De-escalation

It has been said more than once that the police need to learn de-escalation techniques when dealing with people experiencing a mental health crisis.  We know about the risks involved in restraint and of course we hope to avoid them.  We also know, that when the police do resort to the use of force – however lawfully or carefully it is done – it is never going to look pretty to those who witnesses it and having had the responsibility for investigating allegations of excessive force used by officers, it is  true to say that many examples of lawful, proportionate force may still “look” heavy-handed.

So people call upon the police to de-escalate and adapt their training.

This word “de-escalation” is not a piece of language that the police use, so the idea of introducing “de-escalation techniques” into police personal safety training sounds attractive:  here are some new techniques or tricks that might influence people in a way we hadn’t imagined?  I want to argue in this post that actually the police DO do de-escalation, it’s just that we don’t call it that.  All personal safety training for the police includes the use of voice, body position and so on, to maximise the possibility that a use of force can be avoided and people can be influenced or persuaded.  Clearly some officers are better at this than others, but that would be true of mental health nurses or teachers.  And where particular serious or protracted attempts to influence or persuade become necessary, the police service has a cadre of trained crisis negotiators.  It is especially difficult to qualify in this role, such is the standard of thinking and persuasion or influence one must demonstrate.

GOOD AND BAD

I’ve repeatedly had very positive feedback, both incident-specific and general, that police officers are, on balance, very effective at calming situations down.  This has come from nurses who have called officer to inpatient wards, from social workers who have had officers with them during difficult Mental Health Act assessments in the community.  And we must always remember one thing, which I state because I have detected an undercurrent in some of the criticism that follows a use of force by the police:

Just because a police officer ended up using physical force on someone, it may mean that de-escalation failed but it does NOT mean that the officer(s) failed.

To think that it does, must mean we work on the assumption that everyone can be persuaded to do what other people want.  As soon as you accept that we can’t always persuade others to do as we would hope, we must accept that people may either need to be left to their own devices to make decisions we’d prefer they didn’t take; or to be coerced within the limits of the law.

Humans being what they are, they react very differently to police officers.  Some people find the sight of uniformed officers a naturally reassuring presence.  Others find it unnerving even if they are in the law-abiding majority.  I will admit for this purpose that I don’t really want to life my life being constantly surrounded by police officers who are highly visible, I just want to get on with my life and know that the police are there should I feel I need them.  Maybe that’s because I work amongst it all day and need the break!  Who knows …

But why should people living with mental health disorders be any different, especially when there is some kind of unmet need?  Some patients massively object to what they see as the criminalising involvement of the police; some patients find that the police trigger thoughts that they would prefer to live without, either because of bad experiences in the past or because of delusions or paranoid ideas about what the police are doing.  So try de-escalating that … against a background as challenging as the perception of being potentially ill-treated.  Some may manage it with a certain style of influence, others may not.

POSITIVE IMPACT

Meanwhile, many patients have told me that they were very reassured by the police, even grateful that officers responded when they couldn’t access other services, and found officers to be compassionate and supporting.  One lady recently told me that officers saved her life: because they spent time with her just as she was thinking of enacting the plans she had made to end her life.

But my principal point is about de-escalation:  the police train to defuse situations, we increasingly encourage patient time spent before the use of force.  But we must always keep in mind what the police are there for – it is a somewhat broader remit than the individual at the centre of a crisis event.  The police sometimes have to balance individual rights with public safety and there is a limit to the extent that public safety can be compromised.  If the presence of an unwell person on a bridge brings a road to a halt, then we can absorb grumpy feedback from motorists who were delayed.  But if risks are escalating by inaction and a judgement is taken that we have reached that point where coercive action must be taken, it may be a police officers exercises their professional right to detain someone using force.

That someone else may have preferred longer negotiation or no use of force at all, does not necessarily mean that officers have failed to de-escalate something.  I recall an incident where officers were called to an A&E department to a man brandishing a knife in the public waiting area and who had threatened people.  Upon arrival the (large) knife was visible and two officers with tasers drew their equipment and told him twice to put the knife down.  He didn’t so they used force almost immediately.  At the incident there were representations to me from members of the public and staff that they had acted too quickly and not given him a chance.  The officers pointed out that the only way into the building for them meant that they could not get themselves in a position to contain him.  Public and staff were behind him, further away from the officers from the man.  If he had turned towards and attacked them, the officers would have been comparatively powerless to stop it.  So they acted, having seen for themselves that the risks presented were not a risk of being shouted at, pushed or even punched.  It was a potentially lethal threat and they felt a duty to protect others from it.

Maybe in different circumstances they could have set up a contained area and negotiated all day and night for a non-coercive outcome.  That’s why we must remember: all cases on their merits.


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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One thought on “De-escalation

  1. My personal experience and he observation of others’ is that the police as a group are better at descaltation than any other group of front line public servants. Any chance that police methodology could be exported to, for example, mental health units?

    [Some might be shocked to learn that in general the police are usually better at people skills than MHS staff.]

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