Deflecting Demand – Safe and Well Checks

A person with mental health problems who may have taken an overdose walks out of A&E before conclusion of an MHA assessment and before the results of blood tests are fully known.  What do we always call for? – a safe and well check by the police, right?!  Yes.  But it’s pointless; and here’s why –

Nathan CONSTABLE writes much that is moving and insightful about mental health and policing – if you’re reading this because you’re interested in what I write, you should also check out his blog.  We don’t always precisely agree on things and that’s a plus for me, because he really keeps challenging my thinking which I find a very healthy thing.  His latest blog entitled “Crisis? What Crisis?!” gets the mind moving – about what the police are FOR, and what the police can DO:  where does the role start and stop?  It also hints at it issues about how the NHS are handling austerity.  And I don’t entirely agree with him in this blog, although we’re roughly on the same page!

I have had two mental health professionals tell me this month alone how some of their managers are deliberately cutting or restricting services and making ‘policy’ decisions that the NHS will purposefully deflect demand for health services to the police.  << You read that correctly: where the NHS cannot or have chosen not to provide a service for health issues because they have begun to argue they are not commissioned or obliged to do so, they will deliberately direct that demand to the police. Criminalisation of vulnerable people, mostly.

Now, I’ve always said that there is no dividing line between crime and health  – much though many would like that to be so – and that mental health issues are core police business.  So just as I agree with Nathan’s assessments in the examples he cites, we will all agree that where anyone else is threatening other people with knives, there is going to be a role for the police.  But if that incident comes around because of a thirteen-year old with established or even just strongly suspected medical or mental health problems, there has to be a pathway to care available to the officers who had to front up the knife.

We also had a very similar job to Nathan’s just this week, it’s just that ours involved a ten-year old throwing objects at his physically disabled parents.  The NHS response in our case was, “Can’t you arrest him?”  Well of course we could he’s assaulting his parents; whether we should is a quite different assessment.  Do we really want a ten-year old with established medical problems under a CAMHS specialist in the cells?  I admit I’m not a fan of the idea, so let’s try EVERYTHING ELSE, first.

SAFE AND WELL CHECKS

Police officers cannot do safe and well checks on medically vulnerable people.  We just can’t – because we’re not trained or equipped to do so, no matter how much we might want to help or how urgent the issue is. I’ve written about this before in a productive debate with ambulance blogger Ella SHAW.  Her view on all this was a guest post on my blog last year. <<  Crucially, this does not mean that we should not or will not be involved in trying to locate people at risk or in managing safeguarding risks arising from medical vulnerabilities of all kinds.

It merely a remark about limits.

Our basic first-aid at work certificates, the legal limits on the circumstances in which we should assess capacity and an inability to stare at someone and tell what unknown or unquantified substances may be doing to their vital organs prevent this.  We can “safe and well check” a child who may at risk from forms of abuse – because we are trained to assess the backgrounds of adults they are with; whether they have physical injuries; we are trained to speak to them and to question the adults they are with about concerns in a way that allows us to highlight potential safeguarding issues.  We also have legal authorities under the Children’s Act 1989 to take kids into “police protection.”  It’s what Parliament intended to happen.

It is probably from this that we assume the police can “safe and well” someone who has walked out of A&E against advice.  But of course, I can’t! – I can tell you whether he’s where you think he’s gone; whether he’s alive; whether he’s breathing and conscious but absolutely none of that amounts to guarantees on a short or long-term basis to whether he is “safe and well.”  And even if it were obvious that he’s not safe and well – let’s say because we find him self-harming and at risk, there are limits on police officers’ legal powers in his home address.  We have none, unless he is committing an offence – so what do you want us to do?  If you don’t have an answer for that, you’re passing the buck, I’m afraid.

He may or may not look “fine” to me, even to you – but here are two facts:

• A healthcare professional doing a visual examination, or asking clinical questions will get nearer to the truth of somebody’s safety and wellbeing that anything I can do – I can only advise the person to seek help ASAP.
• It is health and social care professionals, not police officers, who have the legal ability to arrange the coercion of someone from their own dwelling if that is felt to be necessary – so please have a plan around what this looks like if it turns out to be needed.

RETHINKING THINGS

So here is what I hope >> that all police forces will consider reviewing their approach to “safe and well checks” for any kind of medically vulnerable person by asking just one question: “Once we find them alive, breathing and conscious – who do you want us to tell?  Because we could not, even if we wanted to, establish whether they are safe and well, medically speaking.“

We want a detailed brief based upon the risks that person faced when they walked from A&E or declined treatment to their CMHT for the potential overdose they’ve taken as to whether we –

1. Call an urgent ambulance and consider Mental Capacity issues;
2. Call the CMHT and request arrangement of an urgent MHA assessment;
3. Refer them to A&E on a voluntary basis or to their GP for follow-up.

And of course, you can’t tell this either because in the hours they were missing or absent, they could have done any number of things that would alter an assessment of their safety and wellbeing.  They could have deteriorated to a certain degree, their capacity will have fluctuated to some extent or they may have consumed alcohol or (more) drugs – you’re going to have to come with us and help if you want it done properly or react in support of us once we find them.  If you don’t or if you won’t, you may find your refusal to arrange (mental) health assessment in situ recorded by the police, in defence of officers legal inability to act or tell.

The police can’t do safe and well checks on medically vulnerable people – we only ever establish where they are and whether they are Alive – Breathing – Conscious.  The ABC of “Safe and Well Checks”.  So if you’re a cop, don’t over-reach yourself by pretending you can doing anything other than a) find them; and b) call for medical assessment of people who are found ABC.

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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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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

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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

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