I recently started a night shift and whilst taking the “handover” from the late shift inspector he was briefing me about a missing person for whom we would shortly take responsibility. When he said, “there are three missing persons enquiries, the most concerning of which is a dementia patient” I was immediately concerned it may have been a particular lady we had dealt with only the previous day.
My team had been involved in a Mental Health Act assessment in support of an AMHP having quite a difficult time ensuring the lady’s admission because of a combination of medical problems, resistance and difficulties securing doctors to sedate her for safe transfer. It wouldn’t have surprised me to hear that she had walked out of the hospital because she really didn’t want to go when we had assisted the AMHP.
But it wasn’t her – it was an elderly man who had gone missing during the ‘early’ shift that day. Later in that night shift, we took a subsequent missing person’s report concerning a man who had just been diagnosed with “early onset dementia” as well as some other serious health problems. That was three dementia related calls and two of them vulnerable missing people in one police area in just 24hrs. Quite rightly, a missing patient can command exceptional levels of resource because of the vulnerabilities involved and can sometimes bring an area’s day-to-day local policing to a halt as it’s “all hands on deck”.
My discussion with my colleague got us chatting more generally about dementia-related demands. The police see it in two situations in particular – missing persons investigations and supporting AMHPs and psychiatrists in Mental Health Act assessments. I have also known, although less frequently, requests for the police to “do something” about challenging behaviour in care homes for vulnerable adults. This is always difficult – the police can attempt to persuade or negotiate or we can use force to prevent crime or arrest people: but neither is necessarily guaranteed to be very effective at all; or even very appropriate.
We heard recently that Sussex Police were involved in a scheme were dementia patients could be “tagged”, with all the connotations of criminality that tagging brings and leading to a quite predictable uproar. Of course, the scheme was a local authority lead scheme, which wasn’t to be forced on anyone, but it shows very adequately, the sensitivities involved here.
Dementia isn’t a disease in itself: it is a symptom and can be attributable to a variety of health-related problems, including simple dehydration. More commonly, it is seen in relation to Alzheimer’s disease, vascular dementia or Parkinson’s. For more information, I would recommend you read the website of The Alzheimer’s Society which is full of factsheets and information, as well as support and advice. There is a Helpline number available for those who want more information on 0300 222 1122 and you can also follow them on social media with links on the front page of their website.
In 2012 The Prime Minster launched a ‘Dementia Challenge‘ as part of the Dementia Friendly Communities programme, something which was supported by Chief Constable Simon Cole on behalf of ACPO. Police actions with regard to incidents involving patients with dementia are obviously, especially sensitive. The Dementia Friends website is also useful to know about.
WHY CALL THE POLICE?
We understand why the police are called when vulnerable people go missing, but it is more difficult when the call is to restrain patients who have been detained under the MHA or are in residential care and exhibiting challenging conduct. I know that we are perhaps tempted to picture frail, slight patients with mobility problems and states of confusion that often come with being a certain age and wonder about the thought processes that went into calling the police or whether it is really necessary? But we also hear from some mental health professionals who have worked with older adults that the only time they have been assaulted in their careers was at the hands of some beyond retirement age and that some have been left with serious injuries, life- or career-altering, on occasions.
I am yet to be convinced that in most cases the police are asked to lead on, there couldn’t have been earlier intervention. Indeed, I’ve had families complain of it to me when we’ve turned up: “Thank heaven’s you’re here, we’ve been trying to get help for days” … sometimes, weeks. I often wonder whether trained nursing staff would not be far more appropriate to most of those situations and whether appropriate de-escalation and / or C&R training would not have been sufficient to manage the risks involved? Even in such situations where the resistance being displayed was more significant – a recent example included a patient who was hitting out with a walking stick causing black eyes – it begs the question what the police bring to the party that a trained nurse could not, with police support where that is necessary.
What we bring that others do not is batons and handcuffs; tasers and CS spray – and arguably, that is all. The legal powers we would have available to us are also equally available to others, the human ability to talk is not monopolised by the police. One might argue that the presence of uniformed officers is “motivating” – I’ve heard this many times. It is equally easy to cite examples where it has made little difference, or has even aggravated a situation unnecessarily. If one reads the advice from the Alzheimer’s Society on dealing with aggressive behaviour, there is every reason to fear that suddenly introducing police officers could make things far worse.
If someone is – ultimately and as a last resort – going to have to get ‘hands on’ with a patient, there are risks about the way in which police officers are trained to use force, which need to be borne in mind. And to those who would say “I don’t come to work to get assaulted” – neither do police officers and they are just as entitled to say so. This is not about who it is more appropriate to assault – it is about early, timely and appropriate intervention by people best trained to do so. If intervention is not early, it might be that the police are the appropriate people – but that comes with the risks associated in Humberside because the tactics for managing seriously aggravated resistance by anyone are few and they are blunt, especially where de-escalating things has been tried and failed.
POLICING AND DEMENTIA
I have certain particular reservations about what I see as the increasing role of the police in supporting services engaged in dementia care – saying this is absolutely not to argue that there should be no role at all and that the police should distance themselves from the issues. Clearly the police have a key role in searching for missing people, this will always be the case and vulnerable patients with dementia, especially the elderly, are always going to be a high-risk priority. They also do have a role in supporting those higher-risk Mental Health Act assessments.
Where my concerns lie, are in the incidents we are seeing more and more: the use of force on passively resistant patients who are being admitted to hospital against their will, detained under the Mental Health Act. I have previously written about the use of force and remain to be convinced that the police are the appropriate answer to certain problems we see emerging more frequently, including for calls that the police should “do something” about very elderly people in care home exhibiting challenging behaviour. But then it is fair to comment that training within the nursing profession to deal with such challenges was a feature of the criticism in the Francis Report. One can see why the police are sucked into the vacuum created, however wrong that may be.
Without for one moment condoning aggressive behaviour towards professionals staff or being seen to imply that they should “get on with it”, there is a reality to be applied to care home situations for people who often lack the capacity to make very basic decisions. Alzheimer’s and dementia can be some of the most upsetting and distressing conditions, especially as adult children see elderly parents progressively deteriorating mentally and struggling to cope with everyday functions we all take for granted. Distressed by this and perhaps having lashed out or become aggressive through confusion, disorientation or basic unfamiliarity, how does it help to call the police to “do something?” As I have said before, the police, broadly speaking do two things: we persuade, negotiate and influence or we use force – to prevent crime, prosecute people and maintain the Queen’s Peace.
We have seen in recent years, the fallout from certain incidents – the “Taser” incident in Humberside; the “Handcuffs” incident Greater Manchester. In courts and in the media we have seen criticisms and debate: should the police be involved at all; and if so to what extent and how? Ian Hanson, the Chairman of the Greater Manchester Police Federation summed it up very well after the Inquest into the death of Mr Alan BAILEY, “Whenever another agency is short on resources or where something does not fit squarely into their remit, then society has got into the habit of calling the police. We are then expected to be experts in everybody else’s job and when we don’t get things right then we get criticised.”
Following the incident in Humberside when the involvement of the police was being debated and the nature of the force used contested by many, Jeremy Hughes, the Chief Executive of The Alzheimer’s Society was interviewed on BBC Radio 2’s Jeremy VINE show and was far more interested in pointing out something else, which I hear as a recurring theme in my operational experience: “It is a real failure of support and a failure of care, which I’d take back a step before the police’s role. The police are doing what they are trained to do … why did it get to a stage where the Doctor hadn’t been aware of a need for support earlier? It is very unlikely that you’d get such a rapid progression in the space of a morning where suddenly someone was in need of support where previously they didn’t.”
We talk a lot about early intervention, the reality does not always reflect this and that’s increasingly why the police get called.
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