It occurred to me recently that the actions of the police can have the effect of appearing to create a mental health patient where none really exists. This can become a self-fulfilling prophecy of repeated interventions which creates a lot of failure demand, for both policing and health services. Let me explain! –
EVER DECREASING CIRCLES
Once upon a time, the police detained a man who was on the wrong side of a road bridge, expressing suicidal ideas and threatening to jump. The road has been closed, officers starting to try and persuade the man not to jump and a negotiator was called. After a protracted discussion to persuade and influence this guy back over the railing, he was detained under s136 MHA – because suicidal ideas, hanging off a bridge may indicate the presence of mental disorder, right? And the interaction with officers may lead to further suspicion that the man was mentally ill. Following assessment at the “136 suite” the man was neither admitted to hospital under the Mental Health Act nor referred for mental health care or support to anyone. << I have known this outcome from such incidents many times in my fifteen years’ service. The person then having been released from section 136, the police resume and the person goes about their life.
What happens if we attend a similar job in the future? – maybe a different bridge in a different area and almost certainly different police officers; but background circumstances broadly the same. Did the MH assessment first time around get it wrong; do the officers even know that outcome or are they simply aware from intelligence systems that the person was previously detained by the police under the MHA? Maybe they are aware of nothing at all and simply start from the basis that the first officers did … suicidal ideas, bridge, communications and perceptions so there is a mental disorder and when they person is persuaded back over the rail, they will be detained under s136 MHA for assessment at the PoS and an outcome. Guess what it is? Not “sectionable” so no admission and maybe a referral to GP or CMHT; or maybe not – all depending on circumstances.
We can see where this is going can’t we? My police area are currently attempting to manage two people who fit this category and on a recent early shift one the men rang the police from his flat at 9am having been drinking heavily and as part of our response to what an officer described as “that regular mental health patient who is constantly ringing” I rang the Crisis Team to find out more about him. Their answer motivates this blog because it suddenly occurred that we – the police – have “created” this mental health patient.
The Crisis Team had assessed this man for the first time about two years previously and had assessed him several times over that two-year period. Every single time they assessed him, it was following a police intervention: either detaining him under s136, including whilst hanging off bridges expressing suicidal ideas; but also following him being arrested for minor offences. They always, always found him to lack any obvious mental disorder and either released him from s136 or advised us to do what we wanted with any criminal allegation against him. Yet look up this guy and several like him on PNC and police intel systems and you couldn’t fail to think he had a mental health history.
It becomes the “obvious” to do – to attempt to involve mental health services in the police response and think about diversion from justice and so on. But he’s not mentally ill, except to the extent that we regard anyone who drinks a lot to be mentally ill. He has been repeatedly offered support for alcohol related issues by both the police and the health system and declined to take up those offers.
The first time I came across a similar case, was about seven years ago: a female drug user who often brought the M5 to a standstill (at massive economic cost, I might add) because of her obsession with a certain bridge and the adverse of its parapet. Repeated s136 interventions led to some frustration being expressed by the mental health trust that the police kept perpetuating this revolving door when a better approach may not involve s136 being used at all. When we asked what they thought would be better they emphatically said, “Prosecution!” Simple when you know how, isn’t it?!
And so we did.
Few people realise that it is an offence under s22A of the Road Traffic Act to place something (including yourself) “on or over a road” in circumstances where it causes a danger to road users. Obviously, someone falling from an M5 motorway bridge onto a 70mph triple carriageway would be horrendously dangerous. So after something like five s136 interventions in a short period of time – all by different officers acting in good faith – we made it more widely known that s22A was the way to go, secure MH assessment in police custody as part of the investigation if that were thought to be necessary and take a broader view than whether it is a “health or justice” issue. It could well be both.
In these cases, criminal sanction for behaviour has been shown to be effective – at least in terms of a short-term solution. All the mental health assessments and the criminal investigation considered the issue of drug use for the woman mentioned and alcohol support for the man. The female drug user was prosecuted, remanded to prison (because of various other criminal justice antecedents) and subsequently found guilty. It brought an immediate end to incidents on the bridge. Maybe she found another bridge, some may ask how effective this strategy was in the longer-term. All fair points, but not issues that prevent us prosecuting those who commit street robbery where we think they’ll take the consequences and just commit more robbery elsewhere on different victims.
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.
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