For years I’ve overheard discussions about when the police should be involved in certain mental health situations and when they should not. Some things, by law, must be done by the police – executing either of the s135 warrants, for example; detention under s136. Other things can be done by many professionals – re-detain an AWOL patient; detain and convey a newly detained patient to hospital. So if we understand the things the police must do; how are we defining the things we do not want the police to do at all, or only when certain criteria apply?
It’s all part of ‘the remit’ game which I so detest and which is seen not only between organisations like the police and mental health services, but also within those services. An entertaining half hour can be spent listening to dual diagnosis, adult mental health and forensic specialists discussing a particular drug addicted, offending patient and who should lead the handling of their care (buy popcorn and drinks, it can last a while). And I throw no stones from my greenhouse as it’s like listening to police officers discussing whether a particular offender is a CID or PPU inquiry – only to find they’re committed with other stuff that they see as more important want ‘uniform’ to pick it up. It’s so utterly tedious and misses the victim (or patient).
COLLECTING LITTER
We would not expect the police to collect litter on a high street full of pubs on a busy Friday night – picking up chip papers and empty bottles. But if the detritus left there presented an immediate, hazardous danger to the public – we would tolerate them taking the time to do so. Although there is not statutory responsibility on the police to collect litter, there is a duty to protect life and prevent harm. So we routinely judge when a line has been crossed and intervene after the line. Sometimes this intervention is achieved by a poor quality quick fix: shifting something to the side of a pavement or road, for example. It can be properly collected and disposed of later, by the appropriate authorities but at least we’ve removed the immediate risk.
I once found myself sitting in a meeting with a another inspector from one of our local boroughs – he was the ‘partnerships’ inspector and was actively involved in improving mental health partnerships in his area. We were discussing whether or not the police should attend an MHA assessment on private premises and went on to discuss whether or not a s135(1) warrant should be obtained. (See the blog index for posts on those subjects). There were two AMHPs present from the local teams and it was genuinely supportive, inspiring attempt to make their local protocol better.
We all seemed agreed: the police should not be routinely used at MHA assessments without s135(1) warrants – nor were they asked to be, I should point out. But there are some assessments where the police should be present, with or without a warrant. How do we define what these circumstances look like. I had a lightbulb moment because we all love a memorable mnemonic! –
RAVE RISKS
- Resistance
- Aggression
- Violence
- Escape
Heightened likelihood of certain risks compared to the normal ‘risks’ of these kind that mental health professionals face everyday and mitigate by joint or team working, or through particular training / planning.
THIS APPROACH IS NOT PERFECT – and it is a ‘rough rule of thumb’ and NOT a strict policy or tool. Nothing will ever substitute professionals talking to each other, with a view to understanding what is to be achieved and why joint working might be needed. And we should all bear in mind, we might need support – call it a favour, if you prefer – next week and we’d hope for reciprocation.
This approach should not come as a shock to the police: we all understand that there are tasks which normally sit with other public sector agencies and which we do not regard as ‘police business’. But if we’re honest, we undertake them from time to time: usually where dangers present themselves as with the litter example, above – but there are many others.
So the same applies to policing and mental health: some things are NHS responsibilities and should literally never involve the police; other things will fall to the police because of the risk or harm involved and / or because of the short notice nature of the emerging need.
- This might be police led – s136 MHA; urgent recovery of high risk AWOL patients;
- It may be the police acting in support of the NHS – MHA assessment in private.
- It may be a primary police responsibility – criminal investigation of assaults on NHS staff.
But if there is a discussion around initial doubts as to whether it is appropriate to be involved in something which is not a primary police responsibility: ask whether there are any ‘RAVE’ risks? It will get you to very probably the right answer, most of the time – if that helps?!
Crucial – start your discussions on this basis; don’t end them on it!
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2012
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 