When I was a uniformed constable there was an urgent request for the police to support mental health professionals at a Mental Health Act assessment in a private premises. This support escalated into an incident and a criminal investigation I will remember for the rest of my life.
It involved a man with a history of mental health problems who had previously been a detained patient and who lived on our area with his wife. The beginning of the story starts with a ‘trigger’ event – an anniversary – which caused him to leave home in crisis. His wife reported him missing to the police and a few days had passed during which attempts to find him were unsuccessful. One afternoon, he returned home, psychotic and extremely unwell. His wife immediately informed mental health services and it was quickly decided that he would be assessed at his home for admission under the MHA. When the professional team arrived at his address, he was quite disturbed and they tried their best to de-escalate a serious situation where his psychotic behaviour was cause for significant concern. One of the professionals rang 999 for urgent police support.
Just prior to the officers arriving there, the man made threats towards the professionals who decided to withdraw for their own safety. He attempted to keep his wife within their ground floor flat whilst threatening her, but the social worker managed to grab her and pull her out fearing for her safety also. They made a further 999 call to the police who arrived almost as the 2nd call to the police was concluded.
Believing the man to be in his own flat on the ground floor, they began to brief the two constables as to what had occurred and that they needed help to get him ‘sectioned’. Unknown to everyone discussing this in the street, the man had gone to the upper flat in the communal block and knocked on his neighbours door. He stated that he was ‘the law’ and as soon as the door open he punched his neighbour hard in the face, knocking him to the floor and jumped on his chest, sitting astride him. He spent approximately 10 minutes punching and strangling him, attempting to gouge his eye and getting to the point where the victim was almost unconscious. He then proceeded into the victim’s flat from the entrance way and took a 10 inch kitchen knife and returned. He attempted to stab his neighbour who had recovered sufficient consciousness to realise the attack and who suffered the most horrific defence wounds to his hands and arms as he attempted to deflect the knife away from his torso during several vicious attempts to stab him.
The police having entered the communal block they heard the fighting and called for more resources. Officers in a public order van with riot shields entered the flat and used force to stop the attack, by which time the man had numerous serious stab and slash wounds. As the police entered the room, he was busy driving the knife into the victim’s chest, causing a punctured lung. He was taken by ambulance to hospital where the A&E consultant told the police to start a murder enquiry because he was certain the man would die. In addition to puncturing his lung, an artery in his arm had been severed.
The offender was removed directly to a medium secure unit on the authority of the mental health professionals present – the ONLY time in my career I’ve known this happen. The only time I’ve ever heard of it, in fact. Fortunately, the victim did not die, which can only have been due to the skill of the A&E staff and the speed with which paramedics and A&E worked together.
Several days later, I moved onto CID and became responsible for investigating this case, closely supervised by the Detective Sergeant who let me loose on it. I had to take the statement of evidence from the victim, something which took me two whole days spent with him in hospital – the longest statement of evidence I have ever taken, covering 24 pages of (my fairly small) writing. Spending an hour writing, giving him a break from it, then another hour, etc., until done. It was clear that the impact upon him, not just in terms of physical injuries, was enormous. He asked so many questions about the mental health system and the criminal justice system: he wanted to know, as many victims of unprovoked violence do, about the mental health history and care history of his attacker as well as what would happen to him. I had to research this overnight in between my two days of taking his statement to give him half a chance comprehend what may have changed his life forever.
The suspect was eventually well enough to be brought to the police station for interview. It was the most ‘open’ interview I’ve ever known: no real questions, no challenges against his account, just an open opportunity for the man to explain what happened and what he was thinking. His responses amazed me: a detailed knowledge of Norse mythology and a delusional, paranoid link between this folklore and the need to eliminate his neighbour. He was charged with attempted murder and having been cleared of this offence on the grounds of insanity, he was detained in hospital on a s37/41 hospital order in a medium secure unit.
NB: ‘diminished responsibility’ applies to murder charges and present an opportunity to substitute an alternative conviction whilst providing for a disposal into the mental health system for manslaughter. Where an offender is charged with any other, lesser offence, the prosecution can offer a defence of insanity – a legal concept, not a medical one. If the defence of insanity is successfully demonstrated, then the person is cleared of the offence: not guilty. However, such a defence having been successful, it opens the possibility of detention under Part III of the Mental Health Act, usually s37 MHA, restricted by s41 MHA. This is an indefinite detention under the MHA which I have explained elsewhere.
I know the issue of violence by mental health patients is extremely difficult and powerfully emotive – it has been suggested that stories like this reinforce stigma and unrealistic stereotypes because they significantly over-emphasize the potential to be the victim of such an attack. I get that completely. I can only repeat the point that this blog is about policing and the role it plays in supporting mental health processes as well as the role it plays in protecting society from harm as we do with all manner of violent crime. Incidents such as this are an infrequent but recurring part of policing. Most are far less serious incidents and get referred to the police as a part of the wider, more extended mental health system. This is where my ‘venn diagram’ of policing, mental health and criminal justice is relevant.
It may be argued – it fact, it is argued – that inquiries, which frequently follow serious offences by patients already known to mental health services, often highlight recurring themes. It it is for those reasons that I argue for far more and for closer working between police forces and mental health trusts; and that I argue ‘diversion‘, if not correctly considered, has the potential to ‘stack the risk deck‘ in favour of events like these although it is by no means certain that all could be predicted or prevented.