Forcibly Medicating Patients

I mentioned in a previous blog that when I first joined the police, it was not unusual to be called to the old Victorian hospital on my area to assist in restraining patients who were being medicated against their will under the Mental Health Act.  It seem intuitive – mental health colleagues facing violence and danger from someone who is also a risk to themselves, the police have a duty to prevent harms and risks like this so surely there is a legal authority to do it?!

Well, as is often the case with the law, things are not quite that straight forward! –

LEGAL ADVICE

Once upon a time, a police service who often faced calls to help restrain patients for enforced medication took legal advice on the subject from a barrister who specialised in criminal and mental health law.  They did so not only because they faced regular calls and wanted to understand their responsibilities and obligations, but also because they had been severely criticised for doing so after patients complained and wanted to understand where the line was over which they should not step.  They were kind enough to share that barrister’s view written opinion with me.  It can be paraphrased as follows:

‘Whilst acknowledging the role of the police to keep people safe and the unpredictability of some violent patients on inpatient wards, it does not logically follow from a duty to keep people safe and prevent crime that the police have a legal right to use physical force to allow mental health professionals to forcibly medicate.  This remains true even where the necessity of forcing this medication upon patients is justified under the Mental Health Act.  To do so, it may well be argued, would be an assault.’

I must be clear: I’m am not saying the police cannot restrain.  For example, when there is a crime, a hostage situation, barricades in rooms where weapons are brandished or concealed, etc..  Anything involving crime can be deal with accordingly and the legal authority to do so comes from s3 Criminal Law Act 1967; or from the Police and Criminal Evidence Act 1984 if searches or arrests are being made.

It is the continuing of restraint after the crime has been dealt with, into a condition of restraint for medication that this legal opinion questions.  I’d be interested in other legal views, if available.

OPERATIONAL GUIDANCE

This caused me to think:  of the nurse or junior doctor in a mental health unit at night who has a quite unpredicted and unpredictable need to administer medication by force, or to move someone to a seclusion facility using restraint techniques.  Where do operational officers stand if they are called to assist?

Well, various reports including that into the death in psychiatric care of Rocky Bennett have made it plain that NHS facilities should have sufficient restraint trained staff on duty to deal with predictable needs as well as access to contingency arrangements.  A requirement to restrain one patient for clinical reasons is not unlikely in mental health care and should be part of routine business for most.  I’m imagining, like the police service, NHS trusts should have generic and specific health and safety risks assessments and procedures to account for managerial decisions on staffing, training and deployment to fulfil these statutory requirements.

But this also raises the question of what should the police actually do if they are asked to restrain or convey – for whatever background reason?

No cop wants to expose NHS staff to risks that they genuinely believe they need help to face.  But at the same time, compounding problems by doing the wrong thing is just as bad or worse should disaster occur.  I can give examples where my officers and I have attended inpatient units and the mere presence of uniformed police calmed down a situation sufficiently to allow NHS staff to get on with things.  No assaults, threats or resistance.  But that is not always enough:

I would suggest that the removal of imminent and serious risks from weapons would be justified, using force to prevent crime, but then officers should then contain, not restrain until such time as the necessary NHS intervention is marshalled by clinical staff pulling on their arrangements via their managers.

Again, if you’re thinking this is unrealistic: you never know til you ask and asking will put into context the subsequent action taken or not taken.

ROLES AND RESPONSIBILITIES

The enforced medication of psychiatric patients is a clinical issue; the seclusion of psychiatric patients is a clinical issue; the (urgent) transfer of a patient to a more appropriate mental health facility for more appropriate care and treatment is a clinical issue – so it should be clinically led.  Even where the police are required in those rare situations of urgent transfer to A&E because of serious or potentially life threatening medical problems, this should only be in support of other NHS services, including the ambulance service.

It must be tempting for police officers – practical people that they usually are – to say, “Let’s just get on with this and get it sorted” not least so they can ‘get back out [on patrol]’.  Well, IPCC investigations are currently ongoing into officers who did exactly this – criminal investigations.  It comes back to that question about the role of the police in mental health care:  it is to apply the quick fix, to restore immediate safety until proper process and procedure can take over as soon as possible afterwards.

Even if attending a psychiatric unit and containing a situation took three officers four hours until NHS arrangements took over; this is little compared to the time and trouble it would take to deal with the situation incorrectly and then have to put the wheel back on or deal with the fallout of tragedy.  It is also fair to comment, that if the NHS are able to rely upon a police willingness to ‘muck in’ for expediency, what incentive is there to ensure that ward managers have access to proper contingencies for these kinds of situations?

It is for this reason that I argue that senior police officers on BCUs need to be certain that their NHS partners understand what can and cannot be done and where the role of the police stops.  Whilst acknowledging the grey areas and the duty to support NHS colleagues at risk, the police are constituted for a certain set of functions and the provision of clinical mental health care is not part of it.

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2 thoughts on “Forcibly Medicating Patients

  1. There should be more dialogue between police, service users and NHS trusts. I do not see how police can evolve a strategy without talking to people who have experienced control and restraint. I have seen it said on the web site of the Royal College of Psychiatrists that there has been little research done on service user perceptions of control and restraint. I do not know one way or the other but I would be interested to know if police officers had researched this area. If you have never been ill yourself how can you tell what it is like to go through such an experience?

    1. A few police officers will know – those who have been detained under the Mental Health Act and have subsequently offered their views to their forces about the police involvement in their own experience of MHA admission. Usually, I don’t think police officers can know but nor do I think the police need a ‘strategy’ for control and restraint of psychiatric patients. Whilst listening to service users is vital it is important that we all first understand what involving the police means and seek to avoid it whereever possible if the situation is a clincal one. Where the police should properly become involved in the use of force, is where risks have escalted to such a high degree as to render the individual’s perception of the use of force as only one factor amidst many important ones.

      NHS control / restraint is very different in both training and tactics and what police officers can say with confidence, is what the law allows them to do, how their use of force is rationalised and deployed and what their training involves. This should all render it clear why the police use of force is inappropriate in most regards.

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