March Newsletter

Since deciding to blog a bit less often, it has caused me to think about how I can develop this resource differently and I’ve decided to instigate something of a monthly ‘newsletter’ – which to give me a memorable deadline, I’ll publish on the 25th of the month.  The aim here, is to refer to a few news articles, reports or other little ideas or incidents, without detail.  As previously indicated, I’ve covered most of the detail in the posts already written, to which I might refer people through the newsletters.

The remaining ideas I have for new posts will be published one at a time on the 10th of the month.  I will do additional posts only if they are specifically indicated for particular reasons.

POLICE POWERS IN A PRIVATE PREMISES

On 10th April 2010 two detained patients on a mental health ward in east London were involved in a violent episode during which Mr C killed Mr E.  An independent report has recently been published on the care and treatment received by each man, as is required by the Department of Health following a homicide incident.

The panel involved in the preparation of this report included a retired Detective Chief Inspector from the Metropolitan Police, alongside a senior psychiatrist, nurse and social worker.  It emerges in the report that on the 01st April, the police and ambulance service were called to Mr Cs home address to a report of him behaving violently.  Unfortunately for a clear understanding of what occured, the nature of the violence is not specified in terms of whether there were assaults committed or damage caused.  Suffice to say, in paragraphs 7.22 and 8.95 of the report, mention is made of Mr C’s violence.  The panel express surprise in latter paragraph that “given the nature of the circumstances outlined by the family of Mr C it is somewhat surprising that Mr C was not taken into police custody on that evening for a Mental Health Act assessment.”

I make an observation amidst a context of it not having been specified what the nature of the violence was and whilst inferring from the report that Mr C was within the family home at all times when the police were there:

There is no power to take him into police custody for a Mental Health Act assessment.  Whether he could have been taken into custody for an offence arising from the “violence”, is not clear without the nature of the violence being specified.  But on the face of it, I cannot understand on what legal basis this assertion is made: even arresting him for an offence is not taking him to custody “FOR a mental health act assessment.”  It would be taking him to custody to investigate the offence, thereby criminalising him.  Maybe that was justified – but as the report declines to specify the nature of the violence, who knows?

Maybe the officers at the scene could have contacted an AMHP and asked for a warrant to remove him to a place of safety for assessment?  Such ideas link to an incident I dealt with recently:

WARRANT OR NO WARRANT?

My team was called to an incident where everything I have ever written about MHA assessments in private premises was writ large over an incident involving all manner of risks and uncertainties.

I spent a whole day at work in command of an event where we eventually had to use officers in protective equipment, often termed “riot police“, to force entry with shields and tasers to detain a man under s135 MHA.  This came about only because of difficult discussions with the AMHP involved about getting a warrant where the police were initially being asked to fudge an entry to a premises where the patient actively opposed it but where his mother had allowed access to the home.

I have dealt with many similar incidents in my service, but this one was very precisely the kind of incident where the police have no powers whatsoever: man in a house, locked in a part of the building and declining access to others, in possession of a knife.  He wasn’t breaching the peace in any way, not threatening anyone, just wanted to be left alone in the locked part of the house and it’s worth reminding that it is not an offence to possess a knife in your own house.

In the absence of a warrant, the police would have to reply upon his mother’s consent to force the two doors that were locked.  His mother was understandably concerned about the tactics that the police would use to manage the situation – I’m sure that talk of what she thought of as “riot police” or the potential use of tasers would be concerning, but the risks involved were just sufficient to cause alarm at the wisdom and safety of a low-level, casual police approach by normal uniformed officers.  The only responsible way of keeping the police and everyone else safe, was to have officers in protective equipment and this was my call as the senior police officer.

Eventually, after several representations by me about safety and legality; as well as about contingency amidst the potential for the patient’s mother at any time to withdraw her consent to the police being in her house, a warrant was obtained.  After many, many hours of negotiation, entry was forced and my fears about the level of resistance were vindicated.

I went home wondering whether any other kind of approach would have led to serious injury or even someone’s death.  I would suggest that even if there were some room in the debate with me last week about the approach to MHA assessments / warrants I have outlined on this blog, nothing will now deflect me from this being a balanced approach to the safe management of risks.  Last weekend’s incident has left an indelible mark upon my thinking because of having pushed this line through the resistance of others and been utterly vindicated in way that prevented serious injury to people.

In anticipation of some remarks in the next item of this newsletter, the incident took nineteen police officers eight hours to resolve.  If Irish mental health law had applied, we would have resolved it in less than half that time, with fewer than half the number of officers: our police service’s mental health law dates from the 1950s.

POLICE SUPERINTENDENTS’ ASSOCIATION OF ENGLAND AND WALES

The superintendents and chief superintendents of England and Wales have a new President.  Chief Superintendent Irene CURTIS from Lancashire Police, who you can follow on Twitter as @barrackslass, is now the leader of almost 1,400 senior operational police commanders.

In her opening remarks about taking on the position, she highlights mental health issues as one of four areas of significant challenge for the police and I’m personally delighted to see it given this level of emphasis.  I’ve previously stated that some officers at those ranks either struggle to get to grips with the issue as a subject in itself and / or find the partnership environment in which we make progress, very difficult to navigate.

Chief Superintendent CURTIS said, “The police service needs to work with others to address the increasing demands created by gaps and reductions in other agencies’ provision.  When it comes to matters involving mental health, external services’ expectations of the police have reached an unacceptable level.  Police are always seen as the last resort, as the ones that will pick up the pieces.  The responsibilities of all agencies involved in the provision of mental health services need to be agreed at both a national and local level, and be subsequently enforced.

“Currently, the police play too great a role in what is, after all, a medical emergency.  Far too many people detained by police under the Mental Health Act end up in police cells simply because there is nowhere else to take them.  It is not a crime to be unwell and the chronic lack of provision for mental health assessment places (“places of safety”) needs to be addressed immediately, as well as the lack of training for officers to deal effectively and safely with incidents involving people suffering from mental illness.

“The legislation surrounding the use of police powers to deal with mental health is also in urgent need of review and clarification. Currently, under the Mental Health Act, officers cannot detain people who are not in a public place and, under the Police and Criminal Evidence Act 1984, officers can force entry to protect life but cannot detain a person in order to do so.

“Officers are also finding themselves dealing with matters which would normally require the presence of an ambulance.  In some cases officers are simply replacing ambulances because there isn’t one to attend. Police officers are neither trained nor equipped to deal with these issues and it is unfair to expect them to do so.”

I wish her well in her role as I know that frontline cops would like her and her members every success with this priority.

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

6 thoughts on “March Newsletter

  1. On the ‘Mr C.’ case, once again I find the whole police actions issue a red herring.

    Killing occurred while he was an inpatient in a mental health facility. Responsibility lies with that facility – not the police. I can only assume the people carrying out the inquiry are trying to look at wider issues, not just the immediate cause.

    Key issue (IMHO) is their failure to move him to an intensive care (PICU) ward after at least four incidents of disturbed behaviour. An ordinary acute ward should be competent and give good care, but there is a limit to what can – or should – be expected. The report says surprisingly little about the decision making, resources etc on the PICU issue.

    1. No doubt it will be some lowly nurse and/or lowly pleb pc that ends up with their neck on the block rather than someone higher up that made the shit decision. it always is…

    2. Nail on the head for me: like you say, they’re looking at the wider issues and I presume the thinking goes “if the police had done X, Y or Z earlier, then his condition wouldn’t have deteriorated quite as much.”

      I hear what you’re saying, though – loud and clear.

  2. Hello learned friend. I know we have already spoken about it but i wanted others to know how common the precurser to your horrific incident about “warrant or no warrant” is. There but for the grace of God go many of us when faced with similar requests. Over the time I have been the mental health lead for my force I am becoming more and more intolerant of the request for police assistance at assessments where no warrant exists. I am not saying we should never go without one but if police are needed then there must be some element of risk or else why do you need the police. If there is a risk then a warrant is called for. This is not me having a go at the AMHP services we work with because thankfully the vast majority of them are really professional and switched on to the limitations and the risks we are placing ourselves in. This is me saying let us do this job in a professional and ultimately safe way for all those involved. There are still some AMHPs who discount the use of a warrant because we are not having to use force to gain entry. As most of the readers will know there is nothing in a S135(1) warrant about entry having been refused or likely to be refused. Actually the incident you describe is very common, where the family allow access and then change their mind or try and impose conditions etc. This leaves everyone in an intolerably vulnerable position that would not occur if we had a power to control the situation. My plea is to AMHPs to always consider a warrant when asking for police assistance or risk that request being turned down. My plea is to Magistrates to be more open minded about granting warrants. My plea is to Ministers to consider legislation that allows professionals to protect vulnerable people in a much more efficient and effective way.
    Well done Michael and your team and thank goodness you were there and knew what you were doing.

    1. I think this incident just showed everything that could be feared about an MHA assessment happening. I know we plan in our heads for various problems and often find they don’t materialise, but here, everything did: family attempting to control tactics, AMHP reluctant to get a warrant that could be sought; communication failing to persuade, genuine risks around patient’s history and physical environment, etc., etc.. It should be a case study and I’m going to write it up as a blog after a passage of time.

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