There was quite a debate about the above programme when it was aired on Channel Four last night – you can watch it for a limited period of time on the Channel Four ‘catch up’ website. Last night, it all focussed upon people’s “state of mind”, ie mental health issues and it was all set in Blackpool, covered by Lancashire Police and the North West Ambulance Service.
Using the hashtag #999whatsyouremergency there were various comments flying around the Twittersphere. Some warmed my heart – a combination of people expressing sympathy for some people who came to the attention of the 999 services in a variety of formats and some who quite obviously did not believe the kinds of mental health demands that hit the ambulance and police services on a daily basis.
I was amazed that at no stage in the programme did the editors attempt to signpost people in crisis to support, to prevent things getting to the stages shown in the programme. Any number of organisations could have been mentioned.
I had a few observations:
- Listening to call handlers using terms like “fruitloop” wasn’t very helpful for me – unprofessional.
- I could do without hearing that someone who has taken an overdose has “been stupid”. Do people really overdose “for a laugh”?!!
- I could do without hearing “These people” to refer to everyone (in the country or the world?!) with mental health problems.
- There also was an underlying assumption that many demands were not really police business and if only the police and the paramedics didn’t have to respond to mop up after other, often unmentioned agencies who were absent …
I’ve written before on this blog, that mental ill-health incidents are core police business – where people’s safety is at risk or where crimes are being committed. Notwithstanding that one guy in the programme was mentally ill, the fact that he was seen with two knives means it is perfectly proper to seek police involvement – possession of knives is a criminal offence, even if you are possessing them in order to harm just yourself because of a mental illness. It doesn’t mean the police will automatically prosecute and criminalise him, but it does mean we have a role to “make safe and signpost”, if nothing else.
Policing is only necessary at all because some people don’t self-police. The existence of an alcohol industry and many of our fellow subjects’ inability to drink and behave responsibly forces untold costs upon the public purse and causes mass demand for policing and emergency medical services. We’re not banning pubs or alcohol, though, are we? We’re not talking in terms of locking up drunken offenders for inordinate periods to ensure they are not free to drink again next weekend. Yet more harm and cost is caused to our society from drunk young men and, increasingly, women.
Why not just lock up all of “these people”? – is it because we, ourselves, along with most people are or have been in this group and we know general labels around alcohol related violence and disorder do not apply to us?! << Stigma in operation. We do actually know that the relationship between alcohol and crime is far more direct than the links between mental illness and crime and that the costs – measured in lives lost and money – are far greater.
MENTAL HEALTH CRISIS IN PRIVATE PREMISES
I also want to focus on something specific: watch the programme from around 27 minutes – they are following a particular job from 999 call to police attendance where a man rings up to say he’s taken a “massive overdose”. After officers force entry to the premises they find him in a private dwelling committing no offence, having potentially taken over 40 tablets. I’m not sure whether these tablets or the quantities involved were potentially damaging but the paramedic immediately says, “We’re going to take you to hospital”. The man refuses to go.
Remember the law in this situation?
- This man is presumed to have the capacity to take his own decisions, including about medical care.
- The taking of an unwise decision does not, of itself, render him without this capacity.
- The police have NO powers in a private dwelling to act under mental health law unless there is an attempted or actual criminal offence – there isn’t – OR unless they anticipate a breach of the peace.
- (Remember: a breach of the peace is an imminent risk of violence following the judgement of R v HOWELL .)
- Did we anticipate an imminent risk of violence when he’s slumped on the sofa declining treatment ?
- I’m not sure I did - not for a minute.
In these circumstances our colleagues in green should have been invited to undertake a mental capacity assessment and start making decisions. Remember - he is presumed to have capacity unless demonstrated otherwise in an appropriate assessment. As paramedics are there, on hand, it is their responsibility to undertake this. Should they feel that he lacks capacity, given that the ingestion of tablets that could have profound health consequences, it could be argued he can be removed under the MCA to hospital but only where this is the least restrictive option, to the medical threats faced. This lack of capacity would need to be demonstrated.
(Incidentally, once arrested, did you notice the ambulance service trying to back off from this non-criminal healthcare situation at a rate of knots?! Quite rightly, a paramedic was persuaded into the police vehicle to accompany the officers and the patient but in reality, he should have been primarily in the care of the paramedics being accompanied by the police, if need be.)
If this whole blog is about anything at all, it is about educating officers who attended these incidents not to put their “arm in the mangle“. Attend to ensure protection of life, by all means. Force entry, by all means. Once you’ve established that you are in his house with paramedics and he is alive and not committing an offence, we should then look to assist our ambulance colleagues to take over the lead decisions.
We need officers who can remind them that the clinical decisions around this man’s capacity to take drugs and kill or harm himself is theirs. This is not my personal view, this is the law of the land. The decision about what to do with him, if they feel they cannot leave him there because of any lack of capacity is theirs and we can help them, if they need it.
Given that upon arrival in Accident & Emergency, he is being uncooperative with nursing staff attempting to triage him but not actively trying to leave, I’m wondering why we are devoting a police officer to sitting with him? For those who would argue that we might as well stay because otherwise we’ll have a high risk missing person I would ask this: following this logic, why do we not just put a police officer in every single psychiatric hospital in the country to stop missing persons, otherwise we will end up with a high risk missing person?
The police have finite resources and they must be targeted against public priorities. What I saw in the second half of this programme was the police failing to distinguish between the necessary initial response we MUST provide, the support to our ambulance colleagues that we SHOULD provide and the ongoing healthcare issues which then become NHS responsibilities. Of course, because the man had been arrested for a breach of the peace, we got our arm caught in the mangle, right up to the shoulder and ended up “policing a patient” … again.