The criminal trial of PC Maurice LEIGH and PC Neil BOWDERY was brought to an end today when the officers were cleared by a jury of wilful neglect. Various questions remain about the incident which led to Mr HOLT’s death and to the events which preceded it – I certainly have loads.
This is not the first trial to occur after officers have been accused of wilful neglect in public office following the detention or re-detention of a patient under the Mental Health Act. I also fear that it will not be the last and I worry that it may be me or one of my officers next.
This blog is published at a point where my team are currently looking for an AWOL section 3 patient who has a history of being resistant on arrest, so who knows how things will go when we find him? For all these reasons that I have given the following advice to my team about the detention or re-detention of anyone under the Mental Health Act, and for that matter that arrest of anyone for crime who is obviously mentally unwell:
- The Three As –
- Arrest – make your detention
- Ambulance – call one every single time.
- Assess – either with the paramedics or on your own if they don’t attend, assess the person for RED FLAGS
Then, you do one of three things –
- RED FLAGS to A&E – if there are any concerns at all.
- No RED FLAGS to Psychiatric Unit – either the place of safety for s135/6 cases or the hospital from which they are missing for s18/s138 cases;
- Police Station – only when all else has failed, you can’t improvise around it and you’ve no other option at all.
RISKS FROM RESTRAINT
Police officers need to understand and react accordingly, that the restraint of psychiatric patients can be a medical emergency. Every bit as much of an emergency as a heart attack, a stroke and or a serious head injury. This is true because regardless of how alarmist this may sound, it is unarguable that where prolonged restraint is ongoing, we simply do not know the underlying health problems that may be causing resistance; or health problems that may be caused by resistance.
They need established before we make precipitous decisions about treatment / care / detention. So raised awareness of this needs to go beyond our understanding our training: it needs to be reflected in professional practice decisions like calling mental health professionals and ambulances to relevant incidents. Only recently, I wrote about this and so will say no more here.
Obviously, the incident which led to the tragic death of Mr HOLT was part of a search enquiry for a missing AWOL patient. We should therefore remember what the Code of Practice says about this, bearing in mind he was found and re-detained and died in his own home:
- “If the patient’s location is known, the role of the police should … be only to assist a suitably qualified professionals.” << Para 22.13 MHA CoP. – Can anyone give an example of this happening? I’m sure there will be some, but I don’t know of any.
- All conveyance of patients detained under the MHA – and this includes initially detained or re-detained by the police – should be done a non-police method. – In reality, this is going to mean a role for 999 ambulances because we cannot predict the need for police usage of ss18, 136 or 138 MHA.
I also have a concern about the fact that during the criminal trial, it is reported that when officers have first attended the address, there was no reply when they knocked. They have then proceeded to enter the building and I’m curious about what legal authority? There is no power to enter a premises without permission or a warrant unless it is believed that life / limb are at risk and this doesn’t appear to have been the case.
More mental health LAW training all round – it’s not the restraint / clinical awareness stuff that we need training on. More training on that would be better than what we get, but things like positional asphyxia are covered in training. What is missing from training, is legal training about section 18 MHA, s135(2) MHA and Chapters 11 and 22 of the Code of Practice. All of those have a bearing in this situation which is why as this case has unfolded since August 2010, I have followed it and progressively wondered how on earth it came about, given our legal and guidance frameworks.
DEFENCE AND AUDIT
Now, I understand that mental health trusts will often say that they don’t have the staff to lead the recovery of AWOL patients, as per para 22.13 of the Code. Some ambulance services (which may or may not have been the covering service for some of the cases where officers have been prosecuted) will distance themselves from Chapter 11 of the Code, arguing that “an intensive care unit on wheels” is not needed for someone who is “just” mentally ill. << Their words, not mine.
Without wanting to sound harsh, I have to say that I simply don’t care. Not one jot.
The prosecution of my colleagues in Kent arises because they were able to be accused of a kind of wilful neglect. Part of demonstrating that the detention and handling of patients was not done with a casual regard to their safety and dignity, is doing things as envisaged by law. So if there is a reasonable belief that a patient is at home and they need to be detained, officers tasked with the missing person enquiry are quite entitled to ask the MH Trust to provide resources to accompany them. Whether this comes from the ward staff, the crisis team, the community mental health team – I don’t really mind or care but the answer to any resistance or protest about it is “Para 22.13 applies here, so if you’re refusing, I’m documenting your name in my audit trail in case legal consequences follow on from this.”
Staff and managers refusing should bear in mind the Munjaz case: Codes of Practice, whilst not being binding, are not mere advice that you can take or leave – they are statutory guidelines that should be complied with unless there are “cogent reasons for departure” and it is up to the departing organisation or professional to justify that. So it is for trusts to decide how they want to resource this business, just as it is a matter for Chief Constable’s to decide from where they will suddenly get 50 detectives for a murder or several hundred officers for a riot, difficult thought that also is.
The re-detention of psychiatric patients is a predictable aspect of running a mental health trust. It therefore amazes me that so many are utterly unwilling / unable to do it. Any suggestion that they won’t undertake such tasks, should never stop officers from asking for it. There is a legal basis for asking for it, so it should be done.
Equally, once they had decided to enter the address and they found Mr HOLT there, they should have called an ambulance, not least to discharge the requirements of Chapter 11 of the Code, but it then would have meant, after the violent episode in which he was restrained and handcuffed and one of the officers injured, paramedics would have been able to take over the clinical monitoring of him and would have been better placed to react from the point of view of skills / equipment, if his deterioration had occured. South-East ambulance service may or may not agree with this approach, but that’s a matter for them. There is a legal basis for asking.
The law of England is predicated upon mental health services providing certain services, undertaking certain tasks and doing it in reasonable timescales to ensure clinical wellbeing. These duties are under-pinned by Royal College Standards, NICE Guidelines and the fallout from a range of inquiries and cases which have proceeded through the courts. By not ensuring that we push for support or leadership from the most appropriate professionals, we merely create the conditions in which neglect can be alleged.
Winner of the Mind Digital Media Award.