As my interest in mental health developed into just some knowledge around it, I noticed that the phone started to ring more frequently. I now get around 20 emails a week asking something about mental health – often specific legal or procedural questions after jobs have proved difficult.
Sometimes it rings when I’m at home and for a range of different reasons, but it tends to be one of two types of officer ringing. Senior investigating officers for serious crime inquiries involving mentally disorder offenders where a ‘sectioning’ process is proving difficult against a backdrop of PACE (custody) timelimites; OR duty inspectors to whom frontline officers have referred numerous types of problems needing answers and leadership.
One Friday night around 9pm the phone rang and it was a duty inspector on the phone, someone I know very well. She’d been faced with an AMHP who was clearly dissatisfied with her final decision around a request for police support and felt she had nowhere else to go with it. She quickly explained she was managing an extremely busy evening as duty inspector, having been at work for half of her shift, which would end at 3am. For all intents and purposes, she had run out of police: prisoners in custody, prisoners detained with a double-guard at hospital, crime scenes, 999 calls ongoing to which a small group of officers were responding, ‘job to job’ and intent on writing up all the paperwork at the end of the demand.
Somewhere in there, a call had come in for police to attend the ward of a general hospital to support mental health professionals who had ‘sectioned’ a man who now needed to be transferred to a mental health unit very nearby. (I later calculated you could walk ‘door to door’ in approximately 7 minutes.) The reason for the request for police officers was that upon being told he was to be transferred, the man had said “No, I’m not going there. You’re not sectioning me.” When I eventually got involved in this incident and asked various questions, I failed to establish what had been done, considered or tried, between “No” and the call to the police. I need to be extra-clear here: the man was not violent, was not threatening violence and if there were any resistance or violence in his previous contact with mental health services, none of this was being disclosed to the police.
Initially, at around 8pm the police contact centre sergeant had explained that in light there being of no immediate risks or threats, there was little prospect of police support for ‘several hours’ because of other demands which had to be prioritised. This had led to a further phone call asking to speak to the Duty Inspector who was promptly told by a bed manager that she was under an obligation to send officers to the hospital. She again established that there was no violence, threats or attempts to abscond and explained that there was no prospect of this occurring any time before approximately 11pm, perhaps later. That’s when legislation started to be quoted with an insistence that she was ‘obliged’.
She rang and I told her to leave it with me and police her area. The three telephone conversations I had were some of the most revealing I’ve ever had: of the extent to which the law was being misrepresented to involve the police in Mental Health Act processes – I’ll leave you to decide whether it was deliberate misrepresentation or not:
The dialogue of that evening was repeated for my benefit, and I reconfirmed that sectioned patient was not violent and had not threatened to be. The bed manager then said, “So in the circumstances, the police have to attend and move the person.”
“Setting aside the most important point, that there are no police free to actually do this, currently, could you tell me where’s that written down in English law?”
“What do you mean?”
“You’re telling me that we’re legally obligated and I’m asking you to tell me where this is demonstrated so I can look at it for myself. If I’m honest, I disagree and I don’t believe what you’ve just said to be true.”
“Err, the AMHP at the hospital said that if she asks you to do it, you have to.”
“Perhaps you should get her to ring me then?”
Approximately fifteen minutes later the phone rang and the formality of summaries and checking questions were again completed. The AMHP sounded fairly frustrated by this stage. “I’ve been here for over 3hrs with this case and this man has needed to be moved since this afternoon!”
“Why wasn’t he moved this afternoon?”
“The police were not available!”
“Why does it need the police? Where were the relevant mental health professionals this afternoon and why did they just go home without resolving this, expecting the gap to be plugged? Three times this evening, I’m not hearing anything about violence or resistance or aggression. I just keep being told that he’s said he’s not prepared to move.”
“Well, that’s right.”
“So what has been tried since then?”
“What do you mean?”
“I’m not sure how I can ask it another way. Have you gathered a nurse or two and attempted to direct him – perhaps with hospital security nearby – or did you just ring the police?”
“I just rang the police. I’m here on my own!”
“So where are the out of hours Crisis Team or community team, to support the process? Your organisation employs thousands of people, literally. It must be possible to get two or three nurses with right training who can come and encourage, persuade or even compel this man in the right way?!”
“Well it’s not possible … that’s not in the remit of the Crisis Team.”
“Seriously?! It’s not the remit of the police either and it’s like us telling police officers they can arrest people but then not training them in how to deliver upon that in reality. In any event, I’ve rung back to argue against this idea that the police are legally obliged. Nothing in this incident currently is making it a priority over the volume of other calls currently being received. The only free officers in the area are literally running from 999 call to 999 call. The reality is, you can’t get the police for a few hours yet. If that changes, they’ll let you know. But it’s quite wrong to push against that decision by arguing they are obligated, because they are not. As and when officers become free from other, higher priority calls, they will consider a request to support.”
“But the police ARE obliged: of course they are! This man has been sectioned and I need the police to move him, because he says he won’t go!!”
“You’ll need to tell me where that’s written down in law: that it must be a police matter purely because you say so. This man is in YOUR legal custody if YOU’VE sectioned him. this is by virtue of s137 of the Mental Health Act and your authority to detain and convey comes from s6.”
“I can delegate that the police move him.” The smugness of the remark was almost unbearable.
“Yes, I understand that you can delegate under s6, but I also understand – if you actually read s6: all of it – that nothing in that section obliges the person to whom you would prefer to delegate, to accept your delegation or direction. At the moment, for reasons explained, the police are not accepting it. So the person remains in your custody, entitled to your duty of care.”
“No that’s not right. Actually, can I ring you back?!”
Fifteen minutes later …
“I’ve spoken to a colleague” … she proceeded to read out all of s6 MHA from the Richard JONES Mental Health Act Manual. (The ‘MHA Manual’ is standard equipment for AMHPs: a textbook I have had cause question on a few occasions, not least because I’ve come across three different bits of written opinion from barristers which do not accord with this reference tool’s contents.) … “just how do you want me to do it if you’re not going to help?! I’ve got another MHA assessment to do! If you won’t do it, I’ll have to leave him here to do my other assessment and if he walks out, it’s down to you.”
“But it’s not, though is it? It’s down to your inability and that of one of the largest mental health trusts in Europe to pull on resources which are consistent with managing just one passively resistant patient. Why can’t you ring your managers or MH trust managers to have someone authorise the necessary contingency arrangements? You are a major health trust, you must have out of hours arrangements and some contingency planning? And it’s only fair I inform you that I’m now going to record your threats to walk out and leave the man, in case that should become relevant during any investigation subsequently.”
“This is ridiculous. We’re not trained, you’re the only ones who can use force.”
“Again, I’m afraid you misunderstand. You have all the powers of a constable in this situation so you are simply not correct in law. In fact, the police have no powers here whatsoever, until they accept your delegated authority, which we’re currently not accepting for the reasons given. Therefore, as things stand YOU are the only one who can use force – or anyone you can persuade to accept your delegated authority which does not currently include us.”
“This is outrageous. I’m going to have to leave him here. I’ll record you’re refusing to help.”
“Yes, we are – but only temporarily and for the reasons given.”
I subsequently learned that the section papers were destroyed by the AMHP who did indeed walk out on the patient, leaving him on the ward. This may or may not have been mentioned in the letter that was subsequently written. Incidentally, the patient remained on that medical ward overnight and following a persuasive discussion with a subsequent AMHP the following morning went to the hospital without any problem at all – no force was used whatsoever.
Incidentally – conversations like this are more likely if AMHPs and police officers work in an area where managers have declined to ensure there is a local protocol which covers who will do what and when. Police managers who try to do so may wish to reflect on why mental health services will sometimes train inpatient nurses to use control and restraint techniques which are deliberately designed to be therapeutically appropriate; whilst community nurses are most usually not trained. I still cannot work out why this is the case when physical coercion may needed in both contexts.
The Mental Health Cop blog
– won 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
– 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.