On 17th February this year, the Observer published an article in the wake of the failed “Commissioner v ZH” appeal in which it was reported that “Hundreds of thousands of pounds of public money used by the commissioner to fight this case [could have] been used to train police officers to humanely treat people with disabilities. The Association of Chief Police Officers has categorically refused to provide such training.”
On 24th February the Observer printed only part of a letter which was sent in response by the ACPO Lead on Mental Health & Disability, Chief Constable Simon Cole. The full press release has been published by ACPO:
“It is not correct to say that ‘the Association of Chief Police Officers has categorically refused’ to provide training on dealing with people with disabilities (Trauma of autistic boy shackled by police, Observer, 17 February). Dealing with vulnerable people and those with disabilities or mental health issues is embedded in officer training across the service. Restraining vulnerable people appropriately is also a central part of officers’ initial training and it is revisited throughout their career. All of this training and guidance has been reviewed and updated with the input of outside expertise from the health and charity sector in the last five years.”
I know that this is true because I wrote some of it and it has been made mandatory in many forces across the UK and embedded within other training programmes like personal safety, public order, custody, etc., etc.. Is it enough? – not in my view, but you’ve got to put my perspective into perspective, as it were.
POLICE TRAINING
More generally than the “ZH” case and the issues arising from it: we can always have a debate about whether some training is enough training, whether it is then used correctly and how we could make things even better – but it must be borne in mind that some of the implications of courts’ verdicts in this country are in stark contrast to medical opinion in some quarters. Only recently, the IPCC issued a formal recommendation to police forces following one of their investigations which is now causing review of whether procedures and partnerships are correct in order to respond to “excited delirium“. And yet if you try to have a discussion about excited delirium with some doctors you’ll find that the very existence of this concept as a disease-condition or syndrome is in question – some pathologists and psychiatrists going far enough to suggest that the term “excited delirium” is language which attempts to medicalise the use of excessive force by police officers.
You also have to remember that the law of the United Kingdom does not always allow a police-led response to certain situations which usually attract police attention. After I published a blog last week on “An Garda Síochána” I went to work where one of the first things my officers had to do was deal with a call from the ambulance service to “do something” about a young woman in her own dwelling who was mentally ill. She wasn’t committing an offence, she wasn’t breaching the peace – actually, she wanted to go to bed by the time the police arrived – but the paramedics’ (perfectly valid) assessment of mental ill-health led to a call for the police. Why not call the CrisisTeam or the duty AMHP? We all too often want to criminalize people experiencing mental health disorders but at least if the event had happened in Ireland, the Garda would have had at least some legal basis for doing something if the threshold for intervention were met because Irish law directly allows the police to act in private premises.
Therein lie the problems: we have mid-twentieth century laws from an era of mass institutionalisation to deal with a no-longer-newly deinstitutionalised model of mental health care which has decided, without design, to rely upon the police for certain responses and certain supports that are not necessarily possible and are often not desirable.
I was pretty appalled by the “ZH” case, if you’re interested – and I predicted on this blog and twitter that the appeal would fail. But we need more than a debate about training – we need debate about the role of the police in our broader mental health system with clearer mandates for both the police and the health / social care organisations. We also need to consider the legal framework we’re still operating from a time when people carried ration books.
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 
http://www.centreformentalhealth.org.uk/…/briefing36_police_and_mental_health.pdf
What a pity the Mental Health First Aid Training mentioned in this document is not considered by more forces.We mostly rely on gut instinct which may or may work but a few approved tactics may be a good use of officers time.If trainers took the course then it could be cascaded on training events as additions to law updates.first aid or officer protection training.
Totally support the view that police should not be the first responders to mental health issues where there is no crime or serious breach of the peace.
In the ZH case, it should have been the ‘carers’ who dealt with the situation, not police.
(Sorry, I’m one of people who are sceptical about ED as a cause of death in deaths following restraint.)
I don’t mind sceptical – I’m also far from certain but I didn’t stick in at school enough to know a gene from a chromosome; but I do know that there are some consultatnt ED doctors saying its real; Coroner’s ruling people died from it and the IPCC are investigating police officers on that basis. Until we know more, it should be presumed real and, where found, taken to A&E via ambulance. Anything else is likely to get cops suspended and / or prosecuted.
Some of the research is convincing – small number of people respond differently to coccaine, become delirious, body temperature rises. My concern is routine use of the ED label when there is no clear evidence of the drug use, abnormal dopamine regulation and hyperthermia. In some instances it does get used as a convenient get out of jail card, when other issues should have been questioned. If people routinely see ED as a cause of death then it becomes not only an excuse, but also means policy makers/trainers CANNOT change working practices – to do so would be an admission that something else, related to their conduct, was at fault.
In GMP we don’t get training on how to restrain vulnerable people (unless you include skimming over the fact it could be an issue and to be aware). Again this week I was called to A&E to deal with an ‘absconded’ patient. Turn up and it was a female with MH problems who had been discharged from hospital after unrelated medical treatment but the staff didn’t want her to walk home. The staff wanted police to forcebly stop the lady making here own way home for no other reason than they were worried but couldn’t explain why. By their own admission the MH issue was minor and she had capacity to make her own decisions. So unhappy were they when I refused that they escalated it to my Sgt. So not only did they want me to break the law but they complained when I didn’t!
As part of our training we need to learn how to say NO
I myself have been on the police training course and was very impressed with the course and especially the training on how to deal with people mentally ill. I was especially interested in this as I am a mother of someone who has been admitted 8 times intoh hospital. The condition associated with bad drug reaction is called Akathisia – my daughter said it felt like she was crawling out of her skin. This is as a direct result of the drug not so called condition. She was suffering nightmares during the day, terrible side effects and this affected her behaviour. There is little understand really of someone’s behaviour when you see someone lashing out. That person is more likely to lash out at someone in authority rather than someone who could be brought in as peer support. Someone who really understands what it is like to be on a shocking acute ward. The group of former patients I meet with would like to see Open Dialogue as well as humane care – the trouble is care is far from open and caring and relatives are often excluded and the behaviour of the person who is ill is often associated with family background however every case is different. People are quick to assume. You just do not know what has happened to that person and mainly a person who is undergoing such behaviour has suffered extreme abuse/trauma of some nature and unfortunately the care is mainly the pushing of mind altering drugs that can enhance problems even more and in some cases the drugs can have a bad reaction and cause the violence and aggression/psychosis as well as suicidal thoughts. I have seen both emotions. I have taken my daughter into casualty and waited and waited to be seen – the longer the wait the more distressing it is to the patient. When something bad has happened to that person under the scheme for instance, this is all too often trivialised and brushed aside. The answer is more drugs every time someone is admitted into hospital so now my daughter is on a high dosage. The drugs make her feel up and down in moods but unfortunately my daughter still is suffering as the drugs just mask the problem and my daughter is clearly talking about what has happened and the care is all about drugs that do not even work. Trouble is there is no facility – safe facility to come off the drugs and some patients desperately try this themselves and take themselves off too steeply because no one listens, no one cases at what terrible side effects they are suffering. The drugs can affect people in different ways. For some they can work but for others like my daughter none have worked and she is classed as being treatment resistant. The Crisis Team used to stay away and so did staff and they rely on the police perhaps because they are too afraid to go into someone’s home to confront that person if they are unstable. That person becomes worse and worse and deteriorates because they are not eating, not looking after themselves and no one cares because as one member of staff said in the scheme ” we have the health and safety of our staff to consider”. In this scheme a latch was broken on the door and people could just come in from the street. That was duly fixed when I called round to see my daughter and in despair I knew something had happened. Care is inadequate. Why not bring in some of the patients themselves to help in such situations- they know best – The patients like to help others and I have seen my daughter helping the most weakest and vulnerable people on the ward herself. I have also seen my daughter snap out of a psychotic situation when approached by someone she knew on the ward. It appears that so much pressure is being put on the police to intervene when the professionals themselves do not want to are incapable of, however there are people that would like to help and that is the patients themselves – people who have been through hell and on the wards and know what that person is going through. It is groups like I go to that should be awarded some kind of funding to do what the Crisis Team is failing to do. As for the first message it is wrong to be sceptical about deaths following restraint. I was impressed with the police training course however it is how you restrain that person that counts but even so, if a person is on a huge level of drugs like my daughter she has often complained of palpitations and strain to her heart. The drugs cause this – drugs that are classed as being safe are passed in the most dubious ways and Professor David Healy correctly identifies this – yes it is possible for someone to die if faced with overwhelming stress and again there is lack of understanding because only someone who has been on this shocking drugs would be able to tell you how badly they felt on them. As regards the absconded patient – it seems that the staff do not care if a patient is voluntary but if they are sectioned then that is a worry for the staff if they go missing and my daughter often went missing. Once she was on a Section 3 and went missing all day. She was allowed to take out money from her scheme and another patient acted as her carer. In fact my daughter had a very nice day out better than stuck on a dismal ward where there is nothing to do. However the police were looking for her and a member of staff thought it amusing. On another occasion she was voluntary but should have been sectioned due to her extreme vulnerability – however staff could not have cared less because she was not sectioned but however she was with a patient who was sectioned and that prompted police to look for the other person, not my daughter and they were missing late at night. The reason why the staff were worried were because under a section they could be in trouble if a person went missing and something happened but they do not care when a patient is just voluntary – they just wanted the police to do their job for them.