<<< If there’s one thing from which I derive very real satisfaction, having blogged away now for six months, then it is emails from frontline officers saying how the blog material has come in useful in operational reality. To get such a story as this one where it is clear a better patient outcome has been achieved for someone whilst I was lying in bed after NIGHTS is gold dust. This feedback comes from Twitter’s @NathanConstable, a blogging / tweeting frontline police inspector who is worth a follow and does good blogs on policing issues. >>>
Your site has AGAIN proved invaluable today as I have quoted Paragraph 10.22 of the MHA Codes of Practice to a ward manager.
A man was seen yesterday by a support worker, at home, who felt he needed an MHA assessment but he left the house before it could be jacked up and he was reported missing as she had concerns for him. He was located several hours later by police who detained him under 136.
He was conveyed to the PoS but they didn’t want him for a variety of reasons. Eventually the night Inspector went down there himself and told them he would be staying there whether they liked it or not.
As I came on at 0700hrs this morning and just three minutes into briefing, we had a call from the hospital saying that a patient was kicking off, that he had assaulted three members of staff and five of them were restraining him. I did not realise at this point that it was the same male.
My view at this stage was that this is something they need to be handling themselves with their appropriately trained staff. However, when it became apparent that he was pre-section and still detained only on 136 I had to revisit that and I sent a unit with specific instructions NOT to remove him from the hospital unless it was absolutely necessary. By this time the patient (still not assessed) had been moved into a secure room by the hospital staff and was no threat to anyone any more.
Apart from their initial unhappiness about our lack of attendance they were then extremely unhappy when the officers refused to take him away. This led to the Ward Manager calling me to discuss.
His view was that the hospital was not an appropriate place for him, they “couldn’t handle” him and he needed to be detained in a cell. My response to that was that a police cell was not appropriate, the HAD handled him and he was now detained in an appropriate place of safety.
Not content with this the ward manager informed me that the room being used was not THE PoS. To which I quoted 10.22 and said he had effectively improvised one.
He persisted that by using the room it was denying its use to a hypothetical service user who might need it later. He even went as far as to say that it would be on my head if a 80-year-old dementia sufferer ended up in police cells because they couldn’t use the room.
My answer to that was – why are you worrying about hypothetical “what ifs” rather than dealing with the service user you have in front of you? If an 80yr-old dementia sufferer turned up I would improvise my own PoS and take her home rather than convey her to a cell.
The debate continued with him accusing me of thinking it was alright to assault staff. I said that is not the case at all – his medical and clinical status is not yet ascertained so I don’t know whether his actions are criminal or not yet – if they are we will deal with them but that is not the priority right now – his assessment is.
Then he moved onto the fact that the patient was unlikely to be sectioned as he had been examined before. I asked him three questions.
Question – “What happens if he is Sectioned?”
Answer – “He stays in hospital.”
Question – “What happens if he isn’t?”
Answer – “He is released.”
Question – “What happens if he is so violent that the AMHPs cannot conduct the assessment or make valid assessment.” … it took him a while to admit that in that eventuality he would be detained for further assessment to which I said, “Two out of three of those scenarios involve him remaining in hospital and the other see’s him walking out. Where does a police cell come into this?”
I then explained that it wasn’t a question of having police officers involved – I was quite happy to supply a double crewed unit to ensure no crime was committed before or during the assessment. For me it was a question of WHERE this would take place and I would not, under any circumstances, take him to the police station now he was secured in a safe and secure room.
The ward manager reluctantly accepted this – which suggests to me that I was right.
The inevitable, “I will be making representations about this” came out but the question is – was I right? I think I was. I will accept that had I known he was pre-section in the first place that might have changed my initial “how quickly we got there” approach but not the eventual outcome.
The fact that seven hours later we are still there is something I have to accept. Their other problem was a refusal to change their schedule for the day. Common sense dictates that they bump this guy to the top of the queue – and assess him – we know where we all are and the room is either utilised fully or he is released thereby freeing it up. Problem solved. Unfortunately they seem to have had a series of unavoidable meetings which is delaying the whole process. What a surprise.
The outcome was, he’s been detained under s2 MHA and admitted. I doubt I have heard the last of this one!
Was this duty inspector right? Feel free to add your own comments to this post. For me, certainly.
He has provided a response which ensured ongoing security to prevent further assaults and whether or not the NIGHT shift should or could have left resources at the PoS to prevent assaults from occurring in the first place, is not clear in terms of the risk background. But that is not an issue for this inspector.
It is quite right to point out, that PoS solutions can be improvised notwithstanding what a PoS protocol stipulates the designated places to be and para 10.22 obliges the police AND the NHS to think of the alternatives. This may not be “textbook”: it might not be what all NHS staff think is the right thing – but we’ve all got personal views on this stuff, haven’t we? It was lawful, reasonable and ethical and it probably caused a faster assessment of MH need in a more appropriate place than if the police had just got back in their box and done as they were told. Of course, had they done so, I’ve got various medical and legal situations playing out in my head which would have rendered acquiescence questionable.
Let’s not forget the criteria for use of a police station is “unmanageably high risk” and the officer points out, they managed it and then were supported by the police thereafter. Let’s also remember: the Royal College of Psychiatrists Standards on s136 indicate that people detained should be taken to and left with NHS services “even where they are disturbed” (p8). That ongoing police support was provided may be considered ‘extra’ to support a service that doesn’t function as agreed by relevant national agencies. We should also remember that the recommendations of the Rocky Bennet Inquiry indicated that where psychaitric patients are in need of ongoing restraint, they should be detained a place with access to a Doctor and defibrilator. That include no police station that I’m aware of.
It is for that reason that I smiled when I read the paragraph above “You’ve effectively improvised one.” Can we doubt the commitment to investigate the assaults against staff or ensure they are not repeated? Not really. Removing the man to a police cell doesn’t un-assault the staff; nor does it ensure fast assessment of need. Providing two cops to remain at the unit keeps the situation from re-escalating and represents a recognition from the police that the risks have raised and that whatever the rights and wrongs of the way the service is commissioned or the fact that staff would potentially prefer to operate outside the law and national guidance, the police have done the right thing in my humble view.
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.