In May 2004 Martin Constable assaulted one of his psychiatric nurses, Helen Kelly. He inflicted life altering injuries which caused her to be off work for over six months and shattered her professional confidence.
Constable also went on the smash-up a Doctor’s office at Penn Hospital in Wolverhampton and despite this matter being reported to the police and taken to the Crown Prosecution Service, it was decided not to prosecute him. The reasons behind this decision were given publicly that “It is not in the public interest.”
Fortunately, she was supported by her NHS Trust and by the NHS Security Management Service’s Legal Protection Unit to bring a private, criminal prosecution against Martin Constable for grievous bodily harm. Over 18 months after the incident he pleaded guilty to wounding and was sentenced at Wolverhampton Crown Court to ongoing detention under the Mental Health Act and to pay Helen Kelly £2,500 in compensation. At the stage, the CPS stepped in and picked up the bill, whilst reflecting on the combined errors of the public criminal justice system.
What I have learned in working in this field of policing for several years, is that when one wishes to have a conversation about why the NHS can sometimes appear to be ‘closed’ to complex, demanding and outright violent mental health patients who come into contact with the police you will be referred to an incident like this one. “Why should we put our staff at risk, unless you’ll help protect them by staying with them and prosecuting patients who assault them, wherever possible?” Try answering that whilst sounding credible.
So whenever police officers feel like getting on something of a high-horse about mental health issues they think should get ‘sorted’ by NHS services which fall somewhere short of their preferred standards, they should think of cases like Helen’s and consider what it is like to walk a mile in her shoes. In fact, I did once send a constable to spend most of a day in his own casual clothes shadowing a nurse on a mental health ward – when he briefed the team about the experience the following day, their collective attitude towards inpatient violence and AWOL patients changed.
These issues are opposite sides of the same coin – it’s about trust and confidence between the agencies and their professionals.
Helen Kelly reported that the police “went through the motions” and that even when officers were taking her statement told her that “it wouldn’t go anywhere” because Constable was a mental health patient. Cynical officers may imagine that she’s over-estimating the sentiment for effect, but I remember hearing a senior detective say exactly this when told that “a section 3 patient has assaulted another section 3 patient overnight.” “Well that’s not going anywhere is it?” “Well not unless you investigate it boss, but you’re the detective.”
I am convinced that mental health professionals and their employers understand that some violence against staff cannot be prosecuted because there are clinical reasons why it would not succeed – one trust in my area reports just 16% of its violent incidents to the police, reflecting such thoughts. Martin Constable was perfectly able to be prosecuted and his psychiatrist said so at the time of the incident. Moreover, it was known that the day before he’d assault Helen Kelly, he assaulted another member of staff. All of this is unlikely to inspire confidence in the victim or create a professional impression of what might be able to be done.
Of course, if Constable potentially posed “a risk of serious harm to the public” – and I think we can agree that violence like this would probably pass the threshold – then prosecution should have been actively considered because even if the legal system found him unfit to stand trial because of his mental health problems, it can still impose a hospital order under s37/41 of the Mental Health Act to ensure public protection. These are also issues for the Crown Prosecution Service, because prosecution recommendations by the police have to be ratified by a CPS lawyer.
I have blogged previously about these issues – inpatient violence against staff; how liaison officers for psychiatric units can improve matters; how to properly investigate allegations that do get reported and to secure appropriate background information; finally, how to approach the question of whether to ‘divert’ from justice and so on.
Justice does not stop at the hospital gate.