Using Force on Vulnerable People – part 2

This is a continuation of previous post >>> Part 1.

THE RATIONALISATION OF THE USE OF FORCE

It was commented that much time and effort was spent by both the NHS professionals AND by the police, attempting to resolve this situation without resort to force.  Officers are not allowed to ‘escalate’ to higher levels of force like CS, batons and Tasers unless they have tried and failed with lower level interventions OR unless the nature of the resistance faced is quite obviously not going to be safely managed with those lower level tactics.  So, if you find yourself suddenly facing a man with a knife, you will start giving verbal directions – “Put the knife down. Get back, stay back!” etc. – but you will NEVER think about using close, manual handling techniques or strikes because it would put you in very close personal danger.  You would be quite entitled to reach straight for your equipment and to use it if the verbal instructions were disregarded.

If the confrontation began at a much lower level, like verbal resistance and passive physical resistance to being manually restrained, it would not be defendable to reach for a Taser or anything else except maybe handcuffs.  But if in the course of attempting to take someone’s arms and guide their wrists into a set of handcuffs, if they lashed out and punched you or threw you across a room; you would be entitled to disengage from manual handling restraints and think about using CS, baton or Taser.  That said, if you are in someone’s house or amidst a crowd, using CS may be a quite inappropriate decision – you could just as well take out yourself, your colleagues or third parties if you use it and become indirectly exposed to its effects.  So you’d think about using your baton or Taser if you are equipped with it – not all UK officers carry a Taser.  If the initially verbal or passive resistance becomes active, aggravated and seriously aggravated resistance, then escalation from manual handling techniques to the use of personal protective equipment can be justified.

Whether everyone would choose to do so in circumstances where it were legally justified, is another judgement entirely.

THE ALZHEIMER’S SOCIETY

If you listen to the Jeremy Vine Show on BBC Radio 2, you’ll hear from Jeremy Hughes, Chief Executive of The Alzheimer’s Society who was more interested in pointing out “It is a real failure of support and a failure of care, which I’d take back a step before the police’s role.  The police are doing what they are trained to do … why did it get to a stage where the Doctor hadn’t been aware of a need for support earlier?  It is very unlikely that you’d get such a rapid progression in the space of a morning where suddenly someone was in need of support where previously they didn’t.”  In fact during this interview, despite the clear concern for the fact that the incident occurred at all, the main criticism appeared (to me) surround whether medical intervention could or should have occured earlier.

Mr Hughes went of to suggest the officers could have “Withdrawn a little bit to calm him in the situation, rather than move him to somewhere else.  Let his wife sit with him, let the family support him rather than rushing him when he’s feeling volatile, he’s already feeling disoriented and sensitive.  The more you pile things on, the more different people coming into the room … a police officer in uniform could be one very upsetting, destabilising event in itself.”  Of course, what Mr Hughes or Mrs Russell may have thought about any assault that could have been prevented by restraint but which was not prevented because of a decision taken to ‘de-escalate’ by withdrawal is not known.  “I wouldn’t want to be condemning the officer involved because the officer is doing what he’s been trained to do and what they’ve been asked to do.  But as we’ve heard the officers have been trained to use force to achieve a result, what they haven’t had is specific training on dementia.”

I want to make a quick remark about dementia specific training and will return to this more fully in a future blog.  Having worked within this part of policing for many years, there are always calls by specific groups for great ‘awareness’ training of, for example, dementia.  But also of Learning Disabilities; of Autism; of Schizophrenia, of Personality Disorder; of Brain Injury.  Place that on top of ‘generic’ awareness training on ‘mental health’ and all of a sudden, you haven’t taught the police any LAW and you’ve been in a classroom for a week.  It is my view having sat through a lot of seminars, conferences and specific training events of the kind described, that condition-specific training is needed only to the extent that it is necessary to dictate and explain a need for a different kind of response – whether Mr Russell was suffering from dementia or any other kind of condition, what difference to the response was needed to that which he would have required if he had suffered from bipolar disorder?  I would argue none – many training inputs that I have attended, run by national charitable organisations for different specific conditions say rather similar things: “patient communication, de-escalate, be careful about language and communication, avoid the use of force.”

To have police officers in a position of being more knowledgable about conditions cannot be a bad thing in itself, not least in terms of an improved ability to recognise those who suffer from various types of mental health problems.  However, I would argue that detention under s136 MHA of a schizophrenia patients is little different in effect or application to that for dementia patients or those with personality disorder.  Communication skills and de-escalation techniques are little different for brain injury patients than for those born with a learning disability.

In this regard and having sat through numerous training events, general and specific, I have long  believed that the specialist training needed by police officers is on autism.  I need to blog more about autism, so will leave my explanation for this to those posts in the future.  Otherwise, in my personal view, other conditions bear specific explanation in the context of good, general mental health awareness training.

This case is extremely difficult and quite rare.  It is for that reason it has reached national media, but regardless: it remains the case that the use of force is a balancing act of considerations – risks of intervening versus risks of non-intervention.  No-one thinks that use of Tasers is an inherently good thing, let alone on a middle aged dementia patient.  But in the descriptions offered of this incident, one can just ‘hear’ the progression through the Conflict Management Model.

OTHER MEDIA LINKS

______________________________________________________________________

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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9 thoughts on “Using Force on Vulnerable People – part 2

  1. Another most excellent blog, thought your description on the Force Continuum was really good, may blog on this myself in the future

  2. Thanks for these interesting blog posts about the use of force in situations to do with mental distress. I think that Jeremy Hughes, Chief Executive of The Alzheimer’s Society, comment was spot on. The psychiatric professionals could and should have done more to give appropriate support so that the police were not involved.

    Where I live, in Fife, the police are often called into the acute psychiatric ward to deal with patients who are distressed. Or who have absconded. It’s like “bring in the sheriff with his shiny badge to restore law and order in the madhouse”. The psychiatric nurses receive training in de-escalation, communication, working with distressed patients etc, but seem to find it difficult to put into practice when faced with distressed patients.

    I have spent time in this acute ward, observing the status quo. Little real engagement with mental patients except at the medication drug queue. I was there all through the morning on one occasion. A female patient was agitated, going about speaking to people whenever she could, she spoke to me a few times. Not angry or aggressive, you might describe it as ‘irritating’. Just wanting to engage and be listened to. Nurses seemed to be too busy – writing reports, in the staff room, on the phone. Eventually this female patient got very distressed, crying, so the police were called. Other patients in the ward, by this time, were also getting agitated, one of them ended up getting restrained, a male. I think all of it could have been avoided if the nurses spent some time with the patients. Surely it’s what their job should be about?

    I think it’s way beyond time for a transformation of psychiatric ‘care’ and treatment. The use of restraint, seclusion and forced treatment in psychiatric hospitals should be unacceptable. A very last resort instead of what seems like the first port of call when people are distressed. I think that because of nurses having to carry out the psychiatrist’s orders eg giving psychiatric drugs to resistant and recalcitrant patients, they can become inured to the distress of a person. Or alternatively call in the police to deal with it.

    Regards, Chrys

  3. Here are a few thoughts I had while reading both (excellent) posts. I have been involved in similar situations (although never with tasers involved) but with restraint being used with older people with dementia. It is very distressing and absolutely EVERYTHING is done to avoid that – when I complete an assessment, I may ask family to assist with conveyance (through presence in the ambulance etc) if that will help – I may postpone conveyance if it is thought to help (we (as AMHPs) have 14 days to ‘action’ the application so can walk away) but in my experience there are some situations where the distress simply caused by the assessment itself means that it would be high risk to leave a person in that situation for a moment longer than necessary so conveying to hospital has to be immediate.
    I would suspect strongly that this was the latter case.
    Generally, I would work very closely with the police/family (urm, often the doctors have left by this point…. ) regarding guidance in this respect.

    This is a difficult case and it feels very uncomfortable but having seen many assessments, I can see how it happened because the importance was both to manage immediate risk and to try and avoid any harm to anyone including the man in question.

  4. Have to agree with Ermintrude Amhps in general try to avoid restraint and in cases of older adults even more so i know from my own experience numerous occasions where we have waited for hours rather than restrain where we most likely would of in the case of a younger person.

    While Mr Hughes may have a point its impossible to know what interventions had been tried but given the Amhp would of liaised with the patients CPN and family i can only guess that this level of resistance was not thought likely. I can also see why a taser was used rather than CS gas if available the only time i have been in a similar situation gas was used and affected me and a colleague more than the older but extremely fit person we were assessing. From my experience the police and ambulance staff are very reluctant to use any force to restrain older people so most likely it was appropriate to use the taser in this incidence. and to echo Ermintrudes point very rare for docs to wait after they have signed papers and got fee forms

  5. Thank you again for raising difficult and contentious issues and challenging professionals about their responses in a thoughtful balanced way. Like you, I wholeheartedly believe that vulnerable people need to be treated with care above punishment and control. And I also agree that there are times when managing risk becomes the overriding priority in the short term, for the individual, the public and professionals. I think that sometimes the public / media forget that if that vulnerable person commits a serious crime or assault during an episode of “illness” they still have to deal with the consequences – whether that is via criminal justice, MHA, social/professional relationships or their own consciences – and this is not an insignificant issue.

    It has been raised in previous blogs that lack of resources, understanding, communication, training are often highlighted as at least partial reasons for a particular situation arising or poor management of a crisis. Several people have also pointed out that earlier intervention at various points might have made a difference to this particular outcome. Not disagreeing with any of this or with the observation of one respondent that given the changes – OK reductions – in services these problems are likely to increase.

    You have previously made the point, rightly in my opinion, that whilst police officers may benefit from more knowledge and understanding of the many mental health problems that exist – they are not clinicians. And I agree should NOT be made responsible for providing clinical decisions or interventions. I don’t want to be made responsible for applying the law in public situations, even if I believe I could do my own job better by having greater knowledge of the law and the role of the responding police officers!

    So, about to make a possibly controversial suggestion to add to those already made, – there is a need for more training! I suggest that there are two – large groups – that need more understanding of the issues involved, the media and the general public. I think Chrys Muirhead referred to the “sheriff’s shiny badge” and this phenomenon is not entirely limited to the police as the “magical wagging finger”. I’m sure medical, psychiatric and social care professionals will recognise when they have also felt recruited to wave the magic wand just by accepting referrals. I am not suggesting that these are inappropriate, but that a general public perception appears to be that if any public service has been alerted / involved all responsibility devolves to them and anything less than a miraculous outcome is a failure of the individuals attending. In addition, it appears to me increasingly that the media opinion is likely to be that an officer does a good job if they are seriously injured in managing a situation regardless of the outcome, but is negligent or thoughtless if they have managed to escaped injury (or anyone else). The alternative outcomes do not seem to impact on their assessment of a successful job.

    I believe we should all continue to be vigilant and critical of all our behaviour, responsiveness and training. At the same time we also need to continue to challenge inaccurate (e.g. MS vs UK) reporting and expectations of what services can and should provide.
    Thanks again MHC

    1. Thanks for putting the link on there. May well insert that into the blog itself later on! … that’s another thing about blogging: you get into the habit of trying to improve things after publication.

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