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.

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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012

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I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk