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Designing Training

So here’s a knotty one – on the subject of police training.  We know that the police need (more) mental health awareness training because Lord ADEBOWALE told us so in a report with receommendations that were accepted after publication.

So it gives rise to a list of questions -

  • How long should the course be?
  • Who attends it?
  • What should the course contain?
  • How will it be delivered?
  • Who would deliver it?

In reality there are multiple audiences amongst the police – if an inspector with no previous background in mental health policing and partnerships were to be promoted to Chief Inspector and be told to lead on the issue for their area, what would they need to know to be effective?  Whatever the answer to that question, it would probably be different if we tried to address the needs of a frontline operational sergeant running a response team.  It would be different again if you were an officer with some interest and experience who was newly posted to a street triage team or a custody sergeant working where a liaison and diversion scheme was just being set up.

So can we agree: the police service needs a suite of options – perhaps modular and adaptable – capable of being delivered in a range of ways and that at least some of this needs to involve classroom inputs and partner organisations?

But what problem are we trying to solve – what is it that police officers don’t know that we need them to know, which we would hope effective training would address? What is it that we want them actually do differently?

PLAN A and PLAN B

One of the most difficult things of all will be to determine the specific legal training in circumstances where we currently know that the requirements of law and the codes of practice are not necessarily adhered to in all areas.  It’s all very well running an input on AWOL patients and pointing out to officers that para 22.13 states that where a patient’s location is known it is for NHS services to re-detain and return them to hospital. What are the implications of training that to police officers, if some of them work in areas where the NHS argue they don’t have resources or capacity to recover missing patients? You may think that it will empower police control room staff to ask the correct questions to allow them to say, “No – that’s a matter for you to undertake” where necessary. But many officers know that there can be other reactions from staff on wards who are physically not in a position to leave a ward or call upon colleagues in other mental health teams to undertake those jobs on their behalf.

So we have to think this through!

It’s all very well lining up the lessons learned from IPCC investigations and Coroner’s inquiries before drawing conclusions about what the police need to do differently but some change may involve the need to adapt partnership approaches.  How do you provide training to protect officers and vulnerable people that takes account of all of this, if certain aspects of partnership working is yet to change or is struggling to do so?  The question is not abstract:  training around the proper response to a mental health emergency involving acutely disturbed behaviour – possible excited delirium: amidst restraint by several officers I can of some areas of the UK where little resistance would be met some NHS areas and it would be hotly contested in others.  How do you train for that, bearing in mind that it is possible to highlight several force areas that cover multiple MH trust and acute areas where the NHS approach is not consistent?  I must stress: I’m not trying to particularly knock the NHS  by saying this! You could say – and I have said! – similar things of the police on various issues in this interface. These are the difficulties of partnerships and of trying to get national consistency on important issues amidst highly devolved local services.

Is training and an improved, raised awareness of legal and clinical risks something which should be trained for it’s own sake in the hope of improved awareness driving change; or is it irresponsible to suggest a course of action that may set in train a conflict between operational officers and colleagues in the NHS?  The reality is it would do both, because partnership arrangements, structures and the role played in different areas by ambulance and A&E services varies – or at least the capacity and involvement of them does.

PARTNERSHIP TRAINING

So what about multi-agency training?  Getting police officers into rooms with mental health nurses, AMHPs and psychiatrists – not to mention getting into rooms with paramedics with whom the police work so closely at a lot of mental health affected incidents.  What is best delivered to police officers alone and what should be delivered in a partnership setting?  All four of the above bullet point questions above apply thereafter and you would have to be careful to make sure all of this didn’t involve significant duplication.

Of course there is also a practical reality to be observed:  even if you answer the above questions and conclude that just SOME officers are going to need as comprehensive a set of training opportunities as we can possibly offer – force mental health leads, street triage officers, etc. – it still doesn’t address whether or not there is an appetite to allow the time for it to happen. Indeed one thing that has been discussed for years is whether Britain would benefit from the adoption of a ‘Crisis Intervention Training’ model that we have seen in the United States, Canada and Australia? So many reported benefits to this approach to policing and mental health but nowhere in Britain has trialled it. Do we need to design what that would look like, in outline, to help convince one senior officer that it would be worth seeing whether it improves things in a British setting.

So the major question is – do we train for the world we are actually policing or does training have a role in setting standards that could or should be delivered?

This is what we now have to wrestle with to determine what good training for the police will look like.  If you have a view – please leave a comment below as this post really is a part of my attempt to gathering different views and ideas to build a balanced perspective.

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
ccawards2013 – won a World of Mentalists #TWIMAward for the best in mental health blogs

was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

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Deprivation of Liberty Safeguards

I once gave a talk at a conference where another speaker was talking in a general, but somewhat excited tone about the Mental Capacity Act 2005 – he said it was “the worst example of legislative drafting in over 30 years!”  It is very easy to see why you may think it because the Act itself received Royal Assent in 2005 but had to be substantially supplemented in 2007 when Deprivation of Liberty Safeguards (DoLS) were introduced to it by the Mental Health Act 2007.  A report by the House of Lords in 2014 stated that this legislation was not fit for purpose and the Government should look at it again – their response to this report was to outline that they do not believe there is a flaw in the legislation as framed (p29).

So in the meanwhile, we have to get on with it and this post is about one particular, very specific legal issue: whether or not the police have any ‘power’ when a patient who is subject to an order made under DoLS can be forcibly returned.  However, just in case you’ve not heard of DoLS, let me explain a couple of basic things and I’ve kept this really superficial – I’m aware of the greater complexities but they tend to be beyond the needs of police officers and paramedics.

GENERAL BACKGROUND

The Mental Capacity Act as a whole is concerned with providing a framework by which to decide what is in someone’s best interests where they lack the capacity to decide for themselves.  For emergency services, there is something of a tool elsewhere on this BLOG to help you form a view about that where an urgent situation obliges you to do so – the “ID a CURE” test as I called it.  A best interests assessor (BIA) is a trained professional who will take longer term decisions, in slow time about things like whether a DoLS order is required to place an elderly patient in a residential care home where they have become unable to look after themselves in their own home, for example.

Where a BIA reaches a view that a DoLS order is required – they would need to have a Doctor’s confirmation that someone is suffering from a mental disorder (broadly defined) – they can instigate it.  Sometimes this is referred to as a Standard Authorisation and it can last for up to twelve months in the first instance and should be regularly reviewed.

CHESHIRE WEST

Earlier this year, the Supreme Court had to reach a verdict in the case of Cheshire West – this case concerned a group of young people from both Cheshire and Sussex who were living in supervised accommodation because of their learning disabilities and were not at complete liberty to exercise autonomy.  They were not permitted, for example, to go to the shop as they pleased or to visit who they wanted without consent and supervision of staff.  The various hearings in lower courts led to much debate about what a ‘deprivation of liberty’ actually was and the Supreme Court had to determine this.

In a very memorable phrase, Lady HALE declared that “a gilded cage is still a cage” ruling that however professional and excellent the kind of accommodation and care that these young people received may be; and however much effort was expended making their lives as unrestricted and enjoyable as possible, if they could not – ultimately – come and go as they wished then they had suffered a deprivation of liberty.  As such, BIAs are going to have to get busier or health areas will need far more of them in the opinion of many.

I wrote a blog in the week following the Cheshire West ruling in which I anticipated a rise of DoLS related issues for the police: whether that was around requests to convey some patients to hospitals and care homes; or whether it was connected to what the police may do if someone subject to a standard authorisation was reported missing or refused to return to the place specified in the order.  We know that occasionally DoLS related requests came up so if we are now going to see more DoLS orders, we will see more police related requests in relation to it.  Surely?!

DETENTION AND CONVEYANCE

So do you have a ‘power’ to convey or return a DoLS patient to a care home for example, if they refuse to return from visiting a relative they had permission to see or if you find them after they were missing?   Best of luck trying to find a specific answer to that on the internet!  This post comes around because of my good friend from West Mercia Police, Inspector Ben HEMBRY, ringing me up on Monday asking the question and it occured to me that I had not yet written a post on this.  And yet since Cheshire West, I’ve had this question several times – I only ever received it once before this key ruling!

Yes – there are good grounds, should it be necessary, to argue that minimal force may be used to return someone to a hospital or care home who is subject to a DoLS order.  Although it was always my view that officers, paramedics and others could rely upon the protection of sections 5 and 6 of the Mental Capacity Act in their efforts to return someone, I came across the case of DCC v KH (2009) whilst researching this piece.  In it, the applicant (presumably a local authority) sought an advance declaration from the court that reasonable force could be used, consistent with the principles of the Mental Capacity Act 2005, in returning someone to their determined place of residence.  Those representing the man concerned argued successfully that there was no need for such an order because such possibilities were covered by the Act as it stood.  The district judge published his transcript of this telephone hearing and whilst this is not a stated case as such, it is about the only legal view I can find and it doesn’t appear to have been contested in the years since.

As with everything related to the MCA, you have to ensure that you are acting with regard to someone who lacks capacity and that you are acting in their best interests, in the least restrictive way.  Obviously, a DoLS order demonstrates that a Doctor and a BIA have taken care of the first part for you, so it’s about police officers, paramedics or others determining whether something is in the best interests of a patient and going about the application of the use of force only where absolutely necessary, using minimal force in the least restrictive way.

You will have to judge that, case by case and context by context, but should you form the view that you need to, the ability to use force to safeguard people is ultimately capable of defence according to sections 5 and 6 of the Act.

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
ccawards2013 – won a World of Mentalists #TWIMAward for the best in mental health blogs

was highlighted by the Independent Commission on Policing & Mental Health
was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

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Social Media In Law Enforcement

ccawards2013It was revealed yesterday that I have been awarded the 2014 ConnectedCOPS Top Cop award at the Social Media In Law Enforcement Conference, or #SMILEcon as it’s tagged.

This goes once step further that last year when I was short-listed for it.

#SMILEcon 10 has just finished – the first time that the event has been staged outside north America and it was hosted by West Midlands Police in Birmingham who published a press release.

Given this award on the 10th September, I used it to try to highlight World Suicide Prevention Day – I said rather more than I normally do about the extent to which the police and emergency services are affected by stress, depression and anxiety disorders not to mention PTSD.  Having deliberately gone out on a limb in front of various senior officers, I found them really receptive to the essential message about the need to improve our responses as staff sickness levels arising from psychological conditions rises.  I hope this partly arose, as I pointed out, because very similar things could be said and are said about many employers.  It’s about how we shift our whole society’s attitude towards mental health conditions and those of us who live with them.

It’s worth looking at the website as many of the talks given were fascinating – I will forever remember the award winning communications team from the Royal Canadian Mounted Police in New Brunswick who expertly presented on their social media response to the triple murder of their officers on June 4th this year.  I wasn’t the only person wiping my eyes at the end.  I also commend you to the talk given by Chief Constable Simon COLE from Leicestershire Police which shows why executive leadership on social media is vital.

The citation of my award reads -

MB“This award is given to the sworn law enforcement executive of the rank of LT (or its international equivalent) and above, at any worldwide law enforcement agency who has demonstrated significant and sustained executive leadership to further the use of social media and internet technologies in law enforcement. This individual is a risk-taker and a pioneer in his or her promotion and use of social media in policing.  The recipient of the Top Cop Award also gives his thought leadership and expertise freely to others.”

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
ccawards2013 – won a World of Mentalists #TWIMAward for the best in mental health blogs

was highlighted by the Independent Commission on Policing & Mental Health
was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.