This post is a direct response to @ConsultantHead on Twitter who has responded to a few tweets recently and asked this question in a serious way. I thought it deserved a post because you can’t answer this properly in 140 characters and because my answer may be of broader interest given how the blog is going at the moment – over 22,000 hits in eleven weeks!
People tend to understand the involvement of the police where resistance or aggression is present and where someone is reporting a criminal offence for invesitgation (whether violent or not). But otherwise, why would the police become involved?
Well – the police do not necessarily have to become involved. However, as a 24/7 agency a certain amount of crisis demand is going to come the way of the police, as they do have a certain emergency social services function, whether they like it or not. They do not doubt these responsibilities where it comes to safeguarding children, for example. It is also fair to remark that the pejorative ‘bad /mad’ debate implies a false dichotomy: even if one accepts those labels or their euphemisms, there is no reason why someone could not simultaneously be both able to be held criminally responsible as well as mentally ill. How you bring such things to a conclusion is legitimately ‘police business’ because of the victim who is entitlted to justice.
Nothing in law prevents the NHS and social care organisations structuring themselves to deliver 24/7 community based mental health care, including staff who are trained in control and restraint for those circumstances where the use of minimal force is required to compel. Indeed, in Portland, Oregan (US), they are experimenting with an approach to community mental health crisis whereby they despatch an emergency social worker in response to 911 mental health calls not involving violence. Where they do involve violence, the police back-up the social worker for lower level calls and take the lead for more dangerous situations. No reason why not – if we chose to do so. In fairness, would an AMHP in a private premises be more use to a non-violent crisis patient than the police? They certainly can bring together a legal resolution to the situation which is beyond the reach of the police.
The Mental Health Act allows for the restraint of patients in wards, for enforced medication and treatment without consent; and for the detention and conveyance, by force if required, of patients who are newly detained under the Mental Health Act or who are recovered from being AWOL. Depending on the type of situation nurses and / or an AMHP can do all of this, and AMHPs / hospital managers / DRs can delegate authorities for various things.
So it does invite the question, where should the police become involved and why do they?
- Serious aggravated resistance:
- We would probably all agree, that there comes a point in the management of resistance and aggression, where the police are the only agency trained, equipped and available to deal.
- Nurses on wards being threatened with knives; patients barricading themselves in rooms with weapons, patients in the community who are to be assessed by an AMHP and DRs with a view to admission who have histories of very serious violence against mental health professionals and the only realistic way to keep the AMHPs and DRs safe, is for the police to be invovled in mitigating the risks.
- Once involved, it is very likely that such conduct amounts to a criminal offence and it is legitimately the role of the police to decide whether to prosecute someone for breaking the law.
- All of this is police business and it’s not controversial as long as the way in which they do it, reflects the patient’s needs, their dignity and takes account of the medical impact upon people with mental health problems of policing of this kind.
It is fair to point out by way of example, that there are instances in many forces of AMHPs wishing to undertake MHA assessments in the community and the only safe way to do it, is to secure a warrant under s135(1) MHA and have it executed by a full police firearms team. I’ve known of this at least half a dozen times. But as stated above, we all ‘get’ this involvement of the police in management or prevention of serious violence.
- Passive resistance
- There is a real debate here; often between front line police officers on 24/7 shifts and frontline mental health professionals; and the answer to it, is ‘senior managers’.
- What if a patient has been given a weekend of home leave, all properly authorised but they fail to return to hospital on time? A phone call reveals they are at home but they have said on the phone they don’t want to come back and will not do so.
- Who should go to recover them and / or use force if it is needed?
- As it is not a criminal offence to passively resist admission under the MHA; or to refuse to return to hospital if AWOL, the police need not be involved from a criminal investigation point of view.
Nothing in law prevents the NHS sending the relevant community mental health team and / or some nurses trained in control and restraint to attend the patient’s house and use authority under s18 MHA to recover them and nothing prevents NHS organisation issuing whatever equipment they think may be needed for these tasks. Usually, objections from the NHS to suggestions that they should do this are met with, “We haven’t got enough staff” or “We haven’t got enough trained staff” or “Well, you’ve always done it before.”
Whether you think this then makes the matter a police responsibility will probably vary from person to person. A part of me admits to thinking, “If you are going to get yourself into the coercion business, you should train and prepare to coerce; not just legally or morally; but physically.” This is true not least because restraint training for the police is by necessity very different to the training for mental health care professionals.
If may say so, I tend to find it is mental health and social care professionals and their managers who do think that their decisions not to resource, or train or equip makes things police responsibility. I have no problem at all with this point of view, although it is not one I share. I only remark that patients often don’t agree – in my experience.
This post is continued in Part 2. >>>