What do the police think of AMHPs?

Here is a touchy one! – I was directly asked what the police think of AMHPs? The question struck me  as a strange one as there are over 136,000 police officers and thousands of AMHPs – neither is an easily described group of people demonstrating personal or professional conformity!

However, the question got me thinking: I mulled over various things and decided only a blog will suffice as there are many strands to any attempt to answer!  And of course, there’s MY answer which because of my interest in this subject may look a bit different to the more general, distant impression of a frontline police officer who isn’t especially interested in this area of work.  It is undoubtedly impossible to answer the question directly, a synthesis of 136,000 views is unrealistic; even just my experience of different AMHPs is varied – as will be yours of police officers (if you are an AMHP).  These joint experiences will probably probe the heights and depths of admiration and respect; frustration and obfuscation.

We do this stuff to each other where it doesn’t work so well.

Firstly, I’m not sure that all police officers know what an AMHP is – there’s no clue in the title.  I know that some still think of the old ‘Approved Social Worker’ title and perhaps because of the clue ‘Social Worker’ that spoke for itself.  There is certainly less clarity about what the new title actually represents.  Usually, experiences are restricted to two types of situation: s136 MHA detentions and Mental Health Act assessments; either on private premises or in police custody after people have been arrested for offences.

What I thought would be useful to get close to an answer, is to list questions that have been posed in my direction following incidents.  I think the questions where police officers come into contact with AMHPs represent a balance of uncertainty, ignorance, and frustration; enquiry, interest and expedience.

  • Haven’t AMHPs got all the powers of constable after ‘sectioning’ someone? – why don’t they ever use them?  This usually alludes to use of force debates.
  • If an AMHP knows someone needs to be ‘sectioned’, but there’s no bed available isn’t their job to find one – I know the answer is no, but it is often assumed the AMHP is in overall charge of the bed identification and overcoming the problem if there are any.
  • If there’s no bed available for a ‘section’ application to be made and we’re running out of time to legally hold them; how can someone just be left in the cells?
  • Why do several AMHPs tell me you can never do a mental health assessment on someone who’s got any alcohol in their system at all, but some AMHPs are prepared to do it as long as someone is not obviously drunk and can engage?
  • When they’re sorting out MHA assessments, why don’t we get a full picture of the risk history if the police are being asked to then manage that risk?  We’re sometimes sent in blind of half-prepared.

Two of my own from getting more involved in this work – because I’ve only ever ONCE seen the first point done; I’ve known the lack of answer to the second point be something that has caused police forces to take legal advice and start legal proceedings against NHS organisations where patients are otherwise left illegally in police cells:

  • If someone’s in custody for a criminal offence, why do the MHA assessment professionals not think about Part III MHA as an opportunity to balance care that’s needed and public protection.  It’s only ever “Part II or nothing” and this sometimes misses a trick.
  • Are AMHPs aware of, and what do they think of, s13 MHA, taken together with s140 MHA and the guidance published (after legal advice) by the former Mental Health Act Commission (now the Care Quality Commission) in their Eighth and Ninth Biennial Reports – paras 4.45 and 2.49 respectively? – what do we think this means? <<< This is a genuine question, not a dig.  It’s ultimately untested in the courts, but I know what I think it means (for whatever that is worth).

The final thing I’d say – those of you how ‘know’ me well will recall this is a recurring theme in my interaction with AMHPs:

  • Most AMHPs I’ve met, don’t properly understand s135(1) MHA and this misunderstanding can be a causes of significant operational friction.
  • It is frequently misunderstood that an AMHPs delegation of detention and conveyance authority under s6 is not something that can be directed.  It is dependent upon acceptance of that authority.

Penultimately, the Richard Jones Mental Health Act manual contains opinion and views that are at odds with various examples of legal advice to the police service from barristers who specialise in Mental Health law.  I’ll let you decide for yourself what you think that means and I hope this post is seen as an effort to engage a debate. Fire it back!

MY THOUGHTS

I’d like to say this: many AMHPs I’ve known and worked with a very impressive people, and those I now network with on social media are commanding professionals full of knowledge and experience.  They have to balance far longer term implications in their decisions the most police officers and have a confidence about how to do so in circumstances where most of us would want to just err on the side of caution and keep someone detained or locked up.

I’ve known officers ask, “How can they not section him?!” whilst demonstrating a lack of insight into the role, the law and the complexity of turning someone’s chaotic medical and social circumstances into a “YES / NO” decision about detention when operating on occasions with very limited information.  And there’s an over emphasis on these decisions where they were supposedly invaldiated by a later outcome.  There seems little recognition of where these (often brave) decisions worked to the benefit of a vulnerable person and in no small way contribute to their longer term recovery and prosperity.

I would also add that I think AMHPs are often left in a position of some isolation within the broader health monolith that they operate.  Why can’t AMHPs who need to co-ordinate coercive activity call upon trained health professionals to help them coerce where this is low level and consistent with the dignity of managing vulnerable people?  I’ve known AMHPs express regret when they ask for police assistance because they, like the officers concerned, know it’s not necessarily the best way through the woods of delicate situations.  But for the want of other options they have no choice but to ask.

I wondered what the reasons were behind changing the role from a social work monopoly to one that involves other (often very suitable) professionals.  Now that we’re seeing mental health social work being excluded from CMHTs, I am asking myself that question afresh because as I’ve become fascinated by this area, I think that the social work role in particular brings something precious to both community and inpatient care that would be (or will be!) sadly missed as we appear to re-medicalise our approach to mental illness.

____________________________________________________________________
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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15 thoughts on “What do the police think of AMHPs?

  1. If you had asked this question 3 nights ago the post would have been removed :o)

    The main issues I have are as follows:

    1) YOU CAN ASSESS WHILST THERE IS ALCOHOL IN THEIR SYSTEM!!!! I’ve lost count of the number of times I’ve been told this. On 2 occasions I’ve challenged this I’ve had complaints made about me for telling them how to do their jobs.

    2) If somebody comes into A&E drunk with suicidal thoughts why do you insist on leaving them in the waiting room to sober up without being monitored? It’s obvious that will get board and walk out! Then I’ve got to go looking for somebody who doesn’t want to be found

    Which leads me to another annoyance
    3) Why are people LOW risk when they let them out on leave then instantly HIGH risk when they’re late back by 5 mins?

    I think the main issue is that they’re not used to being challenged and so become complacent. Previous bad habits become “policy” and the bad practice becomes entrenched. Whereas the police have had very public outings of these kinds of problems and are now good at identifying and tackling them at an early stage NHS and MH trusts are playing catch up with their own cases.

      1. In my local A&E it’s an AMHP who sees them after triage and it’s they who leave them unattended while they sober up. They then call police and report them missing when they get board and walk our. No safeguarding is put in place at all.

        Never 3 was just me having a general rant 🙂

      1. The people I’m talking about aren’t on any section. They’ve come into the A&E voluntary with thoughts of self harm and suicide. In my particular hospital following the usual triage they are then seen by a lone AMHP as a secondary triage. It’s following this that they’re left unattended to wait for a full assesmemt upto 12hrs or to sober up during which they walk out of A&E unnoticed for hours. Police are then called in to look for a suicidal patient. Whilst there are no statutory powers to detain there is a responsibility on the hospital to protect the patient.

        Rabone v Penine Healthcare NHS trust

        http://www.supremecourt.gov.uk/docs/UKSC_2010_0154_Judgment.pdf

        Though slightly different it did involve a suicidal patient being allowed to leave hospital.

      2. I knew what you meant!! … have edited your original comment so it’s there. I do wonder about how directly relevant Rabone is to people taken at zero notice to A&E where their risks and backgrounds would not be as fully understood and clerked as Michelle RABONE’s.

        But I know what you’re getting … there was debate on here on one of the posts where I was arguing about A&Es duty of care to think about circumstances in which it may be necessary to stop or try to stop someone from leaving. Some get it; others don’t.

  2. Thanks for this. As an AMHP, I found it really interesting. Perhaps I need more time to consider my response to what I think of police.. I wish we could clone you! As well as ‘how can you not section him?’ I’ve had ‘how can you section him?’ Mostly though I am grateful for the assistance I receive and we are all very civilised in our relationships. Except those times when I feel a little.. patronised 😉 (although I’m wily enough just to smile and nod along if it isn’t going to change the outcome).

    1. Maybe patronised is a word I should have used – I admit to feeling like an AMHP was trying to patronise me last week, very heavily indeed. Turns out, all he was doing, was demonstrating a level of legal knowledge which I would hope would fail the AMHP oral law exam! 😉

      If you want to write a response or a mirror image piece about the police; I promise to publish it on here in full, should you wish?

  3. good post as norm not a dig but while we may have the power of a PC to restrain we are often on our own with no kit as a PC would have or any C+R training n would need to restrain for hours possibly, how i would love the power to instruct NHS staff ambulance or in-patient to assist in restraint and conveyance would make my role a lot easier on a practical level.

    Agree with Ermintrude that generally the police are very cooperative but clear policy and training for all would hep rather than protocols that no one on the front-line seem aware of and are whisy washy at best to be kind.

    I’m still coming across officers who have no idea of the law regarding Sec136 only recently one trying to be helpful offered to get someone outside so they could 136 them.

    By the way we always make the decision to assess someone whos under the influence on a case by case basis.
    It would be helpful if emergency services recognized that that the distress caused by delay in mental health assessments is a blue light need on the same level as a physical injury.

    1. As a bit of a side issue but I find it slightly alarming that you could potentially face violent/agressive/resistive people in those circumstances and you don’t have any form of restraint training (I take it this includes any self defence/unarmed skills training?). I would think your employer might find itself under close scrutiny by the HSE for failing to make adequate measures to minimise injury if you were to find yourself being harmed, the answer “call the police” I would not say qualifies as reasonable provisions.

      My two days a year hardly qualify as exhaustive training and the kit officers carry will not protect you from everything but it is at least something, I don’t think the handcuffs and limb restraints are designed for prolonged restraint (limb restraints are meant to be took off and re-applied after 15mins) in any case – I am curious as to what measures are used inside mental health hospitals when prolonged restraint is needed?

      1. You’re hitting on my main point and my main concern: police restraint techniques are inappropriate for the kinds of restraint that are often required in all sort of mental health settings. As you say, sometimes, a restraint intervention is required which is the beginning of a long processes. This might include seclusion, enforced medication or transfer to different wards / mental health facilities. In my own view, some of the difficulties the police end upon can arise from the fact that when invited to intervene because mental health professionals are using words like “threatening”, “violent” or “aggressive” etc.; the police go and use the techniques which are used on people in ‘typical’ police situations.

        My understanding is that most AMHPs (and community based MH professionals like CPS, CMHT staff, etc.) have ‘breakaway’ training to get themselves out of dangerous situations and withdraw. What is often not there, is training and resources ot actively intervene to move low level passively resistant patients. I repeat my point – I often have to – no-one is arguing that NHS staff should be restraining actively or aggravatedly resistant patients intent upon hurting care professionals. I’m referring to lower level, verbal and passive resistance.

        I am not actually arguing that AMHPs specifically should have restraint training – I am just arguing that AMHPs are left in a difficult position by virtue of having no-one upon whom to call, short of the police. I agree that I’d be interested to know what the HSE or the courts thought about a fairly strategic decision to train and deploy no-one to manage coercion appropriately with relevant techniques deployed by professionals who are looking for the clinical warning signs; all in circumstances where it cannot (legally) be relied upon to argue that police officers have legal duties (ie, connected to the prevention / detection of crime; the protection of life / property; the Queen’s Peace, etc..)

  4. With regard to past Biennial Reports advice re S13 s140 ie the published advice that an ASW (AMHP) should make out an application and convey a patient to the S140 nominated hospital and then wait for an admission bed to be made available.

    As you state this course of action has not been tested by the Courts. There are serious doubts about the legality of expecting an AMHP to act in this manner. Here are some of the questions that arise:

    Compulsory admission to hospital implies the occupancy of a nominted bed not a waiting area – would this be an abuse of the power to convey?

    The suggested action would require total co-operation of hospital staff in order not leave the AMHP in an intolerable position. How likely are hospitals to provide this level of assistance – especially when they do not even have a doctor on duty to examine the patient’s needs when in the care of the hospital?

    What happens if the AMHP’s working hours are now breaching Working Time Directives? Especially as delays in bed nominations can take many hours.

    Is it always valid for an AMHP to undertake active consideration for formal admission without the certainty that they will be able to admit the patient? Be reminded that the process of assessment is a dynamic interaction that can remove a patient’s last vestige of self control and exacerbate the underlying condition. Is it wrong to start something that you cannot finish?

    It is perhaps a great pity that the lobby ahead of the 1983 Act did not succeed in making the health authority responsible for a patient the moment an AMHP made out the application. This woud have concentrated the minds of health authorities and ceased to place AMPHs in the intolerable position of having responsibility without power – the exact opposite to “the perogative of the harlot throughout ages”.

    1. I agree that it raises questions buy my standard reply to those you have raised, is that nothing in s13 requires the identification of a particular bed in listing the criteria which must be apply before the AMHP “Shall make the applications.” Secondly, whilst unltimately untested in courts the advice we’re highlighted here was legally checked, as one would expect, by relevant legal professionals before being published.

      It is with particular reference to the police that I highlight the advice, although I would imagine there are various non-police situations in which it may give rise to debate. I refer in particular to the situation – sadly, it is very far from hypothetical – where someone arrested for an offence has been identified in police custody as requiring MHA assessment or subsequent to it, admission. Obviously, legal timeframes from the point of arrival at the police station give the police 24hrs (maximum) to complete enquiries and make decisions about whether someone should be charged or bailed in relation to an offence. If the ultimate decision about a charge cannot be (yet) taken for the want of MHA assessment or admission, then the 24hr legal timeframe until the person must be released still applies, unless an AMHP makes application for admission.

      So, if someone is reaching the 24hr limit having been assessed as in need of MHA inpatient admission, criminal charges not (yet) being possible, they should be released from police custody for a want of any other authority to detain. To do otherwise would be avery obviously violation of article 5 ECHR. Of course to do so, in situations where someone poses a risk to themselves or others gives rise to other negative legal violations; potentially in including article 2. It should also be borne in mind that not to release would be a false imprisonment; to release could be one or more versions of neglect. My debate here is, where the AMHP appears to be in breach of s13 (because all the criteria listed within it are met) is it not at least arguable that the police should place that situation in front of the courts, not only to protect police officers from the awful decision of which illegality they would prefer to engage in?

      I’ve heard various AMHPs comment on this and some adopt the position implied by your questions; others take a view that the bed management issue is for the DR in charge of the assessment and his / her PCT / provider. I’m very aware it is a difficult one and I’m not saying the above is the answer; the purpose of raising it is to get the debate going because I estimate this situation is happening daily in most large UK police forces. All I will say, is that I’ve twice been involved in threatening to raise legal action in these circumstances and it usually gives rise to a bed being found ….

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