Do As You’re Told!

I frequently can’t help but wonder whether I’m irritating people?  I think I’ve irritated a few people over the last fortnight or so and reaction to that is the reason behind my taking a few weeks off the tweeting and blogging – this post and a couple of others have been written and scheduled to auto-publish whilst I’m taking a break from it all and I’ll reflect on this again at the start of November after a much-needed break in the North-East.  I need some solitude on a Northumbrian beach in the cold, pre-dawn.  It’s been far too long.  (Look left.)

It seems that by asking questions about what the police are asked to do, occasionally resisting or insisting upon other approaches is irritating.  In so many aspects of the policing / mental health interface, I get the impression that people would just prefer the police not to ask questions and just do as they’re told.  It has happened many times in my career that I have been invited to put myself in a position where I could be blamed if things went awry and I will admit that I really don’t like it very much.  So where I think it is both necessary and professionally appropriate, I resist and push back; these being the cumulative lessons of policing / mental health tragedies over the last twenty years.

It wasn’t my decision to under-resource our mental health system or to fail to prepare for the very predictable implications of our mental health law.  When I find others occasionally quite desperate to be able to say that the police said everything was fine or that it was the police who used too much (illegal or inappropriate) force, I start thinking out loud.  If anyone is under-resourced and I am in a position to help and support them, that’s fine.  Many cops challenge me when I say this, but there are some things that we really should muck and in a help with which in an ideal world we wouldn’t have to.  In that ideal world there wouldn’t be any robbery or rape, either.

But I don’t live in or police an ideal world.  So I have to be able to see where I can make a positive contribution to our collective safety and distinguish it from where I can’t.  There are some things that the police should stay clear or even refuse to do.  There are some things we could never do, even if we wanted to help.

ALIVE, BREATHING AND CONSCIOUS CHECKS

My team was asked to do a “safe and well” check a few weeks ago after a patient made a suicide threat over the phone to the CrisisTeam.  It wasn’t an obviously imminent threat, but standard practice is to tell the police and transfer responsibility for mitigating that risk to them.

Many mental health professionals think that police officers have training, skills and powers to do this.  Pointing out that we don’t often appears irritating and I could tell this when I rang back with my standard response.  “She’s here, she’s alive, breathing, conscious and without obvious indications that she has self-harmed or taken an overdose.  What do you want to do now?”

The reply showed what was really going on:  “Well, as long as your satisfied she’s safe and well.”

Hang on – I’ll stop you right there! 

I’m not saying she’s safe and well – not for one moment.  I’m quite unable to confirm that, even though I’m trying to be helpful.  I’m only saying she’s alive, breathing and conscious showing no obvious indications that she has self-harmed, taken an overdose or is intoxicated.  Whether she has taken an overdose: I’ve got no idea.  She says she hasn’t, but that doesn’t mean she’s telling the truth.  Let’s remember the power dynamic here: this is a vulnerable lady in her own home, who was STUNNED to see the police arrive and stated that when she spoke to the CrisisTeam no-one had made her aware that the police would be sent.

There are only two broad scenarios here regarding self-harm / overdose: either there is a raised risk of it in this incident, or there’s not.  She’s told the CrisisTeam that there is a risk – hence they called the police; but she’s telling the police that there is not.  I’ve known this person for about seven minutes at the point where I’m being obliged to decide whether to take this inconsistency any further and I haven’t read her medical notes.

I’M NOT A MENTAL HEALTH PROFESSIONAL

Far more crucially, I’m not a qualified mental health professional – I don’t know this human being at all and I’m certainly not privy to the kind of history that you will have if she’s open to your services. What I do know is that she must be thinking, “If I don’t convince these cops I’m OK, I’m probably going to get locked up.”  Doesn’t matter that we wouldn’t have a power to do this, this patient may not know that.  Even if she does, maybe she’s wondering if we’re the “step outside for some fresh air, it’ll make you feel better” police who will make s136 happen one way or the other?

So I’m sorry if I’m irritating you, but you’ll have to excuse me for not wanting to put my arm in someone’s mangle so the police can be blamed – as is currently happening to two officers from a southern police force who had a job exactly identical to that above and said, “Yes, safe and well.”  Now being investigated after the person committed suicide.  Guess what mental health professionals are saying?  “Police said the patient was safe and well so we deferred follow up until the next day.”

Meanwhile, back in my scenario, I lacked any coercive legal ability to intervene so I passed this back for a decision about whether any mental health support was to be given, including whether any Mental Health Act assessment is needed.  For the record: if she had been on a public street, I would have used section 136 MHA because I thought she was in immediate need of care in her own interests.  I made that known, too.

But as she’s wasn’t, I couldn’t, so I didn’t – and back to you.  Do let me know if support is needed to execute any s135(1) warrant or for any assessment that is organised.  I’m not trying to irritate anyone or refusing to play my part in something I could help with.  I’m just trying to resist being one of those who will be held responsible for a situation I didn’t create by being unwittingly pushed into thinking I’ve got skills and training I simply don’t have.

And that’s another debate altogether that could have been the story of my irritating people: section 135(1) warrants.  The implications of these warrants are still not widely understood more than FIFTY YEARS after they were introduced in the Mental Health Act 1959. The 1983 Act just carried them from the old Act to the new, untouched.  And we still don’t understand them.

Enjoy the other posts that I will appear whilst I’m away.  See you week commencing 4th November.


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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20 thoughts on “Do As You’re Told!

  1. As a father of a son who died in police custody in 2010, having been detained under Section 136, your blogging is anything but irritating. Compassionate, well-informed, important, practical and realistic are much more terms that come to mind. I think that your tongue is in your cheek here

  2. I’m right with you. The police are unfortunately a necessary part of the mental health services but are taking a hit due to underfunded medical mental health services. It’s definitely not up to the police to assess suicide risk. I only wish I could ring a crisis team and get a patient assessed the same day–it never seems that easy.

    Simon Simon Price GP Clevedon.

    Date: Wed, 16 Oct 2013 07:06:11 +0000 To: sdp_57@hotmail.com

  3. A familiar scenario – and I’ve been retired 10 years. The attitude/approach is not confined to mental health issues – it seems to cut across all services. It’s poor service design, lack of focus on outcomes and user/victim/patient focus. Ultimately it’s down to a culture of management that doesn’t care enough about people and any solution will do that allows someone to put a ‘tick-in’the-box’ to cover their backsides when the inevitable happens and tragedy occurs. It’s something to do with trying to avoid picking up work and liabilities and therefore cost without realising that the approach is building in waste, inefficiency by putting off what needs doing now. So it’s also about not applying systems thinking to the design of services. I also see something about the responsibility placed on an individual ‘Constable’ around preserving life – something I fear is being eroded via so-called reforms. There’s something about lack of focus on values and human rights as well. I could go on.

    I recall many conversations with social workers, A&E staff, doctors – often failing to achieve the right input to try to get to the right outcome and resorting to less than desirable actions to get people the support they needed, e.g. keeping people in police custody when they should have been sectioned …..

    Yes – you will be irritating people – but don’t stop caring enough about vulnerable people to do what you’re doing. I’ve seen colleagues in similar circumstances during my career and they often resisted pressure from managers and peers as well as resistance from obfuscating ‘partner’ services in attempting to get people to do what was needed for vulnerable people. I’ve seen the damage done to their careers and mental/physical health. As a supervisor and manager I supported them and tried to protect them but often found myself facing the same pressures. I was very fortunate to have had such committed and selfless officers working with me (note – not ‘for’).

    If doing the job properly means irritating people – so be it – crack on!

  4. Do you have a links referencing the incident to officers from the southern force. I’m trying to convince my SLT that the very scenario you mention could (apparently now it has) happen.

  5. I took an overdose in July and after 7 hours of being shunted around to 3 different wards in the hospital I removed my tubes and walked out. An hour later 2 policemen knocked on my door to check up on me as they were contacted by the hospital. The compassion, consideration and actual concern they showed for my well being, the fact they sat down and listened to me without judging me that day probably saved my life in reality! The actually treated me better than the staff at the hospital! Thanks to those 2 men showing up at my door i realised that people/strangers were actually concerned about me and after a long talk with these 2 officers not only did it give me a kick up the backside but considerably improved my state of mind in terms of trying anything again.
    Such a shame that the police officers involved in your case are being investigated.

  6. The press coverage today alone indicates that the mental health system in the UK as a whole is under resoursed having been savagely cut. This leads to all parts of the creaking MHS trying to pare back services already cut back to the bone (and sometimes further)

    Then starts the pass the parcel onto another service and hope to shift the blame too. Whilst not understanding what the other service can and is legally able to do let alone has the resources to do. Sometimes feel that they believe does not matter whether the person receives the help they need or care about it.Except what they are passing is not a parcel but a vunerable person at risk to themselves first and foremost (despite tabloid headlines) who by their nature are in crisis now and need to receive help from qualifed MH professionals as a matter of urgency.
    To use an analogy its like somebody ringing up the fire brigade to report their house is on fire and there are people trapped and being told nobody is available to deal with you now due to cuts but they may be able to send round a man with a bucket of something sometime next week.
    In the MHS (including the police) there are many dedicated professionals (such as your self and Nanthan) who are working above and beyond to do their best. For you the creaking service must be just as frustrating and unhelpful as it is for the person who it is supposed to protect.
    I for one appreciate the work you do

  7. A recent incident occurred in the Hampshire Police area where the control room directed a patrol car to the address of a person well known to local police who had absconded from the local hospital. The hospital required their return so rang the police. A deployment was made over the radio to the patrol car, directing them to the subject’s home address and to return them to the hospital if located. The crew of the patrol car had recently been on a mental health training day which is currently being rolled out across the constabulary front line.
    The crew of the patrol car contested this deployment, stating that if the subject has absconded from hospital that an ambulance would be the most appropriate vehicle and not a police car. The control room response was that a trigger plan was in force directing such police action in this case. The patrol car crew questioned the provenance of the trigger plan, asking if the subject’s return via the police was formally agreed and sanctioned. The patrol car offered their services in that they would assist any ambulance crew in keeping them safe during any entry made if required.
    The control room staff who had not received the MH training went away to conduct some research, minded that the patrol car crew had been trained. After some minutes the response from the control room was that an ambulance would be dispatched to the subjects address instead of the patrol car. Sometime later a further call was made from the ambulance service requesting police assistance in gaining entry into the subject’s house. The front door to the premises was forced whereupon it was discovered the subject was not at home.
    It is my belief that if the officers in the patrol car had not questioned the control room deployment they may have been placing the subject in medical risk by transporting them in a police vehicle not equipped to deal with a medical emergency. They would also have placed themselves at risk professionally had any medical emergency occurred whilst the subject was being transported, both crew members only being trained in rudimentary first aid.
    From the initial transmission made by control room staff it appeared as if a police can do and will do it all approach was taken, without consideration as to the duties and responsibilities of partner organisations, until it was challenged quite correctly by the officers deployed to the incident.

  8. Think mental health professionals are as guilty as everyone else of resisting change, whether positive or not, they want to stick to the way they’ve always done it. Personally I’m pleased if you’ve irritated a few people, they needed it. Overall i think your arguments are supported by most in the job and have helped me at least, to give support to why we should take a certain path of action when talking to the police and fellow mental health staff. So enjoy your rest and keep up the good work.

  9. Hi Mentalhealthcop! I do like your blogs and I am a MH practitioner with experience in the acute setting, community and crisis teams. I recognise that there are times when we ask our police colleagues to assist and often don’t really understand the pressures on yourselves as we all exist in our silos. I have had good (and sadly bad) experiences of joint working with your colleagues where I am. When good-seamless services to ensure the health safety and well being of service users, their families, communities and staff. Good staff(MH and Police) are able to work collaboratively to achieve a common goal. Unaware staff do tend to push responsibilities away and do not engage in a problem solving approach. The worst experiences, in my experience, tends to have lead to poorer outcomes for service users et al. MH staff are often unaware of the limited powers of police whilst police officers are unaware of the limited powers of MH staff. This gap is the point of tension between services ( and can include the interface between MH and Paramedics, A&E and primary care. Difficult. We need to identify and highlight best practice and publish.

  10. i too work in mental health and agree with what has been said so far (especially Tim’s comments – and i think that is where we as mental health workers have a responsibility to challenge the approaches of some of our colleagues). The example you gave of the welfare checks should then have resulted in the crisis team contacting the service user to see what they need to help keep themselves safe. It is inappropriate as you say to expect the police to be able to assess the safety of an individual who may well have complex needs with a five minute visit.
    There needs to be more understanding and integration with the police and mental health services so that we are working for the same common aim of helping and supporting the most vulnerable in our society. The systems we work within are not perfect, but that should not excuse a lack of care and empathy. I always think how would i feel if that person was my mother/son/friend. I am glad the police think that way too. Do not stop irritating people, it is the best way to initiate change.
    As an AMHP we have recently had a police officer attend our training forum (at his request), and this is hopefully a regular occurence where we can learn from each other and build sound working relationships, meeting the needs of the community, and each other. We all experience similar frustrations and should be supporting each other rather than trying to pass the buck. No one wins with that scenario.

  11. I wish MH crisis services would actually get a grip and take responsibility. They are so often lacking basic telephone counselling skills yet have no idea that there are other listening and face to face services that can sometimes meet the needs of an individual better and should be actually called in to train crisis workers. The Samaritans beat crisis teams hands down at this yet the crisis team in this area (central London) quite seriously have no idea what they offer.

    So out of hours they tell you to attend A&E or tell you to call the police. They don’t ‘counsel’ you as they will tell you immediately that they don’t have the time to talk on the telephone. They do not do MHA assessments themselves so don’t see why they should come out to anyone unles it is ‘planned’ (their words). So a crisis now has to be planned!

    So as a patient you learn very quickly not to call them – it is actually a huge risk factor to make what feels like a final call only to be told that they havent got the time for you. So you now have a situation where a crisis team wont respond to a crisis in the home, the out of hours GP service now dont send Drs and call an ambulance/police – who as pointed out don’t have either MH training, knowledge of the patient or any power to remove from the home.

    The MH crisis service – which by now means the Duty Assessment Team – have been heard to state that while the police are in attendance they dont need to be as the patient is safe! As someone who has been the patient in a very confused and frightened state I have had the police sit several hours awaiting the Duty team to do a MHA assessment on 3 occasions. And on each occasion the team did not turn up. Eventually sectioned after jumping in front of an oncoming train.

    So Michael please continue to be an irritant and raise the difficult questions and maybe it will encourage your police colleagues to confront the MH Trusts to actually shift their practices rather than try shift the blame.

    1. Matches my experience with a family member. As advised by mental health services, called MH helpline on a Sunday morning, who said call out of hours GP, who said go to A&E who said sit here and wait for mental health nurse, who said woooo that sounds bad, sit here and wait for mental health assessment ( we were very naïve then), mental health assessment now 6pm Sunday evening – said either go into hospital voluntarily or we’ll section you – but we were there to try to avoid admission to hospital and get some support at home………End of story agreed to go voluntarily, couldn’t face it, ran, picked up an hour later under s136 , held in custody, transported to hospital (30 miles away) in a police car at 5am released 3 days later after seeing a psychiatrist. Net result, we are unlikely to ever ask for help from Mental Health Helpline or A&E. Out of hours support needs to provide support and help people access what they need.. And why do Crisis Teams finish at 9pm which is just as most people’s crises are starting to happen?

      1. And I forgot to add o of course it is all so urgent that you then have to wait until the psychiatrist is next around a coupe of days later to be seen by the psychiatrist – makes you feel really important- not:-) I heard of one person who had to wait a whole week to be see when detained under a section 3.

  12. I dont think MH services want solutions sometimes. In my most cynical sane mind and my most persecuted paranoid mind I now believe that suicide is just something they factor in as expected and therefore it is an acceptable defence when they don’t act.

    Without the chaos and trauma poor crisis services generate there would be less of a need for MH workers in the first place. Seems like a self perpetuating industry from where I stand. Common sense and compassion rarely go together.

    If they were really interested in why someone could not access support in a crisis before attempting to harm themselves or others then ask them and the people around them. As they are the experts not MH workers. Do a patient journey as part of the serious incident enquiry. If I hear another ‘lessons will be learnt’ mantra from anyone again I will throw up.

    What may help shift this dynamic in health services (this is what’s left of my idealistic mind sandwiched between the other 2) is that the rules about what Coroners can demand has been extended. So no more hiding behind confidential internal inquiries. Add in a Duty of Candour then maybe one day someone somewhere within MH services will take a stand.

    Until then………

  13. Michael – You continue being a valuable and constructive contributor to the dialogue about how we collectively treat 1/4 of the population with mental health problems. Please keep up the good work!

    So far, I haven’t heard anything about better “joined up” practice in other countries; only the “lessons must be learnt” mantra (quote Experto Crede above) from the likes of Home Sec Theresa May MP!

    “We” should learn from other nations with better systems (in whole or in part); if there are any?
    “We” should learn from pilot projects in the UK; e.g. triage, care/retreats and voluntary sector Samaritans, Child-line, CAB.
    “We” should learn from history; 1980s closing asylums that at least offered security, shelter, work and social interaction; replaced by an underfunded “Care in the Community” AND compulsory tendering in local government that wiped out the then “Green Card Scheme” requiring councils to employ people who needed work support AND more recently the demise of REMPLOY
    “We” should undertake a fundamental review of the whole inadequate and inhuman system currently in place and replace it with one that works effectively and humanely; when ………. NOW !!

    AND who are “We” (above)?
    “We” are the BRITISH GOVERNMENT who are supposed to be running this Nation and are currently making many of us even more sick and tired with their prevarication and inaction 😦

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