Mexican Standoff

Properly considered a Mexican standoff is a three-way situation where guns are pointed around in a circle: each person holds power over one other and is simultaneously at someone’s mercy.  Difficult to resolve that!  This story involves police, ambulance and A&E and is a true story given to me by an exhausted police officer who was amidst this last weekend.  The incident starts off around 5am at the end of already an exhausting night shift of drunks and domestics and an officer who’d already tweeted that they were dead on their feet from fatigue.

I’m going to let this dedicated front-line police officer tell the story! – and let it speak for itself, frustrated language included.  I’ll just point out first that since posting this story, Ella SHAW – author of DiagnosisLOB – has commented on her own blog and reinforced the officer’s fears around unknown, unassessed medical risks.

I’ll add just this – I like the idea that my blog is being pushed about at 6am on a weekend, helping officers through jobs like this – it is EXACTLY why I spend evenings writing and blogging and it’s so accessible to anyone with a SmartPhone.

Had this job not had a happy conclusion, I sugggest the officer concerned would have had little difficulty evidencing that she’d done her best in the circumstances and questions would have headed towards the NHS.  As they should.

<<< UPDATE ADDED A WEEK AFTER INITIAL PUBLICATION OF THIS BLOG: >>> This officer was called back to the same patient a week later after she’d been released after MH assessment – and was injured in another scuffle of the same kind. 

The person has now been prosecuted.  The ambulance service refused to attend: >>>

“Here is the full story of the MH debacle and the Mexican Standoff I had this morning with the NHS … Police called by Ambulance to assist them as a well-known self harmer has taken cocaine and has some unusually bad reaction to it.  She feels dizzy and sick and it was enough to ask for medical help because it was weirder than her normal reaction to cocaine.  I am a good 45 mins away from scene and so firearms vehicle attend. In our force it seems that once you have a gun you lose the ability to think for yourself and (god forbid) the ability to actually use your powers as a police officer  …  a bit like inspectors! 😉

Helpful firearm officer asks over the airwaves “she says if we leave her she will kill herself. I don’t know what to do so can a local officer please come and help me”. Thanks for that. Try communicating with her for a start!

I get there. Firearms say “thanks, see ya” and leave me to get off and finish on time. Ambulance say – there is nothing wrong with her AND I QUOTE “apart from her her heart rate being a fast from the coke”. They know this frequent flyer and stand with their arms crossed saying can you get her out of the ambulance as we need it back on the road. Roughly translated as – I want to go home and I am tired of her again.

Girl says – if you leave I will kill myself. I now have no choice whatsoever. Oh, and I then remove the razor blades she has concealed in her hands which both firearms and ambulance failed to notice.

So I ‘136’ her because I feel that if we leave, bearing in mind her mental health history, her substance abuse and her stated intent, she will make a serious self-harm / suicide attempt.  Ambulance says – we are not taking her in, you take her in the police car.  Out comes your blog for first time to highlight the first breach (of the Code of Practice).

FIRST standoff – I explain our/their policy of ambulance to 136. I explain this is not a criminal justice incident it is a HEALTH incident: me police; you NHS.  Ambulance say we won’t take her unless you sit in ambulance with us.  Fair enough – I agree in order to get this progressed.

Get to A&E for the SECOND standoff of the morning – they did not even let us in, we had to stand in the foyer of A&E. I explained the Red Flag (drugs) and why she needed medical assessment. They did not want to do this – roughly translated as I am tired and I want to finish thank you.  Still in the foyer of A&E and not even over the bloody threshold I stand clutching my iPhone in one hand (with your legislation and blog) and my police Blackberry in the other with our policy on it re 136.  Because the doctor asked our girl 2 questions (being name, DOB) and she did not answer, she declares this patient will not cooperate and asks, “Please take her away.”  No monitoring, no communication apart from 2 questions repeated by a stroppy nurse. I say – are you happy she has the capacity? They say yes. I say – how do you know as you have only asked her name and DOB?  They all shout at me.

I say “OK, if you are refusing treatment, please sign here and I will remove her, then if she dies in custody or at the MH unit due to cocaine intoxication and a lack of capacity that you haven’t assessed, I can evidence that I have tried to get her medical care and this has been refused.”

THIRD Mexican standoff – I am liking Mexican Standoff for the blog title – please sign here.  “No” … we are AND I QUOTE “Not allowed to sign anything relating to treatment unless your Chief Constable asks for it in writing”.  I write – refused to sign. They are not happy I have written their names down and shout at me.

My theory is that if you are convinced that you are right, and can back it up – why are you scared of giving your name? Or signing?! They knew they were wrong but they wanted to go home after working all night.  Me too.

So, I ask can you please phone the MH Unit which is 50 yards away and ask if we can take this girl there or will they refuse us?  Oh no, we cannot phone.  Good will tank now running on empty.  I am now aching through tiredness and frustration to the point where I may need admittance to the MH unit myself and I’m more than one hour off late already and I’m not done.

I take her to MH Unit who agree to accept her under 136 even though she has had a drink because I have to argue a FOURTH Mexican standoff of ” Custody and cells is not the right place for this lady, she is not a criminal, she is not well and the custody sergeant will not detain here there given the lack of medical assessment so far knowing she feels unwell after taking cocaine”.

All my NHS colleagues went home on time, only me off late.  I felt so let down by them that I could have screamed.  I nearly lost my cool in A&E and I did share a piece of my mind because they were being SO obstructive. They failed to see that if our girl died from the effects of the drugs – they assume she was telling the truth about what she’d taken – then it would be ME and not them losing their job, unless I did this properly.

So, that is the sorry saga of the shit service provided to MH patients by the NHS this morning.  Good night.”

UPDATE: >>> please see a blog post on this very story by DiagnosisLOB whose blog in general is highly recommended.

The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.



7 thoughts on “Mexican Standoff

  1. Don’t know your rank but me as a constable would be wanting an Inspector at least to be making this argument or why not just leave her at the hospital as it was a medical emergency not a police matter. You only assisted in getting her there and will there be a follow up complaint as this is a piss poor service. If the shoe was on the other foot you can bet your bottom dollar there would be hell to pay.

    1. I don’t feel walking out is an option.
      1 She would be reported as a vulnerable grade 1 misper
      2 if the patient walks out and turns up dead it’s your ass in a hand cart.

    2. The fact that you want an inspector to do it, just serves to tell me that the real issue here is officers’ knowledge and confidence.

      An inspector has no more knowledge, training or competence I this area than anyone else and the answer is not ‘throw it up the food chain’ – although COMPLETELY understand why you would.

      The answer is to have proper training for everyone involved in front line delivery around policing and mental health: and in my personal opinion to have more training like that for a select few.

      I am an Inspector. I have two hours of mental health training in career.

  2. Well thank the higher powers that this officer saw the person not the problem and had the MHC resources to hand to keep making the arguements. An appalling but I believe not unusual situation, sadly. Those of us who work in the services understand being understaffed, overstretched and put by our organisations in impossible situations. And we all are after all only human and certain individuals will challenge not just our services, but our own limits. That said, we have professional standards and bodies that should be holding us to them. If you couldn’t defend your decision at the SUI or coroner’s court or to your professional registering body let alone your conscience- You Ain’t Doing The Right Thing! Leaving this woman at A & E (miracle they got her there at all) is not an answer, making a formal complaint afterwards might be. I hope this happened. I could go on about the obvious need for more training (of general medical staff about MH issues), more liaison staff, lack of manpower and time for all services to deal with these complicated cases – but it has been said so often.

    So what I want to say really is to Ella Shaw – Thank You, You are a star. I hope we all (public services) support you better in the future and please keep holding us all to account.

    (Very Loud and Long Round of Applause)

  3. I am so proud of my Police officer colleagues as I see and hear this situation on a more regular basis than should be. Everyone shouts “duty of care” but when you get to A & E, where is their Duty of Care? I know they are under pressure in A & E but sometimes I think they just see a problem rather than a person. Didn’t they sign up to actually help people? I think a lot of them forget that.
    I do agree with MHC that none of us have had much, if any, mental health training and I think this is such an important factor in our job nowadays. I think that there should be some sort of training package we could complete that highlights the majority of the more frequent sections of the MHA that we encounter, and some scenarios and Q & A’s. I know we deal with Criminal Justice, but sometimes it seems that we know more about the MHA than those that work in PCT’s! It is very often frustrating beyond relief. I can only offer praise to this officer for all she did to help that young lady, who despite being an addict, was in obvious need of help. She is after all a human being just like the rest of us, despite her lifestyle.
    Well done!

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