To see any of the other paramedic series blogs, refer to the index:
A PARAMEDIC LEAD INCIDENT
Crime – at the risk of stating the bleeding obvious and in order to get it out of the way, anything that involves criminal offences, attempted criminal offences or causing the immediate apprehension of violence – what we call a Breach of the Peace – is core police business.
Specifically, however, you should always bear in mind that it is a criminal offence to obstruct or hinder a paramedic / technician in the course of their work, contrary to s1 of the Emergency Workers (Obstruction) Act 2006. It is also an offence under section 2 of that legislation to obstruct or hinder someone assisting an emergency worker and I have previously mentioned the offence of obstructing an Approved Mental Health Professional – you could find yourself in the position of witnessing an AMHP being obstructed and you should consider on their behalf the ability of the police to help resolve that.
If you and your colleagues are being unlawfully obstructed, you can quite legitimately call for police support. This would include for example, that you’ve attended an address where one person is injured or ill and is seeking your help whilst a third-party is attempting to prevent you from gaining access to them. It is sufficient for your access to be lawful, that one person at that location who is legally entitled to grant access, has done so. It would be worth bearing this in mind at domestic abuse incidents, for example, where a potential offender is attempting to deny you access to a victim who has sought help. Call the police because that person is committing an offence by obstructing / hindering you and we can only imagine that they’ll be keen to help with police enquiries into the original incident, too.
Anything that involves a substantive criminal offence or an attempt to commit one and the police can then use force against the offender to prevent it from happening, or arrest them for it.
General police powers – the police have an authority under s17 of the Police and Criminal Evidence Act, to enter a property by force in order to “save life or limb or prevent serious damage to property.” This authority carries quite a high threshold – it is not sufficient to say, “we have concerns for welfare.” Where you’re struggling to get into a house after a 999 call about serious injury or threats to life, you can call the police.
RESPONDING TO MENTAL ILL HEALTH
Mental ill-health in public – you attend an incident where you are attempting to secure care for someone who you think may have a mental disorder who is a public place. If they consent to your recommendation and agree then all is well and I know the ambulance service deal with plenty of such calls. It’s always interested me that you’re only referral option is to take such patients to A&E and you cannot access MH services directly, in the way that you access certain specialist units for other kinds of medical conditions. Hey ho …
But what can the police bring to this, if the person you’re attempting to help does not consent? If the person is found upon the arrival of the police to be in a public place, to be suffering mental disorder and to be in immediate need of care or control – either in their own interests or for the protection of other people – then the officer can detain them under s136 of the Mental Health Act and remove them to a place of safety. I’ll mention PoS services a bit more, slightly later but there are dozens of articles about different issues within s136 in the blog index.
Mental ill-health in private – if you have concerns around someone declining the treatment or assessment that you believe to be necessary and they are in a private place, then the police are much more limited in how they can help. There is either a gap in the law or a gap in the response of mental health services, depending on which way you view the problem:
The UK is amongst only a few developed countries that does not empower its police to use mental health legislation in someone’s private dwelling – if you’re really interested, compare it with the Republic of Ireland. As such, our powers in someone’s house are restricted to situations where someone is committing a criminal offence or is breaching the peace. To “breach the peace” the person must be behaving in such a way as to cause others to fear an “imminent risk of violence.” So a slightly vague sense that someone may “do something” later or after you’ve left, does not amount to a BoP. << This doesn’t mean don’t call the police, if you think it may help: it is a word of caution that we may not be as much help as you’d hope if the person persists in refusing treatment when we get there.
A few years ago, the Metropolitan Police “used” the Mental Capacity Act 2005 to defend the removal of a patient from their own home for mental health assessment and the courts ruled that this was illegal. The judge reminded us that if assessment was required under the MHA, it could potentially be done at the premises by an AMHP and a DR attending the location and that this approach was Parliament’s intention when they drafted the Act. They even ensured that AMHPs could apply for a warrant from a Magistrate to ensure they could get entry to a premises and control the assessment properly and police officers have to execute this warrant on the AMHPs behalf. The court reminded us that Local Social Services authorities are obliged to have sufficient AMHPs available to meet foreseeable demand for assessments.
And so the worst news is: if you attend a private dwelling and find a mental health related situation which something less than demanding urgent intervention to prevent suffering death or serious injury, the proper response is to engage MH services. This will probably mean the crisis team – and request their involvement, potentially to include an AMHP and a DR if MHA assessment for admission is thought necessary. << Don’t worry(!) – I do live and work in the real world and know that this has almost never occurred when paramedics or police officers have sought it, but it is important to try to secure this response when we know it’s right, for reasons I’ll explain below when we discuss the actually using Mental Capacity Act. I’m also aware that some CrisisTeams do not open themselves up to direct referral from the ambulance service and / or only respond to calls for known patients.
By all means call for police support at such incidents if there are offences being committed and risks apprehended, but I’m sure the police would like me to point out, that we’re somewhat restricted – like you are – in what we can do when we get there, other than arrest people for crimes to prevent them happening or continuing.
In the next blog, I’m going to cover what will be going through the minds of police officers if they call you into a situation they are already dealing with.
Don’t forget three methods of using this blog to find out more:
- There is a full index of over 500 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: any keywords on policing / mental health will bring up the relevant posts.
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
7 thoughts on “You Call Us”
really useful blog, thabks for taking time to put together
Had a discussion with crew mate a few days ago, you touched on it in a blog but i just want to confirm, if we transport someone who is detained under section 2 or 3, it is often without being accompanied by an AMHP, if the situation arises and the patient needs to be restrained, as a paramedic are we allowed to phyaically restrain them (whilst waiting for police back up of course) from your blog i believe we are ubder section 6 (1), just wanted to confirm that applies even without the AMHP present. Many thanks in advance!
I would say you are covered, but I would insist upon a written authority to convey if the AMHP is not travelling with you. This written authority grants you the AMHPs powers of a constable under s6(1), as you say.
Legally, it’s a clear – “Yes, you are!” I’d discuss this managers / unions, though as I know some take a view that even though it is possible, it should not occur. I have my view about that position legally – it could amount to all kinds of neglect in some circumstances – but then I’m not a senior Ambulance Service manager.
For the couple of transfers of detained patients that I’ve done, our local AMHPs do tend to travel in their own car to the hospital, following us. I think they have a “paperwork pack” because we always have a written authority to convey form.
I was wondering, though – I’m a St John Ambulance volunteer, do the rules about obstructing emergency workers apply to us? I’m guessing there could be 2 situations – firstly at an event, where we are the sole provider, and secondly where we are working under a subcontract to the ambulance service and therefore on their behalf?
“that of a person employed by a relevant NHS body in the provision of ambulance services (including air ambulance services), or of a person providing such services pursuant to arrangements made by, or at the request of, a relevant NHS body;”
I read that as events no, sub-contracted by NHS yes.
we fill out a carbon copy of authority to convey form to give to either ambulance or police along with the “pinks” as agreed in a local protocol even though 9 times out of 10 they give them back to us asking what they are supposed to do with them but at least it’s a start
I did wonder what to do with the Authority to Convey copy that we had… An attack of common sense led me to submit it along with our Patient Report Form, so if there was any comeback from the case all the paperwork was present.
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