Introduction

To see any of the other paramedic series blogs, refer to the index:


There was a recent suggestion by a Police and Crime Commissioner of physically situating police and fire services in the same buildings to facilitate greater inter-operability and overlap in the use of equipment / resources. My first reaction to this was, “why Fire? – surely there are greater overlaps between the police and the ambulance services?”

I can’t tell you how many jobs we go to with West Midlands Ambulance Service, it is far too numerous to count, but when we get there we are often working hand in glove. I have never, ever stood in a building with a fire officer making sure our joint decision-making stacks up to an effective intervention involving staff from each organisation – I’ve either been asking questions relevant to my criminal investigation of arson or taking direction about the extent of cordons or evacuations they need put in place when dealing with a fire which threatens public safety.

In contrast, my response team sees the ambulance service almost every day, sometimes several times a day; and the nature of the interaction is that someone needs an element of both healthcare and security and we have to work very closely together. 999 operators often despatch both services together.

It would be remiss of me not to mention the success West Midlands Ambulance Service have had in recent years.  They are currently Ambulance Service of the Year 2012 and when I talk to police officers who work outside my region, they are often surprised at the response WMAS provide to this area, in terms of mental health.  I know why and I’m proud to work alongside them all.

A “PARAMEDIC SERIES” OF BLOGS

I’ve taken some advice from paramedics I know about what would be of use and / or of interest about the role police when it comes to mental health related incidents. After their advice, I have written a number of blogs, to address several types of situation –

1.  The one where you are going to call the police into a situation you are already dealing with; and
2.  The one where the police are calling you into a situation they are already dealing with.
3.  The one where we’re both called to a Mental Health Act assessment being coordinated by an Approved Mental Health Professional; or to a situation where we start wondering about the application of the Mental Capacity Act 2005.

4.  The one where the legal detail of the MCA is covered, when thinking about whether it allows detention and restraint of someone who lacks capacity.
5.  The one where we cover the different kinds of assessments that can occur involving mental ill-health
6.  The one where we cover some legal issues about the use of force – both in terms of self-defence and the safe detention and conveyance of patients detained under the MHA.
7.  The one where we explain what an AMHP is?

I have been advised to do this whilst presuming no legal knowledge at all, and limited mental health training because it can then be read and used by trainees at all stages of their career.  If you think these posts are useful, I’d be grateful to you if you could raise awareness of them via social media or your professional networks.  It will be done over a few posts, to keep each of them short-ish and consumable – but they’re all listed below.

Treat this post as a general introduction or an index to them – I may add to it if you give feedback on the posts or we think of more ideas to cover in a “Paramedics’ series.”  The posts are, by necessity, summaries pitched at Paramedics – they contain links to the longer, substantive posts I have written which fully explain various issues and which are replete with legal technicality and links to specific stated cases, guidelines, etc..  At the bottom of each post are links to the full index of this blog and to the “Quick Guide” series I wrote for police officers which you may also find useful.

If after wading through these you want to think about the knowledge I’m aiming for police officers to achieve, please see this “Knowledge Check” post << everything you need to know about policing and mental health in 500 words.  I also once wrote a post about what the police would like the NHS to know and it has been widely read and circulated within the NHS.  Actually, it is in the top 5 of my ‘most read’ blogs ever.

Posts that may be of general interest on policing / mental health issues –

  • RAVE Risks” – this is a mnemonic meaning Resistance, Aggression, Violence or Escape.  It is my way of attempting to summarise how we judge a situation involving mental ill health where it may appropriate or very necessary to involve the police.
  • Biology, Psychology or Sociology – a post which skims over the different approaches to mental illness.  I found this fascinating to learn and it goes some way to understanding from a 999 point of view why you sometimes feel you are banging your head on a wall.
  • What If Richard Bentall Is Right? – some thoughts about our system of mental health care and the criticisms it often receives.
  • Autonomy and Mental Capacity – some thoughts about respecting people’s right to make decisions.  Absolutely key to our 999 work is considering when it may be right to let someone take an unwise decision.
  • Care in the Community – many people wonder whether community care is responsible for tragic events.  Some thoughts on this, as well as the the history and the alternatives.

NB: I’m using the word “paramedic” generically – I’m aware of the differences between technicians and paramedics and that we see third-sector ambulances which contain first-responders who are neither of the above.

LAWS AND ROLES

Firstly, you’ll see that there are different ranks and roles of police officer. I have previously written a detailed explanation of them all, but you’ll probably just need to know three on the frontline:

  • POLICE
  • Police constables – they wear numbers on their shoulder and actually do the work!
  • The sergeants – they wear collar numbers and three stripes.  They supervise, oversee and direct where necessary.  You are quite entitled to ask to speak to one, if you think it’s needed.
  • The duty inspector – my ‘proper’ day and night job – is the senior operational police officer and every area has one, 24/7 – they are the final decision-maker, they oversee the critical and serious incidents and they handle complaints issues.
  • The duty inspector may also referee some of the politics which I regret creeps into our attempts to make this work – especially when resources are tight or many agencies are struggling to cohere.
  • NON-POLICE
  • Approved Mental Health Professionals, known as AMHPs (pronounced “amps”) – usually a social worker, occasionally a psychiatric nurse or another mental health professionals.
  • AMHPs are legally warranted and at the centre of MH assessments which occur in a different few situations mentioned below. It is a criminal offence to obstruct an AMHP in the course of their duty, under s129 of the Mental Health Act 1983.
  • LAWS
  • I previously wrote a “Quick Guide” to the Mental Health Act – this lists all of the relevant section numbers from the MHA and gives a sentence’s worth of explanation for each.

If you want more detail on these subjects or any others, please email me on mentalhealthcop@live.co.uk and I’ll happily add more posts and link them within this page.  Some police officers have saved the blog itself, the Quick Guides or specific posts to their homepage on their iPhones as a reference – I add that just as a thought you may find useful. There should be an App available during 2013.

FURTHER READING

Don’t forget three methods of using this blog to find out more:

  • There is a full index of almost 350 posts on all manner of topics.
  • There is a series of “Quick Guides” originally intended for police officers, but some will be of interest to paramedics.
  • There is a “search” facility in the top right hand corner: by entering any keywords on policing / mental health will bring up the relevant posts, including entering sections of the MHA like “s136”.

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.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


 

Advertisements

12 thoughts on “Introduction

  1. I think any attempt to facilitate different emergency services in the same building would be shortsighted and dangerous. Different areas have different dynamics but here in West Yorkshire public confidence in the Police is so low and mis trust so high that any joining would have a net negative effect.

    I have been involved in a number of situations (mainly when i used to run a pub) where paramedics have been called to help. You may be shocked at the number of times i have heard paramedics explain to people that they are only interested in their welfare and have nothing to do with the police, often with reassuring effect. People will talk to paramedics and tell them what happened, how they got their injuries and be honest, making treatment easier. It’s amazing to see how peoples behavior changes when the police arrive or just stand too close.

    If paramedics lost that independence people would mistrust them like they mistrust police officers. This would not be a good situation for anyone.

    1. I’m not suggesting we do merge buildings, functions or anything else – you rightly identify important issues as to why not. I’m merely wondering where on earth the “Fire Brigade” thing came from when the natural overlaps with another 999 service lie, if anywhere, with our colleagues in green. It was merely a rhetorical device to start the posts! 🙂

  2. I fully endorse a closer working relationship with police officers, to the point where, after specialist mental health training, we & the police could be co-deployed in a response car, to jobs requiring mental health or mental capacity assessment.

    There would need to be considerable change in a number of areas. These challenges shouldnt be shied away from. They should be embraced and acted on. For the sake of some very vulnerable people.

    Tj
    @meditude

  3. TJ.
    The original suggestions are about consolidation and cost cutting.
    What you suggest would mean at least twice as many resources are deployed per case.

    This isn’t about having plod hold your hand while you do your job.

    1. You’re missing the point, may I respectfully suggest. Most mental health situations which lead to the emergency services via 999 involve clinical and security risks – the police don’t do clinical welfare, except consistent with a basic first aid certificate; and paramedics don’t do security and restraint, except where consistent with maintaining their own safety.

      I’d actually quite like a paramedic holding my hand during various clinical nightmares I’ve dealt with in my police career and I’d would love to be able to prevent crime against NHS staff whilst they face very real challenges. If you never crew the agencies together, you can only ever deploy one set of skills and if you do deploy them together, you might deploy both and then find when you get there that one party is redundant. << None of this means always going everywhere in pairs like lemmings entering the Ark.

  4. I would just like to say thankyou to MentalHealthCop for your series of blogs and information on the intricacies surrounding the Law and Mental Health. I am taking my Part 1 exam next week and have noticed very little detail in MHA or MCA in Blackstones. I’m guessing this won’t be an area of which many questions are asked but find myself thinking that maybe it should be given more credence within the exam

  5. Slightly broader than the leading article but looking at the question raised about co-location.

    First let me identify the ground I stand on, I am a recently retired Group manager from the UK FRS

    To consider co-location or cross skilling in the context of one operational scenario is risky

    The key to effective management of any incident, be it minor or critical, is a clear command framework, good communication, and an understanding of the skills and constraints that come with each element of the resolution team.

    Co-location of non operational elements makes very good sense where a net saving in ‘backroom’ duplication can be made in corporate services. In my county there was a scheme for the co-location of all three blue light services onto one area HQ but Ambulance trust pulled out as it was not seen to be in their interest. There seems to be a paranoia (possibly justifiable) among Ambulance service managers that FRSs will seek to absorb them / take them over. From an operational management/ mobilisation point of view there is much to consider, but from a clinical practitioner perspective the current operational paramedic element has an outstanding skill set that does not need duplication. However if you look at Irish FRS many of them are a Fire and Ambulance Service along the US model.

    There will always be clear demarcation between the various roles as best illustrated by the structure of major incident procedures; Police; secure and coordinate, Fire; rescue and make safe, Ambulance; triage, stabilise and remove to definitive care.

    The sooner certain ‘less flexible’ elements in all services disregard the much vaunted term ‘Primacy’ and just have open discussion about capability, options and limitation regarding the specifics of the current incident or exercise (joint training is virtually non existent in the current ‘low staff, low budget, high workload’ environment) the better the public will be served.

    1. Phil,

      Although I don’t really think this is the ideal forum to discuss this, I feel i need to reply to some of your points.

      I think it is unquestionable that duplication of elements of any service is wasteful, but I would argue that there is little that could be shared between FRS, Ambulance and Police. We are three very different services. Personally as a paramedic for an NHS Trust,I can count on two hands the number of times I’ve been involved with FRS on jobs. I agree that for major incidents, working together and singing from the same hymn sheet is vital – the percentage of our (or police) time that is spent dealing with major incidents is minimal. I also agree that we spend far too little time inter-agency training, but if you were to say to me here is the money for one day of training per member of staff per month there are reams of other areas that would be far more beneficial to a far bigger population than major incident training.

      Personally, I don’t see how and FRS could ever conceivably run an ambulance service – the nature of the work is poles apart not to mention the demand. If the ambulance service were ever to merge with other services, it would (or should) be NHS based. There have been many suggestions for there be to centralised management of all out of hospital NHS services – or at least out of hours services. Ambulance services are moving further and further away from “triage, stabilise and remove to definitive care” every day.

      Aside from this argument, “The Paramedic Series” is a fantastic resource which has helped me countless times in the real world – thank you for taking the time to create it!

  6. An excellent blog, many thanks for your insights. I work as an EMD (999 call taker for the ambulance service, sadly not WMAS, although I have a huge amount of respect for the way they work) and I probably get 1 call a fortnight from the fire service and I probably pass as many over to them.

    I couldn’t count the number of times I speak to police in a shift and one Saturday night I think about 90% of my calls were from the police requesting help. Some are mental health, others are assaults, RTCs, concerns for welfare and others which I never quite understand why they asked for police in the first place! On New Years Eve we had a dedicated call taker who had a fixed open line to police, who’s job it was to simply exchange details on calls all night.

    There are only a handful of times where Fire are requested for an RTC and even fewer times when we are called to a house fire where there are persons reported (again, there may be some other incidents where Fire and Ambulance are both deployed, but these are too few to recollect).

    As such, even the police and ambulance control rooms seem to have an excellent close working relationship. We sometimes visit each others control rooms to learn more about how we work.

    However, I have read media reports suggesting that Fire could respond to some Ambulance calls as the Fire Service have medics who are not utilised as much? So in this instance, could the Fire Service be called to assist police as Medics? Just a thought….

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s