The use of force by the police in relation to incidents involving mental disorder is the thing that has occupied my thoughts this month. Always controversial, often very necessary, but occasionally capable of question in terms of how the situation was brought about that it fell to the police to use force; or how situations escalated to such a degree that the police believed the use of a high level intervention was necessary.
We heard in early May that Humberside Police used a taser during an incident where dementia patient Peter Roberts was ‘sectioned’ under the Mental Health Act. My post on that incident generated a welcome debate on twitter. Shortly after this, I wrote about an incident on which I’d been asked to give a view in support of officers who were inclined to resist requests that they should be the first professionals to lay hands on an elderly dementia patient who was resisting admission to hospital under the Act – verbally and passively.
The fallout form the first incident should be causing us to ask questions about how routine the second type of incident actually is; and why do some NHS areas often have no coercive capacity other than the police? Important to re-state: I’m referring to low level, passive and verbal resistance – no-one is exepecting NHS staff to put themselves at risk of assault or serious harm, but unless such risks are likely, the police may well legally be obliged to consider resistence or refusal in some circumstances. More to be done here in partnerships.
Of course the use of force by mental health or social care professionals is controversial, not just because all use of force needs to be very carefully judged but also because when engaged in undertaking such functions, it is quite possible that the person using force, despite best efforts, planning and proper training, may find themselves assaulted during the resistance of the person being moved, detained or restrained. I’m aware that over two-thirds of assaults on NHS staff are against mental health professionals; I am aware that many mental health nurses will say they’ve only ever been assaulted by ‘older adults’. This makes the discussion about our joint approach and training / deployment of properly trained NHS staff more important, not less.
My own view, is that Parliament legislated in that way that it did – to allow force to be used in realising the effects of the Mental Health Act – with a range of circumstances in mind. For example, it reserved certain powers under the Act to the police – execution of warrants under s135, detention of people in immediate need of care or control under s136. The obvious question to ask is why powers under s18 MHA (recovery of AWOL patients) were not reserved exclusively to the police; why the powers of detention under s6 are reserved to an AMHP, albeit it with the ability to delegate those powers. We should then ask what the practical implications are of AMHPs being unable to direct or instruct other professionals (like ambulance or police) to detain and convey under s6 on their behalf.
I can’t get my head past this: Parliament’s intentions, or the effect of their legislation, is that some MHA patients should sometimes be detained and conveyed using health and social care professionals only; other situations should involve the police being in the background of efforts in case things escalate suddenly; and the police should be the lead agency where the patient can fairly described as ‘dangerous’ or ‘violent’. NB – ‘dangerous’ and ‘violent’ do not simply mean ‘resistant’ or ‘verbally aggressive’. Perhaps those later epithets indicate where officers should be in the background, in support? We need to ask ourselves in a far more meaningful and sophisticated way, what the words “least restrictive” means.
For me, it means uniformed police officers are never the first thought when force should be used.
I repeat my model for indicating where the police should be involved in the execution of Mental Health Act related processes: RAVE risks. As far as I am aware, this is the first attempt to put together a framework to help professionals on all sides understand situations in which the police should be involved, because any suggestion of it causing stigma or the appearance of ‘criminalisation’ (whatever that means) can be explained against the risks to all of the police not being involved.
Autism awareness and the Use of Force
At the end of March, the High Court ruled in a civil action brought against the Metropolitan Police, involving a case where officers restrained an autistic teenager at a swimming pool. The case of ZH v Commissioner of Police for the Metropolis provoked an understandable outcry, not only because of the use of force being used, but obviously because the use of force was ruled unlawful in this instance, therefore representing an assault and a false imprisonment.
Again, it brings into focus the specific issue of Autism about which I will try to blog during June if time allows. I have heard many times that officers not only need “mental health awareness” but they also need particular awareness of sub-categories of mental disorder: learning disabilities, Alzheimer’s / dementia; autism, personality disorder, etc.. They are more. Having attended many conferences, events and training sessions on these issues over the years, I offer this view: of course, officers need training that includes reference to and explanation of these sub-categories and their differences. However they only need specific awareness training of particular sub-categories where the training is able to outline why a necessarily different response to individuals is required. For me, the only example of this is Autism. And this may be because it is highly contested whether Autism should be viewed as a mental disorder at all.
Whatever we think the need for officers to reflect on their communications; de-escalation and the use of force and many other aspects, it is often the case that these things are generic across sub-categories of disorder. incidentally, I’d got further – whenever I hear charities talking about how to communicate well with service users where they are in crisis or at risk, I always think, “That’s how we should communicate with everyone all of the time, anyway!” Avoid jargon, be clear, don’t patronise, don’t deny their emotions as it may escalate situations, etc.. However, in the particular case of police responses to members of the public on the Autistic spectrum, we need to be aware that things are different. This is perhaps why Autism is the only sub-category of mental disorder with its own legislation: the Autism Act 2009.
Contrary to popular belief, “de-escalation” techniques are very much a part of officer safety training: it’s just that we don’t call them that. Officers are only permitted by law, to use force after trying and failing to use “tactical communications” and “officer responses” to de-escalate, or having reach a conclusion that force is required immediately to ensure safety and prevent crime. In other words, if you can talk someone down, you have to or you have to try. You can only move to various levels of force once satisfied that it is “Proportionate, Legal, Appropriate and Necessary” to do so: you must PLAN, your use of force.
This will continue to be controversial and force will again be used because the administration of the Mental Health Act involves the coercion of fellow subjects; whether by NHS staff and / or the police. That’s why we must continue to think and talk about how best to do it, very much with safety AND dignity in mind.
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.