It is currently flying around social medica that the Metropolitan Police is being asked to undertake 5,000 “safe and well” or “concern for welfare” checks per month. I’m not sure whether this number is even vaguely accurate, but if even remotely correct that amounts to over 150 such calls per day across London. (My intelligence sources tell me that it is a considerable under-estimate!)
Not all of these will be mental health: some will be regarding the safety and wellbeing of children and others will concerns elderly adults who have dropped out of contact with family and friends, but some will involve adults living with various kinds of mental health related issues.
I’ve written before about the difficulty the police have in doing these checks and I’m not going to repeat all of that, but I am going to outline a clear model I have developed in my head since that post to help officers understand their limits and to understand how a situation which breaches these limits needs to be referred back to whoever asked for the check to be done or someone with the letters N, H and S on their job badge.
I submit that officers can do little more than find someone and then confirm the following things —
A – alive
B – breathing
C – conscious
I – ill
I – injured
I – intoxicated
And that’s it – so STOP!
It may be tempting to infer from these things whether or not someone is ‘safe and well’ — don’t!
If you attend a house and find someone alive, breathing and conscious who is not very obviously ill, injured or intoxicated, then visually speaking, that person may well seem ‘OK’. Emphasis on the model being a visual one and upon not all illness, injury and intoxication being obvious. Indeed, the person may well be fine but let me remind you why such an assumption is a (potentially dangerous) step too far because of your inability to undertake a proper mini-mental state examination. Your assessment does not determine whether the patient who you were told was suicidal or likely to self-harm is or is not actually and actively suicidal. Remember to look at the situation from the outside:
A police officer is talking to a potentially distressed person about their safety and wellbeing. What does that service user think the officer will do if the person is unable to convince them that they are, in fact, OK? That person has either already walked out of A&E whilst waiting to be seen by mental health services or whilst waiting for an inpatient be to be identified; or maybe they failed to show up for an outpatient appointment earlier that week or said something on the phone to the crisis team that causes concerns to be raised in the minds of professionals.
Might the person fear that officers will detain them under the MHA or some other law, to ensure they remain safe? I have often heard from mental health professionals that the police checking on someone can be very reassuring for those who are isolated, distressed and unable to access any other supports. I accept that in principle, but can equally counter that some people find the opposite and have been quite distressed to find officers suddenly on their doorstep, thumping on the door. How can officers know which welfare check will be welcomed and which resisted?
The dynamics in these kinds of encounter are weighted heavily towards the police officer – they are dealing with a vulnerable person who may have a suicidal intent and is anxious to avoid detention – it is for that reason we need to be careful how the encounter is managed. If the officer is not entirely convinced of safety and wellbeing, they will be thinking about whether they can detain or remove the person to a place of safety, etc., and the person themselves may well know this. The situation where someone finds themselves detained may be the very thing they are hoping to avoid, whether because of previous poor experiences of police or mental health services or for any number of other reasons.
Obviously, in some circumstances reports voiced as ‘safe and well’ requests also amount to reports of people who are now ‘missing’ as defined by ACPO and force guidelines. Many will be high risk reports, so nothing I’m writing here is trying to suggest that we should receive these calls and simply say, “No, we’re not attending that.” I know one force who took legal advice on concern for welfare checks where the location of the involved person is already known and it was argued that there is no specific obligation upon the police to undertake such checks on behalf of another organisation unless there are threats to life or concern that criminal offences are involved (like child neglect, etc..) But there may well be duties to find people whose location is not known, where vulnerabilities may place them at risk?
The difficulty is that when people are found, to what extent do the police take responsibility for confirming the health and wellbeing of people whose backgrounds were often not fully communicated and where officers lack the skills, training and education to make an informed decision? How do we handle those situations where we have undertaken to find or check on someone whose potential suicidal ideation caused sufficient concern for the police to begin looking for them.
Various things -
- Get health professionals involved to assess medical wellbeing – this may be an ambulance, a street triage scheme if you have one and don’t forget the role of out of hours GPs if you can establish who it is.
- Consider the use of s136 MHA if the encounter was in a public place.
- Use the above tool ABC-III to report back to the caller advise the caller of the person’s location
- Always stop short of confirming ‘safe and well’.
- Ask them what action they are now taking in light of the fact that safety and wellbeing can’t be assured – document the response.
- If A&E were the callers, they may have limited ability to do more than liaise with a MH crisis team
- If a situation where you cannot use s136 MHA gives rise to concerns about the “immediate need for care or control” then contact the CrisisTeam for support / advice.
- Consider asking whether a nurse could attend to support; and / or
- Whether an AMHP / DR could attend to undertake a s4 MHA assessment.
- Document all responses given.
Then, having referred the situation to those who can help, you have to make the decision – always involve the duty sergeant / inspector! – as to whether you can legally do more, or having made the appropriate referrals to relevant agencies, you advise the person to return to hospital and resume to other duties.
Remember, the police service have no legal authorities in private premises under the Mental Health Act 1983, limited ability to justify action under the Mental Capacity Act 2005 and can only otherwise act by detention if there is a criminal offence of a breach of the peace. The most important thing, however, is to not give assurances that someone is ‘safe and well’ where you lack the skills, information and training to tell – get NHS support and advice on this, always.
The 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