Do Something!

Can you remember one of my favourite remarks about policing from Egon BITTNER … you should by now, because I’ve quoted it enough! –

“Something is happening that ought not to be happening about which somebody ought to do something now!”

Well, a few years ago we had a 999 call … a psychiatric nurse in the liaison team wanting to tell us that Mr SMITH has threatened to kill his GP and that he had a gun.  We start the ball rolling, because threatening to kill anyone is an offence, guns are serious business and we are the police – badness had obviously occured.

We check the guy out on our systems and find we’ve known him for years, he doesn’t have a firearms licence or any previous connection with guns or violence and he has a massive, Massive, MASSIVE history of alcohol abuse.  It emerges that the GP had referred the patient to the psychiatric liaison team “for assessment” of potential mental health problems and the GP had not rung us about the death threats at all, but instead had started enjoying a week off work.  So we decide to ask a load more questions, not least because we need the GP’s name and number because he or she is the witness to any offence that has occured.

The police were being asked to, “Do something” by attending his address – “he’s threatened people, you have to do something!”  It turns out that the psychiatric liaison team who called us don’t do the assessment  that the GP was asking for, it’s done by the CrisisTeam and they won’t attend because they will be shot, obviously.

So as we attempt to understand more, we speak with psych liaison and the CrisisTeam; and we start hearing different stories about what has occured.  One version is that the threats weren’t specific to the GP, they were generalised, non-specific threats that were not taken seriously and which would not constitute a particular offence.  One of the teams tells us that the other heard these specific threats too; that team denies that they did.  We say that we need to speak to the Doctor, because they are the key to all of this as the direct witness of what did actually take place.  When we eventually get through to them on the phone, the doctor confirms non-specific generalised threats to no-one in particular, except that the man had threatened to shoot himself with a gun – the patient had immediately told the doctor that he did not have a gun with which to do this and the doctor did not take the threats seriously or, himself, feel threatened.

DO SOMETHING!

So, we’re starting to build a picture:  only the psych liaison team and the GP are reported (by others) to have heard threats that would constitute an offence and when spoken to by the police, each denies that they did.  So there’s no offence! – so what is there?

There’s an alcoholic man, whose alcoholism is so pronounced that he consumes 40-50 cans of beer (equivalent) a day and who will drink anything including lighter fluid and methylated spirits.  He has severe physical healthcare problems to the extent that even the CrisisTeam are telling us, that should he at any stage be detained by the police he should go nowhere near a custody office because he could well die if he withdraws from alcohol. << Might remind them of this when they’re turning other s136 patients away in future after consumption of a lager and lime.

So what are we being asked to do, now there isn’t an offence? – a safe and well check?!  We don’t do those, because we can’t.  I can’t look at an alcoholic man in his own house, assuming he answers the door, and tell you whether he is medically OK – neither could the best paramedic or A&E consultant in the country.  In fairness, you’ve already admitted that he won’t be because of his known problems so why are you asking us?!

What I can do(!) and what I want to do to keep you safe, is accompany health professionals as they go about their business of making a health assessment of needs and risks; of capacity and consent.  And if he commits an offence, we can probably use that as a lever to safeguard him and you – and if he doesn’t, you can do “health things.”  Obviously one problem I’m already anticipating is that you may not be able to do “health things” through a fog of alcohol, because this bloke will have had a few gallons of beer by now.

Since the overall threats and risks amidst the chaos of his lifestyle were such that he could be detained under s136 MHA if he were found walking down the road, why not get a warrant under s135(1) and remove to an appropriate place of safety where any withdrawal can be medically managed until he can be assessed, as per the GP’s original referral and then appropriate pathways determined based upon this conclusion?  << This is what I asked for and this is what they chose not to do.  In fairness, the CrisisTeam agreed to attend, but without a warrant.  So I explained the rules of the game from a police point of view, in terms of our legal powers, and we went along.

As the officers and CrisisTeam met and prepared, the bloke came wandering around the corner in the direction of his home address and he was detained s136 MHA.  He was last seen by me in A&E having his physical / alcohol problems managed ahead of a mental health assessment.  Officers were supporting that process, which isn’t ideal, but it at least ensures that he remains engaged to a conclusion.  However, they were put under strict orders: at no stage, will that man end up in a police cell, given what is known about the medical risks which are posed to him, should he withdraw from alcohol.  Obviously, once A&E had given him a physical healthcare “once over” they asked for him to be taken to the cells for mental health assessment.  Err, no.  Nothing prevents the assessment being done in A&E and given ongoing risks, it is far more appropriate.  We can disagree about that if you want, but you can’t force police officers to detain people in their cells.  And what about the health-based Place of Safety – what role could they play?

HERE ENDETH THE LESSON

So the issue here is: the police being asked to “Do Something!” about a situation which has Chinese whispered out of all control and which was, not-straightforwardly a health situation with an ambient background of risk.  Firstly, the police always need to know first hand, what has actually happened.  If I’d just shouted up the rank structure for Armed Police, the Chief Inspector would have asked the obvious questions about evidence and offences and I’d have looked like a complete muppet.  As it stood, the Chief Inspector had been monitoring the incident because of the way in which it was originally described and he rang at the end to say “well handled” in light of the write-up on our incident log about threats and risks; laws and policies, etc..  Always nice.

Far more importantly: it shows how we need to be cautious about putting our arm in the mangle.  Had we run off up there, armed police or not, and encountered this man on our own, unless we could have arrested him for an offence or s136, we would have been legally powerless to do anything and without the appropriate skills or training to get him the relevant healthcare support – whatever that may have been.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


 

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5 thoughts on “Do Something!

    1. That’s precisely my point: what matters? After cutting through the rumours and Chinese whispers we were left with health issues. What would the police be expected to do beyond sit about for a dozen hours whilst health argue about the required response?

  1. Woah.
    This is really similar to a situation I was in, in the role of detainee…
    Differences are:
    (a) I was not intoxicated or suffering from alcoholism, merely a frightened and depressed young woman (19y/o) who wasn’t coping and was desperately seeking help and willing to engage in any treatment (none was offered, hence reaching this desperate stage).
    (b) I did not mention weapons of any kind.
    (c) On initial contact with police, the nurse in question specifically stated that no serious threats had been made and he was merely reporting under the NHS ‘zero tolerance policy’ (oh if only there was such a thing to protect MH patients!)

    Despite these factors, it was decided to be in the public interest to prosecute me. I presume much of the pressure came from MH services who wanted rid of me bothering them asking for treatment, and frustrated police officers who repeatedly 136’d me and performed ‘welfare checks’ to no avail against the shortage of MH treatment in that area.
    The court did recommend MH treatment but unfortunately it seems that cannot be enforced below a secure/custodial level.

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