated mental health emergencies.  Mental health trusts will point out that their budgets are being cut by CCG commissioners against backdrop of rising demand; and somewhere in there, we will put police officers and quite possibly NHS staff through the trauma of being investigated as potential criminals for trying to operate in a system that was badly designed – if it was designed at all.

And all of this will make us forget that actually – even more important than any of that – there is a long list of grieving families with unanswered questions who are campaigning for justice.  And for every high-profile event like those referred to, there will be dozens of lower-level, thankfully less-serious incidents but which still leave vulnerable people feeling like they are second-class patients in a system that criminalises them and denies them parity of esteem.  I won’t exemplify that claim: because I’ve done it all before.

Instead we will continue to see responses that fail to address the core problem, reactions like Street Triage and 136 facilitites that exlude more people than they accept: shiny new services that deny those is most need the access to which they’re entitled.  We’ll pretend everything’s OK because we reacted (too late) to make things better without realising that all we did was do the wrong thing, righter.

I’m taking a break from blogging until after Christmas / New Year.

___________________________________________________________________________________________________________

BadgeThe Mental Health Cop blog
– won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs
– was highlighted by the Independent Commission on Policing & Mental Health
– was highlighted in the UK Parliamentary debate on Policing & Mental Health

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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

13 thoughts on “Half A Million Hits

  1. Please take your well earned break, but please don’t give up. You have to be having an effect!

    Posted by Sue P | December 14, 2013, 10:05 pm
  2. I just wanted to thank you for your blogs. To have a resource that covers and explains these issues in a clear and useful manner rather than pages of incomprehensible legislation and no training we have is tremendously useful. I know you must feel disheartened that things arnt changing but officers are still out there facing these problems and need guidance and information which we certainly get none of at work. Just as important as trying to change the broken system is getting people in that broken system get the best out of it while keeping everyone safe.

    Posted by Peter Pants | December 14, 2013, 10:27 pm
  3. As Sue P says, do not give up, it is voices like yours discussing these issues that will eventually (and I have faith it will) change things. Commissioning within both mental health and social care services is woefully ineffective – from the front line I am continually being reminded by colleagues that there is a paucity of services to support people in the community – despite what politicians say. that causes fundamental problems for mental health services who do not have sufficient beds – as an AMHP i have experienced the situation of “no beds available within the County, struggling to find one nationally” when it is assessed as appropriate to detain someone. There is also a paucity of suitable community resources to support people remaining in the community when their mental distress becomes difficult for them to manage on their own. Something is going drastically wrong and it is only by having the courage to talk about this that things can change. Please do not stop. That would be criminal…….

    Posted by BabsK | December 14, 2013, 11:39 pm
  4. No not a dripping tap but sowing a seed that will eventually grow in to a tree which will bear the fruits of change. Just not as fast as we all want. That comes from someone I know who has severe MH problems and yet has more insight than almost all the MH workers she has to deal with put together. And who regularly gives out your blog details to police – including while being sectioned ( as everything is a learning opportunity and always throws them !). So the info and awareness raising you do gets disseminated in ways you probably wouldn’t ever imagine.

    Posted by Sarah G | December 15, 2013, 1:52 am
  5. And if you had any doubt that the issue of AMHP’s or crisis teams not coming out at police request is not being voiced then check out this weeks Community Care:
    http://www.communitycare.co.uk/2013/12/12/cuts-local-mental-health-teams-huge-impact-patients-story/

    Story also being covered by BBC. Accurate, verified and documented and this is within a Trust area that until very recently was considered to have a 5 star CQC rating ( less said on that the better). Point is it is not just police and MH services who are voicing concern.

    Posted by Sarah G | December 15, 2013, 2:03 am
  6. Well done on the hits. About the post, I’d just confirm what others say. It may feel like banging your head against a brick wall but it does chip away, often in ways you might not see. You’ve helped me understand a lot more about the police perspective and that has and does influence some of the ways I work and things I look for now. Just because effects take a while to filter down doesn’t mean that the echoes from the pebbles in the water aren’t having an effect somewhere.
    Merry Christmas and here’s a a better and safer New Year for those we all work to support and help.

    Posted by Ermintrude2 | December 15, 2013, 6:16 am
  7. I think the blog is great. I think there are problems about what people want from mental health services and what services model of mental illness means they provide. I would guess that most people would want mental health services to keep people safe and make them better. Onviously with medical knwoledge where it is making people better isn’t always that easy. And keeping people safe is also difficult. So possibly instead, all the burden is put on the person suffering from memtal ilness. They are ‘service users’, ‘experts in their own experience’, ‘need to take responsibility for their own actions’. ‘need to engage with therapy’, ‘are too unwell for therapy’, asked ‘what they think will help them’, asked ‘ how they think they can keep themselves safe’, asked ‘what they get out of being picked up by the police’, told thatthey are obviosuly safe because they were picked up by the police, told that ‘recovery is what it emans to the’, told that the
    y are disengaging from serviseces when it is clear there are no services, that they are disengaging if they have to cancel an appointment because of another committment. And on top of that the highest levle of care is a 40 minute appointment once a week. Hsospital is basically for medication, and otherwise is 4 hours of activities and lots of doing nothing. And against that background the police have to pick up the pieces. I would be very happy to hear from any professionals who disagree. Rant over,

    Posted by Judy | December 15, 2013, 10:08 am
    • 4 hours a day of activity and then nothing? Come to Wales where it’s an eight hour shift during which the patients get to do little but smoke and wait for the next cup of tea. That’s ok apparently.

      I am starting to be disillusioned after only being registered since 2010. Is this the best we can offer the lost, the distressed and the vulnerable and sometimes even the public. Is it really? By ‘this’ I mean everything written in this blog since it began and the trifling comment I’ve just added.

      Our ward becomes an Out Of Hours Assessment Unit after 5pm and weekends. I was involved in an admission yesterday where the patient was detained on a S136 before being seen and MHA assessed by an AMHP, a S12 doctor and a specialist forensic consultant at the 136 Suite in a police station. He was subsequently detained under S2 and the ‘clerking in’ was completed by the consultant. Then he was driven 30 minutes down the road in a police van in handcuffs by two officers. They kindly waited 20 minutes for our on call SHO to do a physical exam. Then they took him to his parent ward in the same town as the 136 Suite.

      Are you following this? Does it make any sense? At all? Because to me it’s utterly ridiculous and doesn’t even live in the same postcode as ‘ in the best interests of the patient’. Why oh why didn’t the doctors do a physical? I can’t get my hat on about it.

      Two final quick points…

      The police officers brought him onto the ward in handcuffs, took them off while he was seen by the doctor and then put them back on to transport him to his parent ward. If he needed mechanical restraint in the secure pod in the back of the van why take the cuffs off when he was on the unit and was free to run around and hurt staff. Either you warrant cuffs or you don’t, surely.

      Second point. There’s another unit, in our locality, it has a 136 Suite with Police support. So why oh why is that unit allowed to refuse to take patients ‘because they are red flagged’ (violent). That’s our core business for God’s sake. People who are acutely mentally unwell are not generally known for their capacity to play competitive Scrabble or to do the Times crossword.

      Don’t even get me started on how doctors don’t listen; about communication between teams; about how everything is someone else’s responsibility; about how it takes two or three weeks to get someone referred to social services or some other agency because the person responsible is off sick with stress. I could go on but I’m working nights tonight.

      And they keep on keep on cutting our funding. Either they want an NHS or they don’t. It’s that simple.

      Rant over. For now.

      Posted by Rubicon | December 15, 2013, 12:56 pm
      • Answer to the handcuffs – I’m sure the police will correct me if I’m wrong, police will put handcuffs on when transporting people becuase of the risks of being in a moving vehicle. They will try to take them off if possible, otherwise.

        Posted by Judy | December 15, 2013, 3:30 pm
  8. Thanks for this excellent summary of this ongoing problem. Don’t despair.
    I’ve got two questions I’m working on in 2014:
    What happened in the culture of mental health nursing when Mental Health Nurses now think it is the responsibility of other professions or agencies to deal with THEIR patients?
    How can we re-train this generation of Mental Health Nurses to realise they are mistaken to belief that it is the responsibility of A&E to deal with intoxication in THEIR patients and the responsibility of the police to deal with violence and aggression in THEIR patients?
    Wishing you well for a well-deserved break from a top blog.

    Posted by Simon McArdle | December 15, 2013, 10:33 am
  9. Keep turning the tap :-)

    Posted by ASIF AMHP | December 15, 2013, 10:06 pm
  10. The grief James’s family felt after losing James in police custody was increased significantly by a failure to acknowledge his death as something that could and should have been prevented by handling things differently. I therefore understand completely how frustrated you must feel. Keep at it please and remember Margaret Mead’s wise words. ” Never doubt that a small group of thoughtful and committed citizens can change the world. Indeed it is the only thing that ever has”.

    Posted by Tony Herbert | December 16, 2013, 6:42 pm
  11. A dripping tap to you but a font of knowledge to me and what appears to be thousands of others. I was recently introduced to this fabulous blog when I attended a mental health seminar in October 2013. Since then I have soaked up the excellently written advice provided on the blogs and endeavour to complete the reading of the backlog sometime in 2014. Since October the information you have provided has potentially saved my career on two different occasions. This knowledge base you have created I believe could be considered to be the best reference to the Mental Health Act and how it concerns the police.
    Having scooped the Mind Digital Media Award, the World of mentalists best mental health blog, be mentioned in Parliament, and quoted as a must read for all police officers throughout the nation I believe you are on the right track. I have learnt more about the MH Act in the last 2 months than I had in the last 10 years of police service, and I am still learning, so may I ask that you keep on writing. And most of all may you and your family have a very merry Christmas and a happy new year.

    Posted by ian | December 16, 2013, 7:35 pm

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