A Public Nuisance?

A scenario for you:  999 services are called to a person on a bridge, either over a major road or a railway line, and the person is either overtly threatening suicide or has been doing or saying things which mean it must be presumed that a possible reason for being where they are is the potential that they will jump.

Some of these situations are very public:  it was a major motorway, the M5 just west of Birmingham, the last time I was directly in charge of one of these events.  My sergeants have since dealt with several and I can assure you that the second thing going through officers’ minds concerning the background is the potential that we’re dealing with a vulnerable person with complex needs, probably connected to mental health disorders, possibly connected to the use or abuse of drugs or alcohol prior to the event.  The first thoughts are always about wrapping a security blanket around the incident so harm is minimised – bringing the motorway to a halt, getting the trains stopped, diverting passersby, etc., etc..

Some law for you –

  • Anyone on a bridge in these circumstances would be in a place to which the public have access, so assuming the other criteria are met, section 136 of the Mental Health Act is in play should it be required.
  • But it is not the only piece of law for this event:
  • It is a criminal offence contrary to s22A of the Road Traffic Act to put yourself on or over a road, causing a danger to road users.
  • It is a criminal offence contrary to s34 of the Offences Against the Person Act 1861, to wilfully endanger the users
  • It is a criminal offence, contrary to common law, to cause “a public nuisance” – this is an offence where injury, loss, damage or inconvenience is suffered by the community as whole, rather than one or more specific victims.

So, having attended the incident and wrapped a security blanket around it, the police would commence the process of attempting to get the person on the bridge down, almost certainly by negotiation and this may involve specialist crisis negotiators taking over from the first uniformed officers at the scene.  Assuming we get to a position where the person is persuaded, the attending officers then have two important decisions to make:

  1. Whether to detain the person under one of the laws, above;
  2. And if so, which one?!

If we remember that officers will be thinking about mental disorders and vulnerabilities and information may have come to light during the incident that confirms a service-user’s background or personal history, section 136 of the Mental Health Act has been used a lot.  This leads to a non-criminalising assessment, we hope in a hospital, which will identify someone’s health and social care needs; either for the first time or in a way which establishes whether current care arrangements are sufficient.

WHEN MAY IT BECOME NECESSARY TO CRIMINALISE?

So given all of this, when would it be acceptable to arrest someone for one of the offences above, instead of using the Mental Health Act?  Some would say never.  When I tweeted an article earlier today, the reaction was almost unanimous –

  • “Sounds like that man needs a thorough mental Health assessment and ongoing treatment – not arresting.”
  • “Sounds like maybe a lot of money & distress could have been saved by providing him with a proper MH service.”
  • “Clearly the man needs urgent medical & mental health treatment, not arresting for being a ‘nuisance’.”
  • “Is this really the attitude the police are trained to have towards suicidal people?”

Of course it doesn’t help the debate about the important issues, that the article is badly written and implicity pejorative throughout, but few of us would disagree with the thrust of the notion that where possible, a compassionate route to assessment and care would be best.  So the rest of this blog is about a really controversial idea – the idea of criminalising a person who is clearly at risk for several potential reasons.

What if this was not the first time such an incident had happened? – what if following previous incidents, section 136 of the MHA had been used several times and thorough assessment had occured.  Perhaps the person was repeatedly found not to be suffering from a mental disorder, but had an alcohol abuse problem.  << This is a real example.  Support services were offered, but the MHA cannot provide a legal framework of compulsion by virtue only of alcohol use / abuse.

What if the person was quite well-known to mental health services and thought to be suffering from a personality disorder? – despite a few admissions under the MHA earlier in their lives, it had been deemed correct to provide community care and support, not always welcomed as sufficient, but repeatedly the path offered after ongoing s136 detentions.  << Again, a real example where MHA detention was thought to be counter-productive in the long-term.  Eventually, it was never selected as an option, but incidents kept occurring.

At what point do the police service have a right to say that diversionary approaches to treatment and care, to support and assistance, have been attempted and we cannot continue to keep making the same response to a situation which is not providing a long-term solution to behaviour which continues to put people at risk?

CRIMINALISATION

I cannot think of a single example where the response to an event of this kind appearing to be “one-off” has led to a criminalising outcome – it’s always section 136 of the Mental Health Act or non-coercive route into a health or care pathway, like being taken to A&E.  Health assessment whilst not under arrest having occured, referrals, support or admission was offered where appropriate.  I can only think of examples of criminalisation occurring where those health pathways had been tried and failed, for whatever reason.

Now it maybe that in some situations, the care or support offered was inadequate or perceived to be inadequate and to the extent that putting yourself on a bridge is obviously a cry for help, if that help is perceived as insufficient, it doesn’t matter whether it is considered the appropriate therapeutic or clinical response by the professionals offering it.  But where there are ongoing risks to public safety, where individual autonomy and dignity has been previously prioritised, what potential does the criminal justice system offer?

I have written before, very early in the blog’s life, about criminalisation.  My view, is that it is the role of the police to take intelligent decisions about whether and when to criminalise people and research going back fifty years shows that the police will usually choose a diversionary response to “deviance” (deliberately chosen as being both non-medical and non-legal language) where it is thought attributable to mental health problems and / or to substance abuse.  In fact, depending on how you define “criminalisation”, it has been argued that the police actually under-criminalise vulnerable people, compared to the general population.

But the criminal justice system offers things that the mental health system doesn’t.  For a start, courts can impose various kinds of orders upon those convicted of offences and where mitigation is offered that offending arose from drug, alcohol or mental health problems, it often is.  This can include drug / testing and treatment orders, mental health treatment requirements and anti-social behaviour orders with various conditions around relevant background triggers.  Obviously the probation service will on occasions supplement mental health services in monitoring them and the courts retain a role in handling breaches of orders.

Perhaps more obviously, the courts can send the message that however caused and however mitigated, offending behaviour will have certain restrictive consequences.  Although we will not enjoy the story, in one case of this kind about seven years ago, I remember we prosecuted a young woman with a history of alcohol abuse and a diagnosis of personality disorder, and the brief period of imprisonment whilst on remand the bridge incidents which kept shutting the M5 at rush hour just stopped.

Here is something even more controversial – for some patients with certain types of mental health disorder, I have heard it repeatedly said by a whole range of health and social care professionals, as well as criminal justice professionals, that ensuring people face consequences for their actions can be inherently therapeutic.  I’ve even heard the phrase “therapeutic jurisprudence.”

THERAPEUTIC JURISPRUDENCE

So when may it be correct to criminalise an apparently vulnerable person, found sitting on a bridge threatening or intimating suicide? – 

My answer is that it may be necessary if the history of that individual is well enough understood for us to know that other, diversionary based approaches to ensuring social justice have been tried and failed.  There comes a point where the balance between individual autonomy and rights to access treatment and care, conflict with broader issues of public protection.  There comes a point where an individual who is continuously putting themselves at risk, not to mention those using road / rail networks, deserves to be protected and if this cannot, for whatever reason, be achieved without the criminal justice system, then it deserves a chance to work.

It is not perfect – nothing is.  But those of us who have attended these incidents where someone has not been safely negotiated down have often wondered whether a different approach to the second or subsequent example might have led to a different outcome.  Some of these complex cases have shown that where legal orders, prohibitions and compulsions are ensured via the courts and the police, real human benefits can occur.

So the idea of prosecuting someone is not purely about automated, inhumane responses and the reinforcement of stigma – it can be about human dignity and public safety, as a last resort.


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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9 thoughts on “A Public Nuisance?

  1. A very insightful blog as ever. I agree that for some people criminal charges allow them to access treatment for substance misuse &/or mental health care that they have previously not been eligible for due to some services being ring fenced for those in CJS. I also agree that this is far from the ideal situation and a long way off person centred care packages.
    Also, a vulnerable persons service provider is under more pressure to be seen do be doing everything properly once incidents are under court scrutiny. Nothing like reporting to court to make professionals evaluate what they’re actually doing to help someone.
    I think the saddest part of a few of these cases (such as the young lady you mentioned here) is that there are some people who are so vulnerable or institutionalised that detention by way of cell, hospital or prison is preferable to them than life in the outside world. A sad reflection on society.

  2. These situations are very difficult to navigate as an officer. But, the original article did not come from the constables involved. It was a management level officer. The inspector inadvertently fed the press ammunition with which they were arguably able to damage and stigmatise those with ‘costly’ mental ill health; lining the ill up alongside the poor on benefits, yet again, as ‘the problem’. This adds to a common politically mediated discourse which diverts attention from the £billions still blown by the relatively few people earning massively, dodging tax and diddling the banking systems, but who also have some influence over the journalists. Have restraint and dont feed these half truths with more prejudice. Excellent blog, but ‘the costly ill’ will be difficult to manage as a disingenuous sub-text throughout.

  3. XX Perhaps the person was repeatedly found not to be suffering from a mental disorder, but had an alcohol abuse problem. << This is a real example. Support services were offered, but the MHA cannot provide a legal framework of compulsion by virtue only of alcohol use / abuse. XX

    Surely constantly endangering others, and themselves IS a reason for compulsion, regardless of WHAT has caused the situation, alcohol in this case IS the mental health disorder….?

    1. That may well be so, but the MHA cannot be applied to someone purely by virtue of conduct arising from the abuse of alcohol. This is law as it stands, by virtue of s1(3) of the Act. So any compulsion that is deemed necessary, has to come from the CJ system, not the MH system.

  4. “Although we will not enjoy the story, in one case of this kind about seven years ago, I remember we prosecuted a young woman with a history of alcohol abuse and a diagnosis of personality disorder, and the brief period of imprisonment whilst on remand the bridge incidents which kept shutting the M5 at rush hour just stopped.”……This is MY story. In fact you may well be talking about me! I’m pleased to say that I’m now moving forwards and I hope, leaving these behaviours behind. The progress I have recently made is due to two factors. Firstly, I was given an ASBO, one clause of which is: Not to loiter on any railway or motorway or on any bridge over any railway or highway in England or Wales. This ASBO came after I had been repeatedly detained under section 136 and each time deemed to be fit for charge or safe to go home. The police tried to prosecute for causing danger to road users but CPS decided against proceeding. I started going to the bridges as an escape and a safe place for me to be where I could remain calm when feeling unstable. However, once the police started responding it then became an attention seeking opportunity. I started playing up to make sure the police came and to speed up the amount of time it took them to come! At this point, I was crying out for help and although under the psychiatric services was only seeing my care co-ordinator for about 10 minutes 3 or 4 times a year! The courts were saying they couldn’t give treatment orders because I was already complying with treatment, however 40 minutes of support a year is not going to help me in any way at all! It was only when the file arrived detailing the evidence to support the ASBO application that I became aware of how much disruption I was causing to the innocent public. This was never my intention. I genuinely felt sorry for doing it and realised the behaviours must stop. Along with the ASBO making it enforceable if they didn’t! After my brief period on remand, I was released because an opportunity arose for me to partake in some DBT style therapy. This is thoroughly recommended for people with personality disorders. This is the second factor that lead to me finally making good progress. This therapy was life changing for me. From then on I have made steady progress. I have since had another long standing therapy which has brought me to a point where I now feel I can manage my condition and lead a less disruptive lifestyle. The police are happy with my progress and I have completed 3/4 of my ASBO without further incident. I am certain that without the police intervention, the court involvement and the time on remand, that I would still be receiving woefully inadequate care from the mental health services!
    I still have issues with alcohol, that is my next challenge!

    1. Gosh … you’ve no idea how upsetting and revelatory it was to read that. I am *SO* glad a way has been found to (at least partially) get you through the woods. I would only ask you to believe me when I say there is not a police officer in the land who doesn’t wish that the DBT was offered and taken at an early point: that it didn’t become necessary to seek criminal charges or ASBOs.

      Your case highlights the point, though: whether or not the NHS have reached the right conclusion – and whether they could realistically have known what the *right* conclusion was – there are some occasions where a police response can in the long term get to a position of bringing about real change.

      I so glad you feel what happened to you has brought benefits. Long may it continue.

  5. Much as I might agree with your assessment of the polices actions in these cases I am still disinclined to agree that use of the criminal justice system to help those with mental health problems is the best cause of action. That for some it may well be needed I don’t doubt but I am an idealist at heart and am concerned that you don’t see a better understanding of the situation(s) might lead to commissioning of services/ mental health facilities and procedures that might be better suited for these problems. When all said and done the actions of these individuals are because of their vulnerabilities and despite the current services no helping I would like to believe that there are other ways to help them than criminalizing them.

  6. What if the person was quite well-known to mental health services and thought to be suffering from a personality disorder? – despite a few admissions under the MHA earlier in their lives, it had been deemed correct to provide community care and support, not always welcomed as sufficient, but repeatedly the path offered after ongoing s136 detentions.

    This just happened to me after the worst year of my life I now have a suspended sentence for being a publice nuisance with conditions not to walk on any motorway bridges in my county. I already had that condition in place from a previous conviction but I breached it after just 10 days because the compulsion was too strong to keep me away. Now I feel like im living with an axe over my head. I know that it will be impossible for me to stay away for a whole year so part of me thinks what is the point of trying. I could just go there now and get it over with. I know im going to end up in prison at some point this year.
    This isn’t going to help its just piling more stress into me when I already can’t cope. I feel so let down by mental health services in this country. So many empty promises and unnecessary delays.

  7. I had that same axe over me for 4 years but the fact it was there was enough to give me that extra incentive to try not to breach. I understand your compulsion and your worries for your future. I’m bpd and although now well into my recovery I am still compelled towards risky behaviours. The difference for me is that through a combination of therapy and legal enforcement I have got to a point where I’m causing less problems in public places. It takes time, things won’t change overnight but the good news for you is that the mental health teams are currently changing their focus towards personality disorders and there is more help becoming available. In the meantime, some practical advice from someone who’s been there! See if you can answer honestly to yourself, what is the reason you are compelled to bridges? Then try really hard to think of something that can replace that. I wanted the police attention ( as a cry for help ) so once my conditions banned me from bridges I replaced that with roundabouts. ( only large ones- mini ones are too dangerous) That was enough to still get police attention, but was less dangerous for me and others therefore not deemed a public nuisance! Good luck and I hope you get the help you need soon!

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