You Can’t Help Some People

I was once told by a very senior manager in the NHS about an observation that a social care manager had made of me, regarding attempts to develop effective joint protocols and procedures: “He’ll just make constant reference to the law – talking to him is a waste of time.” Or words to that effect. Read that again and think about it! What do we think he’s inferring?! I’ll admit I laughed.

I once delivered some joint training to police and health / social care professionals where we discussed mental health crisis in private premises and I was reminding everyone that to use s136 in private was illegal. I was challenged about what to do in the “999 What’s Your Emergency” situation – you may remember the job? … the one where the police and ambulance services are in a house with a man who has taken tablets in an aparrent suicide bid whilst drinking. He is not offending and he is refusing to go to hospital. (If you don’t remember, click the link to read another blog before continuing!)

“He needs to be arrested”, said the AMHP on the course.

“For what?”

“For being a nuisance.”

“That’s not an offence.”

“He still needs to be arrested – he’s taken tablets.”

“What if he’s got the capacity to take that decision?”

“That’s just ridiculous! – he’s at risk.”

“So are you when you drive a car – probably far greater risk. What are we arresting him for?”

“You have to keep him safe.”

“So when the officer gets to custody, does the custody sergeant arrest the officer for false imprisonment?! – I’m just trying to understand what you’re saying here!”

My point in this post, is two-fold – the law of our country is the law, whether or not you like it or you agree with it. Secondly, there can be some situations where the law empowers or protects professionals and those to whom they owe a duty of care, but there is something that prevents them from going with it.

CONVEYANCE OF PATIENTS

For example, both chapters 10 and 11 of the Mental Health Act Code of Practice talk about the transportation of people who are detained under the Act being done via a method that is not a police vehicle, wherever possible. There are few reasons why the Code specifies this:

Firstly, it is about patient dignity – if they are in the back of police vehicle surrounded by uniformed cops, they will feel like and be assumed to be a criminal. An ambulance achieves the full status of “patient” and reflects the legal nature of the detention. Secondly, it is about paramedics bringing something to the party which would otherwise be absent. Police officers are usually medically qualified with a basic first-aid certificate. They are not paramedics or nurses and therefore lack the training and equipment to consider medical tests or basic medical obs at the point of arrest, to fully consider whether someone’s presentation IS attributable to a mental disorder or some other kind of illness.

Now we know that an absence of an ambulance in an MHA detention by the police can cause problems. In Dorset and in Kent in 2009, individuals died in police vehicles during a detention or transfer under the MHA when it could and should be argued that the ambulance service should have been called. So why weren’t they?!! …

THE AMBULANCE SERVICE

I have got nothing other than total admiration for paramedics. I have some seen some truly amazing things as a police officer of their skill and the care they offer, often under difficult circumstances. However, in some parts of the UK, the ambulance service have divorced themselves from the requirements of the MHA Code of Practice – I was once asked “Why do you need a rolling intensive care unit on wheels?!” When I recently said, “All detentions under s136 should lead to an ambulance being called because chapters 10 and 11 of the CoP specify conveyance by a non-police vehicle”, it led to long discussion.

Apparently, the ambulance service were struggling to resource car crashes and heart attacks, never mind turning up to ‘simple’ mental health jobs that don’t really need a 999 ambulance. There was no point calling because they won’t come. Apparently.

I’m not really sure I care less. >;>; The law of England says we call an ambulance (or whichever transport provision is commissioned for MH work.) A police officer in the audience suggested that they should speak to their ambulance service and agree a protocol about this. I wondered aloud whether they had a protocol with the fire brigade about being able to call them when the police station burned down? Apparently not, but it wasn’t clear why if we need to agree things in advance. Seemingly, the police need a policy in which the ambulance service agree to be called. Yet they don’t have a protocol about coming to RTCs or to domestic assaults. So why do we need one for mental health jobs?! Section 136 can be about the urgent management of psychiatric and medical emergency – surely we can just ring 999?!! This is stigma and discrimination in operation amidst presumptions others will think likewise.

And just in case anyone is thinking, “well it’s just a Code of Practice, it’s not law”, you should read the case of Munjaz to remind yourself of what the House of Lords said the significance is of a statutory code of practice.

Last night my officers were dealing with a man who had been arrested for causing criminal damage and he had been tasered by the police and restrained by six officers. He was sectioned under the Mental Health Act and directly admitted to a psychiatric intensive care unit. I was in the custody area when the AMHP was looking to affect the transfer and she asked for police officers to undertake it. I said we’d help to undertake it, but she should call an ambulance.

“What for?”

“Because the law says you should.”

“But they won’t do it – he’s been violent.”

“And we won’t do it without clinical supervision because he’s acutely unwell.”

“It’s a waste of time!”

The custody assistant rang West Midlands Ambulance Service with the information against these protests – “Can you attend the police station to assist us in transferring a section 2 patient to a psychiatric intensive care unit? … he was tasered earlier when we arrested him and has a significant risk history, but we’re going to support the transfer with four police officers.”

“Yes – we’ll be there in 7 minutes.” And they were. <;<; West Midlands Ambulance Service are my favourites, because they get it, almost every time. When I hear stories elsewhere in the UK, I admit to thinking, “WMAS wouldn’t go that” and everytime I test my theory, they step up and we work well together. I hope they feel the same.

Why is it, that you can’t help some people?! The law says you do it and you’re not even prepared to try. You’ve got it in your mind that it’s pointless, or that someone won’t respond and against that backdrop you risk the safety of patients (remember Dorset and Kent) by not complying with the law and this is despite the fact that you are putting yourself in the position where if you face difficult questions after something has gone awry, you may well struggle to answer them. Even if you attempt to do the right thing and it doesn’t work because you’ve rung the ambulance service just after they all went to a ten-car pile up on the motorway and they are legitimately struggling to support you – at least you’ve tried to do the right thing and subsequent actions are seen against that backdrop. And then having convinced many this was the medically correct and legally appropriate thing to do, a police supervisor said, “Actually, don’t call an ambulance until we’ve agreed it with them.”

Your laws were consulted upon with stakeholders and debated in Parliament. They are there for a reason and you’ll are judged against them – whether you like it or not.

NB: the picture has no relevance whatsoever! – it’s the view from our apartment in Cape Town. It cheers me up to look at it again so I thought I’d share it, just for its own sake! 🙂

______________________________________________________________________
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 “You Can’t Help Some People

  1. Love it.

    One of my most recurring mantras in training about social care law (which I encourage trainees to take to heart themselves) is this….

    “Who cares what I think?”

    Many trainees even quote it on evaluation forms as the most significant part of the course.

    Who cares what we think? The law is the law.

    1. Oddly enough, Stuart(!), I may or may not have recently asked someone, “I’m not sure I care what you think when you’re asking me to break the law.” I also added, “Inciting me to illegal arrest someone just because you’d prefer it and it’s easier is a criminal offence, so just be careful!” 😉

  2. What is your opinion then guv on the NPIA guidance in terms of the MCA and threatening or attempting suicide?

    “2. Determining what is in someone’s best interests
    The MCA Code of Practice provides that ‘In an emergency, saving life or preventing someone suffering serious harm will almost always be in the person’s best interests and treatment should be given without delay’ (paragraph 5.61).
    Where a person who is threatening suicide appears to know exactly what they are doing and why, others may be reluctant to conclude they lack capacity – basing this judgement on principle 3 (ie, ‘a person is not to be treated as unable to make a decision merely because he makes an unwise decision’). However, it is not the decision to take their own life that necessarily evidences lack of mental capacity, but rather their inability or refusal to consider or fully think through alternative options such as counselling, medical assistance or help from statutory or voluntary agencies.”

    http://www.npia.police.uk/en/docs/Briefing_Note_on_Applying_the_Mental_Capacity_Act.pdf

    When I’ve been challenged in the past I’ve referred to this in my notes but it concerns me that this in an agency’s opinion on the law and not one set by the courts or are there any stated cases on this?

    1. This guidance was written BEFORE the stated case of Sessey v SLAM and the Met Commissioner (see the page on caselaw). That was really the first case on the police ‘using’ the MCA in private dwellings and of course, the guidance has to be seen in light of that. The Sessey case doesn’t totally prevent the police using the MCA in private dwellings, it just renders that kind of use in that case as unlawful. The specifics were that Ms SESSEY was believed to be mentally ill but not behaving in such a way as this constitute “an emergency” to “save life or prevent someone suffering serious harm.” The judge reminded all parties that the proper process for arranging such assessments is for an AMHP and DR to be called where they can then detained the person under s4 MHA.

      Of course, if the behaviour encountered had been such as to present an immiment life threatening risk by someone who you reasonably believed lacked capacity, then you can undertake whatever proportioante acts you believe are necessary to act in their best interests. Whether this includes removal to A&E or something lower level, like moderate restraint within the premises whilst you hastily arrange some further support (either frmo family, friends, CMHT, AMHP, etc..) is a judgement to be made at the time.

      If you read my blog posts on Mental Capacity and the “ID a CURE” test, it will explain in some more detail. The danger with that NPIA Guidance, is that always was a snapshot in time and in terms of the MCA, that was new(-ish) law with no relevant stated cases at the time. Therefore a group of people formed a view, debated the ins and outs, took lots of legal advice and published in good faith. Sessey slightly clarifies things and I’m sure it would have been worded slightly differently, had the judge’s view been known.

  3. Hi Michael

    It’s interesting seeing how different Countries legislate Mental Health Acts. For me it’s the Victoria (Australia) laws that apply (see link below).

    Not that I have read the English laws, but from what I can gather, the main difference between the Police/Ambulance/MH Services relationship is Police can make an initial assess/detention/transport at the Officer’s discretion, in any situation including non-violent/private property/inside home, without any MH professional/paramedic in attendance. If the individual refuses, even only verbally, the Officer can use appropriate force – physical/cuffs/CS spray/baton/taser/fire-arm (a big negative a Police record). This is effectively voluntary detention by coercion.

    My own personal experiences vary greatly, from a quiet gentle discussion with a Constable while I was in extreme distress and ambulance transport, to a Sergeant unlatching his fire-arm on the footpath outside my house, returning after a calming walk, then transport in the back of their “divi-van”. I am not violent or have a history of violence. The first of these occasions initiated my first admission, the second after being at A&E for 5hrs, I was given a taxi voucher to get home – at the expense of the hospital. If I was to resist there would be a potential of charges being laid.
    In regards to voluntary patients in locked Psych Units being denied discharge, another personal experience, do I live in a “police” non-police state?

    http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/LTObject_Store/LTObjSt5.nsf/d1a8d8a9bed958efca25761600042ef5/a7d40fd608d61455ca2577890007feb8/$FILE/86-59a098.pdf

  4. Interesting blog about to ambulance or not. I have just questioned Sussex police about their policy as I have been detained under section 136 at Beachy Head and in other parts of Sussex. At no time was I ever conveyed in an ambulance. The answer was that they were following the law taking me to a place of safety and that the police custody centre was ok too rather than A&E. I feel quite strongly about this. Keep up the good work.

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