It Really Shouldn’t Be This Difficult

This is a guest post from a police inspector in England. You can follow blogger and tweeter NathanConstable and he has been kind enough to give feedback that he’s putting this blog to good use.  Here are some of his observations from the frontline of UK policing – right where the rub is:

I have finally reached the position where I just want to hold my head in my hands and weep. Several months ago I had to deal with incidents involving people with apparent mental health problems which have taxed my brain to exhaustion and where the outcome of each case has made me despair.

Each of these has taken significant time, thought and resources to try and manage and in each case it has fallen to the police to effectively shoulder responsibilities that should be spread or best burdened elsewhere.

REMAND FOR FORENSIC ASSESSMENT – ALMOST

The first case involved a man who had been making disturbing comments about wishing to undertake terrorist acts.  It had also been reported that he had assaulted another family member.  The family rang the police not knowing what else to do.   The first call to the crisis team was met with resistance.  They had dealt with this man before and practically told us that if we did arrest him they wouldn’t come out and assess him because the outcome was that he wouldn’t be sectioned.  They were asked how they could possibly pre-determine the end result in that way and it took a couple of calls to persuade them otherwise.

We did arrest the man for the assault and had him initially checked by the FME who was sufficiently concerned about how he was presenting to suggest he be fully assessed under the Mental Health Act.   The same people who had initially told us that they wouldn’t section him then came out and assessed him.  Having done so they then decided that he was displaying disturbing behaviour and appeared mentally ill however, they chose not to section him!  Apparently he was too dangerous for the local psychiatric hospital and needed a full forensic psychiatric assessment.  According to them, the only way this could be achieved was if he was presented before the court for the criminal offence and then ordered to hospital by the court.  They would be able to send him to a more secure and appropriate hospital.  (Note from MHC : this what I call the “Criminalisation Contingency“.)

Call me a cynic but this sounded like nonsense to me: either he was ill or he wasn’t.  Surely the easiest option was to simply section him and get him to where he needed to be?  Surely the system allows for this type of situation?!  Even his solicitor was concerned for his mental health but all protests fell on deaf ears.   The assessment team wrote a lengthy letter to the Magistrates which was to accompany the file and would outline what action they needed to take at Court.  Clearly they have no experience of dealing with the criminal justice system.  The man was then interviewed and charged.  He was apparently well enough for this but still needed to be detained for a forensic examination.  I couldn’t work that out either.

Officers accompanied the man to court the next morning armed with the letter which was presented to the prosecution solicitors.  The assessment team were utterly confident that the Magistrates would do as they suggested.   Predictably, they did not.  The man had admitted the assault and was therefore dealt with there and then and given a conditional discharge.  He walked free from the court and received absolutely no treatment and no forensic psychiatric assessment despite being in need of it and “too dangerous” to be sectioned under s2 or s3.  Tell me again why you can’t be sectioned under s2 or s3 to a medium secure unit?  (MHC: you can be.)

THREATS TO KILL – BUT WHO?

The second incident involved a call from a concerned Housing Officer who had spoken with one of her tenants by telephone.  During the course of this call he had made a number of alarming comments about feeling the need to kill people and started to praise a number of high-profile murderers.  Naturally, she felt the need to call the police.

I contacted the Crisis Team and discovered that they had a history with this gentleman.  He is being treated for a personality disorder and has a long record of not engaging with mental health care or self-discharging from hospital.  It would seem that he made similar such comments during a meeting with mental health workers about a month ago and this was all recorded on file.  At no point had anyone referred him to MAPPA.  It also transpired that the Housing Officer had called the Crisis Team that afternoon and expressed her concerns to them. All that had happened was that a note was put on the file. If I hadn’t made contact it would have just sat there.

I asked the Crisis Team to contact the Emergency Duty Team.  I felt if they went in sideways as fellow mental health practitioners it was more likely to get a positive result. I believed that the intervention needed to be clinical rather than criminal.  Guess what? … EDT refused to assist.  I had suggested they obtain a section 135 warrant and we, the police, could meet them at the address to assist if needed.  No – apparently they couldn’t get a 135 warrant because no-one had tried to get the man to voluntarily submit to treatment.

This was utter nonsense and I knew it.  They even kindly suggested that police attended and arrested the man.  When I asked the Crisis Team operative “Arrest him for what?” – I was told “the threats.”

There followed, after a brief period of choking, a lengthy explanation into the definition of threats to kill.  There was no offence here: the threats were general and non-specific.  The danger was to the public at large and quite vague but police had no power to pre-emptively arrest for that.  Again I stated that the need for intervention was clinical not criminal.  The way to neutralise or properly assess the threat was to assess HIM.

A different Crisis Team operator called me back a couple of hours later.  They weren’t going to come out tonight.  Instead they were going to get the morning staff to try to contact the man by phone. I had no choice other than to go along with this.  They did try to contact him but couldn’t get through.  They made an assessment based on what they already knew about him and concluded that he had made this kind of threat before and was therefore no risk.  When asked to provide a written rationale for us they refused quoting data protection.  He is still unseen.

SOME THOUGHTS

Believe it or not these examples have been cut back and edited. There are other factors involved in each of these scenarios which make them all worse and more complicated than I have presented them.  A few things have struck me:

  1. The complete lack of knowledge of legislation displayed by some MH professionals
  2. The expectation that the police will just arrest, irrespective of whether there is a power under which we can
  3. The complete unwillingness for them to bend from rigid protocols to work with what is actually happening
  4. The almost total reluctance to take ownership or take charge
  5. The fact that they seem to think that I am stupid.
  6. That there is a prevailing attitude that they can refuse to help, put the phone down and, as far as they are concerned, the problem has gone. Leaving the police to reach for the rule books wondering how they can bend legislation to make things work and provide some duty of care.

Each of these people needs MEDICAL intervention. Police cells are not the place to have detained them – they need help.  Instead we have met resistance, inaccurate information, differing medical opinion, lack of co-operation and a “not my problem” attitude.

Each of these people presents a threat to themselves or others – in every case the mental health side of business has effectively turned them away, either citing process or “lack of bed space” as the reason.  They have not helped one little bit.

It really shouldn’t be this difficult – but it clearly and evidently is!

____________________________________________________________________
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.

Advertisements

11 thoughts on “It Really Shouldn’t Be This Difficult

  1. Hard to know where to start having conducted countless assessments under the MHA i have never even heard of refusing to assess someone on the basis of them been too dangerous, its a nonsense. Yes each sector has it’s faults and we all get things wrong but ignorance of things that you can look up quickly, if you don’t know is a pathetic excuse.

    1. In reference to the first incident with the vulnerable person wishing to undertake terrorist acts- you may get a better response if you try to deal with him with the Prevent Strategy in mind. Within Greater Manchester this, I believe, could come under the Channel Project which ensures a multi agency response to vulnerable people who may be at risk of radicalisation. Your Police Public Protection Units/ CTU may be able to assist. Another consideration if you feel you’ve exhausted all other means of addressing the risk concerns.

  2. Tragically, I am not shocked by this. Appalled, certainly, but not surprised. The standing “joke” at the last Trust I worked in was that the Crisis Team had misunderstood its remit – they were meant to resolve them not create them – but unfortunately they were definitely better at achieving the latter than the former. My experience was that service users, carers and – yes – MH and health professionals found that attempts to enlist their help / support / services was a frustrating, pointless and often counterproductive exercise. I know that that is scant compensation for your difficulties, but hopefully helps you as a police officer feel less targeted for the response that you received.

    I know many excellent MH professionals who try very hard to deliver an appropriate service under challenging circumstances (AMHPs. S12 doctors, CPNs, etc.). That said, Crisis teams are often given the role of ” bed managers” and are gate-keepers to access to acute psychiatric in-patient units, as well as being crisis management and home treatment teams.They are very often severely under-resourced, especially during out-of-hours shifts. Their Trusts frequently expect them to deliver “target diversions” (to quote MHC whatever that means). which generally means various equivalents of “the computer says no”. Whilst I cannot in any way excuse any MH professional failing to make an appropriate clinical / risk assessment and acting responsibly, I do genuinely feel for the individuals who work in these teams as I believe they are put in invidious positions of balancing impossible demands and managing risks which they have no authority to resolve.

    There are a number of issues which contribute to this and may relate to the examples given in this blog.

    – under-resourced crisis teams, meaning they do not have time to make own clinical assessments or support vulnerable/ challenging service users
    – under resourced in-patient units, meaning they are reluctant to admit challenging / violent patients
    – under-resourced in-patient units, meaning that they do not have therapeutic resources, e.g. psychology / OT, to manage complex patients
    – lack of apppropiate placements to refer to
    – lack of support from senior management
    – lack of support & understanding of the complex nature of the issues by commissioners
    – lack of understanding about “personality disorder” as a diagnosis – it is not one, but many and the best response may vary widely, that historically was something that excluded folks from services. I have heard so often that anyone with a diagnosis of any pd should “never” be given a hospital admission as it will at best harm them. I am like a broken record saying that PD diagnosis is only one aspect, someone can be diabetic and still have a broken leg – PD may be a more chronic condition, but doesn’t exclude an acute crisis that needs addressing.

    There is clearly a need for Crisis team staff to be better trained – not least in the LAW (tragic) and in risk assessment /management. But without the support of Trust management – AND more importantly the COMMISSIONERS of services it will continue to be the frontline staff who have to work to solve these problematic cases – in their own time, through their own personal networks.

    What is a major source of shame to me is that it is not coming from health professionals. What should be a great source of pride to you is that the police in general and specific officers that are leading this crusade are considered the last resort. That may be why other agencies / services keep handing “the baby” to you.
    Thank you – and sorry again.
    PS I don’t believe anyone thinks you are stupid, maybe they just believe you are the safest pair of hands – you shouldn’t have to be, but many of us are grateful that you are.

    1. so then we should start ‘lobbying’ commissioners. I for one am now going to research my local commissioner and start contacting him about this dreadful state of affairs. I agree with you entirely on this subject and feel for the police officers who yet again are left “holding the baby”.

  3. OK, I have just had feeedback from a former colleague that says my response sounds like I expect the police to fill the gaps that mental health services fail to address. NO. The police already fill too many failings in the MH system. The commissioners and senior management need to step up, as do MH professionals. I apologise if my reply sounded as if I expected police to be the fail-safe response. I am grateful for dedicated police officers and value the work that they do.
    Thanks to you all

    1. yes, I have to admit that on occasion, when I have been in crisis, I have received far more support from the police than I EVER have from my local MH team. BLESS THEM ALL.

  4. Sadly the experience of being treated as though you are stupid by mental health professionals and particularly those on so called crisis teams is not unusual. From a former service users point of view being treated like an idiot and a time waster rather than offered consistent and helpful intervention was a regular occurrence. Yes mental health teams are underfunded and overworked but that’s no excuse for the “all knowing doctor” attitude which it appears pervades even their interactions with non service users. I know of several people who have been turned away while in crisis for not being ill enough… Go figure.

  5. Great blog and sadly these situations are only too common. I sometimes wonder why some of these people are even in psychiatry. Just imagine though, at least you have some authority, try getting help when you have none. It is truly a sad and quite frankly disgusting situation and needs to be changed.

  6. When concerned about my partner’s state of mind it took me a week to get the appropriate help. In the interm, I contacted my local Mental Health services who informed me that the best thing was to have him taken into police custody, who would then “figure out” that he was mentally ill and contact the appropriate services! I then went to my local police station to have a chat with then regarding this, and was told that because of the Human Rights Act it was very difficult to section anyone.

    I felt that it would have been very inappropriate to have my partner arrested and detained. It was the intervention of my local housing officer, who advised my GP that she might want to visit and assess my partner (I’d had to leave my home by this time because of how my partner was presenting) that finally led to some action.

    The outcome was that my partner was sectioned and subsequently diagnosed as Bipolar 1.

  7. Maybe just maybe MH issues are more complicated than you make out. Threats to kill by someone with PD like 80 per cent of the prison population is not the remit of MH services. What would you have done if the person didn’t have pd? DO That. Angry denigration of other professionals based on misunderstanding not helpful.Policing often black and white ,MH all grey.

    1. I like your black and white versus grey analogy because I understand why you say it, but often it’s not the case. Policing is as grey a business as you’ll ever find, but the necessity of both police work AND of mental health work is to reflect the endless shades of grey in black and white decision making.

      I think the police are good at making it very crudely black or white and quickly; I think mental health services are quite good at making nuanced black and white, but only slowly. Therein lies the partnership problem.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s