Paramilitary “Nursing”

In the general debates about policing, we hear a lot about the importance of policing by consent and those who have read into the history of policing will know that the service was founded by Sir Robert Peel who set down nine principles of policing.  These principles, in the opinion of many officers including me who have them postered or framed on their office walls, have stood the test of two hundred years of policing as we’ve moved from industrial, nineteenth century Britain to the current time.

I would like you to read these principles and think about what you want your police service to be – it won’t take long:

PEEL’S PRINCIPLES OF POLICING

1. To prevent crime and disorder, as an alternative to their repression by military force and severity of legal punishment.

2. To recognise always that the power of the police to fulfil their functions and duties is dependent on public approval of their existence, actions and behaviour and on their ability to secure and maintain public respect.

3. To recognise always that to secure and maintain the respect and approval of the public means also the securing of the willing co-operation of the public in the task of securing observance of laws.

4. To recognise always that the extent to which the co-operation of the public can be secured diminishes proportionately the necessity of the use of physical force and compulsion for achieving police objectives.

5. To seek and preserve public favour, not by pandering to public opinion; but by constantly demonstrating absolutely impartial service to law, in complete independence of policy, and without regard to the justice or injustice of the substance of individual laws, by ready offering of individual service and friendship to all members of the public without regard to their wealth or social standing, by ready exercise of courtesy and friendly good humour; and by ready offering of individual sacrifice in protecting and preserving life.

6. To use physical force only when the exercise of persuasion, advice and warning is found to be insufficient to obtain public co-operation to an extent necessary to secure observance of law or to restore order, and to use only the minimum degree of physical force which is necessary on any particular occasion for achieving a police objective.

7. To maintain at all times a relationship with the public that gives reality to the historic tradition that the police are the public and that the public are the police, the police being only members of the public who are paid to give full-time attention to duties which are incumbent on every citizen in the interests of community welfare and existence.

8. To recognise always the need for strict adherence to police-executive functions, and to refrain from even seeming to usurp the powers of the judiciary of avenging individuals or the State, and of authoritatively judging guilt and punishing the guilty.

9. To recognise always that the test of police efficiency is the absence of crime and disorder, and not the visible evidence of police action in dealing with them.

THE BROADER MENTAL HEALTH SYSTEM

I have had concerns about the emerging role of our police service in the broader mental health system for some years, precisely because we implicitly attempt to undermine these general principles.  Other posts I have written highlight in particular how we expect more and more that the police will be the agents of the use of force in administering the Mental Health Act, despite the fact that Parliament intended this to be far from a frequent occurrence. Perhaps in community setting where there is limited circumstances where there is an urgency and broader risks to the public we can understand that it has legitimacy and utility, but I never forget the incidents where the police are calmly requested to attend mental health wards to restrain patients for medication, almost on a pre-planned basis.  “You’ve got to be kidding?  You knew this patient would need medication at 8pm and yet you haven’t planned to have sufficient staff or sufficient trained staff for that time?!  Are you aware that some barristers argue that this is not legal on a few different grounds?”

The above picture is of officers detaining someone in a non-mental health context: it was during public order disturbances around St Paul’s Cathedral, London in 2008.  One of the main objections of the public when they see this, is the number of officers involved.  And yet guidelines for the NHS in undertaking restraint is to have one professional per limb, one ensuring safety of the head and airway and one taking an overall view.  Just count the number of officers, above bearing in mind they are also applying handcuffs to a resistant adult man … now imagine again that this was on a mental health ward somewhere near your house.

And this is not just a debate about resources, either:

  • We know that NHS organisations have difficulties in staffing health based places of safety, in accordance with Royal College of Psychiatry Standards – in other words, being able to receive patients without the need for ongoing police support “even where patients are disturbed” (p8).
  • We also know that many AWOL protocols fail to acknowledge in reality para 22.13 of the Code of Practice to the MHA, despite it being fairly unequivocal.
  • We know that where force is deemed necessary after a patient is subject to compulsory admission under the Act from a community location, AMHPs do not believe it is their role to use force (training, lone working, etc.) and they are not at liberty to call upon other, trained mental health professionals in order to coerce those patients whose resistance or aggression is consistent with non-police professional management.

It may be that some people would read the above and think that there are good reasons to prefer the police service to undertake these functions.  Perhaps it’s an argument about their training and availability; perhaps it is about something else and you are entitled to your view.  I’ve got two things to say on this –

  • It’s not what Parliament intended – our laws, our codes of practice were put together after exhaustive democratic processes.  Even where we are referring to non-statutory guidance like Royal College standards: they are documents agreed between organisations like ACPO, BASW, etc., but to what point if they’re ignored?
  • Is anyone asking service users about this?  I know from what little mental health training I have received and from some experience picked up along the way, that cognitive issues around policing can be serious problems for patients.  Whether manifested in delusions or paranoia or some kind of less-acute anxiety about whether it will be a humane, sensitive and patient police officer who arrives – such feelings can be aggravating factors for people in crisis.

Of course, if the police also subsequently struggle to access other services quickly and efficiently: all of this can aggravate the impact upon someone’s clinical condition.  Only last week a police surgeon, section 12 qualified, stood in my area’s custody office and said, “Being here is making it worse – we need to get her to a hospital.”  But the clinical features in play were not ‘RED FLAGS‘ – no-one wanted to deal and this was making the patient worse.  So which hospital?!

Are we not at risk of developing a paramilitary style of something well-short of nursing and creating a situation where the only role that policing plays in the broader mental health system is coercion?  Is that not precisely what Peel said policing should NOT be about; and precisely what our mental health system should NOT be about?

If the last resort – policing, police stations and “paramilitary nursing” – is often also the first thought, where does this leave our principle of ‘least restriction’ in social care?  And if I’m wrong that it all too often is the first thought, why do we still have areas of the UK with no NHS place of safety where the expectation still remains that police officers will potentially breach laws because we can’t get our commissioning together?  Where are the community deployable nurses or nursing assistants who can use low levels of proportionate and therapeutically appropriate force on nervous, frightened and / or confused patients without the need for uniformed stab-vests and tasers implying “or else” somewhere in the background?

Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England.  It doesn’t substantially alter the post but certain reference numbers have changed.  My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here.  The Code of Practice (Wales) remains unchanged.

______________________________________________________________________
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 “Paramilitary “Nursing”

  1. Love the blog
    Speaking as an experienced Mental Health Nurse who used to teach clinicians Control and Restraint, im afraid the prospect of employing more nurses and nursing assistants to physically restrain individuals in their own homes is a nonstarter.
    1.No resources – less beds and less clinicians than ever before (20-25% cuts in my area of London). Can`t staff wards never mind sending extra people into homes. MH services have started and will continue to `pull back` from previous activities over the next few years
    2.Besides the obvious risk and conveyance issues (people tend to be far less likely to act in an aggressive manner when police uniforms are around),asking people who aren`t police to enter homes and restrain people is a rocky road and will almost certainly lead to lots of adverse incidents
    3.It`s got to be remembered that your average nurse or social worker is not physically up to the task of restraining people whether mentally ill or not. Unless we want to go down the road of MH workers having fitness tests and the like before their 3-4 year training (and post-training?) most clinicians are not safely able to restrain people. Hospital based restraints, with potentially a number of staff around ,are usually managed up to a certain level. If we want to change this we`d need to completely relook at the type of people who are employed in MH services and with limited resources would probably shift the focus from therapeutic interventions to a more custodial model. This is not wanted by anyone.
    3.I`d caution against the urge to medicalise lots of behaviours. Many people brought on 136s or who have a MHA do not have a treatable mental illness. Asking MH services to get involved with people whose main issues are alcohol,drugs,personality,bad behaviours etc will only take resource away from those who need it. The perception that there are loads of people out there who are mentally ill and are being channelled in the wrong direction,while an understandable way for someone with no formal training in MH to try and make sense of `off the scale` behaviour, is often wrong.

    1. Thanks for the comments – all welcome and valid.

      1. The “no resources so we’ll ask the police to do the wrong thing in the wrong way” argument is non-starter: if we have criminal prosecutions of police officers and adverse Coronial directions following untoward events, there has to be recognition that parliament legislated in the way that it did, for a reason. How MH managers choose to deliver upon these realities is a matter for them and frontline MH staff do need to be part of reminding them of this, because I can think of various situations in which an MH request for police conveyance and / or a use of actual or implied force would lead to a resounding “No” from me and various other police supervisors. The no would persist for as long as it could to get your managers out of bed, names to be taken, legal warnings to be given, etc., so that by the time a police officer is going hands on, we’ve got the audit trail we’ll need in court and for the regulatory agencies to whom we might choose to refer clincally inappropriate practice.

      2. Nothing I wrote in his piece or any other piece should be interpreted as me saying the police won’t be there beside appropriately trained people, helping them and being prepared to keep them safe. So no-one is asking MH staff to enter homes and restrain people alone, but I am saying that there is a sound legal basis for expecting MH staff to be involved in this wherever the police are kicking doors off for MH related reasons. As a rough rule of thumb, I employ the “RAVE risks” methodto determine where we are (see blog). If you anticipate no RAVE risks, it’s probably not a police matter at all; if you anticipate resistance or aggression, you should be involved in leading with police support and if we are managing violent people or those attempting to escape, we should see you supporting the police.

      3. How MH managers train their staff to do their jobs and who they employ to do them, is a matter for MH managers. Police officers are not trained in clinically appropriate restraint of patients either! Unilateral withdrawal is OK to a point; but that point is crossed too often where I know of MH nurses and AMHPs who will say that it is NEVER their job to coerce. << True story, and quite wrong.

      4. I completely agree with you and have said so many times but would firstly point out, that whether someone has a treatable mental illness or not is not the key factor in determining whether s136 was correctly used. Someone appearing to suffer mental disorder who is detained and then found after they collapse in the police vehicle to have had a decades long undiagnosed diabetes problem – real example. The guy's life was saved because the detention meant he collapsed in the custody of people who could rush him to A&E for urgent treatment and this is success not failure. Do agree, however, that many s136 detentions are a pointless waste of everybody's time and we should be prosecuting people for crimes instead or offering other solutions to behavioural problems. I would point out that this various by area though: in some, I know that 75% of 136 cases are not mental ill health connected whereas in a large area of my force, 50% of people detained 136 are subsequently admitted as inpatients and 30% get a health based referral to their GP or a community based mental health team.

      1. Hi
        Excuse my ignorance, but where in legislation does it state that MH professionals should be physically managing people in their own homes? I don`t suspect Parliament considered that nitty gritty for 1 second. Assessing and placing people on a Section if appropriate yes, but clinicians restraining someone in their own home,on the street, in a public place?.Where would we draw the line or does one exist……..
        MH professionals are involved and alongside the Police in the form of an AMHP and S12 Drs. Police are asked to attend on occasion if violence or aggression can be reasonably expected.This seems to be a reasonable expectation.The idea that a MH social worker/nurse would only be employed if they were fit enough and capable enough to restrain people would terrify not only them but the ill people the best clinicians work with.

        I fear the talk of audit trails and coroners (and legal warnings),while entirely understandable,is behind many of your concerns and we are in danger of perpetuating this myth that somehow MH workers have some magic restraint methods.I`ll let you in on a secret-we don`t.

        Police involvement with MH cases will invariably be with people who are kicking off,being behaviourally challenging etc. The vast majority of cases MH workers see are different. It`s just a reality that if MH services were now to take responsibility for physically managing people,whether mentally ill or not, in the community , the nature of the work would change.The workforce would have to change to reflect this and the day to day interactions between clinicians and `ill` people would suffer.

        There is a much broader context to the work MH services do than dealing with Police cases (I say that with ultimate respect for the work Police do).

      2. Whether or not parliament “considered that nitty gritty” is almost besides the point if you don’t believe they did: it IS nevertheless the effect of the way that they have legislated. I do think they considered it, for various reasons connected to the way that the (failed) Mental Health Bill 2004 was hanlded. Feel free to check out the other comments on this post from current and former psychiatric nurses and you’ll see the essence of the police problem. But to answer your questions straight on –

        1. No-one – anywhere – said that MH professionals should be restraining someone in the street or in a public place. There is not so much a line, as a grey area. Some stuff is black, some is white and there are many shades of grey where we could argue all day long and that is why I find the LAW is handy. It helps blend those shades of grey into black or white. So for a FIRST EXAMPLE: after someone is ‘sectioned’ in their own home, the person is in the AMHPs legal custody, only the AMHP may detain and convey (s6 MHA) and whilst they may ask anyone to assist and they may delegate their formal authority to detain and convey, they may not force anyone else to accept it. So the law says, that this mental health professional has the LEGAL DUTY, to detain and convey and it is a matter for their organisations how they do this. Of course the police may assist and should assist in some circumstances. But that is the answer to your question. SECOND EXAMPLE – the recovery and repatriation of AWOL patients whose location is known is a matter for MH services (para 22.13 CoP MHA). They may seek police support where this is required, but the Code makes it clear that this should be to support “suitably trained professionals”, not to replace them.

        2. I have never said anything about fitness, appropriateness of MH workers. You introduced that and I make no comment but it is a legal reality for your managers under various legal frameworks, that they arrange their organisations to deliver on statutory obligations. I have written before and already said on this threat, that where RAVE risks are in play, the police should either support or lead on the use of force. There CANNOT be a blanket assumptino that all force is a matter for the police – not least because the courts don’t agree with you.

        3. Neither do we. Restraint is a difficult and complex business and experts on the restraint of mental health patients have said that anything amounting to prolonged restraint is a medical emergency and should only be performed by trained staff with access to people who can use the drugs and defibs that should be available (Rocky Bennett Inquiry). I now reflect on that advice in the context of various restraint nightmares I’ve seent the NHS wipe their hands of.

        4. Why would MH services take any responsibility for managing people who are not mentally ill in the community?!! I don’t understand that. All I am trying to say in this post and in others I have done on the use of force, etc., is that it is quite wrong to get yourself into the coercion business if you are not prepared to coerce, especially when the legal frameworks and patients’ expectations are against you.

        You mention the broader context: read the policing principles again but think about them in the context of the use and the utility of force by mental health services. For example, if the force is seen by your public as illegitimate, then it will fail to attract support and this can undermine the whole point of having a detaining framework of mental health laws. We have seen this lack of support when the police have been called to handle a variety of MH situations connected to “sectioning” and then seen major criticisms in the media and in courts about how it was handled. And yet some of these incidents were handled in a textbook fashion, from the point of view of officers’ training; but the criticism keeps on coming. It seems fair enough that where such incidents occur against a backdrop of omissions on the part of others that these are highlighted as part of police services defending the position in which their officers are placed.

  2. Interesting blog. I find it odd that you have police officers requested to attend mental health wards to restrain patients while medication is administered. We have always been told that ON NO ACCOUNT are we to assist in the restraint of an individual for that purpose. Restraining someone so that they can be assaulted (which this technically is) is far outside the remit of police officers. We are told that our role is to assist and support when dealing with people suffering from mental health problems when OUTSIDE the wards, but once they are inside that is the job of the mental health professionals. We have even received a talk from one of said professionals telling us that they are trained to deal with these patients and are trained in restraint techniques that we are not. Even then, we would not be allowed to restrain someone outside a ward for the purpose of administering medicine.

    I agree 100% with what you are saying otherwise. Despite the Home Secretary saying that the police deal with crime “No more, no less”, there is an increasing reliance on the police services in this country to fill the gaps left when other support services have suffered from increasingly crippling cutbacks. There needs to be an overview taken of the entire problem, bearing all the services in mind rather than the current approach which deals with one service at a time. When I have been asked to allocate police officers to assist mental health professionals, paramedics, fire services, social services, nursing staff and ambulance with their duties I have several times received the complaint that we should not attend and instead “let them do their job rather than us doing it for them”. The simple fact is that there is no-one else to do it and if we don’t muck in, the people that will suffer are the public.

    1. I think we agree 100%, actually. I’m not saying that I think it is right or that it is legal: I’m saying the opposite and whilst I’ve heard of examples around the UK of cops doing it, I’ve never done it and have always refused for exactly the reasons you state.

      You’re right,though: sometimes the absence of others organisations undertaking their function causes or contributes to the nature of the demand faced by the police. This is true in all policing, though and I’ve often wondered why we pick out mental health (and children’s homes) as the object of our frustrations?

  3. I agree wholeheartedly with everything you’ve written here. It was always my experience when working as a M H nurse that problems arose only because of the unwillingness of managers to plan for and provide adequate staffing levels even when numbers of staff could have been available. Management of budgets always appeared to have a higher priority than safety of staff and patients. There was always an expectation on management part that police would take up the slack. I was often complained at for refusing to call in police officers to do my job. Saying that I always found it beneficial to have a close relationship with local officers and, working permanent nights always found the best approach to be working in partnership with them. They knew that I would not expect officers to remain with a patient at our place of safety unless absolutely necessary. I only once had to call officers to the ward I worked on one occasion they redacted promptly and appropriately and had my utmost thanks for their actions. The incident again was brought about my managements unwillingness to provide adequate staffing.
    I’ve said it before and I will continue to say it, the only way to work is to have a relationship between police and MH professionals based on mutual trust and respect at a local ‘ coal face’ level.

  4. I’m a mental health nurse. I totally agree with this post.

    The increasing use of police to enforce MH care is very questionable.

    People talk of resources. Yet the level of resources available in MH services now greatly outstrips those present many years ago – when there would have been no question off calling police to a hospital ward to ensure a mentally ill man got his medication. I won’t disclose operationally sensitive information given in confidence, but the number of police officers policing a whole town or a division of a city (~100k population) at one moment in time can actually be less than the number of nurses in some mental health facilities.

    My specialist area of research is death following restraint, and it is very worrying that 50% of such cases following police restraint are now MH patients.

    At the end of the day these are police officers, not nurses.

    I would suggest the core issue here is attitudes and perception of role.

    Sorry for the minor rant here, but feel strongly on this one.

    1. Thanks for saying so – it adds weight to the point given your professional background. There were 15 ‘contact deaths’ for policing in the last annual figures; of which involved people with mental health problems. Like you say and as was said in the Rocky Bennett Inquiry, we need to be careful about restraint and I can’t help but worry about further situations into which junior officers are invited where they put their finger tips in the mangle and find that they are in over the shoulder before they know where they stand.

  5. Jo “Excuse my ignorance, but where in legislation does it state that MH professionals should be physically managing people in their own homes?”

    err unless I am missing it where does it say that police professionals should be explicitly doing so either? Not everyone who joins the police does it for a chance to roll around on the floor and not everyone likely to come out to help are 6’6″ with biceps like tree trunks. I agree there are certainly times the police should be involved but it should not be an automatic ‘force = police’ decision.

    Recently I did joined an AMHP, doctors, ambulance and me and my colleague to a home visit for a sectioning. After some talking to the poor chap the AMHP walked out saying “I can’t get him to move” (after asking him twice), I got the blokes shoes and put them in front of him and he walked out without even so much as a crossed word.

    You say that you have no magic restraint techniques but my two days a year running around the gym a year for my safety training has not made me invincible. I carry a pair of handcuffs (legal for anyone to carry) that I have seen bent before and a pair of velcro limb restraints (again legal for anyone to carry), these are not magical tools and personally with the right training I cannot see that appropriate nurses/staff could not be just as well equipped to restrain patients in low risk cases.

    1. I think the fact that the chap walked out for you proves my point. Often people will acquiese to Police requests whereas they are likely to refuse for anyone else (often on the misassumption that MH workers won`t physically intervene.Which when you think of it is quite undertstandable) .
      So nurses should carry handcuffs and limb restraints? Why not tasers? Batons?

      A recent MHAA i attended resulted in a patient grabbing a knife and attempting to stab a police officer.Thank god she
      was ok thanks to stab vest.Police were only there because it was anticipated patient would refuse to go to hospital not because of RAVE risks. Presumably that knife would have been in the chest of the MH worker without police involvement. This type of incident would increase with less Police support in the community.The first nurse,patient or member of public to die would result in a entirely predictable media,political ,public outcry.

      Despite some attempts to define THE LAW as clear in this area it seems clear that MH providers and presumably Police Forces do not agree, otherwise practice would be very different.

      In the broader context to this,it`s worth remembering that MH workers,like police, used to be able to retire earlier than most in recognition of the mental and physical stressors that come with the post.This was abolished several years ago, so i will probably recieve a pension at 70. The thought of a MH workforce, diminished in numbers and ageing rapidly, expanding the role and particularly taking on more physical interventions is beyond parody.

      Despite high profile Police deaths under restraint, i am not aware of any that took place following a MHAA. This is a red herring and having MH workers restrain someone, as opposed to Police in the community, is unlikely to result in fewer deaths unfortunately(Rocky Bennet). In fact the removal of the calming effect of a police uniform would certainly lead to an increase in untoward incidents.
      I fear much of this is driven by understandable concern at the often over the top criticism police receive after an untoward incident and an equally understandable reaction to that criticism by feeling that someone else should be dealing with it. I know that many Prison Officers and Paramedics feel the same having spoken to some.Often this is driven by a misunderstanding of mental illness and the complexities of interactions between possible illness,personality features, behaviour etc though not always.
      An excellent recent blog on here entitled `Least Worst Option` probably sums up my view

      Finally despite a wish to dismiss resource realities that is not going away.In my area of Inner London, beds will have been reduced by 1/3 in the last 7 years by this summer. Plans are afoot to close the major S136 suite (unbeknown to Police yet) and severely ill people are waiting increasing lengths of time for appointments if indeed they get one at all with many discharged back to the `care of` their GPs.
      The relatively small of cases that come to MH services via Police cannot and will not be immune to these cuts.
      Anyone who makes recommendations or proposals without acknowleding that is in cloud cuckooland. The conversation between Police and MH services needs to be about how to manage this decline in the best way of course, but expecting radically new services or interventions is a waste of energy.Good talking point though!

      1. Not tasers and batons, because they are illegal for you to possess! As a slight aside, it was recently remarked to me by a psychiatric nurse that they had attended an event where continental European psychiatric nurses were present and there had been an interesting exchange about perecptions of mechanical restraint, for example using devices of various kinds; versus chemical or physical restraint. The main observation of the UK nurse was that the European’s were fascinated and disturbed by the lack of willingness to consider mechanical restraints, because they felt that chemical and physical methods were altogether more horrifying.

        So in the end, we could just be talking about cultural views. The answer you give, above, shows the extent to which you may well have totally misunderstand what I’ve written both in this post and in the RAVE risks post. If a patient (the one who grabbed the knife) was antipated to be likely to refuse to go to hospital, how is she not Resistant?! THAT is your RAVE risk. The question is, whether that type of risk should at least initially be managed by mental health professionals with police in support in the background. If you thought this resistance would involve aggravated resistance and knives then the answer would be ‘No’, the police should lead it. If you thought she’d be verbally resistant, but either persuadable in the end or capable of being managed by MH professionals knowing the support of officers is right on hand, then answer (in not just my opinion), would be ‘yes’. My question for that assessment is – did it have a s135(1) warrant in play?

        I agree that you can’t divorce this debate from the stigma, violence, fear debates that we see the media stoke up. But we need to ask ourselves if mental health professional really, Really, REALLY believe the stuff that MH trusts and charities put out about the mis-made connections between mental illness and violence if the first resort to ANY kind of resistance is the police. (The fact is, most of the research on which such claims are made is of the poorest kind and we don’t know enough from good quality research to be sure of anything in this regard.)

        You’re quite right about cloud cuckooland – I see my attempts here to try and argue and in the operational incidents I have to manage for what we all know is the right thing. Some may say that is naive or idealistic – I would actually say that even where I KNOW that MH services and professionals will not do things correctly, such arguments on my part and those of ANY officer I can influence will only help them defend their actions in the event of untoward incidents, should things go awry after MH services have decided (on resource grounds or on any others at all) that they are not going to act in accordance with laws or best practice guidelines. It’s not that the laws are opaque – it’s that few people are bothering to challenge services who routinely disregard them.

        I look forward to hearing more about the Metropolitan Police area and can’t wait to see their reaction. Presumably, they’re not just going to say “Take them to the cells!” because we know that this would breach things not worth breaching, too and there various reasons why senior MH professionals / managers need to think about the law on that decision, too.

      2. Actually deaths following police restraint, in the context of MHA, have occured. Andrew Jordan is one.

        There are also cases where police oficers have been called inside mental health units, to restrain seriously ill patients, followed by the patients death.

        Any changes regarding retirement age have not taken effect at this time. That genuinely is not relevant.

        Resources are another red herring – NHS expenditure on MH has doubled since 2000.

        There have been changes in gender, attitudes and training over the last decades. These may well have resulted in the MH workforce being less capable in directly caring for resistive or violent patients. There needs to be more honesty – the MH industry alternates between saying there is no connection between mental illness and violence then the next day claiming your patients are so violent you cannot care for them. Obviously the truth is complex and you need to start adjusting your capabilities to match the challenges posed by the people you care for.

  6. Jo, the police don’t have a magic restraint technique either. However our training and yours are very different. Yours is for MH patients ours is not, so you ARE the best people to be doing it. As for lack of staff, join the club, which is all the more reason why MH services shouldn’t be passing their responsibilities to the police.

    Also, what’s the issue with the MH workforce changing to be able to restrain patients in community. The way MH patients are treated has changed to allow community treatment so adapt and move on. Police don’t refuse to enforce new laws because it would mean change.

    Finally, by behaviourally challenging I’m guessing you mean refusing to do as you want but not being violent. It must be as that’s the main reason why I’m called to assist MH workers in the community.

  7. There appear to be two main problems I can see here. Lack of resources (ie trained MH professionals) and lack of knowledge/training (ie ability to know how to manage various restraint methods and for what reason.

    I can see that over resourcing for what may need to be a half hour (i may be wrong) medication administration could be challenging. Likewise providing officers for a MHPs job is a challenge for our colleagues in blue, as well as being inappropriate. This is then mitigated by a lack of knowledge in some areas where the wrong request for assistance is made and, the assistance, however well meaning, is erroneously given.

    MHCop and I have kicked around the idea of MH Paramedics for a little while now. I hope to be taking up a new post shortly that will enable me to look at this idea in more detail. This may be part of the solution of having a knowledgeable emergency response available.

    Tj

    @meditude

  8. http://nationalpsychosisunitsurvivor.blogspot.co.uk/
    The above is a shocking example of NHS care for you. My daughter was sent here and I would describe it as hell on earth.

    As regards myself, for someone who has had every check done during an application for the police – I was treated like a criminal and the staff were not honest enough to come out and give me a reason. At first my daughter was allowed out all day with me and I visited every weekend. We would spend lovely days out in Croydon and Bromley – suddenly all this stopped. They harrassed and bullied me for 2 days (legal teams of SLAM and Enfield were involved) – took me to court – I backed down through their bullying as I had no time to get solicitors in just 1 dat and they imposed S 3 despite the fact my daughter was willing to remain in hospital voluntarily but they just wanted to experiment to their hearts content at this research hospital where my daughter’s face was absolutely covered in bruises and where they force patients to take drugs as they get the money from the drugs manufactures as correctly described in this wonderful blog. They put my daughter on Clozapine and Metformine which is meant for diabetes but is given for weight loss. Dr Ann Blake Tracy tells me it is to counteract diabetes and to stop them from being sued. THE CARE IS ABSOLUTELY APALLING AND I FEEL SO VERY SORRY FOR THE PATIENTS. Not content with labelling my daughter with Schizophrenia and pushing drugs on her she did not even know she was on because she was so drugged up and she could barely walk she needed a walking stick so she told me – yet they provided a member of their staff to escort me like a criminal everywhere. I was told not to go running behind bushes with my daughter because staff needed to keep an eye on m e at all times. This is absolute abuse and I am documenting this fully on my website. Now to top it all Enfield Mental Health sent my daughter to Cambian Four Star Wards. The psychiatrist referred to my “past behaviiour”. All I did was disagree and speak up for my daughter. Their letters and no doubt the files are full of discrepancies. Apparently the Maudsley labelled me as aggressive and nasty and the new psychiatrist excluded me from the start. I now want a full investigation into this private sector hospital and Enfield Mental Health – it is truly shocking that the police have to step in to do the job of doctors. The minute a patient sees police in uniform it can be truly upsetting – that is going by what my daughter has told me. The patients then feel the police are against them but it is all to do with a failing care system . They failed to look after my vulnerable daughter in the community. They allowed her to go downhill to such an extent on 14 mind altering LSD serotonin reuptake drugs that cause a dream like state during the day. Patients act out their nightmares – “please help me Mum, I feel like I’m crawling out of my skin” – “I would rather go into seclusion for the rst of my life than be on these drugs that make me feel so terrible” And where is the proof of such a diagnosis – there are four in the file by these so called experts – I have tapes of laughing psychiatrists. They say it takes them 2 minutes to come up with a diagnosis – I have watched them smugly smile – both the doctors, the pharmicist at the Maudsley and social worker at Enfield. They think they are above the law and the law protects them unlike my poor daughter who has been moved miles away from home and family and contact with me severed virtually to the extent I am only allowed supervised phone calls and escorted leave. What right to a team have to impose such sanctions and guess what all the time my daughter is in touch so it is not as they are saying because it is her wish. It is a complete and utter lie and I am prepared to take matters to court to prove this. It was a group of ex patients that came to my aid – complete strangers who got in touch with me via my website and they are lovely people – they have suffered extreme cruelty and the law fails to protect them.

    I wanted to be a police officer because I fully understand how these patients suffer and have seen the most shocking sights on the acute wards that fail to protect vulnerable patients. I have seen someone who once had a job, once was learning to drive, go to college etc turn into a zombie and the drugs cause the violence by the way, nothing to do with the condition. Proper assessments are not carried out and I am requesting one from Dr William Walsh who has been involved in investigations for Scotland Yard and also Peter Bennett has done similar research and he was a Superintendant of Forensics. Now I want these tests to determine which type of depression my daughter has. Dr Walsh who has done extensive research has identified 5 bio types of depression. Undermethylated – the drugs can work. Folate Deficient/Copper overload the drugs can make m atters worse and that person may never get better. Thank God this psychiatrist has left for the time being and a new one replaced her. Cambian have been voted Best Care Provider 2012 and I have never seen so much control – even worse that the Maudsley and that is saying something. I would rather my daughter have been sent to a police cell instead of any of these horrific places where they drug someone and force the drugs on them without even doing proper tests in the first place and where there is NO SCIENTIFIC evidence and by the way I am not a Scientologist!

    So the Maudsley could spare a much needed nurse to escort me everywhere for 1 hr or so and listen to every word of conversation so she could report back to the consultant psychiatrist.

    This is not care – THIS IS ABUSE – in prison there is more respect and more freedom that iin these horrific places where they drug people and shorten lives without any kind of care whatsoever – where there is nothing to do at the weekends – no-one visits to see what is going on. This is where the police can get involved – they should do something to appear nicer to the patients and like the trip they provided for a week for my younger daughter, a project with mental health patients in hospital providing therapeutic activities where they themselves join in could make the police appear more approachable. I recommend you go down to the Bethlem Royal Hospital Fitzmary II Ward and see what you can do to brighten up this place as I was so shocked by what I saw but then there are many places as dismal as this up and down the country where police can visit to engage with the patient rather than just turn up to arrest them.

    It is a pity the police cannot visit these wards to check on the patients to see if they are alright. This is a place where staff where name badges back to front – where they gang up on parents if you dare to speak out about the shocking care especially when you have it in writing a drug free period of assessment was promised by Professor Murray and then get told “its all about Clozapine here”. No wonder why Novartis give funding for this experimentation and I have seen the seminar presentation papers detailed on the wonderful blog above.

    It m ust be exasperating for the Police to have to do the job of so called professionals however I have another solution. Open Dialogue Approach is 85% successful in Tornio, Finland. Open Dialogue respects the family, they respect the patient and treats them like human beings unlike the present system full of secrecy and meetings behind closed doors. The whole team – everyone gets together and they offer a lot of support. I believe peer support is so important and have noticed how patients like to help others. They are made to feel worthless, they are talked down to, ignored. Just look how I’ve been treated. The police think these doctors are experts – well I would be most willing to show them some of the recordings I have and there are many mothers who have sons and daughters trapped in this h orrific cruel and abusive care system who are most unhappy – not just me and then there are the patients themselves who have suffered abuse who have helped me more than anyone else. If such patients like I am in touch with could be involved in approaching such people rather than officers in uniform and staff who are not nice to the patients for the most part from what I have seen – the patient may respond to someone who has been through it themselves and been on the acute wards. I know many patients who want to be involved in the Open Dialogue approach and this would work more than the Crisis team – only someone who has been through hell can understand how another feels when going through crisis. All doctors want to do is push more and more drugs that do not work in many cases. THE OPEN DIALOGUE APPROACH IN TORNIO, FINLAND IS NEEDED HERE IN THE UK WITH PEER SUPPORT AND ACUTE WARDS ONLY USED SHORT TERM NOT FOR 2 YEARS AND PROJECTS LIKE SOTERIA, CHY SAWEL AND ROOT AND BRANCH set up. The police would have far less work to do if there was decent care that gives proper
    assessments like in Dr Walsh’s book Nutrient Power and holistic care alongside Open Dialogue Approach.

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