An incidental introduction to this month’s newsletter – this is my 300th post on this blog and not long ago, we surpassed the milestone of 300,000 hits. Averaging over 1,000 hits per blog is not bad going for the fact that I’m banging on about the potentially very dry subject of mental health and criminal law, as well as policing and mental health guidelines. I’ve now managed to set up a YouTube account (and have done a test post!) so I intend to start playing around with video blogs, to present a lot of this stuff in a different medium and to supplement the written versions you’ve already read. First of those should appear during June, so keep an eye out!
I will celebrate reaching these thresholds in the usual manner: after pay day I will crack open a new packet of plain hob nobs to enrich my morning coffee experience. POLICE WARNING – chocolate ruins hobnobs.
It has been quite a busy month! – hence a few more blogs than I would have intended, but there’s been an exceptional amount to cover, including –
- The Adebowale Report
- The Home Secretary at the Police Federation Conference
- More MS v UK cases
- Interesting Crown Court appearances
- Taser Statistics
- MSc in Mental Health and Law
THE ADEBOWALE REPORT
The most important event of the month in policing and mental health has been the publication of the Adebowale Report. Although specifically about issues which arise from the handling of fifty-five cases in the Metropolitan Police area, the report has rightly been stated to be a report of national significance. The report doesn’t pull any punches: it led to national newspaper articles which talked of “police failings” leading to avoidable deaths.
Thankfully, the balance of the report when you read it cover to cover, recognises the role that health and social care organisations have to play in both preventing the escalation of some crisis events and in supporting the police when they intervene in high risk situations. Of all things in the report, I was particularly keen to see mention being made of the ambulance service – their role in reacting to mental health emergencies irrespective of whether the police were already present; and in terms of dedicating resources to the issue of mental health, with pathways into primary and secondary care. I took a view that in the case of Colin HOLT who died after being re-detained under the MHA by Kent Police, that involvement of an ambulance would have contributed greatly to a better response and as it is a requirement of the MHA CoP to transport detained patients by ambulance vehicle, one should have been involved at an early stage.
The Metropolitan Police are implored in this report to introduce a range of mandatory training – I was delighted to take a phone call from a senior Met officer on the day the Report was published, thanking me for work in support of them and inviting me to contribute to the development of that training. I look forward to that enormously.
HOME SECRETARY AT THE POLICE FEDERATION CONFERENCE
The Home Secretary committed more of her annual speech at the Police Federation Conference to mental health issues than ever before. In recognition of what a priority it is for the service and for her as Home Secretary, she committed to “a drive” to stop police cells being used as a place of safety. In her speech, she managed to provoke some disquiet amongst our colleagues from the ambulance service when she referred to them as “Ambulance Drivers“. My post about the use of that term is now the 4th most read post I’ve ever written and my blog dashboard suggests it was being widely read around the ambulance service! Given what Lord Adebowale said about the importance of the ambulance services’ support for police interventions on mental health, it is important that we properly understand what paramedics and emergency technicians bring to the party.
The Home Secretary also made mention of rolling out nationally a scheme whereby mental health nurses accompany police officers. This is being done in certain areas of the country already, like Leicestershire. I don’t necessarily object to that approach, but I have offered some views about “Street Triage” that I think are worth bearing in mind to those who are thinking of committing money and resources to such schemes. What problem, precisely, are we trying to solve by sending mental health nurses to incidents and is it the most effective way of solving that problem? All views welcome – so post comments if you have any.
MS v UK
Do you remember the case of MS v UK? It was a human rights case which led to the UK government being fined for breaching Article 3 – the right not to suffer inhumane and degrading treatment. You may further remember, that one purpose of court judgements is to interpret the law in such a way as to define the standards expected.
It is therefore with regret that I recall a case this week in my own force area where a lady with a considerable mental health history had been detained by the police under s136 MHA. Because the NHS place of safety was unable / unwilling to accept the patient’s detention, she ended up removed to the cells. She was obviously in a floridly psychotic and acute condition. By the time she had been removed from the police cells after 50hrs of detention, I was shouting “MS v UK” very loudly in the custody officer’s ear in order to give him the words to press NHS buttons. It seemed a shame that onward removal from a police cell only occured when the police start saying legal things, implying challenge and sanctions and not because it was recognised that when you get to a point where you are naked in a police cell and drawing on the walls of the cell with your own bodily fluids, it’s all starting to look a bit “MS v UK shaped”.
In this incident, the lady concerned was acutely unwell – over the course of fifty hours in custody, she would not eat or drink; she would not consent to medication that was offered to her; she declined to allow police custody health staff to ensure her ongoing wellbeing by taking her medical obs. So concerned were we for her welfare that at one stage we called an ambulance to see whether our colleagues in green could persuade her to be examined. This was all because, the removal of her to the police station had not occured after good physical examination of her by paramedic or A&E colleagues. The paramedics who came to police custody were outstanding and after lots of patient negotiation over some period, managed to get her to consent to basics obs checks to confirm her basic health remained in order. I wrote to their boss praising their patient, persuasive skills.
Mental health trusts and NHS Commissioners need to recognise that case law from the courtss defines standards that are subsequently expected and to which vulnerable people are entitled. This needs to be reflected in our operating protocols and this incident got me thinking: what are MH trusts business continuity plans for situations where their s136 PoS is out of commission? Business continuity planning being a another legal requirement. I know what happens in my force if our cell block shuts down, as it did last year for a major electrical fault. What happens when a 136 suite has to shut – bearing in mind paragraph 10.22 of the Code of Practice?
CROWN COURT APPEARANCES
You may have noticed: in the last few months two defendants who were arrested for murder, sectioned under the MHA and subsequently charged with murder have appeared directly at the Crown Court, bypassing the Magistrates’ Court entirely. Why is this? It comes back to powers of remand under the Act – Magistrates can only exercise powers of remand after a person is convicted before them or found responsible for the incident. When a defendant first appears before them, they can either remand the defendant to prison or bail them – they cannot authorise ongoing detention in hospital.
The defendants who have been charged by West Midlands Police with the separate murders of Christina EDKINS and Amarjit Singh BAI were both arrested and sectioned because they were unfit to interview. I wrote about why this is done in a post after the first of these terrible events. It shows how, if mental health services and criminal justice agencies think creatively and work together, the twin-track system and MH / CJ can work together to ensure both safety and security in the name of achieving justice, as well as patient assessment, treatment and crucially, informative psychiatric reports which will be produced for both trials later in the year.
There was an interesting article in the Independent this month about a Freedom of Information application made to all police forces about the use of taser on mental health patients. The piece is headlined to suggest it looked at taser use on psychiatric wards but the article itself talks more widely about detention and conveyance, which are separate matters – so we need to bear this lack of clarity in mind along with the fact that not all forces responded to the application for information.
It is reported that 52 uses occured over a three-year period and we then read certain objections which we have heard before about the usage in the context of mental illness. I have replied to those objections before and since writing about it have had more direct operational experience of taser being used under my authority. I’m not sure that anything in this article or arising from recent incidents convinces me to change my view that a) we cannot hope to resolve all incidents to which the police are drawn without any of them involving the use of force; and b) taser cannot be ruled out, because it will occasionally, albeit rarely, be safer than the alternatives.
What we need to have, is awareness of the risks involved in this approach and an ability, often quickly, to weigh them against the risks involved in –
- Doing nothing << bearing in mind the criticism that we know will follow if the police are perceived to have done too little where subsequent untoward events occur;
- Use manual restraint << with all the recently-debated risks around positional asphyxia, etc.; and the risks to officers from trying this where dealing people who are armed with weapons;
- Use police batons << this does mean hitting people with metal poles;
- Use of CS spray << which often does not work on mental health patients and cannot be used in confined spaces;
- Use of firearms << the risks of which speak for themselves.
You may also want to watch and read about the Buckingham Palace taser incident. The man arrested in this incident was yesterday pleaded guilty to two charges of possession of knives in a public place and sentenced amongst other things to a mental health treatment requirement. Another charge of affray was dropped at court.
MSc IN MENTAL HEALTH AND LAW
I sometimes think I could have been a perpetual student! … I admit I’d love to do a PhD one day and I keep spotting MSc courses that I would have loved to do. I’m very conscious that I’ve got absolutely no qualifications whatsoever in this chosen area of interest and I keep looking about for some kind of course that I could do, to claim some legitimacy. I recently saw an MSc in Mental Health and Law, which will be available for the first time in September this year at Queen Mary’s, University of London. This includes part-time and distance learning options, which may be more suited to some.
Having made some enquiries with the course developers, I end finding myself invited to contribute a couple of lectures to the course(!) and I’m currently enjoying putting together some materials for the next academic year. So it occurs to me, that it may be my “qualifications” are the operational experiences as a police officer of fifteen years and that of lecturing on two post-graduate MSc courses at Russell Group universities?! That will have to do! Interesting to note however, that the Adebowale Report recommends that Mental Health Liaison Officers should benefit from continuing professional development, so maybe there is scope for a qualification in policing and mental health? Any university providers who think they’d like to develop a distance learning based qualification?! – please get in touch if you would, as I’d love to be involved and think there could be a market for it in the future.
Finally, by the time you’re reading this post, I’ll be waking up to this in my favourite place in the world! Much needed R&R and a two week break from blogging –
Winner of the Mind Digital Media Award.