Throwing Your Dummy

You know when you say what you really think, and then really, Really, REALLY wished you’d phrased it better without wanting to withdraw the point you’re trying to make …. *that*!

I often search @Twitter with the key words “police mental health” and see what’s been tweeted the world over.  Today, I came up with an article from the Police Federation of England and Wales which argues that their National Custody Forum in September 2013 will argue that “Police officers should not be able to detain someone under section 136 of the Mental Health Act as it can lead to inappropriate treatment and excessive time in custody.”  Instead, the Federation now appear to argue for the removal of all powers under the Mental Health Act for the police and a response by a mental health crisis team.

Let’s consider what this means for a moment –

  • Vulnerable person committing an offence – officers go to an incident where a vulnerable person with mental health problems is potentially very unwell and instead of being able to use s136 to remove them to a place of safety, they are obliged to think about arresting people for public order offences, breaches of the peace or other criminal matters.  They are then taken to police custody 100% of the time, unless needing A&E treatement.  This means, across England / Wales, tens of thousands of vulnerable people to the cells, more than is the case today where around half of the c25,000 s136 MHA detentions go to hospital.  It could be far more – see below.
  • Vulnerable person committing no offence –  the person who is unwell in a public place and a risk to themselves and others cannot be proactively detained to keep them safe or to protect the public, if that were needed.  The police are now busy calling the CrisisTeam asking them to physically come to where the police are and take detention decisions – what happens if they start attempting to take tablets to overdose upon arrival of the police?  No power to detain.  Why nurses and not paramedics?  In Australia, one state has debated giving paramedics the authority to detain under the Mental Health Act.
  • Ring the CrisisTeam – it is right to point out, CrisisTeams are busy slashing staff and introducing criteria to deflect more demand to the police, not accept more themselves.  We’ve heard of staff reductions, we’ve heard of restrictions and access criteria changing – not conducive to them turning out from hospitals to support police 999 decisions.  If they accept the need for the role … do mental health nurses want to take detention decisions; have we asked them?  They will probably cite damage to therapeutic relationships and a lack of recruitment being focussed upon the necessary skills and physical-fitness abilities.  Would they carry handcuffs and other restraints?
  • This will also alter the way in which the United Kingdom compares to other major western democracies – many countries afford their police more, not fewer, powers under the MHA that the UK.  Ireland, India, Australia, Canada and South Africa all offer legal frameworks which provide something extra: either the extension of s136-equivalents to private premises, or an outright ban on police stations being used as a “place of safety”-equivalent.  So in many ways, this could be seen as a retrograde step by international standards.

POLICE POWERS

“Police powers of detention under the Mental Health Act should be removed.” << This quotation is in the middle of the article as a stand alone paragraph.  It is neither qualified nor explained – it does not seem restricted to s136 MHA.

Police powers under the Mental Health Act go way, way beyond s136 and this paragraph in bold moves to the use of a plural.  Officers have powers to detain AWOL patients, under s18 MHA – those who have absented themselves from hospital.  This is usually nothing to do with crime, either.  Officers also have powers to re-take people who have been prosecuted into and in some cases convicted by, the criminal courts of this country: only the police may re-detain those offenders or defendants who have escaped from pre-conviction or post-conviction remand under ss35, 36 or 38.  So for example, the defendant charged with the murder of Christina EDKINS, currently remanded under the MHA to hospital pending trial and having been charged with murder, would not be able to be re-taken by the police if the Police Federation statement was interpreted literally.  How else should we interpret it?

Do we envisage a situation where nurses are called upon to re-detain such patients?  I can’t see it being considered correct for them to do so, I can’t see it happening and can’t see it as appropriate, either.  If this point appears flippant, I’m sorry: it is intended to highlight that the consequence of what is being argued for, is not fully appreciated in its significance.  If we want to remove s136 MHA and keep other powers, why aren’t we being careful enough to say so?  If we’re keeping some but not all of the other authorities, then let’s see the argument for the distinction drawn and we’ll consider it on its merits.

What we really seem to want, is the promised delivery of health based place of safety services, that work.  This article, to me at least, reads like a “stamping of the foot” – I originally called it, “throwing your dummy” – because no-one’s sorted it out yet.  Except in the West Midlands and the Metropolitan Police and Leicesteshire, obviously.  Others probably – I do find it hard to keep up to date whilst doing a 999 response job on shifts.  Between 2008 and 2013, we moved from two-thirds of s136 detainees to the cells, to half.  Not fast enough, but moving in the right direction and there’s more impetus now than in 2008, not least because of the political notice this issue has received.

COGNITIVE DISSONANCE

The Federation are arguing in this article that it’s either OK, or it’s at least inevitable, to hold people in custody when they are arrested for criminal offences.  People like Sean RIGG, for example? … he died in Metropolitan Police custody in 2008 having been arrested for a public order offence and there are many others:  Even today, the IPCC has published news of a new independent inquiry into a police force in England regarding a vulnerable detainee with mental health problems, but who was originally arrested for a criminal offence and almost died.  He had serious mental health problems, but was never detained under s136 MHA.  The IPCC were mentioned in the above article by Federation officials who pointed out that mental health was a key factor in the report on deaths in contact as well as in suicides after release.  Of course, the figures that went up, were those arrested for criminal offences and taken to custody, not those detained in police cells under the MHA, which is reducing and contact inquiries remaining stable.

I agree with their idea that when someone is in custody and MHA assessment is required, the PACE clock should be stopped, to ensure arrangements can be made, but the main point about vulnerable people both at the point of arrest and the point of being detained in police custody and beyond is that we need to be able to work out what is mental health and what is not and ensure a proper response to this clinical need, irrespective of the legal detention framework.  It’s the therapeutic needs of people that need addressing, not some arbitrary distinction being drawn between either the legal classification under which they are detained (MHA / PACE) or the type of professional who has detained them.  If only the world were that simple!

We need to raise our game – all of us.  More research, more education and more understanding.  We see the HMIC and the CQC joint-publishing documents which tell us that they don’t understand s136 MHA, now the Police Federation broaden it to the whole Act despite the fact that it will increase the likelihood of untoward events and achieve the opposite of what they are intending.  This proposal would, in my view, increase the number of vulnerable people going to custody, increase the risks associated with that, and provide an environment where officers expected to “Do Something!” would find themselves impotent.  I admit to thinking it quite an inane proposal and I was really surprised to read of it.

Go to Birmingham, see the 97%+ of people who are detained MHA being handled via the NHS, often within a couple of hours.  See the cases of patients under the influence of alcohol who still get admitted and assessed and see the officers who (whilst not always agreeing with the need) support their NHS colleagues with challenging patients.  There are other benefits to this scheme in the face of tragedies and untoward events which I can’t comment upon yet, but which will come in due course.

It doesn’t work perfectly every time, but nor does anything else and it is way, Way, WAY beyond the arrangements we see in some areas of the UK.

I’m now really worried this reads arrogantly; but I’ve been just a part of getting this sorted in one of the most demanding areas of the country.  There is no reason why other officers, paramedics and mental health professionals can’t sort it in theirs – how we did it this in Birmingham is all documented within this blog, so you don’t even need to do the 10,000hrs of work that I’ve done because it’s all there for you.  This is sortable by those who want it sorted – the real problem is, that not enough people do.  << That’s the real tragedy of policing and mental health: people just want to push it away and not recognise it as core police business. 

That’s why I suspect the Federation want to push away a legal power that probably keeps people safe and prevents them being criminalised.


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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3 thoughts on “Throwing Your Dummy

  1. I agree those with mental health problems shouldn’t be criminalised by use of Police custody as a Place of Safety if an appropriate health facility is not available. I’m sure most of those working in mental health and adult social care would support this assertion. In my opinion, and it isn’t a professional one, removal of police powers under Section 136 MHA is likely to lead to an increase in those suffering from mental health problems being detained in police custody; officers will likely resort to arrest for a public order offence to take the person somewhere safer than the streets. The Bradley crew may have been approached by the PolFed MH rep for support however I don’t believe there will be a great deal of acceptance from them. This appears to be an ill-conceived attempt to drum up grass-roots support for a potential attack on police powers in the vain hope of reducing impact on police time.

  2. It sounds as though the removal of police powers under Section 136 MHA and possibly all powers under MHA could easily be counter-productive for police as well as bad for the vulnerable, as it could lead to an increase in crime by the vulnerable (so hardly a measure for crime prevention).You suggest it may be “sort out badly needed health based place of safety services or else” or an attempt to push away mental health issues.And the comment above suggests it may be being proposed “in the vain hope of reducing impact on police time”. But probably there are safer ways of saving time/money on the interface of police and mental health (plenty else I expect as well such as -has the issue of who pays for policing football matches in the top divisions been worked out yet). First off we’ve seen in Adebowale several recommendations that might save time/money. Recommendation 17 includes “Mental Health nurses with experience related to offenders must be available to all custody suites”, Recommendation 21 “The MPS should transfer commissioning and budgetary responsibility for healthcare services in police custody suites to the NHS ” (for immediate implementation 3 months ago !). And also Recommendation 23.Presumably these recommendations have wider application than just the MPS.
    I have been wondering about Treatment Orders (hopefully a venn diagram can bear a tangent). Would it save police time if police could offer a treatment order in the same way as a caution is offered. Of course someone might dispute its necessity and prefer to go to court but the present situation seems odd. As I understand it someone sectioned to mental hospital for dual diagnosis does not have to accept treatment for a drug problem that may be exacerbating or triggering the mental health problem.Unless a treatment order is in place. But I’ve further been told treatment orders are given where criminality is involved , for example stealing to get money for drugs. Surely reform is needed so that at least a mental health assessment could stipulate a treatment order in addition to a section 2 or 3.Yes I know theres a big difference between having a joint while feeling depressed or having a joint that triggers a paranoid attack on strangers but it should be possible to distinguish between those things. I am particularly thinking here of high THC cannabis (commonly called skunk) which since early 2000s has been linked as a trigger to psychosis and to triggering schizophrenia in those with a genetic predisposition to mental illness.Certainly I have met many people in this situation when visiting wards in the last decade.
    Reading your True Story 2 I was struck by the fact that the person who later went on to the very serious
    psychotic episode had earlier come to police attention 6 times for matters exacerbated by cannabis. Is it naïve to think the episode might have been avoided had a treatment order been put in place after the third incident ?
    Clearly if high THC content cannabis could be removed from the market many crimes might be avoided and many critical mental health beds freed up. And yes treatment orders would not do this on their own, . As far as one can tell its not going to happen but there needs to be a rational debate about the pros and cons of legalising and regulating cannabis. For the world of mental health it might be significant in regulating out high THC content cannabis which might eliminate skunk within a decade .Might save police time and money.Its highly probable that I only have a superficial understanding of the mental health problems linked to skunk, but health professionals say it exists so is anyone amongst them suggesting a remedy ?
    Lastly if used widely the Mental Health Court mentioned by the FME in the post “A foot in both camps” would probably save money in the long run taking such a good multi agency approach,
    Thanks.

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