Firearms

Armed Police on Mental Health Wards

FirearmsWe have seen for some while a story circulating on the internet and social media that “armed police on mental health wards, FoI reveals.”  My immediate concerns were raised because the wording of this headline denoted to me either that it was being reported to have happened more than once OR that it was some kind of routine thing to incidents on wards.  I suspected both things to be false.

The piece itself follows on from concerns that 48 officers, including armed police, riot police and dog handlers were called to River House in south London, after a disturbance.  River House is a medium secure unit in the South London and Maudsley NHS Trust and there are understandable sensitivities around the location and the police being called to it, because this is the place where Metropolitan Police officers responded to another incident which led to the restraint-related death of Olaseni LEWIS.  So we can all agree that scrutiny and concern about further police responses to such incidents is justifiable.  We can also agree, that preventing the need for further police responses to incidents can never be guaranteed because unpredictable events can always occur.

I’ve resisted for some while the urge to blog on this, as I admit to thinking it something of a non-story, but it keeps persisting in its circulation, so I have given in to better judgement.  I stress for the record, that I was not involved in the incident because it occured in another police force and I have no inside information from officers in the Metropolitan Police nor have I discussed it with them.  Beyond mentioning things that are contained within information confirmed by the police involved, I reserve myself to other observations and considerations about responding to disturbances on mental health wards and to considerations that go through your mind when you are in command of these events.  Following on from this article, some things just appear to need saying, because of the unchecked inferences about what actually occured.

ARMED POLICE NOT ON MENTAL HEALTH WARDS

Firstly – and most importantly: the Metropolitan Police issued a release when contacted with respect to this incident in which it made categorically clear that armed officers were not directly involved in the resolution of it but were in the vicinity of the hospital as a contingency.  I will explain more about this later.

Secondly – the Metropolitan Police said that they were called to River House following reports of a serious disturbance involving a number of patients and that staff had been forced to abandon the immediate area of it because of fears for their safety.  It was at staff request that the Metropolitan Police were called.

Thirdly -the officers were told that several patients were involved in violent conduct, would have access to knives.  At the risk of pointing out the obvious, a medium secure unit is the kind of location where some patients pose “a serious risk of harm to the public” and are detained following criminal trials for serious events.

Fourthly – there is absolutely no barrier in law, protocol or procedures that prevents the police being called to such incidents and no ability to dictate the operational terms upon which police commanders restore safety to a situation and prevent further crime.  It is down to the police commander to bear this responsibility.

So take all of these things together and we see a complex, unfolding and dynamic operational environment of some gravity where officers may face serious physical resistance and / or personal attack.  But they may not.  And we don’t know what resources may ultimately be needed to minimise harm to patients, staff and infrastructure, if any beyond the local 999 response team.

COMMANDING UNFOLDING EVENTS

PathToDoorIt is my role in my day job, to lead the police response to these kinds of events and other critical incidents, if they occur.  So I thought it might be useful to go through some of the thinking processes with reference to one of my own jobs?  I have been that police inspector who asked for armed police to support an intervention in a mental health incident and with this in mind, it outlines why it was perfectly proper for several different reasons to ask for it —

Some years ago, the police were asked to detain and convey a man from his mother’s home to hospital for assessment under the Mental Health Act.  The problem was, he’d locked himself in the upstairs front room of the house, with a knife and the man had a significant history of violent behaviour and weapon possession.

It posed a proper problem for the police, because he had committed no offence and the AMHP leading the assessment had not obtained a warrant under s135(1) MHA which would allow the police the right to detain him and remove him to a PoS.  It was my position that to act properly and safely, and to then justify the use of any force we may ultimately have to resort to, we would need to firstly, spend an appropriate amount of time genuinely attempting to negotiate a non-coercive outcome; and secondly, obtain a warrant under the MHA which the AMHP didn’t want to get and which would take time to obtain even if I did manage to persuade.

So we had several hours ahead of us and who is to say what would occur during that time, whilst we aimed for a peaceful, non-coercive outcome?  The man could decide to leave the room with the knife for any number of purposes; he could have chosen to start using it to hurt himself.  There are plenty of other scenarios which could have unfolded.  As the police commander at the scene, it is your job not only to start policing what is in front of you, but to think ahead to a multitude of different scenarios.  You can call them whatever you like – but I’ll go with “Plan A and Plan B and Plan C”.

PLAN A – PLAN B – PLAN C

PlanAYou initially plan for and start trying to deliver the most desirable outcome – Plan A.  This is the one you would choose from the “solutions catalogue” for mental health incidents.  You use the resources initially there to start attempting to deliver it and first-things-coming-first, you obtain whatever support is needed to that situation to maximise the chance of it happening.

So the first two cops on the scene establish the facts of it and start attempting to negotiate for the outcome you need.  I start getting a few more officers there for different reasons and one of the sergeants came down.  I get a negotiator contacted by the control room.  If all things go well, these resources will be able to deliver “Plan A” and all resources for Plan B and Plan C will just be released.

You also then also start taking care of the indirect implications – at an incident like this, there were also concerned family members to manage.  Firstly, in terms of making sure that they know what’s going on and what the police are thinking and what they’re up to.  Secondly, as they included the house owner, one of them had explicit rights to control what was going on in their own home and this needed to be respected in the decision-making that is needed.  I need an officer to available to them – to answer questions and convey messages, and frankly, to stop them controlling me as I have wider responsibilities.  And you also start planning for what you will do if and only if Plan A fails – you will resort to the use of force to resolve the matter, if and only if the AMHP secures the necessary warrant, in this particular example.  We’ll call this Plan B.

But you also start planning for the outcomes you genuinely hope you don’t have to manage – inevitably, Plan C.  What happens if events in the room begin to develop?  If there is the commission of a criminal offence, then the legal framework alters and as the incident commander, I then get certain rights to determine how things proceed.  Should this happen, what am I going to do?  Well it depends on whether the offences is one that requires immediate action or not.  If he threats to kill someone, but makes no attempt to try, then we continue as for Plan A and get ready for Plan B.  If he actively starts attempting to do so or starts harming himself, then an urgent physical intervention may be required and Plan C kicks in.  But if things escalate, am I sending in officers dressed and equipped normally officers to deal with a patient with a knife and significant risk history of violence?  No, I’m not.  So the sergeant gets an instruction to arrange a unit of officers to get into public order equipment (riot gear) with shields.  These officers are maintained at a discreet distance away from the incident.  I hope not to use them – they are outside the address as part of Plan C and Plan B, if instigated.

You also then start planning for the consequences of untoward outcomes – what happens if someone gets injured?  At what stage do we call an ambulance?  This could be necessary in either Plan B or Plan C but we don’t want to tie up an ambulance for hours and hours if our Plan A is patient negotiation.  So we set an instruction – 999 is called if events suddenly escalate or fifteen to twenty minutes before we give up on negotiation and move to a use of force.  Meanwhile, we’re telling them family all about this – if you look down the street you will see what you think is riot van and officers in riot gear.  These people are coming nowhere near your property unless the events here escalate unpredictably and someone may get hurt.  They are in that equipment because it is merely protective equipment to stop the officers getting hurt.

THE USE OF FORCE

Once our incident developed to the point where negotiation had failed and force was to be used, we called the ambulance.  There wasn’t one available in any quick time because it was a very busy Saturday night for the ambulance service.  So I asked for firearms officers to be in the location.  Why?  Because they are trained in first-aid to a standard that way exceeds the first-aid training given to most of the rest of us AND they can operate in risk environments that some paramedics may not wish to enter.  So if an officer was stabbed or the patient injured in whatever way, I want someone with more than a basic first-aid certificate on standby bearing in mind that I was warned by one of the psychiatrists involved that “this is the next death in custody for your force unless you handle it right.”  No pressure, then.

The AMHP had been persuaded to obtain a warrant, I executed this warrant on the householder and then directed officers in the correct equipment to enter the room and detain the man under s135(1) MHA.  As soon as they tried, after some final negotiation, he repeatedly tried to stab the officers with the knife.  It all ended with a couple of minor injuries to officers and a cut to the patient’s foot after he stood on something during the restraint.  It could have ended so much differently, if we hadn’t carved this up into Plan A, Plan B and Plan C and determined individually what was required to undertake each.

ARMED OFFICERS ON MENTAL HEALTH WARDS

RiverHouseSo what does this tell us about the original incident in London?  It tells us that when you see 48 officers including riot police, dogs and firearms you need to break that down into what they’re all doing.  And it won’t be easy to tell, because they’re not carrying a placard to show which scenario they are there for.  Some were there because they are the local response team who own the job and would have a role to contain the general area, so those officers tasked with their Plan A or Plan B could operate with others focussing outwards from the incident as they focussed inwards.

Some of them were supervisors and commanders.  Some of them were “riot police” because entering a hospital to a disorder of the kind indicated could be highly dangerous business and for a mental health unit with dozens of patients, a police public order unit, trained in tactics to sweep and contain buildings, deploy in groups of 25, led by an inspector who would not be the duty inspector for that area.  That accounts of over half of the officers present.  You also need officers controlling out perimeters of buildings whilst that main group is going in.

Dogs, firearms are all part of the contingency planning as the Metropolitan Police made clear – armed officers did NOT enter the hospital.  We can only speculate about the particular reasons they were there, but whatever your speculation: armed officers don’t just point guns at people with a view to shooting them.  They are highly trained first-aiders, they also carry “less-lethal options” like Tasers but the commanders quite possibly felt that an armed response might – just might – be required if Plan A and Plan B did not go to plan.  This last point is just speculation on my part, but I can imagine what might have been thought.

When I looked at the street after my incident described above, which was on a much smaller scale and only involving one patient, I saw a fleet of emergency services vehicles.  I was joined at the end by other sergeants to conduct an independent debrief of the use of taser, to take over the scene so other officers could clear to hospital and start the considerable administration that was subsequently required.  It involved nearly two dozen officers and anyone standing in the street watching could have said, “Blimey, they had about nine police cars, vans and they had riot police and firearms there!”  All of them, in my humble view absolutely justified – but none of them walking around carrying a banner to explain their particular role and whether it fits into Plan A or Plan B.

When viewed from the outside, it’s all just a mass of flourescent jackets wandering about and why do you need riot police for just one bloke?!  Well, having watched the incident unfold when officers entered that room to face active attempts to stab them, I was astounded by their bravery and wouldn’t have been too surprised if one of them had been more seriously injured despite having done everything possible to mitigate against that possibility.  It was their bravery that meant a very unwell man was safely admitted to hospital under the MHA.

___________________________________________________________________________________________________________

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
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10 thoughts on “Armed Police on Mental Health Wards

  1. Wow. Do you really think that armed police being called to an environment where people are traumatised – and re-traumatised through coercion in hospital – is a good idea? Oh sorry, armed police were only in the vicinity! That’s OK then!
    FFS, did the staff not know what the job they signed up to involves, you know, the one in a secure hospital? Would you not expect them to be able to deal with bad behaviour in the patients? To you know, do their jobs, not run away and get someone else to do it?
    And how the F did patients have access to knives?

    If we try the radical notion that even EW SCARY MENTAL PATIENTS are people…what did the staff do to contribute to this situation? The natives tend not to rebel if treated like human beings.

    Yet another example of the lazy, nasty morons who make up most MH workers failing to do their jobs and calling the police.

    Get out of mental health. Unless you actually like further traumatising people. How many more deaths in custody?

    1. Have you read what has been written? Firearms officers have advanced trauma training and access to medical equipment that regular officers don’t such as oxygen. If an ambulance is not available their medical training is second best. It has nothing to do with them cat tying guns though that is why they were given the training. If seen firearms officers safe the life of a suicidal male who threw himself head first out of a bedroom window because of their advanced training. They had been but on standby because the ambulance were tied up, their weapons were locked in a safe in the vehicle at the time.

    2. I appreciate your sentiments about the effect of such a response on those patients within the mental health setting, but I feel you are failing to realise that for this action to be put in place the incident within must have been extremely serious and causing distress and trauma to all those within its walls. And by all I mean patients and staff.
      Y
      As a mental health nurse myself I am fully aware of the career I signed up for however there are occasions when due to the severity and escalation of situations staff within the setting are unable to safely manage the situation and that is when police attendance is called for.
      Also you neglect the issue that staff involved in “dealing with bad behaviour” might have been injured.

      Also in mental health wards patients are at times able to access cutlery – for example meal times/therapeutic activities like cooking. You’re statements show that you have very little experience/knowledge of mental health settings and that contributes to your ignorance around the issues of managing serious incidents like the one discussed in the blog above.

      In response to your comments about staff contribution to the situation, there is possibility that staff interventions did not help the situation but as this is speculatory we can’t really discuss it further.
      What I would say is that some people with mental health problems have some horrific experiences as part of their illnesses and this could have been a cause/contributory factor.
      There are sometimes errors made and illicit substances make their way into hospitals and the two combined can be deadly resulting in an uncontrollable situation needing more than nursing staff to manage it.
      Another issue may be that is was not ill treatment by staff but an altercation between two or more patients that ignited the incident. From experience this can be like a red rag to a bull and cause a domino effect in provoking anxiety and agitation in others in the environment and cause multiple incidents – another possible reason for police attendance.

      I’d also like to say that not all mental health professionals are “lazy morons” and yes there are a few individuals that join the profession for the wrong reason but on the whole we are a respectful, hardworking, caring group of individuals that enter the career to help others in their time of distress. Yes we expect some violence and aggression however this does not mean that we have to accept being assaulted.

      I hope this post will make you think about your views and the stigma you continue to promote in your comments above.

      Kind regards.

  2. “safely admitted to hospital” – what goes on in some of these wards is abuse and my daughter’s face was covered in bruises and I thoroughly agree with some of the comments above “tend not to rebel if treated like human beings”. This is not the case at all under the mental health. All the more reason to have patient involvement themselves and open dialogue. The right approach rather than this approach would have been more humane. It is a pity the police do not do more to care about the patients within the hospitals and the way they are treated.

  3. Michael,

    You wrote ‘I have no inside information from officers in the Metropolitan Police nor have I discussed it with them.’ and that ‘the Metropolitan Police issued a release when contacted with respect to this incident in which it made categorically clear that armed officers were not directly involved in the resolution of it but were in the vicinity of the hospital as a contingency.’

    I would very much appreciate if you could provide a link to what must be a public press release from the MPS as I have not seen it and have not been able to find it subsequent to reading your post.

    It is very difficult to figure out whether this is a story or a non-story as the only report that has eventually been published has been published in a heavily redacted form. The FoI response from the MPS that revealed how many officers from which units were deployed to this incident doesn’t say what role they had (it’s at https://www.whatdotheyknow.com/request/river_house_2012_10_01_incident#incoming-465743), and my attempts to obtain some kind of report from the MPS about this incident have so far been frustrated (currently pursued with https://www.whatdotheyknow.com/request/river_house_2012_10_01_critical)

    The apparent reluctance by SLaM and the MPS to publish what happened at this incident over a year ago combined with the number of police officers deployed, and the units they’re from, is of concern even if as you wrote you can identify some instances (in a different setting) that would involve a large number of officers including armed officers.

  4. But I now of an example when police with tasers called to wards when this is not the situation. I can send you the incident report. The tasers were drawn. Easier to get police to ward rather than a senior doctor or manager.

    Frances Small

    Date: Wed, 12 Feb 2014 22:35:54 +0000 To: francestsmall@hotmail.com

  5. A few years ago now I was invited to attend a MH incident with the Armed Response Unit at a hostel. The ARU were all big Audi’s & MP5s & it was both exciting & a liitle bit unnerving.No Warrant was sought or seemingly required, I suspected no one stopped to think about it because the chap was thought to have a firearm = a berretta hand gun.

    As it turned out he had a very lovely berretta gun box – it was a beautiful box, all rose wood & velvet & seemingly reclaimed from a skip? But we only new that after the event.

    Working together & by taking a measured risk we managed to achieve a safe outcome, for everyone. In the middle of planning what to do & how & who would do what an opportunity presented itself for myself & a CPN colleague to engage the chap in converstaion in a public area of the hostel, with th epolice officers providing protection from a discreet distance. This chap has red flags for violence & is no fan of anyone that does not do as he request/ requires. It was a difficult & again unnerving conversation for us & we deployed all our “special” social work & nurse skills. In the meantime other police officers were upstairs seaching his room & recovered the item – without a warrant.

    What followed then was a bit of a farce. He had done nothing wrong, other than been threatening & unpleasant towards towards the staff & other people he lived with & he was certainly not ill He was however very unhappy & more than a litle abusive. Again we deployed our special skills & managed to persuade him not to get himself arrested. The situation was explained to him & we all went on our way. I will say out loud again that the police were helpful & professional.

    I am not sure that I can totally agree with the comments made above, if it reflects personal experience people are entitled to their view of the world. I do qestion psychiatry & share a diffrent model & perspective on mental illnes & distress. I do accept that there is an element of the system failing & that includes me. We should always seek to work in a manner that is respectful & decent & sadly agree that we don’t always achieve that. But it is at time a very difficult job & at times risky. Patients in MSUs & indeed Special Hospitals have access to knives & forks to use like you & me. Sometimes depending on risk assessment access is allowed only to plastic cutlery or under supervision.

    Mental illness does not equate to aggression or violence but sometimes individuals are, both those that are ill & those that are not = Friday & Sat nights in town. As a society with have voted for the police to deal with this kind of behaviour. It’s not a real vote, but it is the way things are & they are human also……

  6. I imagine staff on duty contacted the police as a last resort following an assessment of the incident and in relation to policy and procedures ensuring the safety of both patient/s involved and that of staff and other patients. Intense training is often provided to staff as part of induction based on conflict resolution, solution focused practice etc etc. Staff would also be required to read policy and procedures as part of an induction and to be able to promote dignity, respect, show empathy, non-judgemental and express having an caring, understanding attitude within their role and responsibilities regardless of role. To be able to listen to others, allowing time, patience and understanding.

    I have experienced many sensitive and challenging situations which have often been diffused by simply listening and using an empathic approach to a given situation. I don’t doubt that such approaches were not used, however I also know that listening, talking and having the right approach can make also make a real difference. I do not comment to make judgement or offend but to simply promote how listening and talking can be effectively used to prevent and diffuse sensitive and often challenging situations.

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