Somewhat Exasperating

I sometimes think we’re getting somewhere with this stuff and then quite unexpectedly, I come across apparently minor and incidental things which make me suspect all the progress we think we’re seeing is an illusion – somehow apparent because of cosmetic changes that seem both intuitive and convincing.

• If we build a load of place of safety services and get 97% of people into them whilst 3% of people go to the cells, surely we can make massive claims of moving forwards?
• If we get clinical decision-making to the point of detention, surely we can influence not just whether someone is detained, but also the pathway (or route) that they take whether detained or not?
• If we have mental health provision in police custody and at the Magistrates Court, surely we can prevent unnecessary access to the criminal justice system?

Why wouldn’t we do all of this?! – it makes sense, doesn’t it? Well it’s not just what you do – it’s also how you do it.

LEGAL PROFESSIONALS

When I ask police officers what they would do in the event they instigated use of section 136 and were then advised by a mental health nurse or paramedic to remove someone to the cells because of highly resistant, aggressive behaviour – very possibly brought on by an immense overwhelming fear for that person of what the officers are actually trying to do – I am yet to find an example of an officer who knows when it would be wise, legal and in furtherance of proper guidelines around the dignified medical management of people to ignore that advice.

Yes, ignore it. Disregard it and plough another path.

I also sometimes ask police officers and mental health nurses whether they can conceive a situation in which someone wants to access a form of support or assessment and is willing to go with police, ambulance or mental health services and where this should also be disregarded. Why would you choose a legalised restrictive route when there appears to be another, less-restrictive option available which the mental health nurse or paramedic would like to follow? I cannot recall answers that reflect the learning from some tragic events we’ve seen where the key issue was whether someone who needed assessment and care finished it. Easy enough to start something on a voluntary basis, but what if the consent of acquiesance is removed before the process finishes?

When is it acceptable to take that risk and when should we not gamble with the issues – and who decides?

It is with enourmous distress that I keep reading and hearing of some influential people and some professionals operating in the new schemes we are seeing who are actively pushing the proposition that people who are “violent” (their words) need to be removed to police cells after the use of s136. Because where else would you take a resistant or frightened person suffering from mental distress?! Of course, I will speculate that the people who advocate such things have never spent years of their lives battling and campaigning on behalf of a deceased loved one for answer to why their sons, brothers and fathers died in the custody of the state; they’ve probably never been interviewed under criminal caution by the IPCC, prosecuted in the Crown Court for criminal offences ranging from assault to misconduct in public office; they they have probably never seen their Chief Executive officers being personally criminally investigated for Corporate Manslaughter arising from policies that raise the risks of deaths in custody.

It’s such an intuitive argument isn’t it? — the police lock up violent people in cells, this is a violent person ergo they must be taken to the cells. But it’s actually anti-logical – here’s the evidence why we should not do such things anything like so casually —

• Faisal AL-ANI
• Leon BRIGGS
• Kinglsey BURRELL-BROWN
• Rafal DELEZUCH
• James HERBERT
• Colin HOLT
• Matthew LOVELL
• Andrew JOHNSON
• Olaseni LEWIS
• Thomas ORCHARD
• Toni Emma SPECK
• Michael POWELL
• Terry SMITH

…… and this is just in the last five years and is not an exhaustive list during that time: I could keep going and going to really ram home the point. In case you are unaware: each of these people died in contact with the police or in custody, whilst thought to be experiencing mental health problems. That is thirteen families who have been to hell and back wondering what on earth happened to their nearest and dearest and many of these families still don’t know, years after the original tragedy.

MEDICAL OPINION

I remembering reading in a reputable handbook for emergency medicine the following phrase: “Most violent people need a policeman, not a doctor.” Remember, this is a medical textbook – written by people who studied science and the scientific method to postgraduate levels over decades and are the cream of the cream of our country’s academic attainers. This quotation is in a handbook for the ease of junior doctors’ reference, written for them by more senior doctors, including consultants in psychiatry and emergency medicine.

So here’s a different way of saying exactly the same thing – “Some violent people need a doctor, not a police officer.” Or perhaps they need both? Either way, it’s exactly the same thing, isn’t it?! … although I managed to avoid the gender stereotyping from the original version!

Of all the things sitting behind violent behaviour, most people will need a police officer and some will need a doctor. Most will be drunk and / or angry and / or hateful and others will be injured and / or ill and / or intoxicated. This therefore gives rise to the following quandary: how do we tell the difference between the people who come into contact with our 999 services who are so violent they need a policeman and those who are so agitated they need a doctor? And when you set about answering this question, bear in mind that the causes of agitation in some people are invisible, unknowable and sometimes beyond the wit of paramedics with bags of kit to tell.

How does a police officer approach this question, replete with a basic first-aid certificate?

Does this mean that everyone who is violent should go to A&E? – of course it doesn’t! But it does mean we need to train police officers to a certain level of understanding about agitated behaviour and health risks. If someone is drunk and angry with a visible head injury, we know that the injury needs checking by paramedics and / or A&E and medically clearing before we start decanting them to the cells. If we know that someone is suffering a serious mental health problem and they are exceptionally resistant to being detained to keep them safe from other risks that can’t be ignored, we also know that various expert opinions (see the Rocky BENNETT Inquiry, for details) argue that the ongoing restraint of those of us with mental health problems is a medical emergency. We know that such views have been expressed in Coroners’ Courts by medical experts and also such views have been offered by families who would expect a serious mental health crisis to lead to medical assessment, probably via ambulance.

The quandary about how to distinguish the one group from the other, is essentially a clincial judgement. It can be taken by police officers in the most obvious of cases, but when subtleties and complexities become involved, it becomes more important for paramedics and doctors to become involved. What role mental health nurses play in this, I don’t know – and listening to debates between mental health nurses and emergency nurses about pre-hospital clincial screening doesn’t reveal a clear and settled view, either.

SUBLIMINAL MESSAGING

So why, despite repeated mentions in Coroners’ Courts, untoward incident inquiries and other authoratitive documents do we still keep seeing non-police professionals arguing that the police should keep doing what the police have done before. I refer to the kind of incidents which Lord ADEBOWALE spent six months of his life reviewing in order to conclude that we all need to do better all ’round – health and social services services included? Ironically, he concluded these things after an advisory committee included some who can now be spotted saying these sorts of things! It was with some dismay last year that an influential figure in the whole s136 / mental health debate told me quite casually in a lunch queue “of course, violent patients need to be taken to custody – that remains right”. WHY?!! Haven’t you read this stuff? Haven’t you at least followed the news?! It’s highly disingenuous at best, to issue such blanket statements in defiance of all that has gone above.

Far more importantly – such views are not binding on any UK police officer as we’re not obliged to do as we’re told where it conflicts with our legal responsibilities – we all took an oath of office to discharge our “duties faithfully according to law” ensuring “dignity, fairness and fundamental human rights.” << I’ll be busy doing that, if it’s OK with you.

There is a subliminal message hidden within this narrative – the police should just do as they’re told. It’s when the (untrained or poorly trained, quite frankly uneducated) police ignore the advice of the experts in these issues that we see all manner of problems, according to some.

Actually, I’d argue it’s because the police have followed such implicit advice in the past, that we have seen some of the tragedies we have. The officers in the case of Michael POWELL in Birmingham in 2003 did exactly what the structures of the NHS expected and wanted them to do at that time. Having done so, they were suspended for three years and criminally prosecuted in the Crown Court. The officers in the case of Colin HOLT in Kent did exactly what the NHS expected and wanted them to do at that time. Having done so, they were suspended for two years and criminally prosecuted in the Crown Court. We could keep going along this line, but I think you see my point.

Meanwhile, it seems the wholesale breaches of large tracts of the Mental Health Act Code of Practice that gave rise to these contexts were not sufficiently important to be challenged by anyone. (For the legal significance and importance of a Code of Practice, read the Munjaz case.)

How many of these incidents do we need to see before we realise three vital things? –

• Mental health awareness training for cops is not good enough
• the legal knowledge of health professionals is not good enough
• the intergration of health and police services to delivery lawful, safe outcomes is not good enough.

Absolutely none of this is going to get any better as long as we keep hearing reputed professionals casually offering opinion that flies in the face of history, law and the NHS’s own guidance on these things. Read the Royal College Standards (2011) – read the NICE Guidelines on the Management of Acutely Disturbed Behaviour. It’s all there. It’s not just ‘hearsay’ or my opinion. Read the legal judgments in the case MS v UK (2011), Webley v St George’s (2014) as well as the Coroner’s verdicts from the death in custody cases above, which have progressed to that stage. I will admit that I find it truly startling: the notion that you could read and absorb all of this material and yet still form a view that “violent people should go to the cells” is an acceptable blanket statement.

Perhaps it is just rhetoric? An almost political device to keep the police absorbing risk and liability. To claim that “Most violent people need a policeman, not a doctor” is about as anti-scientific as things can get and the public and our police officers deserve far better, quite frankly.

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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2014

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I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk