A recent experience at work just had to become a blog – mainly because this is about the third time that this has happened to me. Police resisted becoming involved in a mental health job – causing delay, inconvenience and frustration to the frontline professionals involved – and were then thanked for doing so, because the resistance and the escalation it caused brought to managers’ attention issues faced by frontline NHS staff. This is something that frontline staff were grateful for, because their attempts to address the same problem were not, in their view, listened to or acted upon.
Officers were requested to attend a premises after a very elderly lady had been detained under the Mental Health Act. The request was for officers to use reasonable force to coerce her to hospital, the AMHP having explained that she had to go because she’d been ‘sectioned’. The lady did not agree on the need for it or the legalities of it, so reasonable attempts to persuade, encourage and direct having been tried and failed, the police were called.
The control room in the relevant area despatched officers to the address to assess the situation after the lady was described as verbally aggressive but quite rightly on the part of the police, there was a reluctance from the start. I say this because the thought of two taser-equipped police officers, in stab vests with batons coercing an octogenarian from her home is not attractive. Aren’t we supposed to use force in the ‘least restrictive’ way?!
Only this week, I’ve blogged on the back of publicity for an incident in Lincolnshire where the police use of force on a dementia patient was massively criticised, despite the fact that “significant levels of violence” were displayed and despite most people, including me, not knowing the full facts. The internet was alive with a broader debate about whether the police should be the agency to coerce people at all, where it is in the context of MHA admission. So today, my force were asked to coerce a substantially older patient who was verbally and passively resistant to admission. At no stage had she attempted to hurt anyone.
The duty inspector in this particular area was quite clear to his staff: “We’re not going ‘hands on’ first. That’s not our job. If the NHS find that resistance to their attempts to move this lady escalates to violence towards them and they are at risk of being hurt, then we’ll assist. But it’s not dignified for this woman to be dragged to hospital by the police when she’s probably fairly frightened by the prospect already.” He deployed his officers to assess the situation, they tried verbally reasoning – as I’m sure the AMHP already had – but to no avail.
I got brought into this to advise the duty inspector on whether he was on safe grounds to continue to refuse? His approach stacked up to me. What happens if the officers say “OK, let’s crack on” and then restrain the patient only to break her arm – bearing in mind she was in her late 80s? You can then see the headline, “Police break elderly dementia patient’s arm” and then we’re talking about policing again, rather than about decisions taken by the NHS – consciously or otherwise – to have no appropriately trained mental health resources available to the AMHP to avoid the use of the police.
Meanwhile, the AMHP who had been there several hours with someone in custody escalated the issue to an AMHP-lead in her area – why were the police not agreeing to this and what was she to do? In the conversation I had with the AMHP-lead, I outlined that in my view there needs to be something in between the patient saying, “Sorry I’m not going” and the AMHP saying, “Call the police”. NHS Trusts often employ thousands of people, community based and inpatient based – why can’t they arrange to deploy two C&R trained staff?
I’ve said this before: if you want to be in the coercion business, you should expect to find yourself in situations in which you need to coerce. A patient, once sectioned, is actually in the legal custody of the AMHP and parliament gave the AMHP “all the powers of a constable” in these situations for a reason. This should be reflected in acceptance that there are at least some situations in which those powers should be used. Yes, I know that the AMHP can delegate authority to anyone else: but they may not DIRECT anyone else to accept that delegated authority. Again, we must presume that parliament legislated like this for a reason. Low level, passive resistance would seem the place, as far as I’m concerned, to see AMHPs and / or their NHS or Local Authority colleagues using appropriate training to act for themselves.
To be clear: nothing that I’m writing here implies that anyone expects AMHPs or C&R trained nurses to manage serious aggravated resistance by patients intent on deliberately hurting NHS staff.
It took several more hours for the AMHP lead to attempt to engage senior managers to consider what, if any, contingencies could be accessed to deliver therapeutically relevant restraint and for that manager to then ask to speak to me. By then it was nearly 5pm on a Friday afternoon so people were going home. Senior managers had nothing in their toolbox, one presumes because nowhere in the planning of the delivery of mental health services was the ‘need to coerce after MHA assessment’ scenario considered. And of course, no-one in that area had remembered to write and agree a local policy with the police on “MHA assessments in private premises.” <<< This is a requirement of the Code of Practice to the Mental Health Act – oops.
So there’s it is >>> having established there was absolutely no other way to get the job done, the police did the right thing and attended to coerce, paramedics and AMHP in support. It had reached the point that unless the police did it, the AMHP would have chosen to walk away because of an inability to complete the task. Obviously, no-one was going to leave an 80-odd year old woman in her address alone when she posed a risk to herself.
Predictably it took nothing more than an officer taking her by the arm, pulling her gently to her feet whilst telling her to sit in a wheelchair whilst trying to calm her verbal distress at being moved. The sergeant involved explained that it was “barely any resistance at all” to get the job done. Why could that not be done by an AMHP a paramedic or a CPN? No reason at all, if we’re honest.
This story is far from rare: the point I’m making in this post is the AMHP-lead saying this: “You resisting in this way has caused this to get escalated to senior managers, I’ve been able to register this matter as a clinical incident and the Chief Executive will hear about this. It may be that the police resisting this will cause managers to discuss things frontline staff have raised for years, but which haven’t been addressed.” <<< Read the paragraph again and think about it.
So – we think we got thanked for taking the trouble to cause significant inconvenience and delay to a frontline AMHP – albeit we checked at every stage and repeatedly that the AMHP wasn’t at risk or the lady’s health deteriorating. The AMHP was aware that any sudden change in the situation ring 999 for police and / or ambulance. One can only hope that next week, people take seriously that there are important discussions to be had about how we make the processes of coercive sectioning as dignified and humane as it can be, balanced against managing risks and threats which may, from time to time, require the police.
UPDATE >>> Since publishing this blog a few hours ago, I have already had AMHPs and other mental health professionals from other areas ‘nodding’ at the above including an Older Adults Psychiatrist suggesting that this is a police force quite rightly putting dignity first. One MH professional pointed out that in their area, the police would not have been called because there is a commissioned service upon which to call in this situation. This needs to be wider practice.
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.