Reluctance and Resistance

We heard in yesterday’s debate in Parliament the view of former Minister of State for mental health, Paul BURSTOW MP that the NHS institutionally discriminates against mental health patients; and in a variety of ways.  I want to provide two examples from the real world, involving the same police officers in the same area along with the same Accident & Emergency department and the same ambulance service to show that this is true.

The examples are provided precisely because they are not isolated and because the proximity of occurence and the geography involved makes the point Mr BURSTOW was trying to highlight yesterday.

These examples occured in November in England —

  • Police officers detained a man under section 136 MHA following dangerous behaviour found him leaping in and out of traffic and very obviously suffering from serious mental health problems.  He declared a long history of mental ill-health and previous admissions to a psychiatric unit in the next county and was also physically injured from a self-inflicted injury to his hand that would require treatment.  Because of the immediate need of care, he was detained and then significantly resisted.  Officers were required to use significant restraint techniques, including handcuffs and the journey to hospital was very difficult.  No-one knew at that stage what the medical issues were, beyond the behaviours that could be seen visually and his declarations.
  • Three days later, the same officers attend the scene of a robbery where offenders had forced entry to a building and struck one of the victims to the head with a heavy metal bar.  The result of this was to render the victim (who had been drinking) into an agitated condition and when the ambulance service were trying to respond to him, he was aggressive in his decline of treatment and was restrained by police officers and taken to hospital against his will (Mental Capacity Act).

THE RESPONSE

Firstly, no issues at all with the ambulance service: our colleagues in green took each case seriously, tried their very best in difficult circumstances to begin to get a basic understanding of this person, their health needs and a sense of what was needed next.  They remained engaged in the process when police officers ended up going “hands on” to keep these people safe and, ultimately, to compel them to hospital under law.  Good 999 team work – the difference emerged in hospital.

Obvious reluctance in case one, which eventually built up to requests that the man be removed from A&E completely and taken to the cells, even though no considered examination of him had been done.  At best, a visual examination from a distance of about 3m was the extent of the triage and care before requesting the cells be used.

Meanwhile, the man with the head injury was brought in and very quickly sedated so that more meaningful examination could occur over time and pressure and strain upon be relieved.

It’s self-evident that I’m not a doctor.  I fully understand that we don’t just sedate everyone when they’re aggressive and that there are reasons for different approaches, of course.  It’s not down to me to make medical decisions, etc., etc..  But I would submit that the doctors and nurses in case could not have done a very thorough examination of man one from 3m away.  We’ve read before on this blog about cases involving the police and sometimes paramedics, where casual dismissal of violent behaviour as either simple violence which is a police matter; or as arising just from mental health issues, has led to misdiagnosis.  We also know what the Rocky BENNETT inquiry said about violent mental health patients in need ongoing restraint – “to be treated as a medical emergency” said the experts, most of them doctors.  Remember the diabetes patient who collapsed after 136 resistance; the non-visible head injury; and the brain tumour patient?   Remember all the unexplained deaths where pathologists simply could not agree on a cause of death and where the last intervention had been police restraint so it was argued – not unreasonably given everything I’ve just written – that the police should have recognised the seriousness of things and removed the person to A&E?

This is what families have argued for after the deaths of their loved ones.  Wouldn’t we all?

CONSISTENCY AND ISOLATION

But another reason for highlighting these examples, is that I have several personal experiences of detaining people like man one and removing them to A&E where they were treated like man two.  In particular, I remember about seven years ago meeting a British Army doctor in an A&E setting in Birmingham who did exactly this.

I asked for a few minutes of his time given my interest in these issues and asked why he took that approach when many of his colleagues say, “Not doing it – take him to the cells!”  He patiently explained a lot of the underlying problems that could be giving rise to such behaviours – even in people are are “just” mentally ill – and he mentioned the risks from restraint by the police whilst acknowledging that many other doctors didn’t see it like this, but that he failed to understand why.

These are not isolated examples and clinical consistency is an issue.

But what good is all of that, if the police do exactly as families, Coroners, the Rocky BENNETT Inquiry experts and human rights groups like Black Mental Health UK and Inquest argue – only to find the doors of the NHS are shut to some such patients?  We read elsewhere on this blog from medical professionals about the various medical things can be ongoing leading up to or arising from restraint and we know why the care received by both should have been equitable.  Be violently resistant because of a head injury or a stroke and the doors are not closed, but mental ill-health?

Cells.

And we know that this is the trajectory of many cases that lead to IPCC death in custody inquiries – where it is police officers who end up accused in some cases, of criminal wrong-doing.

The police officers involved in both of these incidents were the same people: they know that to all intents and purposes, the patients were very similar in terms of challenges presented to all and we know for a fact that officers were not expecting to drop either patient in the doorway of A&E and leave – they were prepared to remain and support NHS staff if that were required.  But telling medical staff that one was “detained section 136” and the other was a “crime victim who has been hit to the head” made all the difference in the world and yet both were patients exhibiting behaviour that is explicitly written about in the NICE Guidelines on Acutely Disturbed Behaviour.  One patient benefitted from the application or at least the consideration of these guidelines, the other most certainly did not.

It is the legal status of the patient and the assumptions around mental ill-health that make the difference to the healthcare received.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


Advertisements

4 thoughts on “Reluctance and Resistance

  1. XX Be violently resistant because of a head injury or a stroke…XX

    A stroke?

    One I have never met before, and that is myself having one included.

    A violent stroke patient is…? Normally it is difficult to keep us “awake.”

    I would be interested to hear more.

    1. Any number of academic studies available about inability to control anger or aggression in stroke patients, some studies reporting that 1/3rd of stroke patients can have such difficulties. Just do a bit of Google searching and they’re easy enough to find.

  2. with my academic mindset – as opposed to my own experience as patient who has been detained under the MHA a number of times when unwell, and suffered physical harm as a result of medical inaction, despite police attempts to get me help – I believe attitudes exactly like those you describe here may contribute to the health inequalities and lower life expectancy for people with mental ill health. Difficulty in accessing physical health care exists at all levels of the health service for people with mental health problems. A&E is the sharp end, but the attitudes are more widespread, and services are very reluctant to admit such discrimination exists. It’s good that people such as yourself are talking about this. http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens-between-those-mental-illness-and-general-popula

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s