Monthly Update – I’ve been a bit busy!

I’ve had a quiet few weeks on here.  As well as some time off over Easter when I took my son’s Under7 rugby team on a tour to Lancashire and had one of the BEST weekends for years, it has also been due to planning and work around our restructure at work and a massive amount of time being spent on that ahead of ‘D-Day’ in July.

I’ve been busy on the mental health front and thought a little update may be of interest – I’m going to start a regular ‘update’ blog instead of blogging on specific subjects all the time.  Frankly, I’m running out of topics that I haven’t already covered but want to keep covering a bit of what I’m up to and a bit of stuff in the news.  There may well be specific posts too, as news or events dictate or if I or you come up with some fresh ideas!!  (There is one coming up entitled Mexican Standoff which is a very interesting true story!)

Last Friday I spoke at an event at York Racecourse where I had been invited by Dr Keith RIX to talk to an audience mainly comprised of mental health professionals – including a large number of psychiatrists.  I spoke mainly about how we should consider the investigation and prosecution of inpatients on psychiatric wards where there are assaults on staff or other patients. It was delightful to meet Dr Simon WILSON from the Institute of Psychiatry because he and I co-authored a published article on inpatient violence without having actually met!  Having worked on that it was clear we’d sing from the same page and this proved to be the case.  A gentleman who shared my distaste for what he called the ‘inappropriately dichotomous’ nature of the debate on diversion.

I have blogged about inpatient violence several times and it remains an important issue for the NHS.  68% of ALL assaults on NHS staff occur in mental health trusts whereas some may have presumed it as the “A&E on a Friday night” thing.  However, in some trusts anything from 15% to 25% of those assaults get reported to the police – some trusts report NO offences.  There is much work to do on this area where the police recognise they are not consistently providing the best investigative response and the NHS need to recognise that they are not always as forthcoming as they could be with background about someone’s mental health history with (properly disclosable) information to inform the legal decision-making by police and CPS.  Bad outcomes all round where those failures emerge and one way around this is to have an inpatient liaison officer who gets to know what they’re doing.

I’ve also been progressing details around an idea I had about six years ago which I’ve been trying to get off the ground since.  My ACC has agreed that we should pilot this idea to see what value it adds:

Police officers lack training around mental health and also around laws / procedures on mental health law.  This type of feedback is a regular feature of mental health professionals’ and service users’ feedback about their experience of policing.  Because X or Y or Z didn’t work (to their satisfaction) or because attitudes may not have quite been where those individuals would have preferred to see them, “The police need more mental health awareness training”.  Maybe  …  probably  …  more training on many things would be nice.  However, if you are a regular reader of this blog or if you look at the INDEX of posts and the FAQ page, you’ll see that there is much to learn!  (It’s has taken my a decade of getting obsessed after getting curious to develop any knowledge I’ve got.)

My standard response to this response about police mental health awareness training – EVERY SINGLE TIME – is that such claims may well be true, but mental health and social care professionals needs more “police awareness training” around procedures and law.  Most AMHPs I’ve met, can’t explain s135(1) properly, for example – although many can.  Most mental health nurses on wards who are asking for patients to be arrested following assaultative behaviour, don’t realise that we arrest people to commence and investigative and criminal justice process, not for the convenience of NHS staff.  If there is no complaint of an offence or no evidence of liability, arrests don’t occur however desirable someone may think that would be.  (You should see the list of people I’d arrest in a fantasy world where we do it because I think it would be a good idea.)

My idea for police training is this: rather than give thousands of officers 4-8hrs training in the hope they’ll learn the contents of this website and then recall it all effortlessly in the 2-5 jobs per year where such detailed knowledge is required.  Let’s remember, a lot of ‘mental health jobs’ don’t necessarily involve specialist procedural or legal knowledge at all, such as jobs where criminal arrests need to be made of suspects with mental health problems.

So! – let’s give a certain percentage of cops 3 or 4 days of mental health training including:

  • Mental health awareness:  inc learning disabilities, autism, personality disorder as well as ‘functional’ mental health problems like schizophrenia, bipolar and depression.
  • Law knowledge around s136, 136, AWOL, inpatient violence, supporting NHS agencies in enforced medication, conveyance etc.,
  • Knowledge of where to secure resources, help; how to avoid or mitigate against critical untoward events;
  • Resolution of incidents by de-escalation, moving away from the use of force.

Then, deploy those officers with that raised knowledge and WITHOUT branding them as experts of ANYTHING which approaches crisis services to jobs involving mental health issues.  We will categorise all MH jobs into three categories.

  1. High risk – critical or complex incidents: inpatient psychiatric violence; s136 cases involving A&E and prolonged restraint, s135(1) or ‘Assessment on Premises’ jobs;
  2. Medium risk – non critical volume incidents, AWOLs; standards s136 jobs, criminal suspects in police custody.
  3. Low risk – Any other business.

The idea is, we ALWAYS deploy these officers to Category 1 jobs; we deploy them where possible to Category 2 and ensure their advice is sought if not possible; we let ‘normal’ officers deal with Category 3 but our specialists are there for advice, if felt needed.

This is not original! – the US, Canada and Australia have started off this concept after it was commenced in Memphis, US.  Each nation seems to be adapting it, but this pilot would appear to be the first time the UK have considered it and after six years of trying to give it a go, I’m really excited by what it may achieve.

Finally, I was delighted to give a very informal talk about policing and mental health at the main mental health unit for my home county and very impressed at their biscuit collection.  I was invited to do it after by a psychiatric nurse who used to be one of my PCs when I was a young ignorant sergeant.  I spent two really very enjoyable hours giving a police perspective on supporting “psychiatric emergency” and “criminal suspects who are mentally ill”.  (I usually divide general talks on this work into those two categories and cover: s136, s135, AWOLs and some other bits in the first section; prosecution, diversion and inpatient issues in the second.  Loads of great questions and engagement and at the end a crisis team manager said, “My team love your blog.”  Given it was originally written for police officers’ reference, those are warm words which make blogging in the evenings and in my own time very worthwhile indeed!

(Incidentally: the U7s rugby – 10 played, 7 won, 1 drawn and 2 lost.  Given 1 draw and 1 loss was them playing U8s at Blackburn, we were proud as punch and I got to watch my son score his first competitive try and then go on the ‘make’ the winning try in one of his games … proud as punch.)

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16 thoughts on “Monthly Update – I’ve been a bit busy!

  1. Thank you for this summary and congratulations to your son!

    One minor point – while MHS are always quick to point out others’ needs for further training, has anyone suggested that MHS staff need for training on assault avoidance techniques. This is something they could learn from serving police officers who are arguably the UK’s experts at confrontation avoidance whereas those operating in the secrecy of closed wards are sometimes reckless in their handling of confrontations?

  2. 25 April 2012

    Dear Mentalhealth Cop

    Congratulations to your son and his winning try! Proud father indeed!

    I think that the law of the land needs to be simplified. There are too many laws of which the standard citizen is unaware. That the law enforcers are ALSO unaware of all the law means one thing – a RADICAL reorganisation of the law of the land needs to be done, just as in the 19th century and PEEL.

    I am campaigning for legal reform – just as there has been Education Reform and NHS Reform and Planning Reform – now just 50 or so pages rather than 1300 pages or so.

    What do you think? Would it make police work easier to understand?

    Thank you so much for your brilliant blog.

    Keep on blogging!

    Best wishes

    Rosemary

  3. I’ll be really interested to see how your Pilot goes. I suggested something very similar to my Force in 2009. Your experiences may assist us in considering this further. Good luck!

    1. I’m really keen about it as there is no doubt that where officers with greater knowledge are involved in MH jobs, we get consistently better outcomes – measured in a range of ways and for a range of reasons.

      I’ll let you know!

  4. – “You should see the list of people I’d arrest in a fantasy world where we do it because I think it would be a good idea.” –

    Gosh yes – the amount of people who are agressive, rude, irresponsible, love to escalate situations, have litle regard for humanity and generally think they can do whatever they want without fear of recrimination! But people don’t like it when you arrest the nurses… (!)

    Seriously though, the sentence “I spoke mainly about how we should consider the investigation and prosecution of inpatients on psychiatric wards where there are assaults on staff or other patients” sends a chill down my spine, due to personal experiences.
    A psychiatric ward is the only place in the NHS where people are held against their will – that alone would increase violent situations, not to mention that to reach the hallowed heights of actually being admitted means someone is either struggling with severe psychosis or overwhelming, crippling emotion. This would naturally lead to a highly charged atmosphere.
    My concern is that rather than de-escalation techniques (or even sometimes basic respect/kindness), staff would prefer to criminalise patients to get rid of them or punish them. I don’t mean get rid of them by putting them in jail, I’m referring the the more subtle technique of citing ‘violence’ or ‘refusing to engage’ or ‘the hospital can’t help you’ or diagnosing someone with personality disorder (because of violence) then saying ‘they don’t have a mental illness’ as PD is a grey area in that respect.
    Not to mention that the ward psychiatrist can overrule the nurses’ judgement of a patient’s condition – even though they have spent far more time with the patient and there may be four or five of them disagreeing with the psychiatrist.
    (With all this in mind, Joe Paraskeva’s case springs to mind though I realise you won’t be at liberty to comment on that).
    The sort of ‘care’ that happens in mental health would not be tolerated elsewhere – I’d love to film undercover like the recent expose on abuse in nursing homes for the elderly. Sadly, mental health patients receive less sympathy than the elderly – and are more likely to be disbelieved and have no-one to speak up for them. The very people who may be neglecting or mistreating them can undermine their opinion – they’re mad, after all, or lying, or attention-seeking…
    Another big concern is this: I have a record for ‘violence’ in NHS care settings, despite having never committed at act of violence. On further investigation, it appears that ‘being agressive’ actually counts as violence. I was once struck of a GP’s list for ‘violence’ – after a TELEPHONE appointment, which is why I started looking into it!!
    How many people are going to get stigmatised and labelled violent when they have done no such thing and are probably struggling desperately and overwhelmed, with the very people who should help just trying to pass the buck and escalting the situation through harsh, innapropriate treatment, accusations, and passive-agression?
    If you broke your leg, went to A&E, and the doctor then proceeded to manhandle your leg (argh!), kept you waiting another nine hourse, poked your leg again, gave no painkillers, then sent you home without a plaster cast saying “You know where to find us if you need help”, you’d be livid! I think we could all sympathise, at least a bit, if you thumped the doctor! However in mental health care this kind of thing is routine – and if you so much as disagree it all gets written down and is used to discredit you in future.

    For the sake of balance (!) I have to say there are some good people working in mental health – and good luck and much respect to them. Unfortunately it must be like swimming upstream, the whole force of the underfunded, institutionally neglectful system against them.

  5. I work in a mental health charity as a criminal justice worker, most people we meet have fallen between the cracks and are a ‘revolving door’ in and out of prison, with simple interventions these people can recover form their mental illness and as a result stop offending, i applaude your work, some of the younger officers we deal with in my role and that as an Appropriate Adult are veryu aware of people suffering MH problems, this is very refreshing, although i am with you in saying more work is needed. Keep up the good work !!

  6. 29 April 2012

    I know it is a radical idea, but I really cannot understand our penal code. Peel was a great reformer of the penal system in Britain and I believe we need a thorough overhaul of the entire state – from education, health and welfare – so that we can maximise the localism and helpfulness and goodwill that exist in our local communities at grassroots level.

    The public services are great but without enormous spending, it will not be possible to keep them going. However, with localism, it can be built up with the voluntary sector – ie just ordinary people helping one another.

    But one thing does seem to make people reticent – that of being accused of not helping someone in distress might end up with them being accused under Section 44 of the Mental Capacity Act 2005. And be prosecuted.

    Seeing from your posts how difficult it can be to get someone “sectioned” it makes me wonder how many people are wrongly assessed as having capacity and wrong assessed as NOT having capacity.

    To me, this is the Wisdom of Solomon – and very worrying.

    What do you think?

    I have campaigned about this particular issue to the Law Commission, the Law Society, the Bar Council, the Department of Health, the Ministry of Justice, the HMCTS and the MP for the Isle of Wight.

    A prominent counsel has actively warned prosecutors about this act.

    It is a dog’s dinner in my opinion and needs to be revised.

    Best wishes

    Rosemary

    1. I doubt people are that worried about being accused of neglecting someone ‘without capacity’. Even mental health professionals don’t seem bothered, so clearly it’s hard to take legal action for this. They can always claim they DO have capacity. Please mentalhealthcop, after hearing yet more horror stories from a professional who takes suicide attempts to hospital, about the neglect they suffer, please tell me why no-one is being prosecuted for this? Please tell me how to expose it to the public, please can we stop the cruelty and neglect of these damaged people.

      1. What about a RIDDOR report I made about 2 nurses refusing to get an INJURED person out of a car and onto a stretcher that this person wanted, and refused to get out without a stretcher but these nurses refused to give her one. That is mental cruelty and is to my mind punishable under Section 44 of the MCA2005 REGARDING NEGLECT BY HOSPITAL STAFF who were already treating this person.

      2. I wish to correct my above post – what I meant to say was that if these 2 nurses believed that the injured person lacked mental capacity and then neglected to section her and have her taken into hospital for her own sake, then that would be a question of liability under Mental Capacity Act 2005 Section 44. However, if the 2 nurses believed as they apparently did that she had capacity to decide for herself whether or not to stay in the car, then NOBODY is liable at all, and then it is just a question of the person making their own choice and nobody is to blame for what some people might claim to have been wrong and full of errors on the part of the hospital staff.

    2. I think the capacity thing when considering, for example, an elderly dementia patient in the later stages on the condition is comparatively straight forward: it is when considering ‘capacity’ in relation to people suffering functional mental illness that is more challenging.

      You rightly point out, that capacity assessments can be inconsistent and I’d also point out that assessment of ‘capacity’ is to make a situationally specific assessment. Someone can simultaneously have and not have capacity with regard to two different decisions they seek to make. For example, the capacity to think they are fit to leave inpatient care and the capacity to take a decision about whether they would like a cup of tea.

      It is for many of those reasons, that asking about capacity, is possibly to be asking about the wrong thing when it comes to inpatient offences against staff or other patients.

  7. A number of points;
    Didn’t the U7s do well!
    Think the pilot plan sounds brilliant and sensible. Can’t wait to see the evidence.
    Agree wholeheartedly that NHS staff / MH personnel need, want and would benefit from training about policing and legal perspectives on police responses to their requests. I think this would improve the type and frequency of these requests and the interservice relationships.

    That said – no not just going to complain – part of the problem I think has been the rapid changes to services, some of which has been nationally (government) driven and associated cuts to staff and changes of remit of services / teams. This has meant that previously established personal networks to clarify difficult situations has been disrupted, current policies and procedures are out of date or out of synch between police/NHS/ Ambulance/ MH etc.
    I suspect that a great majority of previously negotiated interservice policies re transport/ AWOL / Vulnerable Mispers / Violent incidents in acute settings are no longer valid and certainly not working well. Each service has updated these independently to address their own staff cuts, changes in remit, etc and with staff turnover/ redeployment at senior as well as junior levels the communication has collapsed in many areas. Not necessarily for want of trying. My experience is that frontline staff of all services want this to work better and to support each other but find themselves negotiating (or arguing) responsibilities or responses that are beyond their authority – and then feeling understandably frustrated and scared about the outcomes. In the current climate where these issues seem to be changing on an almost daily basis I don’t have any concrete suggestions for addressing this, other than we all need to be badgering the most senior people in our organisations to address this and not keep passing the buck. AND for the frontline staff to remember to support each other and to stay focussed on what would best achieve the optimum outcome for the members of the public we are employed to SERVE.

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