It’s Just An Opinion

I am well aware that not everything I say on this blog is agreed by all who read it – I usually try to acknowledge those things I’m saying that are not agreed and present the other perspective.  Feel free to point where I’ve forgotten to do this.  This whole enterprise is a place where I’ve brought together a lot of my own opinions in the face of laws and stated cases; professionals guidelines and the real world in order to offer some views about where this may be done differently.

But at the end of the day: this is just my opinion, a point of view.  I hope to couch it in argument and I do hope to influence.  If you’ve read my stuff and you continue to disagree, that’s fine.  I’d enjoy a debate to find out why, because I’ve admitted all along – I’m making this up as I go, hoping to bring it all together conscientiously after research and debate, but if I’ve missed something, let me know and we can talk it through.  At the end, we may still disagree because the interface of policing and crime is about endless shades of grey, about choosing the least worst option and making various other decisions from uncertainty.  So there will be room for opinion as we try to draw the balance between individual autonomy and broader public interest.

Ultimately, certain decisions rest with certain professionals and as they are accountable for them, they must be allowed to take them.  I will happily hear your concerns about whether someone will be arrested / prosecuted, but I’m afraid I will retain the right to take that decision on my own terms.  It’s not going to be you justifying to my professionals standards department, senior officers or a court why an improper, unnecessary or illegal arrest took place.  But I’ll happily hear what you have to say about it.

So when decisions rest with mental health professionals or where there is a public debate, please don’t fear the expression of a viewpoint and please don’t misrepresent what I’ve said in expressing it.  This doesn’t mean that I seek to deny you your professional judgement or your personal view; merely that I wish to see it exercised in the face of knowledge that I often find missing and that I want to ensure was available.  This is all lovely and vague so far, isn’t it?!  Let me explain! –

Two debates have recently resurfaced – they are far from new – on which I’ve expressed opinions on social media and during a conference presentation.  It seemed to arouse strong feelings amongst some who accused me of “unilaterally deciding how AMHPs should conduct their professional business.  It is not for the police to do.”

MENTAL HEALTH IN PRIVATE PREMISES

Remember the debate about mental ill health in private premises? … the police have no powers in a private dwelling to anything coercive unless there is a crime or a breach of the peace.  As such, when we get asked to attend an address in support of MH services to mitigate risks and keep people safe, we sometimes lack the powers by which to do so.  If the AMHPs coordinating the assessment had a warrant under s135(1) MHA then all is well, from that point of view.  But if they do not propose to get one, it might present a problem.  I said “might”, not “will” … anyway, this is their professional decision, not mine.  I cannot, by law, ask a magistrate for such a warrant.

What I can do, is discuss something with the AMHP if I have concerns about a proposed assessment where I believe I am being asked to mitigate risks where I lack the tools.

I was asked to do this earlier in the year.  The effect of the AMHP’s / DRs’ decisions were to ask me to do things in the face of what eventually became potentially fatal risks, without any legal authority to do so and in the face of relatives exercising their rights to determine which police officers can and can’t enter their home.  I believed that the non-availability of a warrant and the decisions by the relatives were pushing me into a corner where risks were building and where I, as the senior police officer present, was being asked to be responsible for things I couldn’t control unless and until people were started to get hurt.

As it happened, there was a perfectly straight-forward solution to the problem: get a warrant from a Magistrate under s135(1) … the AMHP’s decision, obviously.

My decision was whether I was going to send under-equipped police officers into a room to face a man with knife who has not committed an offence and is known to be very unwell.  As he’s not actively hurting himself or others and as the hurried entry of uniformed police officers implying he’s about to be forced could well activate a response we don’t want to see, we won’t be doing that.  We all know the dangers of running into crisis situations to use force, far too quickly and Canada are debating that right now, following the fatal outcome to the police shooting of Sammy YATIM just a few weeks ago.

Unless you get a warrant, the situation escalates without provocation by the police or until he comes out of the address where section 136 is in play, we will be containing the house and no more. << That is my professional decision, not yours!  It was the only time in my career where I’d ever had to say this.  Subsequent debate with the AMHP’s manager led to a very quick volte face and they went to get the warrant.  Twenty minutes after it was executed, the man was safely in legal custody, with only a minor injury where he stood on something sharp during restraint.

SO SHOULD WE EXTEND POLICE POWERS?

Now I’ve been misrepresented a few times during the debate about whether or not s136 of the Mental Health Act 1983 should be extended to private premises and service users have told me that it is not for the police to call for this as it is a political and civil liberties issue.  So let me be clear –

I don’t mind or care whether or not police powers to act in private premises are extended or not – all I want, is a recognition of the fact that the law currently leaves a legal ‘gap’ in our ability to keep people safe, because the police lack legal powers by which to do so and mental health services lack the capacity by which to do it.  And I want that rectified so that we – our society – have the capacity and capability to keep people safe in predictable events.

Whether the police are (part of) the solution to that, as is the case in the Republic of Ireland, is for our elected politicians to decide.  For what it’s worth, I doubt that the NHS will ever get itself to the point where they prioritise emergency mental health care to this degree, that they will be able to ensure rapid response.  Many mental health nurses have themselves pointed out on this blog that they are not an “emergency service” in the 999 sense.  So I admit I do come back to thinking there is merit, with appropriate safeguards, in looking at the police as a solution to the ‘problem of the gap’ – but that’s just an opinion.  And it is for others to decide.

Incidentally, my views on s135(1) were at one stage different to those you’ve read about on this blog: I was heavily influenced by a mental health professional’s persuasive argument!


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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6 thoughts on “It’s Just An Opinion

  1. Your point about the value of getting a warrant obviously extends beyond the specific case of mental health assessments. The appeal courts would probably deal with far fewer cases relating to powers of entry if police officers (mainly sergeants, inspectors and detectives) more often applied for warrants rather than trying to stretch without-warrant powers. Magistrates don’t like it because it they get woken up more often, but some force civil-claims departments have been saying this for years.

    1. I do think the point about warrants is especially apposite to MHAAs because of the extent to which we’ve seen officers get their arms caught in the mangle by poor planning of the assessments in ignorance of police powers without a warrant and / or because of bluffing and blagging on the part of the police. Probably a bit of both!

  2. I wish I knew more to make informed comment, but if it was standard policy for the police to ask AMHPs if they have got a warrant, or to remind them to get one, when AMHPs first contact the police to ask for a police presence for an assessment on private premises,then surely that’s that ,given that’s the regulations. The figures I’ve seen (which may not be representative ) show that generally waiting times for Section 135 are long enough to get warrants. Ironic that I say that since I wish they were shorter.
    But that does not deal with the urgent cases that need to be seen in half a day
    When you suggest the possibility of extending Section 136 to private premises would that be conditional on a police presence having been requested for an assessment by an AMHP ?

    1. You can get a warrant in a couple of hours. Most of the time is spent arguing wether one is needed or not.

      1. The last two I insisted upon, I told the AMHP to leave with me the arrangements to put them in front of a magistrate – sent a police car, picked them up: warrant within an hour of me saying I wanted one and job done within two. As you as, most of the delay is prevarication.

  3. Just to expand on that a bit. In my experience ,over ten years, carers and relatives that i have met do sometimes find that they contact MH professionals to report a worsening MH situation but find that nothing happens. So the situation worsens until an incident occurs where the police get called in, the person is then transported to a police station and assessed
    Things should not have got to this stage in the first place .I’m not sure why the wait and see approach is taken but that phrase you articulated in Throwing Your Dummy “damage to therapeutic relationships” may be involved. I don’t think we can really afford the luxury of that approach in this society ,as it can lead to innocent victims suffering .I think MH teams must be encouraged to respond quicker to their more difficult situations If Section 136 was extended to private premises conditionally , so that it allowed police to attend MH assessments on private premises (where a police presence was requested ) without the need for warrants it sounds good to me as it would save time and save time in urgent situations. But if it was an unconditional power where police enter premises without MH professionals this might lead to an increase in MH clients being both transported in police vehicles and assessed in police stations, both of which are to be avoided where possible I think.Given that nationally 79% of those assessed are detained it remains good sense that where possible they travel from private premises to hospital in ambulances.And if police had uncondional 136 access this might disencourage MH professionals further to wait and see.
    (and yes i have not mentioned the civil rights aspects which i can see may exist)

    Lastly i have some figures for Camden for waiting times for assessments for April 2011-March 2012. These show that there were 513referrals where no police presence was required and the average waiting time was 3.65 days. In the same period there were 83 requests were a police presence was required. The average wait was 11.58 days. i do not know what the national averages are, but if they are anything like this its probable that some untoward incidents may occur before assessment occurs.
    Resources are clearly stretched for NHS and police but quicker responses by both is probably economic good sense in the long run as well as getting people to a place of safety quicker

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