I have noticed recently that the number of times my blog has been read in the Republic of Ireland has markedly increased. Our colleagues in the Garda Síochána are serving in the country of our nearest neighbours and I have recently become curious about the similarities or differences between policing and mental health both in our two countries.
GENERAL
The Republic of Ireland last updated their legislation in the Mental Health Act 2001. This formalised certain roles for the Garda in the detention, conveyance and recovery of certain people or patients and additional details can be found in various Codes of Practice to the 2001 Act. A useful document in understanding how this new legislation operates can be found in the report of a joint working group on Mental Health Services and the Police (2009).
This identifies many issues that will be familiar to readers in the United Kingdom as well as in other areas where this blog is read like Canada, Australia and New Zealand: there are issues around the capacity of health and / or social care services to respond to situations out of hours which creates a vacuum into which the Garda are drawn; there are issues around the training given to Garda trainees in the identification of people who may potentially be experienced a mental disorder and the nature of what an appropriate response to that may be. Like most countries, the nature of police responses has been questioned in response to deaths in Garda custody because of the prevalence of vulnerable people experiencing mental ill-health issues and drug or alcohol problems.
Arising from recommendations in the 2009 report, the Health Service Executive of Ireland and and published a memorandum of understanding (2010) to bring detail to joint working agreements. There was a review of the Mental Health Act (RoI) in 2012.
EMERGENCY INTERVENTION
I want to concentrate minds on the difference between legal authorities in the UK and the RoI on the ability to apply an emergency intervention. It is these powers I am contrasting across the countries concerned:
- Section 136 Mental Health Act 1983 – England / Wales.
- Section 297 Mental Health (Care and Treatment) Act 2005 – Scotland.
- Article 130 Mental Health Order 1986 – Northern Ireland.
- Section 12 Mental Health Act 2001 – Republic of Ireland.
In the United Kingdom, none of the three pieces of legislation cited allow UK police officers to detain anyone in a private place and therefore do not offer a power of entry, by force if required, in order to do so. The Republic of Ireland does –
“Where a member of the Garda Síochána has reasonable grounds for believing that a person is suffering from a mental disorder and that because of the mental disorder there is a serious likelihood of the person causing immediate and serious harm to himself or herself or to other persons, the member may either alone or with any other members of the Garda Síochána –
-
Take the person into custody; and
- Enter, if need be by force any dwelling or other premises or any place, if he or she has reasonable grounds for believing that the person is to be found there.”
It is not only the public / private and “power of entry” issues that are different: s12 MHA (RoI) requires a higher assessment of risks than in the UK legislation. You will recall that British MHAs call for “immediate need of care or control, in that person’s interests or for the protection of others.” Quite clearly this can include situations of “immediate and serious harm” as per Irish law, but it includes other, lower levels risks where purely on the basis of a perceived need for care, the police may intervene if that need is immediate despite it not necessarily being likely to lead to “serious harm”.
CLARITY
This allows An Garda Síochána a clear operational advantage over UK police services responding to mental health crisis situations in private dwellings. The ability to remove someone to a safe place for assessment by a doctor where there are immediate fears around serious risks, whether apprehended in a public or private space, removes the possibility of the “999 What’s Your Emergency” type incidents. Ireland are not unique in this regard – most states of Australia and Canada are the same, as well as South Africa.
Irish law provides further clarity around situations which are routinely frustrating in the UK and British officers reading this may not enjoy this next point! – where a patient in Ireland has been “sectioned”, the applicant for the patient’s admission to hospital may request An Garda Síochána to assist them secure safe admission if they are unable to do it themselves and the Garda must assist.
There are so many advantages to such clarity – whether or not you agree with individual points – that just a cursory reading of Irish Law reinforces how many grey areas of debate British law currently creates. It is Irish Mental Health Law that I cite when trying to highlight how we leave so much unspecified and how we’ve managed to make it so complicated.
I’m confident from reading the 2009 report and the 2010 MoU that there are still problems in operationalising effective joint working practices as Ireland continues to move to a full model of community mental health care – but to have to attempt it against a background of modern mental health legislation whose attraction is in its simplicity must be a real advantage.
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.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2013
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 
The law is failing to protect vulnerable patients – so called professionals can manipulate, control , drug up as much as they like under the law. My daughter is on a S3 and I have never seen so much bullying and control and I dispute the many diagnoses she has as she has not had a proper assessment done and the labelling of someone is harmful and inaccurate. The drugs fail to help everyone as detailed in Dr William Walsh’s book Nutrient Power. The team have banned my phone calls, tried to replace me as Nearest Relative and manipulated the legal process to their hearts content. The NHS has completely failed – the acute wards and constant drug pushing at my poor daughter has led to her becoming worse. The wards are far from safe places and are volatile and noisy as well as un-therapeutic. Care is all about drug pushing and yes I sympathise with the Police who have to deal with patients who are on high levels of drugs – cannot cope in the community because of lack of support, see the worst side of the police who have to step in and do the job of the failing mental health crisis team. The answer – to involve some of the patients as peers like in the group I go to who so want to see Open Dialogue – so do I. In Tornio, Finland they have 85% success rate and no problems whatsoever. The care is failing yet the Government do nothing. Why not let Soteria, Chy Sawel and Root and Branch set up for those long term cases where patients are constantly admitted into hospital and also as a matter of choice. For some patients the drugs work as they may be undermethylated (see Nutrient Power by Dr Walsh) in other cases like my daughter the drugs could be making her worse because of an overload of serotonin. There are no proper assessments and now I am demanding this. I was training to go into the police myself but sadly had to give this up as my daughter was deteriorating so badly – in desperation I appointed a private psychiatrist and this care seemed to work. For once a doctor listened – for once my daughter got treated like a human being. As far as the labelling goes – this is inaccurate – my daughter has about 5 labels, the latest being chronic treatment resistant yet they still continue to push the drugs at her despite this. She is miles from home – they tried to discourage contact, they are now trying to delay the Tribunal and play on the fact that she knows what she is doing and has the capacity. This is why so many end up unnecessarily on long term treatment orders when they are of no risk to the public and they become institutionalised and never ever get better. My daughter is at Cambian and I never had so much bullying and seen so much deceit. I have it in writing they say she wanted supervised phone calls – for instance this is my daughter’s response “that is not true Mum but you have no idea what it is like here” This is where the police should be visiting the wards and watching out and listening to the patients for signs of abuse. SOME OF THESE SO CALLED PROFESSIONALS THINK THEY ARE A LAW TO THEMSELVES. THEY SIT THERE SMILING SMUGLY AND YES THE LAW PROTECTS THESE PROFESSIONALS. WHO IS GOING TO LISTEN TO A MENTAL HEALTH PATIENT WHEN THEY ARE BEING ABUSED? I am waiting to hear about my daughter who was covered in bruises at the Bethlem and have not had a satisfactory response. Letters get copied in with so many other names. The team stick together and gang up against you.
The law is disgusting as it is failing to protect vulnerable people and you may see the occasional programme about abuse going on during programmes such as Panorama but more should be done to protect the weakest and most vulnerable people.
Whilst it is good that you have this blog and shows you take an interest as you have to deal with so many cases how many cases come to court that someone is convicted of abusing a patient. Much could be prevented if the police had more involvement like they go onto school premises they could be involved in projects so that they can build up a decent relationship with the patients and get to know what is really going on behind closed doors and then get to learn if there is any abuse that needs to be investigated. Many of these patients especially at the Bethlem where staff have their name badges back to front! have no visitors – this is why abuse goes on because no one is watching and they did not like me visiting frequently at the weekends where I soon got to see the reality. If only the police could be involved in other ways apart from just arresting.
The patients I meet with regularly tell shocking stories of the abuse they suffered on the wards so the wards are not safe places as you mention. The abuse in many cases comes from the staff themselves and nothing gets properly investigated as the complaints procedures are hopeless and this allows staff to remain silent.
As a mother they have threatened to have me arrested so many times and lied that I was aggressive and threatening when in fact it was certain members of staff that were. I have never encountered so much bullying in my life and now I want a full investigation as I feel there is manipulation in the legal process of my daughter’s Tribunal – I am not going to sit back and do nothing about this you can be sure. On a high level of drugs, someone may lack the capacity – for instance my daughter would never have gone and changed her perfectly good solicitors with another one recommended by the hospital themselves and she does not understand what these solicitors are saying to her- complete manipulation on the part of the team and then they have tried to replace me as the Nearest Relative twice and excluded me from important meetings and treated me like a criminal.
The law is failing and so is both care/care in the community because it is all about drug pushing and false labelling – with 5 diagnoses the latest being Chronic Treatment Resistant that says it all! I am in touch with many people now and many are too afraid to speak out against what is happening and I am documenting how you get treated when you do challenge the current care system. As a professional doctor says who I am in touch with “it is a travesty – I have been trying to change the system for 20 years now”.
Not entirely sure that the above comment is on topic but I agree with Susan’s comments and sympathize with her. I have been sectioned 7 times in the last 8 years – a mixture of section 2 and 3. My longest stay in hospital was 7 months and yes the wards are awful and yes I have seen patients made worse by their treatment.One young friend of mine went downhill over about 9 months and eventually ran off from a member of staff and killed herself.
Recently I was subjected to very frightening intimidation by another patient and while staff struggled to keep her away from me I was told I could call the police. I didn’t because somehow it didn’t seem right – surely staff should be able to deal with it but I wish I had. The intimidation continued while I hid terrified in my room. After a couple of days the doctor took off my section and discharged me because it was acknowledged that being in the hospital was not therapeutic. I had to leave when actually I ought not have done and had to struggle alone at home. I made an official complaint and got the usual dismissive response. My own psychiatrist admits that the NHS mental health system is letting down patients badly particularly those with complex needs like myself and it seems like Susan’s daughter.
Was it on this website that I read about police visiting psychiatric wards on a regular basis. It seems like a good idea.
Again and again the police have had to search for me when the frantic calls for help I have made to the crisis team have not been responded to. I repeatedly apologise to the police officers when yet again they have been called but they are very nice and tell me it is part of their job but it shouldn’t be so much as it is.
It would be good if the police had cooperation from the mental health services so often they get dumped without really knowing what to do with a person in mental health crisis. Recently late evening the mental health team refused to come out to see me (I had lost the plot that evening and gone wandering for hours in the freezing cold) and eventually I had to be taken to A&E. Fortunately the police did not use Section 136 – perhaps because they realised it would be pointless and a waste of time. I would only end up going round in a circle within the system.
I have spoken out time and time again right up to the highest level but paranoid or not I feel that I have a big black mark against my name and now I have abruptly lost my community support – ‘we cannot offer you anything else and can no longer provide long term support’. My psychiatrist tells me I should concentrate on getting better and then fight the system but where I see it failing I shout.
If a UK patient tried to escape a Section by going to Ireland or another part of the EU, what powers and duties would police have to bring them back?
I had a really elaborate escape plan when I was sectioned, involving getting out of the country. Am quite curious as to what would have happened?
What would be the powers and duties of the police if a patient from the UK on a section ran away the Ireland or elsewhere in the EU?
I had quite an elaborate escape plan when I was sectioned, am curious as to what would have happened if I’d tried it.
EU countries will just send you back.
Be careful what you wish for. One chap ran off to a particular country and behaved in the way which had always lead to a laydown in hospital back in the UK. In that country they just saw it as a crime and put him in prison. When he became aggressive to guards they shot him. Not ever country sees ‘mental health problems’ as a justification to treat people differently.
Is a section ‘portable’ across the EU then, or would they have to section me again in Ireland?
Don’t worry, I’m not planning on doing this any more – just curious what would have happened had I been a bit less crap at running away. I got lost, walked round in circles for about two hours, got soaking wet in the rain with no coat or shoes, and eventually handed myself in at a church.
It’s my first time commenting on a blog but I just wanted to say thanks to Michael, I’ve been reading his blog after being directed there from planetpolice and while I have no experience of mental health policing or policing in general I have read this blog with great interest and it’s been a very educational read, especially this section on the Guards, being Irish I found it very informative to see the differences between our lot and the UK police’s approach.
Thanks again, as always looking forward to your next entry.
Brainduck …. Patient on (example) section three, liable to be sent back essentially until normal date section ends. Ireland definitely does so. Few countries have a desire to pay tens/hundreds of thousands of pounds of their taxpayers money on some other country’s mentally ill.
As I say, be cautious what you hope for. Behaviour taken sympathetically as part of ‘a mental health problem’ in the UK will be seen as a crime or dangerous madness in some countries. They may be rather more robust than here. Becoming ill in one of those countries may not be a happy experience.
The Irish Health Service website hse-ie is in chaos – none of the links are working!!
I am discussed with section on my Daughter I know she has problems but these have being on going since she was 14yrs old but in all wisdom of doctors and social workers no one has tried to contact her family to try to get to root of problem because they believe every word she say’s especially does not want contact with me , I think if doctors got us all in a room to try to get to bottom of problem it might help, if I am problem that is ok I just want her to get back to her family of 4 children youngest is only 7yrs and I will keep away, but not a day goes by that I don’t think about her I do love but we clash
Psychiatrists & drug Companies have turned mental Health into
big business, There are no tests at present to identify Mental Illness
all you get is the opinion of an Insider .Once in the system , you are trapped for life , a valuable asset , revolving doors. This whole system needs a public inquiry.
The taxpayers are being robbed, and the Police being used in areas where they have little or no experience. Who is profiteering from
these vulnerable people ?
“When will we recognize – and publicly identify- the medical criminals
among us” ? – Dr Thomas Szasz, M.D. Professor of Psychiatry Emeritus.