Using Force on Vulnerable People – part 1

In early March, Humberside Police were called to an incident where an Approved Mental Health Professional (AMHP) and two Doctors had ‘sectioned’ a 59yr old man who suffered early onset dementia.  The MHA assessment did not initially involve the police – one presumes because the mental health professionals predicted no need for their involvement.  After the decision to ‘section’ had been taken, there were problems persuading the patient, Peter Russell, to undertake the journey to hospital and the police were called.  It is a terribly sad case.

The subsequent events have been subject to much debate in both print and broadcast media, after one of the attending officers used a Taser, in order to manage the situation they faced.

Wherever you think you may sit on the “should they / shouldn’t they” debate: this is NOT a simple decision or a straight forward issue.  So I’d invite you to challenge yourself by considering the opposing view to your own instinct.

The police were called after Mr Russell became agitated towards the NHS staff,  Once the first officer arrived (alone), there were “significant levels of violence” both towards and then by the police.  Mr Russell was tasered by after the second officer to arrive had been ‘thrown across the room’ and eventually six officers attended and manually restrained him, including the use of leg restraints.  This was described by the media as Mr Russell having been ‘tied up’.  Thereafter he was conveyed to hospital and arrived without injury whilst two police officers were injured.

Presumably because this whole affair pertains not to a criminal, but to a vulnerable patient, the use of force in this way has generated this debate about its appropriateness.  Of course, resistance and risk is still resistance and risk notwithstanding whether the reasons behind it are crime or illness – and let’s remind ourselves again that these are not mutually exclusive categories.

I’d incidentally observe that the most significant, the most demanding and the most threatening violence I have ever faced in my career came from various mental health patients I was obliged to secure and convey.  Often this is precisely because of cognitive problems arising from their condition.  Burglars often stop fighting you when you’ve got control over them and they realise they are going to jail.  Patients often don’t, because the fact of being subject to the use of force, potentially to the use of handcuffs and other restraints, compounds the original fears and confusion, causing greater resistance.

Amongst other things, it has been suggested that the officers should have ‘de-escalated the situation’.  Various other suggestions involved asking why they did not ‘slip something in his tea and come back later’ – quite what they should have slipped him, I’m not sure.  Why did they did not ‘leave him to calm down and come back later’?  Well, maybe it was because any number of things could have then occurred for which the officers would have been directly liable arising as it did from a deliberate decision to walk away from a man who was in the legal detention of the state, by virtue of the actions of the mental health professionals who ‘sectioned’ him.

I am very familiar with, utterly sympathetic to and keen to explore, whether training for police officers could be improved to reduce the need to use force.  In particular, I am aware of various international initiatives to improve overall mental health training for police officers and there are undoubtedly things that could be learned.  Indeed, I have pushed now for over six years for a pilot of just such an approach in the UK which I’m glad to say may well be piloted in my force area later this year.  Whilst those initiatives in the US, Australia and Canada often do report decreases in use of force incidents, research has suggested that there could be various reasons for this not simply the fact of improved training.

I have got no idea whatsoever whether the force used was legal and done in accordance with guidelines.  Neither have very many other people.  The specific details are known only to those who were there; and to those senior officers from Humberside Police who have reviewed the matter and written a post-incident report for the attention of the Police Authority.

Senior officers have repeatedly publicly backed their officers for their actions in this difficult situation.

So I’ll say this:

  • By virtue of an AMHP and DRs decision to ‘section’ a patient, they are in legal custody by virtue of s137 MHA.
  • The officers are under a legal duty to deliver patients so detained into the safe care of the receiving hospital.
  • Failure to do so could constitute any number of types of neglect, particular if there had been specific negative consequence arising.
  • MHA assessments are risk assessed and planned – to one degree or another – in advance of occuring
  • In deciding whether the police should be involved in incidents of this kind, AMHPs start from the position of wishing to employ the ‘least restrictive’ method of detention and conveyance.
  • They did so and set out on this particular assessment without the police.
  • As they did not ‘pre-book’ police attendance, there was no advance sharing of background, risks and so on.
  • So the officers walked into that incident mid-nightmare and potentially quite oblivious to various important things.  Decisions were taken very quickly.
  • Calling the police to an MHA assessment because of unpredicted (or unpredictable) risks is not a decision that AMHPs take lightly – actually, most will say they try to avoid it wherever possible.
  • AMHPs and DRs are not trained (at all, usually) in restraint techniques – so it was “leave him there or call the police” time.
  • Whether a debate occurs about whether community based psychiatric nurses SHOULD be trained, to be deployed to events like is entirely beside the point – there was no predicted need for the police, so presumably there would have been no predicted need for such nursing staff.
  • Once present at an incident of this kind, the police officers must balance their duty to safely detain and convey the patient; with a duty to protect themselves (from being assaulted) as well as a duty to prevent crime (against Mr Russell’s wife and the attending mental health professionals).
  • This means, if there is a suggestion that the officers should / could walk away temporarily and return, it would be balanced off against the risks of not doing so.

Ultimately; you have just TWO broad choices: you back off / walk away (temporarily to de-escalate) OR you use force in accordance with laws and guidelines.  Of course, BOTH of these choices carry risks – neither is perfect.  Each may work, depending on the circumstances; the professionals present may or may not have reached a consensus, but the police have been placed in the driving seat – ironically enough, probably quite reluctantly! – and have to balance how to deliver the safe outcome in their professional judgement.

This post continues in >>> Part 2.

______________________________________________________________________
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.

 

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11 thoughts on “Using Force on Vulnerable People – part 1

  1. Mental health professionals are taught physical restraint techniques (a week long course as a minimum) – as far as I know they aren’t issued with tasers!

    1. In my experience, this usually extends only to inpatient staff; even were it to extend further as soon as we’re at the level of people being physically thrown by patients the police would be called anyway; and once there the police apply their training to the situation. This last point is widely recognised in all joint policies, and it is important to understand the legally, the considerations around the application of the use of force by mental health professionals and police are different.

    2. They also work in teams. They also regularly call the police when they loose control of a patient!

  2. Upon considering this from the perspective of a sw (which I am) I support the means deployed by the officer. The patient appears to have been presenting a risk to himself and others. Accepting that there was no intent due to the man’s poor state of MH and that he is a VP the situation needed to be managed and he needed to be safely conveyed to hospital for detention. This was the end result. He was conveyed without injury to himself and renamed safe.

  3. This would have been an unpleasant experience for all involved. I have been involved in sections where the police have had to use force to protect families, HCPs, themselves……but ultimately the patient. Unfortunately this can sometimes be the grim reality of violence brought on my a mental health problem. It is unpalatable to watch and for many incomprehensible. I truely hope this chap is now somewhere where is receiving the appropriate, caring treatment he needs and deserves.

  4. In response to this interesting post. I have 30 yrs experience,as an RMN and nursing home deputy manager.This scenario happens and I’ve been directly involved in this situation many times. In fact only a few days ago.When deteriorating mental health poses risks, be it to self or others then we as professionals alert the CMHT and Consultant. Usually, but not always, and because we know our clients this is well in advance of any need of ‘urgent’ admission. We find, due to either a lack of CMHT care coordinators or the busy consultant the clients condition can further deteriorate,more meds missed etc, to a point of needing admitting to hospital.And I can only see this getting worse, teams are being reduced in numbers as I type! Some of my clients are coming off CPA an will only be open to Team.Wow! A different CC every time one is needed who doesn’t know much history of risks and behaviours an may never have met the client. And it’s these professionals who we look to to assess in times of crisis. They tend to either not appreciate risks or err on the side caution an bring police too readily. My point is before we as a RMN nursing home get to this crisis stage it possibly could have avoided or handled differently if we had the support earlier.
    Once at crisis point if client is aggressive,refusing meds to reduce agitation etc then the process of detaining and removing them should be done quickly. Most times when Iv witnessed such situations, dragging it out, leaving the client to calm down or bringing other people to talk them into going ‘peacefully’ only ever has it prolonged the inevitable. And whilst it’s upsetting and risky, it needs to be done to get the client the support and treatment they need.

  5. Firstly I’d like to say I’m not a police officer and neither am I any kind of expert on MHA. What we do need to do though is look at the situation as to how it presented.

    Initially the DR & AMHPs risk assessed the potential for harm or violence and decided it was not a factor.

    Following, or during, the process of the sectioning the pt desplayed signs that were indicative that the initial assessment wasn’t accurate and therefore the decision to involve the police was taken.

    Once the state had removed the pt’s freedom and took them into custody (regardless of the reasons for this) the state has a responsibility to provide safe conveyance of the pt.

    Within the oath taken by the police (I know this because I used to be a SC) it is sworn that each officer will protect the Queen’s peace and prevent harm to others where the threat arises (as in Section 4 of public order where officers can arrest without warning if someone threatens and has the immediate means to carry out the threat). MH takes on many forms, just think about drunks and people high on illicit drugs – their mental state has been altered and people are quick to blame their actions due to being intoxicated etc etc.

    The pt posed a physical threat and danger to those around him and it is the responsibility of the police to remove that threat and danger. When a person is physically violent and aggressive one would have to deal with that as a priority and then in the aftermath look at the reasons for why the person ‘flipped’. In my view if the officer felt the need for physical force to restrain the pt then we have to trust their decision

    1. 13 May 2012
      Dear Stephen Wilkinson,
      I am interested to read your comment that “MH takes on many forms, just think about drunks and people high on illicit drugs – their mental state has been altered and people are quick to blame their actions due to being intoxicated etc etc.”

      Have there been any studies scientifically about whether Mental Health disorders / Mental Health issues are caused by alcohol and/or drugs?

      And what is the police perspective on this?

      Are all drunk people and intoxicated people and drugged people and “stoned” people actually now having “mental issues” and liable to be taken under Mental Capacity Act 2005?

      If so, there may be potentially many people who might be accused of feeding their habits by not protecting themselves from themselves, so that the bartender might be arrested for allowing a drinker another drink.

      I believe that this is not what was intended but if what you say is so, then we may have a large number of people before the criminal courts.

      1. I think you might be confusing the Mental Health Act with the Mental Capacity Act. If not then YES Alcohol and/or Drugs can affect a persons capacity to make decisions so is (in part) a reason to deprive somebody of their liberty under the MCA.

      2. I think you may have mis understood what I was trying to say here. What I was actually trying to say is that mental health isn’t something that can truelly be quantified. Yes there have been plenty of scientific studies on the effect of mental health and the relationship between alcohol and or drugs. Such substances can have a detrimental effect on a person’s mental health. Long term alcohol abuse can and does have a physical effect on the functioning of the brain that can lead to mental health issues. When looking at cases of long term alcohol abuse, people often refured to as alcholics, one would have to question why that person drinks so much that their judgement is impaired. The MHA and MCA are closely linked because they both address the ability of a person to look after themselves without intervention of a third party.party.

        With relation to your comment about bartender’s being arrested to allowing a drinker to buy another drink it is actually illegal for a bartender to serve any person they believe to be intoxicated and unable to look afterthemself. Whilst the bartender cannot be arrested as it is not an arrestable offence it is still a criminal offence for which they can be prosecuted. Bars and pubs can be held accountable for their patrons actions whilst under the influence of alcohol.

        My point is that a police officer isn’t someone who is best placed to deal with the situation of someone experiencing an episode of pyschosis due to mental health. And I don’t mean that in a way that could be construed to decry the worth of police, what I am trying to say is that there is not enough time or training that can prepare them. What exists is the training to deal with people that pose a danger to others and lots of other situations.

        What I feel needs to be done are mental health nurses and doctors that have the knowledge and training to deal with people experiencing mental health issues given the power, training and equipment to detain such persons when the need arises. Quite frankly it will take a hell of less time to train these nurses and doctors safe detention techniques and information on how to use personal protection equipment than it will to train officers to understand the complexities of mental health.

        Hopefully this makes sense

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