I spoke recently to a former police colleague who is now a psychiatric nurse. I am aware of a couple of police officers who used to be psychiatric nurses earlier in their careers. I admit to thinking that this dual professional perspective must be fascinating, not least because it’s clear to me after the work I’ve done – with no professional or personal background in mental health – that there are many cultural differences between the NHS and the police. It caused me to wonder how people adapt to the second phase of their career in such a culturally different organisation.
I am aware for example of an incident to which the police were called where a psychiatric nurse was being rapidly approached by a patient who had somehow acquired a knife and was making to hurt him, verbal threats and a manner which indicated an intention to try to stab him and / or others. The nurse was stood next to a healthcare assistant and there were other vulnerable patients nearby. So bearing in mind NHS policies on control / restraint, the avoidance of control / restraint techniques which involve the deliberate application of pain; the requirement to demonstrate the least restrictive principle he decided that the only reasonable way to properly mitigate that very real, potentially lethal threat was to punch the patient in the face to cause sufficient distraction and disorientation to allow him to push them backwards, off-balance and get the knife off them. They then got into a restraint situation until other staff and the police arrived.
Reasonable? Well in law, yes. Desirable? Definitely not: no-one would want this. But whether or not this is considered therapeutic / dignified and so on is a separate debate. Any investigation into nursing professional standards or healthcare standards would have to take account of the person’s right in law to defend themselves: quick attempts to verbally de-escalate the situation were tried and they failed, the risk to people was imminent, the reaction was one that couldn’t be thought through as there were seconds to react, so what else was left? Everyone – including psychiatric nurses on inpatient wards – has a legal right to self-defence under s3 Criminal Law Act 1967 and when faced with a potentially lethal threat, it becomes all the more reasonable to ensure that the level of force used to protect oneself is sufficient to make sure.
Afterwards, the patient made a complaint of assault to the police and did have a facial injury. The police there and then were able to determine from witnesses that the nurse faced a very real threat and could arguably have done little else than use the force that they perceived to be the minimum necessary to ensure his own safety and that of others to whom he owed a duty of care. No further action and no protracted investigation to work it out; the nurse’s conduct was reasonable, therefore lawful, according to three witnesses.
Now I’m aware that if you were to have a conversation with many psychiatric nurses – and I have – they would tell you that they are ‘not allowed’ to do things like this. Well it depends what you mean by ‘not allowed’. Like all things mental health (and policing) you have laws, codes of practice, regulations, policies and protocols and these things are collectively intended to guide and control the behaviour of the state’s agents towards vulnerable people. There are conflicts within these frameworks: whilst a local policy may say many things; if this is in conflict with the law, there is a tension, eg psychiatric nurses cannot use techniques which involve the deliberate application of pain (CoP). But what if to try things which do not do so, is to put oneself at risk of assault? The law allows people to use “reasonable force” to defend themselves. Laws and statutory regulations trump Codes of Practice; Codes of Practice trump local policies and so on.
So such belief as “You can’t punch a patient” is demonstrably nonsense but to say so, most crucially, is NOT to put an argument for doing it or doing it more. It is merely to say that all dynamic situations must be assessed on their merits in light of the law. No-one would want to do such a thing.
Meanwhile, I wonder about we’d do our jobs if more had that dual background: would mentally vulnerable victims and witnesses get a more sensitive hearing when reporting crime; would there be a greater willingness to stop AWOL patients from leaving wards? What would attitudes be like towards the situations in which one of the organisations is wanting the other to use force?
As ever, the reality is that policing and mental health is not as far apart as many would believe. I know that mental health services very often call upon police officers and their skills in inpatient settings; I know that at least one Chief Constable has suggested he may need to employ psychiatric nurses to assist in managing mental health related demands. There is still a lot of room to learn from each other to improve how we work in partnership.