If we all gathered in a good pub – and I think we should – to discuss those mental health related tasks which belong to the police (at least initially) and those that do not, we would probably agree at the edges. Management of individuals who pose a risk to the public because they are extremely violent, perhaps in possession of weapons ‘belong’ to the police – mentally ill or not. Those with mental health problems who are not Resistent, Aggressive, Violent or posing a risk of Escape (RAVE) are the responsibility of the NHS.
Even where they are presenting ‘RAVE risks’, if detained by law in a psychiatric unit patients remain the responsibility of those staff who are more appropriately trained to cater for their particular needs with appropriate safety techniques and greater awareness of the medical implications of any particular intervention. So, responsibilities are contingent upon the situations in which they occur.
As we draw the extremes closer together, the black and white clarity of certain situations gently gives way to complex shades of grey where the answer may well depend on your personal politics, as much as any sense of a delineation between the agencies. I have heard psychiatrists argue that where patients on wards are violent towards staff, it is the responsibility of the police to keep staff safe, as we would A&E staff. Fair enough – I have said before that the police need to better at investigating violent crimes against NHS staff.
But what if that violence is clinically attributable and the required intervention needs to progress naturally to compulsory medication under ss58 or 62 MHA? I’ve read formally commissioned legal advice from a barrister which says it is highly doubtful whether the police have legal powers to restrain where that restraint is done with the intention of then medicating without consent.
Clearly lawyers and psychiatrists need to talk, but in the meanwhile we have decisions to make in the real world: when attempting to establish which responsibilities sit with the police, how does one begin to decide? Does the police view or the NHS view hold primacy if they are not the same thing? We accept the principle that although the police are a large body of people and resource many of our civic emergencies in lieu of others – they are available 24/7 and at short notice – they are nevertheless constituted primarily for a certain set of responsibilities. We do not expect the police to visit patients to check if they have taken medication for their mental illness, for example. This is true even though we know that some patients may become a risk – most likely to themselves – if they don’t.
I’d welcome your views, but I keep coming back again and again to the statutory responsibilities that I and every other police officer signed up to when we were sworn in by a Justice of the Peace:
- Prevent crime and bring offenders to justice;
- Protect life and property
- Maintain the Queen’s Peace.
- Protect fundamental human rights
If necessary tasks sit outside these criteria, one could argue the police are not going to be best placed to discharge the functions. But it is not primarily because of discussions about resources that I make this point and believe it important: it is because of arguments around STIGMA. (And I’m familiar with the suggestion that it is easy to cite stigma or vulnerability or criminalisation to deflect attention from the allegation that police officers just ‘don’t do mental health’. I think this is nonsense.)
Service users have commented that ‘setting the police’ upon them, is a stigmatising and criminalising act, not always welcomed. I’ve heard mental health professionals who have delivered local awareness training for police officers highlight how some service-users suffer from paranoid delusions about the police – only to then find that professional WANTS the police to return someone to hospital when it is not immediately clear why the NHS can not do that themselves. How is this helping with paranoia?
I’ve expressed my reservations elsewhere about this criminalisation argument but one can understand why a patient may wonder why it were necessary to send uniformed officers to their home address to recover them whilst AWOL if they were not violent or even when they were not refusing to return at all? Was it really necessary, along with stab-resistant vests, batons and possibly taser stun-guns to have the implicit semiology of wrong-doing and overwhelming air of coercion?
It we are to achieve dignity for service users, then the use of the police in my view, needs to be restricted to those situations in which the skills, training and equipment of the police is necessary to mitigate the risks faced. Anything else is stigmatising. I appreciate the arguments that the police are a flexible body of individuals and easily deployable to such tasks – but where the risks do not necessitate uniformed, equipped, possibly armed police officers – taser or firearms – then we should as a society be able to convene a dignified, alternative solution.