I can’t begin to imagine the gradual build up of distress and despair that must overwhelm a person who has to watch their nearest and dearest be gradually consumed by Alzheimer’s disease. To reach a point where one must wonder whether or not your parent or partner even still recognises you and the love you give them must be heartbreaking. If it were then learned that during a brief period of respite the police had attended a care home and restrained them using handcuffs, we can all agree we would have questions to which we would demand answers: from the police AND from the care home – and from appropriately senior managers.
It is for those reasons that I don’t want to focus on the reaction of relatives to the recent handcuffing of 76yr old Keith HYRONS in a Malvern care home. Mr HYRONS had been placed there to afford his wife a period of respite from being his full-time carer and I’m sure all we can do is wonder how traumatic it must be to have found out that within twelve hours the police had been called and handcuffed him. I’d be furious and have questions, too.
I am a front-line police officer leading a team that answers 999 calls and I would argue that my team alone, in just one UK police area, is called to a residential care setting once a week whilst being invited to use force on a vulnerable person because ‘agitated behaviour’ or a ‘behavioural disturbance’. In planning a recent contingency in a nursing home, I recently had to ensure that we had officers with both tasers and the police protective equipment which is better known as “riot gear”. Such was the nature of the episode. Whilst we thankfully resolved that particular incident without anyone using any force whatsoever by playing a waiting game, it has not always been possible to do so. On other occasions inaction would have meant the very real probability that someone would get hurt
I have written on this blog about how I have perceived in recent years an increase in dementia-related demands for the police, so these kinds of incidents will potentially recur and cause further debate unless we learn the lessons now from what has already occured. It is against these backgrounds that I want to take issue with just one part of the reaction to this sad case.
ABUSE
It is the reaction of the Alzheimer’s Society that particular engaged my interest when their West Midlands spokesman, David ASH, attacked the handcuffing incident. In fairness to them, they have published information about handling aggression in dementia patients and forewarned that introducing police officers to situations may exacerbate problems. They have also covered this issue in their magazine, arguing for a different approach and better training for officers. All of that said, the comment still bears scrutiny –
‘‘Any case of abuse against a person with dementia is absolutely appalling. The most vulnerable people in our society should be treated with respect and dignity. Our care system in the UK is broken and underfunded.”
Abuse? — can we agree on three things?
1. None of the people talking about this incident in the Birmingham Evening Mail were actually present in Malvern, so do not know, ultimately, what occurred? – if we are to reach a position where the officers’ handling of the situation is labelled “abuse” let it be following a properly constituted investigation which hears all sides.
2. Using force on anyone to prevent harm to others should be done only where it is necessary, as a last resort? – given it is established form, we should assume the officers at least attempted to communicate the situation into a safe position, before resorting to force.
3. Describing a use of force as “abuse” without knowing whether it was reasonable in the circumstances is premature? – and when one considers the magazine article which calls for any needed restraint to be done in another way, we start to see that it is not restraint per se, that is the issue.
I have met and interacted on social media with many people who think it is always possible to avoid using force when dealing with vulnerable people – it often emerges from discussions where they’re have been criticisms of the police for failing to de-escalate certain situations. Now de-escalation training, by that name, is not taught in police training. But the concept is and I’ve heard many people from health and social care backgrounds say that police de-escalation skills are usually first-rate.
It was recently a question on Twitter from a PhD researcher from a mental health nursing background – whether restraint could always be avoided? The consensus was that it could not always be avoided, but that we need a debate about whether we’re doing the most we can to avoid the need for it. Suggestions of where we could do better were in the arena of staffing levels, staff training (in police AND health / social care) as well as in access to relevant services and crisis support. If you read the Alzheimer’s Society’s full comments in the Birmingham Evening Mail, you see the attack is at the care system itself, into which the police were invited.
The above-mentioned magazine article calls for police officer to use velcro straps instead of handcuffs – presumably this means the leg restraints with which we are (mostly) already issued? And this moves the debate on to the more specific area territory of how dementia patients are restrained, if that is deemed necessary, rather than whether they are restrained whilst exhibited various kinds of challenging behaviour.
LAWS AND ETHICS
So I want to finish by highlighting the apparent clash of laws and morals in this kind of incident. West Mercia Police have publicly backed their officers using the language of law: highlighting risks and threats and having words like “rights” attributed to them. Meanwhile the remarks from the Alzheimer’s Society show the background factors of concern to his family couched in moral terms; as well as the proper assessment of needs we hear language like “abuse” and suggestions of treatment like a “common criminal” inflaming our emotions about what occurred.
The problem here, as with the Humberside ‘taser’ case and the Manchester ‘handcuffs’ case before, is that BOTH are right. It is an outrage that things get this far but those of us who police know that we are often demanded to instantly restore order to situations which took months or years to deteriorate. By the time we are making minute-by-minute decisions in the middle of the night involving risks and threats with people who we know little about, we are are not talking about precise, nuanced interventions – we’re talking blunt, crude options which may lack utility. This is the very real danger in these cases because the complaints the Alzheimer’s Society spokesman had after labelling the intervention as “abuse” we’re all about the care system: not the police. When the officers arrived, they had three choices: do nothing, do something without resorting to force, use force to prevent harm to those present and call for further medical assistance which we know was done, because Mr HYRONS was detained under the Mental Health Act in an older adults unit.
I’m sure we all wish him and his family well and regret the events, however necessary those involved may have considered them to be and I’m sure they would be further reviewed if that is what the family wish to see happen. But as with many incidents, the necessary actions to avoid the police use of force as a last resort, were things not in control of the police that needed to occur way before the 999 call was made.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2013
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
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At the moment, dementia care is visit your local care provider
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I’m Keith Hyrons son – this should never have got as far as the police. My father was assessed twice by staff at Howbury Lodge and on both occasions they decided that they had the resources to care for my father. Nothing could be further from the truth. Within an hour of us taking him to the home we’d received answer phone messages saying that they found my father too difficult to deal with?!? I’m sorry but one hour? After the incident with the police I spoke to Mark Ransone-Williams who said that his officers were within their rights to handcuff my father behind his back in fact it would even have been OK to ‘put him in a cell’ for breach of the peace. This was a man who was not violent, this was a man who was so frail that he weighed only 6.5 stone on his death bed on 8/11/13. My father never recovered from this ordeal and I believe the so called care he received played a major part in his bodies decision to give up although we will never know. We’ve never received an apology from the home or the police. As a personal trainer I used to try and keep my Dad as fit as as possible but his lack of understanding coupled with a lack of mobility caused us to stop. My father had a very limited range of movement in his upper body particularly his shoulders yet the police saw fit to handcuff him behind his back …. if you still think that the way this was handled was correct then I hope no family member or friend of yours ever receive similar treatment.
I’m really sorry to hear that your father died recently, you must be devastated. In circumstances I can only imagine it must be more distressing still to know of this incident – my heartfelt condolences to your family.
Just to be crystal clear: I am not defending the handling of the incident at all. I wasn’t there to make any assessment of it. I’m merely pointing out that neither was the man from Alzheimer’s West Midlands who labelled the response to be “abuse”. Everyone agrees that this should not have reached the point where the police were called, but for whatever reason they were and officers turning up to the care home than have an awful decision to take, based upon what they find on arrival and inevitably without a detailed knowledge of those people involved. In general terms, it is far to say that if someone in a distressed condition is displaying challenging or agitated behaviour and it is perceived that this is putting others at risk, then they have available to them all the options that would apply to any other context of agitated behaviour. Obviously, they should be choosing their options especially carefully, but I can’t judge whether they were right or wrong because I wasn’t there, haven’t read any reports that were made and haven’t spoken to those involved.
You will undoubtedly know more about the particulars than I do and if you’re saying it wasn’t handled correctly, it’s not for me to say otherwise. My interest is in highlighting some of the issues you touch on: where can better (or proper?) planning prevent hte need for the police to get involved at all? Sadly, I see many examples of where failures to plan and take easy steps to mitigate risks in caring for vulnerable people mean eventually the police get involved. And whilst acknowledging those omissions by health or social care it doesn’t alter the position officers are placed in. Many might sum up that predicament by saying “damned if you do, damned if you don’t.”
I appreciate recent times will have been extremely difficult and upsetting – I hope you get to a point where you feel any representations you have made to police or the care home have achieved a level of satisfaction; and if there is anything I could do to support, please let me know.
I have worked as a care assistant in a nursing home for people with dementia and other additional problems. The residents at THIS home were often violent towards the staff or other residents. I was frequently punched, bitten and scratched. A resident tried to put a fork into my eye once when I was trying to get him to eat his dinner, and very nearly succeeded. I could have been blinded.