If We Agree, Why Are We Arguing?

When I first starting writing this blog, I didn’t quite know where it would all go and I certainly didn’t have a plan for what to write about.  There were some obvious topics like s136 MHA, Places of Safety, prosecution of offenders, etc.; but I certainly didn’t predict getting into certain territories like CRB checks and specific blogs to be posted as reference tools on s42 MHA, etc., etc..

What I did anticipate to a degree, were some strong disagreements about certain things – frankly, because I’d faced precisely these disagreements in practice and thought they’d re-emerge.  You can tell from some posts that what I have really be trying to do, is nail down some common misperceptions from a police point of view – misperceptions held by police officers, but also by some mental health professionals.  I also hope the blog informs service users and carers whose dignified treatment and care we’re ultimately trying to ensure.

This disagreement simply hasn’t emerged.  I’ve often had the edges of my own understanding tempered when I ventured into territory that isn’t on policing, in my own bumbling effort to explain mental health to cops, but what we haven’t seen is the kind of disputes that I have often faced in practice.  We haven’t had, for example, AMHPs commenting and emailing that my understanding about s135(1) is utterly incorrect, and that perhaps I should go and read the Richard Jones Mental Health Act Manual.  Actually, I can’t read my copy, because it’s wedging a door open, but that’s another story.

My experience of dealing with MH within the police is basically this: discuss any issue properly in a meeting and we’ll all end up more or less agreeing about what should be done.  Discuss things in the heat of an incident, where practical decisions and resources are involved and we get into the cauldron of turning theory into practice where resources, approaches or underlying philosophies dissolved amidst considerations of resources, expedience and sometimes, convenience.

Sometimes, I’ve found that the law of the land can count for little: recently, an online forum sought advice about whether a five-hour wait for a psychiatric intensive care bed was ‘reasonable’ amidst a situation where a service user was described as volatile, aggressive and in a police cell.  It’s the beginning of MS v UK again, although five hours is at the faster end of my experience in terms of how long it takes to get a PICU bed.  We know that MH services are reducing the number of inpatient beds – one county I recently read about is reducing its beds by one-third, having already previously reduced them by a quarter.  This takes general inpatient acute and rehabilitation beds from 128 to 64: overall reduced by half.  You can draw your own conclusions about service flexibility and demand management from those figures.

As public sector reform continues and we all adjust to new budgets, new ways of working against old legal frameworks, we need to refocus on the “must do, should do, could do” priorities.  We know that reported s136 usage is going up.  We know that people are spending shorter periods of time as inpatients and being managed more frequently than expected on Community Treatment Orders, many of which involve recalls and revocations.

If you assess the way in which the country is managing deficit reduction, the public sector reform that is associated with it and the way in which mental health and health services are reacting to it, we can see a gradual tipping of demand towards policing.  And yet we KNOW, that this is where tragedies have occurred in the past: deaths in custody include 17% of cases where people had mental health problems along with substance abuse problems.  We KNOW that 15% of policing demand is connected to incidents where people with mental health problems have come into contact with the police.  We KNOW that we haven’t properly understood the size of the problem or what we mean by ‘diversion’.  We KNOW that policing and mental ill-health issues lie at the heart of what we require from our Government: our health and our safety.  We KNOW that many basic services at the juxtaposition of policing and the NHS don’t operate the way we have decided they should.

We KNOW what we MUST do, what we SHOULD do and what we COULD do: all that is left, is what we WANT to do about this, if anything at all.

____________________________________________________________________
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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7 thoughts on “If We Agree, Why Are We Arguing?

  1. The shutting down of mental health beds is definately a sad state of affairs. But let’s audit who is being treated and who is being denied treatment.

    Are medical staff able to cherry pick their patients to ensure they will not be subjected to verbal insults or injury from detained mental health patients who pose a risk of harm to the care professionals?

    Are we cherrry picking and keeping patients who have private health care coverage who pay 100% of the patients forced treatment, and keeping only patients who are easy to look after?

    A lawyer in British Columbia Canada who worked for the BC government’s Ministry of Health once had written “Those with non-treatable mental illness will usually be refused treatment”. That was in [The Guide Book for the Helping Professional of BC].

    “If we agree why are we arguing” Oh we do need to argue, because we do not all agree on the best practivce methods and mental health policies for police and the medical profession.

    If appropriate funding ever gets thrown into mental health care, then more audits and accountability need to be in place to ensure that capable citizens are not being detained and treated against their will, and that ciitizens at risk of harming themselves or others receive appropriate treatment, and are not denied that right to get the help they need.

    The Pharmaceutical Industry involves BILLIONS of dollars, and when Billions are at stake, Ethics and Accountability can easily get ignored and tossed by the wayside, by the Big Picture, and that is PROFIT!

    Gordon W. Stewart is a Canadian Mental Health Advocate who in 2001 started up Pacific South Western Advocates in Victoria, BC.

  2. It’s not just the shutting of beds that’s the issue here, but whether or not there is appropriate resources ploughed into community facilities as well. Working in Scotland, I’m not hugely familiar with the situation in England and whether this is the case. Certainly, in Scotland, service users are more in favour of community facilities as opposed to admission to hospital. However, if someone requires a PICU bed they do need to be in hospital so enough beds should be available and where possible people should not be waiting in police custody for one.

    In terms of budgets, the reality is they are being cut. Most NHS trusts are being asked to make huge cuts. It’s the same for social work budgets – all of which has an impact on the patient experience both in and out of hospital. If community resources are cut it will invariably have an impact on in-patient services. People whose packages of support are cut are more likely to require readmission to hospital, sadly. The whole system is a little short-sighted in this respect. Without getting too political, it does continue to stagger me that despite the budget deficit having nothing to do with people with MH problems and / other disabilities, they continue to be the group that suffer as a result.

    In relation to the comment above mine, as far as I’m aware no mental health professional ‘cherry picks’ their patients and, with respect, I take offence to the implication it does. By and large, In-patient mental health services are offered to those in greatest need of in-patient care, where it would not be appropriate nor safe to treat the person in the community. Also, I’m not sure what the person’s point is about ‘easy to look after patients’ or those who are detained posing a greater risk. This is not how service provision is decided and it’s unfair to imply those who are detained are more likely to cause harm to MH professionals. Unless, of course, you have a reference for a study that shows this? Those two paragraphs don’t make sense to me and aren’t particularly relevant to psychiatric care as I know it, in Britain. Also, the vast majority of people in Britain are offered treatment on the NHS so whether they have private health care insurance is irrelevant.

    1. Elizabeth, I have read your comment, and I’m gald to hear the concerns I raised are not an issue in Scotland, and can’t say what takes place in Britian.

      In British Columbia Canada, police can take a person for a psychiatric assessment under BC MHA sec.28(1), the police are not required to provide medical staff with a written objective report, and usually provide only a subjective verbal report..

      In most Canadian provinces police are required to provide written reports, and it’s Legislated in the Mental Health Acts. Writing a mental health written report which gets handed over to medical staff by police is not rocket science. It’s simple, and makes plain common sense. There have been cases of incapable citizens refused treatment who harmed others after release, and capable citizen who have been committed and drugged because they refused to speak with a psychiatrist. This should never happen, If the reason for refusal is because detainee wants call to lawyer and inform their family of there whereabouts.

      I applaud the Scottish Government’s New 2012 Mental Health Strategy Committment # 26 “We will undertake an audit of who is in hospital” that says alot for mental health advocates, an audit will shed much light on who is being detained and who is being refused treatment and why.
      In BC we sure need audits and ask for them, but it’s not forthcoming, as of yet.

  3. The sad fact of all this is cost. Cost to train officers, mental health staff and thats before we even consider treatment etc.

    The reality is that we are scared to scratch the surface for fear of what we will find. Quite disturbingly is the increase in calls for help that combat stress has seen in the last 12 months and the consequences if help is not offered. Unfortunately it seems in an increase in crime and additional calls for help from other services.

    I am convinced that we should spend today for tomorrow.

  4. I read all your posts with interest, but have to comment on this one. As a Paramedic we (police/amb) often attend the same jobs involving MH patients; either you back up/support us or we take the ones you don’t arrest due to their MH problems. From my point of view, MH provision, certainly in my area, is woefully inadequate and only getting worse. One particular patient I took to hospital hoping to get them a MH assessment was discharged NFA. I then saw him in my other role as a custody medic 2 nights later having done what he was scared of doing when I took him to hospital, a pretty serious domestic assault. Obviously there was no come-back on the MH system as he was seen in A&E and deemed not to require significant intervention at that time as the only beds available were PICU. Talk about criminalisation of people with MH problems – for want of a bit more attention then he ended up with a criminal record. The system – such that it is these days – is letting patients down due to lack of resources. I wonder if you are in a position to influence policy in your Force area? Once started, any good system might catch on! Something needs to change before it all goes horribly wrong. Again.

    1. Thanks for this – I often wonder whether the 20/20 hindsight so often applied to policing should be applied to MH services as far too many predictable outcomes seem to emerge that were essentially preventable. Of course, we have crisis services not early intervention services and we don’t match services to demand in any meaningful way so know wonder we’re scraping people up in various ways. Bonkers.

      1. So if so may front-liner’s can see this WHY can’t the powers that be?! It’s so obvious as to be verging on neglect when nothing is done. Like you say – bonkers!
        (I do have a few little soap-box moments about this at work – especially about the incident above as he was essentially a nice kid, but no-one listens!)

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