We Don’t Know What We Don’t Know

This whole blog and various specific tales within it are testimony to my interest in, my commitment to and my passion to widen awareness about mental health issues within the police; and about policing challenges in our society when officers deal with mental health issues in various forms.

A few months ago, I was posted to a duty involving my second police passion: public order policing.  I was posted as police commander for a large cultural event in Birmingham.  Within that event, there was to be much singing, dancing, music as well as food stalls, bars and other entertainment.  It was more than a local event, it attracted well-known musical entertainers who have topped the charts and have a large following.  We were expecting potentially tens of thousands of attendees.  The whole event was a great – a family atmosphere, a community policing style where officers were enforcing little, ensuring safety and engaging in good-natured ‘banter’ within men, women and children across the whole day and although the bars were open there was no alcohol related violence or disorder.  But there was just one fight: and it broke out within a few metres of me and three other police officers who were immediately summonsed to it, by those around it.  A man and woman who don’t know each other had an argument about queues and pushing and he allegedly punched her in the face.  Her friend, another man, tried to push him away at which point people were looking for and calling the police.

As soon as the four of us ran over, the alleged offender and his mate were off.  He was distinctive enough, because he was the only man around not wearing a shirt.  Trying to disappear into a crowd who were busy listening to the headline act of the show, pumping out well-known pop music at ear-blistering levels.  Not my musical cup of tea at all, I’m afraid.  The need to grab this bloke before he vanished was time critical.  With so many people around, unless we grab him within 60 seconds or so, he’ll be lost within the crowd and we’ve got no idea who he is.  So two of us went after him and arrested him for assault.  Because of his extremely violent resistance, the loud music and the crowd, it was a dangerous arrest:  would the crowd back off and give us the room we needed, would they turn on us for detaining him, thinking our tactics excessive?  All relevant stuff.  This man resisted massively and the two of us could only just get him out of the main crowd and to the side.  We more or less just had to hold him, whilst waiting for more police and it ended with up with a bout six of us to get him handcuffed, leg restrained and then carried to a police vehicle.  All the while, he was threatening to kill us, punch us the minute the cuffs came off, etc., etc..  Frankly, we were so exhausted from restraining this guy, that when the other officers arrived to support, they took over because we were fatigued and to this day, months and months later, my right wrist hurts from the strain my arms were under and I’m reminded of this job every time I lift a heavy box.

So imagine my surprise when we get to the custody office and he tells the custody sergeant of his mental health problems.  How could I miss that?!  Then I’m having flashbacks – he’s stripped to the waist; he’s extremely aggressive; he was being restrained by six police officers; he’s got mental health problems; we don’t know whether he has taken drugs or alcohol, but we found drugs on him.

I was thinking about this incident this week in light of various discussions and news articles about mental health related restraint incidents and contact deaths.  This incident involved a lot of things:  allegations of crime, the need to preserve evidence, the need to arrest a man; the need to do this quickly, because if we don’t do it now we may not do it at all; the need to do it amidst a crowd who seem good-natured, but may have any number of responses to an arrest right in the middle of a crowd at a cultural event; the need to then keep the public and police officers as safe as possible from an extremely resistant man; the need to get more officers to a place which is difficult to describe because the ‘main stage’ is a large place.  Oh, and mental health problems which might, but which just might not, be relevant to anything at all of immediate priority.  It may, it is only of relevance slightly later.

I highlight this case, not least because of more feedback about blogging real incidents, but also because of the difficulties in identifying (potential) mental health problems.  I’ll be honest: at no stage did I think “mental health” and I’ve always understood that even where officers are aware of mental health issues; or even here extremely committed to better identifying or responding to them, we won’t always get it right.  I was undertaking to the best of my ability, restraint in accordance with training and as other officers took over when they arrived after several minutes of heart pumping exertion, I watched them do likewise: in accordance with training.  Of course, what I knew nothing about, was any history of any mental health issues, any previous contact with services or whether any care he was in receipt of included any omissions.  In hindsight, professional assessment confirmed those issues to be of no relevance to the investigation which then took place into the alleged assault.  They would have been of relevance to any “restraint” inquiry had the worst occurred.

Sometimes, policing needs to react quickly in accordance with law and training to situations where unknown background factors could – but fortunately for us, did not – conspire against a safe outcome for all.  In other circumstances, where more is known or where time allows for a more nuanced consideration of someone’s behaviour, mental health considerations need to be woven into the care offered to detainees on arrest and during the investigation of allegations against them.

NB:  Nothing in this blog is a reaction or response to any specific inquiry of police restraint, or in any way a general reaction.  It is merely an anecdote and some of my observations about it after the event.

____________________________________________________________________
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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17 thoughts on “We Don’t Know What We Don’t Know

  1. I nearly answered this with ‘you can’t know what you don’t know’ then saw the title of the blog post! But it’s true. At the end of the day, whether or not this man had mental health problems, doesn’t change the risk he posed to other people on the day. It might effect the way he’s dealt with afterwards in terms of custody, seeing the FME and disposal from court etc but on the day, in that moment, you’re being employed to ensure the safety of everyone at that event. It is easy to think that punching a random stranger over a fairly minor disagreement (and being topless) would indicate a mental health issue, but sadly many are like that and are of perfectly sane mind! What is important here is that when people are restrained it is done so using proven safe techniques by people who are fully trained in using them and that minimum force is used. Glad I’m a social worker….!

  2. 5 August 2012

    Dear Mentalhealthcop

    A timely reminder to us all that we cannot know what we cannot know.

    I have been having similar thoughts to you, that it is impossible to know in a split-second whether a person is or is not someone with mental health problems, and in such a fast-flowing situation as you describe here.

    I do not envy your lot but am grateful that you protect us.

    What was the outcome for the arrested man? Did he get mental health treatment or did he get convicted or what happened?

  3. Excellent piece as ever. Worth pointing out that I have met people, who once contained and hospitalised, express their understanding that the arresting officers had not actually damaged then and even had a grudging respect for their arresting officers.

  4. As a member of the public this really interested me. Had I been there I would have assumed drink or drugs, mental health issues wouldn’t have crossed my mind. Just goes to show I suppose. Mind you I imagine people may pretend to have mental health issues to get ‘special’ treatment or to get away with something possibly.

    It’s clearly a difficult and sensitive issue, one that needs training and understanding to recognise and to manage arrest and detention as best as it can be but I don’t think it will ever be perfect.

    Do you think mental health issues related to smoking cannabis has increased? Seems to me more and more people take drugs these days and behave erratically at best and violently/worse at the extreme end of their behaviour but that could just be my age!

    1. I do think mental health issues connected to cannabis have increased, not least because when I first joined and we seized cannabis at jobs, the smell was that sweet, sickly smell, but bearable and probably stored in the normal property store at police stations, under arrangements for seized drugs. In the last ten years, similar sizes of seizures have had to be accommodate in different arrangements, because staff complain that the sheer strength of the cannabis now being seized is overwhelming and whereas before sometimes bearable, now often induced heaaches and feelings of nausea. That’s just the smell of it through police plastic evidence bags.

      A realise this is a highly anecdotal way of looking at it but I would add that as various bits of research and media over my career have made the link between cannabis and mental illness, IQ and so on, I’ve been asking myself, “Has it taken all this time just to work that out?” We could have just asked drug workers, police officers and mental health professionals who every day see people who are damaged by frequent consumption of large amounts of very strong cannabis and we often see near psychotic states induced by it. In turn, police management of such conditions has also been connected to tragic outcomes where psychotic paranoia led to resistence against detention, restraint and untoward events.

  5. I am a Canadian Mental Health Advocate in Victoria BC. I believe the headline “We Don’t know What we Don’t Know”, to be true. Police act on information provided to them by other citizens. But what happens when someone Acting in Bad Faith provides police with mis-information about another citizen in order to discredit them or to gain control of their affairs/assets property etc?

    The police officers not knowing if the information is true, may, (on the side of caution) take the citizen in question for a mental health assessment. But what happens when police provide medical staff with a verbal subjective report to medical staff who are usually multi-tasking? Written objective reports needs to be made Policy in every country, because what if it was you detained/arrested/apprehended by police under the provisions of an emergency Mental Health Act? Let’s say it was you, a capable citizen with no mental health issues and no mental health history, what would you do when forced to meet with a team of psychiatric staff.

    Would you ask to use a phone to contact family or a lawyer to check the validity of your detention by police and to inform your family or lawyer where you are? If you are a capable citizen, you probably would know your rights and request them, and you may also refuse to talk to mental hrealth professionals, at least until you have been provided with that phone call.

    I’m not sure of your emergency MHA policys in Britian, but here in B.C. Canada, police are not required to provide written objective reports to medical staff, in other Canadian provinces police are required to provide written reports and leave a copy with the medical staff, it’s legislated by government.

    Medical professionals do not need to be second guessing why police brought a citizen to them under the MHA? So verbal subjective reports needs to be outlawed.

    So I hope all police take this into consideration when detaining someone against their will under an emergency MHA.

    There are reports of capable detained citizens being denied their requested call to lawyer and family. Sometimes detained citizens who refuse to meet with the assessment team, and who refuse to be medicated because they were denied call to lawyer leaves a very BAD impression of police and medical MHA staff, with the end result being other citizens refusing to seek treatment for themselves because they don’t have confidence with the police or medical staff because of quetionable detentions and forced treatment.

    There are positive stories where citizens were glad they wwere detained by police and assessed and treated because they needed intervention and were not aware of how out of control they were, and they are so thankful.

    To arrest/detain/apprehend a citizen under a Mental Health Act and lock that person in a safe room in hospital is one thing in order to keep the peace and remove the risk factor of citizens and the detainee themselves from being harmed. But when Capable citizens are locked away in the same fashion, and deined their legal right to contact a lawyer and inform family where thy are, and in some cases drug them without their consent, we then need to look at who is doing what and why!

    Remember it could very well be a cop or medical professional who is being taken for a mental health assessment,

    Wouldn’t you want your family notified that you are detained against your will and be informed of where you are? Would you want to call a lawyer if you feel you are capable and believe that someone gave police mis-information and were out to discredit you.

    Detain citizens if you must, lock them away in a safe room. but don’t deny them their right to call a lawyer, it may be their only opportunity to defend themselves against individuals Acting in Bad Faith.

    1. The law in the UK does not demand a written report to mental health staff from the police, but most areas have developed a monitoring regime within which officers document their reasons for detaining under mental health law. I would agree with you, that greater understanding of detention reasons would come from written reasons being mandatory. All that having been said, if someone had been removed to a police station under mental health law (sadly, still the majority of cases across the UK) laws around custody records in police stations would mean that the custody sergeant documented the arresting officers reasons for acting.

      Finally, there is a right for all people in police stations to access a lawyer, including under mental health law. When detained under MH law in hospital, it is not an explicit right but is accommodated where requested in my experience. You might want to check out a recent dilemma I posted on here about lawyers and mental health assessments, as I was quite surprised recently the number of mental health professionals who would be prepared to exclude a lawyer from such an assessment, even where the lawyer is only giving advice to the client on the legal pros / cons of answering questions which are put to them, in order to undertake assessment.

      It is here if you wish to look at it: https://mentalhealthcop.wordpress.com/2012/08/24/legal-opinion-sought/

  6. I’ll be honest: at no stage did I think “mental health”

    Well, in all fairness, what you described doesn’t mention anything that would have made someone think of a mental health issue – all you knew was that somebody had an argument and then punched someone. And as you said, his mental health issues turned out not to be relevant to the offence. So it doesn’t seem like you need to feel bad about not thinking ‘mental health’.

    1. Not sure i’m feeling bad, more reflecting on the certainty I have that had this man died in a restraint event, the fact that he had a mental health history would have been made to be seen as very relevant and questions asked about why not spotted, reacted to, etc.. Of course, my point is, that neither I nor anyone else thought of it at the time.

      So my point is more about retrospective inspection of dynamic events.

  7. You didn’t miss anything. You reacted appropriately & reasonably in the light of the available information. It’s not as though you’re expected to be clairvoyant.

  8. Reblogged this on Police Geek and commented:
    This blog by Mental Health Cop provides an excellent operational example of the decision making before and the debriefing after a use of force incident and is very relevant to the two blogs I have written on the subject. It is a particularly useful example of the difficulties caused by unknown unknowns.

  9. Sir,

    Unrelated to this topic but a question I have none the less after just seeing a little bit on your twitter stream linked to it.

    S136 is an arrest by virtue of Sch2 of PACE. S58 of PACE says;

    “A person arrested and held in custody in a police station or other premises shall be entitled, if he so requests, to consult a solicitor privately at any time.”

    So a S136 arrest that goes directly to a PoS (other premises), and someone asks for a solicitor – do they have the right to have a solicitor present? Not that I have faced that scenario I just wondered about it – I would have no idea of the technical issues of arranging one if it is the case (same people who do telephone advice for drink drive/breach of bail?). We all know that it can sometimes take hours for a S136 case to be processed and unless I understand it incorrectly they are held in our custody until the result of the assesment.

    I do work in the same force as yourself, is there a standard method of recording S136 arrests? I can see some falling through a gap, if they are not PNC’d in the log then any subsequent FLINTS checks will not show anything. If they are not arrested at their home address then any checks on the address may prove negative. We are being discouraged from completing WC392’s because all appropriate agencies are aware and we are not gaining anything by completion of one, other than perhaps to fill the data gap.

    1. 25 August 2012
      Dear Mentalhealthcop

      I am very interested to read that S136 is specifically arrest. So is it automatically the person’s right to legal advice? How does this person get it?

      I have been informed by a Mental Health Trust that there is no Next of Kin in the Mental Health Act 2007 so that I have not any rights to complain about treatment of a relative to hwom I am Next of Kin.

      What worries me is that this is standard policy but in fact is inaccurate as I contacted the Department of Health on 6 July 2012 who informed me by telephone that indeed I AM Next of Kin and OF COURSE I can complain and that I cna complain to both the Mental Health Facility as well as the local Primary Care Trust as well as to the Care Quality Commission and the PHSO. And when I said, well I have not been answered in my complaints by the local facility, the local PCT or the PHSO, then I was told I could complain to the Department of Health directly.

      But this is not shown widely as far as I can see.

      I also said I wished to make specific complaint about many of the health and social care professionals involved, and again I was informed by the Department of Health that of course I can make complaint to the individual regulators.

      Yet when I did contact the General Medical Council about specific named doctors, I was told that it was not in their “remit” and I had to complain to the Care Quality Commission or to the Mental health trust but NOT to them.

      I took this to the Charity Commission as the GMC is a charity, but they told me that they do not have the “Remit” and only have the charitable objects which were sparse in number.

      I complained to the CHRE which is the supervisory body that oversees the Regulators including the GMC. But today I am informed by them that I have been told several times that they do not investigate or get involved in the GMC’s refusal to investigate doctors.

      So I now think that we are in a blak hole.

      How can anyone complain about Mental Health legislation if the people who implemen it – the doctors, nurses and social workers can simply get away with telling the Next of Kin that they cannot complain?

      This is Orwellian.

      We are living in 1984.

      Rosemary

    2. Sorry for the delay in replying … I’ve had a mad month! –

      I would argue that they are entitled to a solicitor and you’d go through the duty solicitor scheme if they didn’t have their own. I realise that this gets into practical difficulty around giving custody numbers or admin numbers, if they were never in the police statino at any stage, but it doesn’t alter their legal entitlement. It would probably be the case in our force, of get the custody officer to open a tape-interview-only ICIS record, get the solicitor reference done and shut the record, telling the solicitor which PoS the person had been removed to.

      No need for a 392 as the act itself of removing under s136 is the immediate referral to health – what happens after that PoS assessment is a matter for the AMHP and any subsequently necessary referral that they wish to make … either to social services, GP or anyone else. Officers were asked to PNC check every s136 detainee and paste into the log, precisely so FLINTS recognised the detention, or to submit an IMS about it. I’m guessing your question is raising doubt as to whether this is always done?

  10. What’s interesting is that he sees fit to mention it to the custody sergeant. I mean, I have mental health problems but I don’t tell people in order to explain my behaviour or expect to be exonerated if I behave badly.

    It’s increasingly used deliberately as a ‘get out of jail’ card. One of my students has mild learning difficulties and to my knowledge has been let off minor offences twice for playing the gooj card. I know damned well he’s just showing off to his mates in the town centre and his learning difficulties have bugger all to do with it. He’s basically a nice but daft lad. I still think he could do with a bit of taking in hand and I find it curious (no, I don’t really) that he’s savvy enough to have worked out that he’ll be pitied and given a mild finger-wag if he pleads dumb. He’s not the only one of my lads. They all know and play the system.

    Learning difficulties. Mental health. I dunno. Offending is actually about impulse control which isn’t linked to either of those imho.

    1. This poses a philosophical question – what is good and what is bad behaviour? and who determines what is good and what is bad behaviour? Are our culural norms now the same as they were, say, 100 or 1000 years ago? Is there anything we accept as normal and good behaviour now which was considered bad behaviour then? O mores o tempore!

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