Is Mental Health Police Business? – part 2

<<<  This is a continuation of a previous article – Part 1.

Nothing prevents the police from acting as the coercion force to administer the Mental Health Act should a Chief Constable choose to do so – as long as the way in which it is done, doesn’t breach other governing frameworks, like the Human Rights Act.  Ultimately however, police resources are also finite and Chapter 22 of the Code of Practice to the MHA (Chapter 29 in Wales) states that the recovery of AWOL patients, for example, should be done by the NHS with the police supporting “where necessary”.  Police supervisors would be on safe legal ground to, at least initially, resist this type of request by arguing it is the legal responsibility of the NHS.  The person remains their detained patient whilst AWOL and the NHS still owe legal duties of care by virtue of the European Convention on Human Rights; the CoP MHA instructs them accordingly and the importance of the Code of Practice has been declared by the highest court in the land!

But if the request arises from the NHS not having trained or available staff at that time, regardless of why this comes about, does it then become a police function to step in to keep people safe?

Well, how unsafe it may be for that patient to remain un-recovered will vary from patient to patient.  Some will become at significant risk, others will be fine for several days or until a CMHT or AMHP can be organised to undertake recovery or assessment for admission.  So sometimes you step in, sometimes you don’t.  Some police supervisors don’t want their names to be the thing the IPCC read before a vulnerable person caused themselves harm, as they are unconfident of how to rationalise to attempt to push it back to the NHS.

  • What does “where necessary” mean?
  • If it means, those situations where the NHS can not or will not do something, then it means one type of demand upon the police.
  • If it means, not unless properly trained NHS professionals have tried and failed or legitimately assessed the level of resistance and aggression as requiring police skills, equipment and training, then it means something else all together.
  • It is also important to think about what powers the police have: if the above AWOL patient was a voluntary patient, not a detained MHA one, they have no legal powers whatsoever unless the person is committing an offence.
  • I remain totally unconvinced that “where necessary” kicks into place where the NHS have taken some deliberate decisions not to resource things that we all know sit with them.

This is why senior managers need to meet, set strategic partnership arrangements and ensure the development of proper protocols backed up by training.  They also need to ensure proper channels of communication between 24/7 service managers – this would be the duty inspector, for the police.

There is a chasm on some issues like this – and what the police should do with an intoxicated s136 patient – and the width of it varies by area.  In some areas, the very notion that mental health professionals would recover AWOL patients is considered sheer fantasy and as I’ve previously posted, attitudes towards the Code of Practice vary greatly.  You can correctly quote it all you like, some professionals don’t have a moral problem disregarding the Code where their managers have said they should for whatever reason.  That is my experience.

Parliament legislated that the legal powers of detention, conveyance, admission and recovery are also available to AMHPs, and anyone else.  So local protocols should reflect at least some circumstances in which they use them.  Otherwise, it is self-evident we are working against the will of Parliament.  In what circumstances do or should AMHPs and / or hospital managers delegate to other healthcare or social care professionals legal authorities to coerce passively resistant patients and what training and staffing is required to make this work in reality.  I’ve never, ever known it in my experience.

So, which police supervisor is now going to step up and say, “I know you’re telling me there is a vulnerable person in that house and that you are refusing to go and get them” or “I know you’ve sectioned this person who is refusing to move and you’re refusing to shift them but however reasonable or outrageous that may be, I’m now going to do nothing, even though to act and plug your gaps would not be illegal.”  Takes a confident, knowledgeable sergeant or inspector to do that.  Often, they’d be thinking: how do I defend this to the IPCC if the person takes their life after my refusal to act and then the MH nurse or AMHP cites my refusal?

I’ve known some police officers regard this as emotional blackmail and call it as such in discussions.  Never oils the wheels but none of us like being taken for granted.

My answer is this:

  • I don’t like to reduce to simplistic criteria the necessary partnership responses to complex issues where all situations are unique and where we need to think about things.
  • I just don’t think you reach a position very easily where ‘this’ belongs to the NHS and ‘that’ belongs to the police.
  • s136 shows very clearly where nightmares can unfold if organisations polarize responsibilities: we need to repsect and support each other.
  • This means we all need to admit our shortcomings:  the NHS need to get better and faster at managing low-level passive resistance where parliament intended them to act.
  • The police need to understand: the point at which it becomes necessary for the NHS to seek support from the police will vary from nurse to nurse; AMHP to AMHP and to stop obsessing about whether stuff is ‘yours’ or ‘mine’.
  • We also need to massively improve investigation of inpatients who assault staff and other patients.
  • As a rough rule of thumb, I use the approach of ‘RAVE risks‘ – where there is an anticipated, heightened likelihood of Resistance, Aggression, Violence or Escape, I support the notion that the police should be involved.
  • But RAVE risks are a start to a conversation; not an end and they refer to risks raised above those which can be mitigated and managed by available NHS resources; or which cannot wait for the marshalling of those resources.
  • If this comes around because of perceptions on the part of police officers that the NHS haven’t resourced, trained or responded accordingly, the place to take that up is in a meeting between senior managers.
  • So whether you agreed to plug a gap or decided you were entitled to say “No”, the place to take the frustration is your inspector or chief inspector’s office as a starter for ten.
  • There should be meeting structures in your area to where this can be taken and those managers will find much available material on this blog to help them get past certain arguments which emerge as barriers.

I hope that helps!

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7 thoughts on “Is Mental Health Police Business? – part 2

  1. No wat I believe is I prefer police involved in some cases for instance an incident I had is I was I crisis one day I was scared lost,
    First place I thought of was police station why?coz I felt safe I think police do in some ways should play a part in Mental health matters are the police should have a specific police personal to help in these situations
    That understands cases such as MH

    1. But the police would be involved, and were, because you went to them. Their role, is to keep you safe, or invesitgate any crime your reporting and refer you on to agencies who can deal properly. Police are a sticking plaster in MH matters – frequently necessary, but not really the solution.

      1. Yeh your right mc but only the police helped me mh are nhs didn’t involve at all
        Second time police came to me I was taking to hospital…
        But I still think its a brilliant blog

  2. When I was last sectioned, I was passively resistant in leaving my home to go into hospital. The Approved Social Worker telephoned the police and within minutes my quiet cul-de-sac was full with four police cars and a police van. Six officers came into my sitting-room where I was sat quietly on the sofa. One officer brandished a CS-spray and said, “Are you coming quietly or do I fucking spray you?”

    I was handcuffed behind my back and put into the back of a police van.

    I guess if I’d committed an offence I might expect such treatment, but my only crime was to become ill.

    Hmmm police and mental health awareness? I think not!

    BTW: I have never been arrested for a violent offence either

    1. Thanks for sharing this experience; no-one is going to seek to defend this. I am not an apologist for such disgraceful behaviour and hope you complained. I can only ask you to believe me when I say that there are very many positive stories about police involvement in such incidents and other mental health related incidents and that this just shows what work there is still to be done.

      To the point of the blog; I wonder what your view is about what should have happened? If you’re passively resisting lawful detention under the Act, would you expect MH professionals to have the capacity, skills, etc., to deal with this; or do you support the involvement of the police in such incidents – assuming the officers could remember not to leave their manners and their humanity in the van?

  3. Thought-provoking blog post as ever. In reality though, is it ever appropriate for non-uniformed non-police to restrain someone in a public place? What if a member of the public misunderstands the situation and gets involved? What if the level of aggression escalates, in a public place, and there is a serious injury to the patient or a member of the public, or staff? Assessing and managing such risks in complex community settings are not within the skill set of mental health professionals, and nor should they be.

    In my experience (which is in Scotland) services are generally very sensible in thinking about whether an absent detained patient needs to be found immediately or whether it can wait until the next day. If the patient can be contacted by phone it may, for example, be reasonable to extend the pass until the next day when he or she will return without need for any other intervention. Where a patient is known to be at potential immediate risk to self or others it is generally the police who will be best placed to find and return such a vulnerable detained patient safely.

    I agree professionals need to work together, and where a detained patient needs to be taken back to hospital it should be done with as much compassion as possible. Often patients will return with gentle persuasion, and I agree police involvement may be counterproductive. It is also the case that patients are generally of far more risk to themselves than others. However … detained patients are frequently at risk of harm to themselves or others, and the priority has to be safety of the patient, staff and the public. Where there is a realistic possibility of physical resistance in a community setting I think it would be difficult to justify any lack of police involvement at a Fatal Accident Enquiry.

  4. A great thought prevoking blog MHC. Also some great comments. Have to agree with the points raised by fallingxx. I too would be concerned about how the public would act on witnessing hospital staff using measured and appropriate restraint in a public place to return a person to hospital. With uniformed police the public’s response would be different and possibly less alarmed. Also a person may be more reluctant to act violently towards uniformed police – of course some may act more violently. Of course greater cooperation and understanding between all involved is key to managing situations like these. Working in MH services I’ve met many police officers who have been excellent and worked very well with others to manage situations safely and have set maintaining the service user’s dignity as an important priority. Other officers have has a cursory understanding of the area of MH. I wonder what training the police provide for their officers in this area?

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