It is a common feature of feedback to the police that we need to get better at “communication” and “de-escalation”. When one looks at incidents like the “Humberside Taser” incident or the “Manchester Handcuffs” incident, the importance of patience, prioritising dignity and using force “only as a last resort” are a regular features.
I have seen, including recently, some absolutely excellent examples of patient, communicative and supportive interventions by police officers, not predicated on the use of force. I have also seen examples where officers have been too quick to think of force as the method by which to resolve incidents involving high levels of resistance and violence. Let me give an example:
YOU MIGHT HAVE TO TASER HIM
I recall being asked to attend a medium secure unit some years ago to a patient who had assaulted staff and “torn the place apart”. Upon our arrival, it wasn’t hard to work out which way to head because there was a trail of physical destruction that took us to a room where the patient had barricaded himself in, although it had to be said this mainly consisted of posters ripped from notices boards.
Being a modern unit, it was fitted with anti-barricade doors so this wasn’t a problem, it was more a case of working out what the staff were asking us to do, how the MH staff and police would work together to achieve this and how to approach it all. MH staff said, – NB, not “asked”, but “said” – “we need you to restrain him and take him to the seclusion room so we can medicate him. You might have to taser him.”
We did have two taser officers present at the incident. Visual assessment of the patient in the room showed a highly agitated man, physically imposing and obviously very strong whose demeanour was concerning in terms of how we might keep people safe. One of the taser officers even had their equipment out of the holster, before we’d decided how to approach it.
The seclusion room was only a short distance away and there were just enough officers there to ensure that we could block access to other rooms and corridors so that the only natural method of moving anywhere was to go where the staff wanted him to be. Everything seemed geared up for a use of force and given two assaults on staff, who were injured enough to have got out of the situation completely, some level of physical intervention would have potentially been justified. So we prepared and I heard officers and staff talking about “red-dotting” him, which means pointing the Taser at him and focussing the red-dot to induce compliance with instructions amidst a direct threat of the equipment being used.
At this point I said, “Right, we’re going to ask you to open the door and we’re going to talk to him, put your taser out of sight. If that fails, we’ll escalate things, but not until.” So we got several officers out of view and opened the door, calmly and reassuringly asking, “Jimmy, can you come this way, mate?” And he did. He walked to the seclusion room and we never touched him. Staff then administered medication, again without the police touching him at all, although we were right there in close proximity in case when staff got near him his demeanour changed. Then we left having spoken to the assaulted staff to handle that appropriately.
No force used at all – despite everyone being inclined to think it would be needed: the lesson here is to ensure you try the least restrictive approach.
DE-ESCALATION
I think police officers are better at “de-escalation” than we give them credit for and that we think about officers needing de-escalation training because the training we do provide doesn’t normally use that particular term to describe or explain what we want them to do. De-escalation is a mental health related term, so the police mustn’t do it, right? Well, possibly.
Police personal safety training could be argued to encourage an approach to the use of force where officers go into a situation, using force above the level of threat to make sure it’s contained with minimal danger to the officers. But we all know that “tactical communications” is a golden thread running through all police use of force. In one training scenario I had during annual refresher training, the use of force was considered a fail, because the situation had been designed to mean that officers with sufficient persuasive communication skills would resolve it without force. I asked the trainers about this and the vast majority of people be tested on that situation recognised this fact and passed. And this was against three days of training using batons, handcuffs and CS spray where instinct tells you that all you’re preparing yourself for in assessments is that you can show lawful, effective use of your equipment.
We all know that there are some police officers (and some mental health professionals!) who can wind up almost anyone without trying hard, but I also know some police officers that could sell snow to Eskimos. Far more of them, in fact.
So I’ve always thought the police are good at de-escalation generally speaking and when they put their minds to it, as above. I’ve also seen mental health professionals call for the police to use force and officers have declined, resolving difficult situations without any force at all, as above. This is not an argument that the police are always spot on, although I do receive feedback from mental health professionals of officers attending wards or MHA assessments in the community and being persuasive and patient, avoiding a need for restraint. It must be said, I’ve also seen paramedics, mental health nurses and AMHPs doing likewise during assessments or in police custody.
In this time of resources being somewhat scarce in all organisations, it is worth remembering that most professionals in out health and emergency services were selected for the task because the recruiting processes they succeed in and the training systems they were put through, thought they had the skills to be patient, responsible professionals, capable of judging these issues. Although culturally organisations may differ, they may call things by different names, most of us are trying to do the same thing so the issue is not so much about whether it is “the police” or “mental health nurses” who need more or better training, it will inevitably be that some professionals in all of these organisations need to remember to get that extra, patient mile in avoiding the use of force.
And you can call that whatever you want!
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, 2014
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Mental Health Cop 
‘We all know that there are some police officers (and some mental health professionals!) who can wind up almost anyone without trying hard, but I also know some police officers that could sell snow to Eskimos.’
Having been at the receiving end of both kind and patient mental health staff and police and the opposite end where there is a lack of appropriate speech and body language I have seen (and felt) what a difference it can make. Yes a situation can be made worse by the wrong attitude. I have seen a situation on a psych ward many times blow up out of proportion into violence – if I can see it coming why can’t the staff? Professionals need to realise (role play during training perhaps) how a tone of voice, hint of harshness, aggressive stance all come into play when dealing with a person having a mental health crisis of some kind. Treating the person like a human being is a good place to start – mental health patients are not 2 years old or animals.
It’s good that officers like yourself know this and hope that blogs like this can spread the word.
More wise words as usual.
There are consequences when people fail to listen and I mean _REALLY_ listen.
I’m currently looking at the realities of failed listening balanced against successful listening in my work with veterans and serving soldiers and reservists.
Is anyone else interested? Maybe willing to share some experiences of both good and bad listening outcomes?
You have to remember that someone might read a different intention (than reducing risk to self or others) into a restraining persons behaviour, (or the real intention.) How many times does restraint coincide with a devaluation of a person, explicit in body language, tone of voice, flippancy, smirking, etc? You have to consider that there have been probably been other situations in which devaluation has occurred, which have been detrimental to the persons wellbeing.
I think a guide ( within) yourself is whether there is satisfaction or schadenfreude in restraining someone, and this would indicate a wrong state of mind, such as a puerile desire to punish or humiliate. Unfortunately, most psychiatric nurses are poor in pressure situations from lack of intense training and poor selection processes. I know this from thousands of hours observation. I don’t think the extensive paraphernalia the police carry these days helps with their mentality either. If you use tasars or CS sprays then you are starting to look.more like criminals with uniforms, or adolescents. Unfortunately, authoritarian roles do attract adolescent people.
Seriously? – where’s the evidence for *that* claim?!
How did the police manage before they started carrying CS, tasars etc? Probably by having better communication skills. Nowadays, they just look awful. Not only my opinion, but my father’s who worked his way from pc to detective chief superintendent in the met, with 32 years experience, and common sense.
It’s a viewpoint you and he are entitled to hold – but the point is that many of them didn’t manage, not for one minute and historical officers did not work in an era of unprecedented inspection and accountability. And it must be said, that many of the generation of police officers that preceded my own were dreadful. The other point is, that prior to Taser being made available, police officers occasionally shot people dead and it happened often enough for us to see a call for less-lethal options. Remove taser and you have to accept that with certain levels of threat, people may be shot instead. Not easy, is it?!
I personally don’t like being threatened with a knife and be expected to deal with it whilst armed with a small tin of pepper and a metal stick and I know that the families of dead and injured police officers also have views that shouldn’t just be dismissed because they don’t accord with yours. Like all difficult things in life, there are pros and cons to every decision (about what equipment and training cops should have) and it’s not just about how it “looks.”
How the police appear is very important though, as a little thought would make obvious. If the police appear on the news as though they were prepared to use excessive force or dressed as if they had watched too many SWAT films then they lose their legitimacy. To suggest that historical officers were less competent or had questionable integrity or faced less threats is one you can hold, from your own extensive experience.
I didn’t say it wasn’t important; I only said it’s not the only important thing. I’d prefer it, if you are going to attempt to patronise me by encouraging “a little thought” that you tried reading what I actually wrote, rather than what you choose to read into it so you could continue to argue a point I’m not disagreeing with. Thanks.
Please don’t use the word cops, this isn’t America. Try police officers, who police with the consent of the public. Try forming a proper argument; how people look is communicating something, as is holding a knife. Many millions of people have died or been injured to provide law and order, and they don’t want their efforts undermined. If you enter into a situation armed to the teeth and projecting the use of force it often escalates.
I’m all too aware that this is not America, but if it’s OK with you, on my own blog I’ll choose the language I prefer to utilize and since “cops” as slang for police officers derives from “coppers” and has documented usuage in England dating back several centuries including prior to the establishment of the modern Metropolitan Police and any Unites States police agencies, it seems fair game. As for “proper argument”, if you can’t see one within what I stated, then you’re not reading closely enough so let me summarise it for you: the appearance of officers is important, as is their ability to keep themselves and the public safe through the use of modern, relevant equipment. These two things will, to some extent that we can argue about, conflict with each other given that a bright yellow taser hanging off a twentieth century dress police tunic is always going to look irregular. Somebody somewhere has to identify a compromise and that’s what you’ve currently got. I’m not defending it, as I have various views about police uniform and appearance that will not be made known here since it’s not what my blog is about.
In court proceedings I would prefer police officer as cop would sound far too casual, especially if you were explaining your justification for using a taser.
Anyway, I’m glad that you prevented your colleagues tasering an ill member of the public, which they were trained to do. Pandering to public demands is not on everyone’s agenda. Haven’t the mentally ill.seen enough hatred?
I doubt whether policing makes it into the top 50 most dangerous professions in the country. School children probably experience more violence than most police officers. People need to get things in perspective, fast.
If the police mislead people about the risk they face in the line of duty, aren’t they also not to be trusted in reducing the stigma associated with mental illness which derives from the ludicrous over estimation of the dangers this group of people pose to “society”. Furthermore, resources are being squandered on massive police operations which would far more profitably be spent on reducing suicide by earlier appointments and more support. I know this might upset colonials but, well, quite frankly I don’t give a damn. That the ‘animal’ who needed tasering has a 10 per cent suicide rate isn’t even mentioned. Who needs common sense though when you can retreat into group narcissism or a legal carapace?
I believe that if public services fail to.understand what types of thought people are having when they appear to pose a risk to others or themselves, then it is going to be extremely difficult to resolve the situation and achieve a best outcome for all concerned.
The suspicions people have about someone’s thoughts and intentions can reflect aspects of their own personalities, experiences and imaginations, whether they are the staff or the patient. If you are on a psychiatric unit, there may be distortion in the way patients view staff behaviour, but also, it has to be said, vice versa.
Added to.that, it is very important to watch body language and facial expression, as these are taken as more reliable indicators of what peoples intentions are than what they necessarily say. Any kind of devaluation can cause explosive violence, particularly among ‘reactive offenders’. These are people who.have a very negative view of themselves, and when this is ‘confirmed’ then they can become violent or self harm. This negative view can distort thing said or done, but unfortunately this aspect of their thinking is rarely seen as an area of intervention.
I suppose what I am saying (in a roundabout way!) , is that issues of fairness are worth negotiating from both sides, that it is good to see the situation from the others perspective, even if it does seem illogical or distorted, and acknowledge that the police have benign intentions in the patients best interests, because abused people especially are very suspicious.
One possible explanation of why people can be violent on psychiatric wards is that violence (and self harm) are mood regulators (in the short term). Unfortunately, this applies to almost everyone; people can feel ecstatic when their military wins in a war, when England win at rugby, or whether they win in a confrontational situation.
Given that people suffer greatly on psychiatric wards, they also have to deal with the widespread belief that they deserve their own suffering and are somehow responsible for it.
We often refuse to accept an idea merely because the tone of voice in which it is expressed to us is unsympathetic (nietzsche). How often does *that* happen?! Willfullness / willingness.;)