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Ignorance Is No Excuse

WMASI went to a job today where a man had been seriously injured in a car crash.  He was trapped in the vehicle and his leg was partially crushed, preventing him from being easily removed.  We could tell he was bleeding and in a lot of pain and after the provision of some reassurance and some first-aid, officers gave way to the paramedics who turned up.

The fire brigade also emerged to start trying to extract him from the car.  As we started trying to piece together what had happened, I couldn’t help but notice that the victim was screaming in some distress.  The paramedic was talking to him and being very reassuring, but I noticed that she wasn’t administering any kind of pain relief to this man.

As the bloke was making a horrible noise, I felt it was appropriate to ask if she intended to give him something for the pain?  She opened up her kit bag and I couldn’t believe what I saw next:  she pulled out what seemed to be IV morphine and started explaining she was going to get a cannula into his arm to administer it.  I know that paramedics carry different kinds of pain medication and it seemed really obvious to me that she should have been giving him IV paracetamol – morphine can have various fatal side effects, can’t it?  So again, I felt I should say so.  What I didn’t know was the patient had already explained to her whilst I was busy with something else, that he was allergic to paracetamol and so to my utter amazement, she disregarded my advice and did her own thing!  Unbelievable – I’ve got a few friends who are paramedics.  I’ve even read some of their clinical guidelines and done a few lectures on mental health law on some of their university courses.

Of course the above three paragraphs are utter nonsense – I’m sure you worked that out prior to here!  Of course, I did not go to a road collision and tell a paramedic which drugs to administer to a patient in pain.  I wouldn’t dream of doing so, as I would predict being told where to stick my traffic ccone and it would be altogether quite ridiculous, woudn’t it?  I’m hoping you questioned it and wondered what the hell I thought I was doing!  I’m also trying to imagine the disciplinary hearing at the Health and Care Professions Council where the paramedic was facing gross misconduct charges after administering a drug they knew would be inappropriate which had caused serious damage to the patient and saying, “But a police officer at the scene said he thought IV paracetamol would be better!”

It wouldn’t get off the ground, would it?!

ONCE UPON A TIME

DoorGuess what happened?  The complete reverse happened, some months ago now.  Police officers were called to a house by a man who had indicated he was intent on harming himself.  Upon arrival, the man answered the door by opening it slightly and appeared distressed.  When the door was fully open, he was holding a kitchen knife in the hallway of his house and pointing it at officers as he backed away, making threats to harm himself.  Officers entered the building and having used a taser to control the situation, detained the man in handcuffs to prevent a breach of the peace which they feared was imminent.

The ambulance had been called early in the process and paramedics entered the situation once the man was handcuffed. Attempts to engage him were futile, he appeared to be highly agitated and suffering from some form of mental health disorder. The paramedic felt he needed to be checked out at A&E because of high skin temperature, possible head injury and the after effects of being tasered. He’d also consumed some alcohol.  The paramedic also had one other view: the man should be detained under section 136 of the Mental Health Act.

All I can say to that, is you’re entitled to your opinion!?

This is where it gets messy: the officers duly obliged!  They did exactly what Lady Justice HALE said you can’t do during her judgement in the case of Seal v Chief Constable of South Wales Police [2005] – she stated that by removing someone from a premises having apprehend a breach of the peace and then by applying section 136, the officers acted illegally.  You cannot lawfully detain someone in a house, remove them to the street and then detain them under the Mental Health Act.  You just can’t!  In no way, shape or form can that be said to involve someone who was “found in a place to which the public have access.”

And if you find yourself getting questioned, grilled or investigated over allegations of unlawful arrest, you certainly cannot say, “The paramedic said we should do it because he needed Mental Health Act assessment!”  It just is nothing like sufficient to pass responsibility for legal decisions to an unqualified, untrained professional from another organisation and hope it will provide you with an element of protection. So the punchline of this post is —

YOU NEED TO KNOW YOUR LAW!

You really need to know it – and you have to take responsibility for the legal decisions that you take.  As the police often say to the public when investigating allegations of crime, ignorance of the law is no excuse.  It may be fair to say that legal training in emergency mental health law is inadequate.  It may also be fair to say that the incident being policed was a private premises situation where the Mental Health Act does not apply and where resolution to incidents can be difficult.  But given the imminence of someone who may well hurt the officers having pointed a knife at them, you can justify the legal detention and removal to custody of such a person in any number of ways.

It was said to me by an inspector on my second day in the police: you need to know your law, because knowledge is confidence and confidence gives you authority.  This is why I’ve faced this very request numerous times in my career and just said, “No!” before proceeding to try for another solution.  I recently refused to illegally force entry without a warrant to a patient’s house, too.  There are numerous resources kicking around on mental health law, many of them on this blog or linked via it.  If you haven’t ever read the parts of the Mental Health Act that apply to the police, or read through the stated cases that are key to operational decision-making, take a couple of hours to do so. Pick a NIGHT shift or a Sunday morning on EARLIES and spend a few hours that represents an investment.

In particular, try to digest the “Part II” and “Part X” of a my short summary of the MHA.  And see a short post which amounts to a knowledge check – the latter contains links to things you might want to read more about.  And don’t forget, you can also bookmark on a smartphone these “Quick Guides” to a range of different operational situations – there really isn’t an excuse!

Because I will be honest: when I hear of officers using section 136 in a private premises I just think, “How ridiculous – it’s well-known to be illegal and highly inappropriate. There is just no excuse for it under any circumstances.” Just read back the first three paragraphs and remember how ridiculous it sounded – a police officer telling a paramedic which drugs to administer. Well, the same applies to legally detaining people – it is ultimately a matter for the police, having heard whatever opinions might be floating around at the time.

And the same applies to decisions *not* to detain people - it is, ultimately, a matter for the police.

CASE LAW BLITZ —

  • D’Souza v DPP (1992) – you need a s135(2) warrant in order to force entry to a premises to detain or redetain a person under the MHA, unless s17 PACE applies.
  • Syed v DPP (2010) – you cannot force entry to a premises because of a concern for someone’s welfare.  Officers need to have reasonable grounds to believe that life or limb is, literally, at risk.
  • Seal v Chief Constable of South Wales Police (2007) - incidental judgement that arrests under the MHA are unlawful if they follow people being removed against their will from a dwelling to a public place under other provisions in order to then be detained under s136.

___________________________________________________________________________________________________________

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

22 thoughts on “Ignorance Is No Excuse

  1. Very interesting Blog as always. Why don’t police officers complete mandatory refresher training sessions on things such as mental health and law? Or do they? The same should apply to paramedics, nurses, doctors, social workers and even teachers – anyone who works with and is responsible for the care and safety of people in fact.

    Posted by maria | February 6, 2014, 8:57 am
    • I agree with you – fact is, though, they don’t. Not sure why – because there are loads of example of professionals of all types getting basic aspects of law wrong. A real shame, because it is such a proportion of most people’s work that it merits proper understanding.

      Posted by mentalhealthcop | February 6, 2014, 8:59 am
      • AMHPs do attend mandatory update training etc & to my knowledge are the only professional group involved in all this who attend extended training regarding the use of the MHA & other bits & bobs of legislation e.g. MCA. Indeed becoming an AMHP now involves undertaking at least a PGDIP in Mental Health. In terms of the MHA others do get training & than learn “on the job” or like MHC take a personal interest.

        I would not be so bold as to suggest that AMHPs always get it right & it is a complex bit of legislation, that is at times open to interpretation. But what is often missing is discussion/debate on the ground is a degree of professional courtesy. In My experience, during MHA Assessments, AMHPs are often questioned in a manner that is inappropriate. Often police officers will double check with their supervision before taking action. They certainly will not take the word of the AMHP. I have no problem with officers checking. However I do take issue when the advice is wrong & then we are in a stalemate. Medics, nurses, paramedics & anyone else who is there seem to bring their own version of the MHA with them. Very few of them have gotten as far as reading the Code of Practice.

        When a police officer arrests you, very few people question his/her right to do so. The uniform helps etc but it is the warrant card that gives him/her the authority to do so. I don’t often say this out loud, but AMHPs are also warranted officers with (in terms of the MHA) the powers of a constable, with that level of authority & professional & personal accountability for their actions & decisions.

        As I have said elsewhere, currently I am liking lots Secs 126 & 129 & thinking out loud about how I might concentrate the minds of some partnership organisations by inviting the police to consider them.

        Maybe, perhaps working together we might overcome some of this & arrive at a common understanding that meets the needs of service users & manages better any risks.

        Posted by asifamhp | February 6, 2014, 2:13 pm
      • Exactly. I watched a clip posted on Facebook a while ago of an ‘idiot’ in a white van shamefully running rings round 3 or more police officers who were trying to question him after a he’d performed a suspect manoeuvre on a public highway. The ‘idiot’ had clearly once read a text book and quoted some legal terms which seemed to throw the officers who were not able to take control of the situation. The ‘idiot’ was abusive and racist and agitated and refused to get out of his van. He ended up driving off after ‘wiinning’ his argument with the officers who were left standing, not sure what had just happened. They had clear powers to detain him while they satisfied themselves that he wasn’t drunk for starters judging by his driving but they seemed to have forgotten all they had learnt. The ‘idiot/career criminal’ must have been very proud of himself which disgusted me. With regular refresher training days this would be much less likely. Sorry for going such a long way around trying to make my point but as you said in your blog, “knowledge is confidence and confidence gives you power”. I hate to think that the ‘idiots’ ever get the better of the Police.

        Posted by maria | February 6, 2014, 4:38 pm
      • AsifAmhp – sorry to burst your bubble, but people question police officers’ rights to arrest people all the time, also their right to enter and search property or to seize items as evidence. It’s everyday business to find yourself challenged by people from the public and partner organisations about legal assessments we’ve made, most recently by a mental health nurse who didn’t like an identical legal view held by six different police officers.

        I think that holding public office (as constables and AMHPs do) means you must expect to be challenged and have the professionals to justify your legal actions against the law. I think one reason officers do question the legalities put forward by mental health professionals, is that they have too often been found to be wrong. Unfortunately things includes AMHPs on far too many occasions – and I immediately make it clear that this includes police officers on far too many occasions, also.

        Posted by mentalhealthcop | February 7, 2014, 7:37 pm
      • My bubble has been burst many times – but I keep bouncing back for more.

        As an AMHP I expect to have to explain myself & am duty bound to inform people of their rights in terms of the MHA. I think my point is that police officers when challenged (even when they are wrong) are able to whistle up mates & use muscle to enforce their interpretation of the law & situation. Yes they are open to challenge during & after the event & I have even seen people dearrested with an apology & officers in trouble for their actions. Also I see them not using the powers they do have in certain situations because they are unsure of the MHA. Though in terms of my work, I always acknowledge that they are often very helpful & very good.

        No one or group of professionals is infallible & the situations we are invited into are often difficult & complex. I like the idea of policing by consent – even if it is not always a reality.

        So as ever for me its about how we all work together & there are some peeps not at the table discussing the issues.

        good luck with the jocks :-) though i am hoping for rain ;-)

        Posted by asifamhp | February 7, 2014, 9:24 pm
      • I’m hoping the senior team just replicate what the u20s just did tonight – Sco 15-48 Eng! The Ire v Wal game should be exceptional, in theory and a Welsh fan I spoke to earlier is also very fearful!

        Your example of them not using powers they do have comes back to the parlous lack of training! Emergency Mental Health Law courses all ’round, say I! :-)

        Posted by mentalhealthcop | February 7, 2014, 11:03 pm
    • and probably add in there those answering the phone in the MH Section of the Care Quality Commission

      Posted by simon gould | February 9, 2014, 5:31 pm
      • sorry my comment on those answering the phone at Care Quality Commission was intended to add a comment to Maria’s list of those who need to have a working knowledge of the Mental Health Act (in the first reply)

        Posted by simon gould | February 9, 2014, 5:36 pm
  2. The MHA is minimally taught to almost all healthcare professionals – sorry! Reblogged and retweeted in the hope of addressing this.
    Kirsty – an Emergency Medicine doctor.

    Posted by drkirstyc | February 7, 2014, 9:03 am
    • Helps to have interested allies, especially in A&E who often seem on the periphery of these debates. I know why you often are, but I don’t wonder whether the world would be a better place if you guys piled in to it!

      Thanks for reblogging! :-)

      Posted by mentalhealthcop | February 7, 2014, 7:39 pm
      • We are left on the periphery because we seem to be the only people who can’t say no….. I love a good game of prisoner ping-pong with a custody sergeant at 3am – not! – and it’s not good care of the patient/prisoner or a good use of anyone’s resources. Although to be fair the individuals involved in those exchanges are usually intoxicated (not necessarily alcohol) rather than with mental health issues.

        I wonder if you can help with a question that occasionally gets debated though? Would you consider our Emergency Department to be public or private in terms of s136 – sometimes we get patients who have been persuaded to attend by paramedics/relatives, or also who initially attend voluntarily with police, but then get more upset and want to leave. Can s136 be used if appropriate to detain them?

        Thanks!

        Posted by drkirstyc | February 8, 2014, 5:49 pm
      • I don’t think there’s any doubt and the answer is really easy – Accident & Emergency IS a “place to which the public have access” for the purposes of s136 MHA. The judge in the case of Sessey said so in judgement in that case, so I think it’s beyond any debate. I think it can be used and have done so many times.

        Posted by mentalhealthcop | February 9, 2014, 9:29 pm
      • Thanks MHC, that’s very helpful :-)

        Posted by drkirstyc | February 10, 2014, 9:24 am
      • I’ll bet it is! … many cops will try to find reasons not to use s136 in A&E and arguing the public / private thing is just one of the obfuscations to choose from.

        Posted by mentalhealthcop | February 10, 2014, 9:42 am
  3. Yes

    Posted by Asifamhp | February 9, 2014, 9:10 am
    • ASIF AMHP…maybe police officers would trust your judgement and knowledge more if the AMHP service actually came out when requested to. Too many police officers end up spending hours and hours in people’s home with paramedics waiting for the AMHP who in this area of London wont come out unless a bed is already identified. And this can be 24 hrs later or longer even with people deemed at very high risk to themselves.

      So instead the AMHP tries to persuade the police officer to remove under the MCA despite the dubious legal ground. As an AMHP you won’t (yet) be the professional facing the legal challenge/disciplinary process for illegal removal/detention or neglect when you have to leave the suicidal person in their home and they kill themselves. Or the personal guilt if this happens. I say yet because actually it will at some point be the LA’s who are sued as they have a statutory Duty of Care for vulnerable people that goes way beyond the MHA .

      Blame game very easy to play when you dont actually have to be the front line or first on scene

      Posted by Experto Crede | February 11, 2014, 9:49 pm
      • EXPERTO CREDE – I try very hard not to play the blame game & the whole thing is very complicated at times. In my part of the world the AMHPs are dispatched without knowing if a bed is available, if it is needed. Here the AMHP is very often the one left waiting with the person & family for a bed to be identified & then a bed is found sometimes 100s of miles away. Our local ambulance service will not convey out of area & the CCG has not commissioned any alternative. Indeed the ambulance service will very often not attend the scene of any assessment if there is an elememt of risk or resistance & insist on the police attending = the classic catch 22 descibed elsewhere on MHC.

        Sometimes also other services attempt to short cut their own responsibilty by asking for MHA Assessments inappropriately. Just today I have had to suggest that a GP & CMHT actually go & knock a door & assess the situation rather than simply seek an AMHP to gain a Warrant to put the door through etc. From where I am standing there is nothing to suggest that any reasonable steps have been made to attempt to engage or offer treatment if it is even need, nor from the very vague referral is there any risk that requires this level of state intervention.

        BTW i dont think anyone should have to wait 24hrs & that includes the person, the AMHP or the police. Bigger Picture stuff now – how many people at times of crisis in their lives threaten to harm themselves or indeed others ? I do not know the answer to the question. But I do know that if we (thats all of us together via the state systems in place) had to respond we would be unable to. Also the MHA can only be used to stop you from harming yourself or indeed others if you are assesssed as having a mental disorder. That then opens a whole other debate & I am very often on the frontline & wish sometimes the whole thing was different.

        take care

        Posted by asifamhp | February 13, 2014, 5:09 pm
  4. ASIFAMHP
    I get it I really do. But while professionals are playing the ‘blame game’, or avoiding responsibilities , or not commissioning or just so incredibly stretched it is impossible to deal with the situation there are real people in real distress who need protection and yes, a hospital bed.

    So I and others , who are very experienced across the board and who have waited for MH services and attenders of all descriptions to sort this out, now simply believe that each and every part of the system is not fit for purpose. The EDT/AMHP service and the MH Trust are failed service providers and yes the CCG should step in. BUT and this is a real problem you have a monopoly on the ‘service’ you provide and are not going to tell your funders ( whether that be the CCG or local government funding bodies) that you are failing. The CCG doesn’t have the robust systems it needs to monitor this and is totally dependent on what MH Trusts/ LA report back to it.So massage the figures, soften the MH Law Group annual report and bury your heads in the sand and presumably cross your fingers and pray to a god that no one dies on your watch.

    So given this how many of you or clinicians or any member of the crisis teams or liaison teams actually speak up directly and complain formally and loudly at the time case by case. As I have stated before yes you should attend and assess and the individual should be put first each and every time over and above the needs of the LA or the MH Trust or any other body. Because that is the right thing to do otherwise people die.

    It is only asked that you work according to policy, the code of practice and within the law. If for eg all AMHP’s did this then the failings would become visibly and glaringly obvious to all authorities very quickly, the DATIX or other reporting systems would end up showing the failings and incidents ( or decisions would have to be taken to actively cover up) and the reports fed back to the CCG would reflect this meaning that they would have to commission accordingly. If you dont do this then the CCG continues to get at best inaccurate data and at worst falsified figures. So by not doing so MH professionals collude with the failing system.

    The All Party Parliamentary Group on Mental Health are currently taking submissions on emergency care in mental health. The link is on MIND’s website. So each and every MH worker involved in emergency care could at the very very least take even 10 mins to submit something. Anything is better than nothing

    Like I said at the beginning the situation is lousy and distressing for all but so much worse for those affected directly. It is not the AMHP or the crisis team or the MHLT who get to find the body of someone who did not get the assessment needed. And that is why I post here because I can’t raise the dead

    Posted by Experto Crede | February 13, 2014, 9:36 pm
    • Experto Crede – Thank u :-)

      I agree that the system is not fit for purpose & I assure you that there are peeps like MHC & me & colleagues highlighting this everyday & career limiting – but that is ok because it is about putting people first. People like me & you & my friend & my brother & your mother & my sister & his father = 1 in 4.

      BTW I do cross my fingers often & it is not much of a risk management plan & I very much like the COP & try very hard to hold others to it. also just sometimes it is the AMHP & the crisis team (HTT) with the police that find the body :-(

      Posted by asifamhp | February 14, 2014, 12:35 am
      • ASIFAMHP
        Apologies for my tone. I could and should have delivered the content of my message more compassionately. Truth is me , you and others who post here are all trying to do the right thing by the person in distress or we wouldn’t be aware enough to post. I had just experienced another horrific situation where the sole carer attempted suicide because they could not cope any more. Someone with no MH diagnosis just hidden extreme distress and another casualty of a system that doesnt work.

        Posted by Experto Crede | February 14, 2014, 10:17 am
  5. No apology needed – take care of you & for those that you can.

    Posted by Asifamhp | February 14, 2014, 12:49 pm

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