Social Work and a Spot of Psychiatry

I won’t lie: you often hear cops grumbling about being “social workers”. This usually accompanies tasks that are not seen as “real police work” (whatever that is) and any analysis of policework is going to have to address this extent to which policing is predominantly not about crime. Even where it does involve crime, it is not predominantly about law and enforcement, despite the popular myths.

So if the police are busy not enforcing the criminal law and attending to crime by bringing offenders to book, what do they actually do all day?  The Economist seemed surprised to find that it involved “social work, relationship counselling and a spot of psychiatry.”  We’ve known this since the beginning of policing.  It’s absolutely nothing new.

OFFICER, WHAT DO YOU DO ALL DAY?

There probably isn’t a police officer in the land that hasn’t offered marital and financial advice, who hasn’t sat with someone at the lowest point in their lives and held their hand, listening. Most of us have assumed responsibility for people who are likely to cause themselves harm and so there are various reinforcements as to why a complaint is made that we are de facto social workers, therapists and psychiatrists. We do see out of hours social services deflecting demand to the police that is better managed by them in the ideal world I don’t live in. We know that some of this demand is deflected purely because of other agencies’ inability to service it. Many of these tasks do not need a police officer, strictly speaking, either for legal or any other reason. So we see the requests for “safe and well checks” on the elderly or children who may be at risk, just as we see those same requests coming from mental health crisis teams, who have in some instances decided (without reference to the police on whom such duties then fall) that they will no longer undertake any work at all that isn’t situated in A&E or police custody. And if this work could be done by social services or mental health crisis teams, even if it should be done by social services or mental health teams, does this not mean that I’m becoming a social worker if I’m doing tasks that more properly sit with them?

Of course it doesn’t – although there is a difference between the police going to an address where it is necessary to prevent a breach of the peace and with a view to using powers under the Children Act 1989 that only the police have, and going to an address just to do a kind of check-up that any competent professional could undertake whether that be a social worker, a police officer or a teacher.  But it is not that difference that defines policework.  Most police work involves the police doing a multitude of tasks that many professions and individual citizens could do.  So it has to be something else that defines it.

This moves us on to the need to do “a spot of psychiatry”.  I don’t recall doing a medical degree or ten years of post-graduate training and qualification, but here I am, called upon in the middle of the night to make certain kinds of medical decision. Often without the ability to get any support from the health system about whether someone’s presentation should be triggering alarm bells of a particular volume, I am expected to discern criminal and behavioural issues from medical and mental health ones. (As if those things are in any way discreet entities!) I’ve sometimes had to decide on healthcare pathways for people with medical needs I haven’t got the first clue about, in circumstances where the decision may have long-standing medical (and legal!) consequences.  The role of police officers in responding to incidents involving mental ill-health has been noted for fifty years in policing research, going back as far Egon BITTNER in the 1960s.  Very memorably for the purposes of this post, US academic Linda TEPLIN referred to police officers in the title of one of her pieces in the 1990s as “Street Corner Psychiatrists.”  I suppose, in fairness to the proposition, I should admit possession of a copy of the Oxford Handbook of “Emergencies in Psychiatry” in my collection. (It’s always best to know thine enemy!)

On the other hand, we know that the political vision of policing at the current time is that we should “reduce crime: nothing more, nothing less” and we keep hearing the rhetoric about “single-minded crime fighters.” This was always going to jar with reality. The very body of policing research that I referred is replete with findings that crime plays only a very small part of the overall demand faced by the police – and that crime may actually not be the most important thing to the public anyway.

READING THE CHILDREN ACT

I reflect upon the last month at work and can recall many, many conversations with members of the public about legal and social issues that were absolutely nothing to do with the police and / or the criminal law.  A particularly rewarding hour was spent with a woman and her 16yr old daughter discussing the Children Act because of ongoing dispute with her ex-husband about access to her younger daughter, whom Dad had not returned as per their court agreement.  Not unnaturally, the woman thought, “He’s breaking the court order” and she phoned her solicitor.  The solicitor said, “You need to go to the police and tell them it’s their duty to go and find the girl and return her to you.”  So even less unnaturally, she came to the police and didn’t fully understand why front office staff told her that the issue was not a police matter and she should contact a solicitor.  Surely solicitors know more about the law than the police?  Not always. Suffice to say, that by the end of the hour, I’d convinced her that we wanted to be as helpful as we could possibly be despite having no legal authority in her situation and having quickly reminded myself of parts of the Children Act that don’t feature in police training – because they don’t affect the police – I gave her references to the law, some practical advice and off she went armed with the right information to take the issues forward.  She even rang me the next day to thank me and tell me how it had worked and that her daughter was back, safe and well. She would address the longer-term problem via the courts and her solicitor.

Not police work. Not even social work. Just advice to the public, hopefully helpful.

I’ve never seen those parts of policing that are connected to social care and family law processes as “social work”.  I don’t see those parts of policing that are connected to mental health as “a spot of psychiatry.”  To go back to BITTNER, whose sociology and criminology I admire, policing is what happens when “something’s happening that ought not to be happening about which someone ought to do something NOW!” It is the word ‘NOW!’ that defines policing, regardless of how we got here.  If someone needs access to mental health services and they somehow come into contact with the police, officers don’t usually detain that person under the Mental Health Act – they don’t even do it very often.  Far more likely, the officer will give advice or support, sign-posting them to people who can help, contacting those people on behalf of the person or enabling access to relevant services, possibly via the ambulance service or A&E.  This is quite correct – just like officers have to judge whether a dispute about the sale of goods is a civil matter where people are sign-posted to the Citizen’s Advice Bureau or a solicitor; or whether it has involved a deception and become a fraud.

Other academics like WADDINGTON have characterised policing as “order maintenance.”  Your mental health emergency can be sign-posted or referred where it is unconnected to any form of social disorder where you are threatened or threatening.  Once that social disorder threshold is passed – irrespective of whether that constitutes an offence – officers are expected to start intervening.  This may involve starting to think in terms of detention to ensure the restoration or “order”, but sometimes we influence outcomes by just talking to people.

DOING EVERYONE ELSE’S WORK

Police officers sometimes clear up debris after a road collision – we don’t make the road immaculate and take the detritus to the tip, we just shift it to the side of the road so no more accidents will happen.  Once that is achieved, the actual clear up of broken cars and road furniture, the proper repair of the road and it’s accoutrements as well as disposal of it all is a matter for the local authority who we contact.  This initial shifting of the debris is not local authority work – it’s policework because it needs to happen NOW! and is connected to the maintenance of safety and order (on the roads).

Police officers sometime help people shift their furniture upstairs when they are about to be flooded – we don’t stop doing more important things than that when lives are at risk, but where officers are free in circumstances of social emergency, they have been known to muck in.

That’s why police officers sometimes agree to move mental health patients from one place to another, despite guidance saying that the ambulance service or mental health services should do it. Agreeing to muck in, might mean that we prevent the patient going missing for the fourth time in two days and the investment of a couple of cops doing a twenty-minute job might mean we save hours and hours of police time in preventing further absences by a patient clearly unable to be contained in the place he is currently detained. I have been known to say “No” to requests to move people, because saying no is sometimes without consequence to the police and the public at a time when other 999 demands mean I can’t spare the resources. But last week, I proactively offered help when no request was made, because it was in the interests of the public at a point where I could spare two cops for twenty minutes.

“Something’s happening that ought not to be happening about which someone ought to do something NOW!”

A definition of policework which means I might get to do any number of things that might be better done by others and which falls squarely under their remit.  It’s just that they’re not here, for whatever good or bad reason.  Everything that the police do is necessary because somebody, somewhere either isn’t able or willing, they aren’t competent or responsible, but most usually they are just not there, for whatever reason.  Whilst you’re busy debating it all, this thing it still needs doing NOW, because it contributes to social order and social safety – and that means it’s down to the police, more often than not.


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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16 thoughts on “Social Work and a Spot of Psychiatry

  1. This casual use of language is something that frustrates me – great post, by the way, which touches on the complexities.

    My frustration is that ‘social work’ is somehow perceived to be all about checking people are ok, having cups of tea, helping society in some way, or being a generally nice person – when actually, it’s a complex job which has a particular skill set and isn’t just about popping in to see Mrs Jones and checking she’s ok cos her care workers haven’t been able to get in. Using casual phrases about police ‘doing social work’ shows an inherent misunderstanding of both roles.

    I’m sure police want to do ‘real’ policing but surely some of the things that might be dismissed, are just that. Roles can blur of course, but I despair at the lack of understanding in general of what social work actually consists of.

    1. Thank you for saying this outloud 🙂

      Social Work is a very challenging & at time frustrating & yet rewarding profession & often very misunderstood.

      Often social workers are expected to work with people who have all sorts of problems – ranging from issues of poverty & huge inequalities in terms of health & education & oppotunity. Social workers can & do engage with indivduals in a positive way & support them to deal with their problems. Often this is done by buliding a relationship based on some level of trust & impathy. Social workers are often unable to compel individuals to “do the right thing” nor are social workers the DWP or the Housing Dept etc.

      People also forget that social work intervetion is not only underpinned by theory, but also by a legislative framework e.g. the NAA, Community Care Act, MHA, MCA etc. Social Services Departments (as where) & social workers don’t exisit because someone thought it was a good idea to help people. This legislative framework dictates what the State can & cannot do. Its the classic somebody should do something! but who & how is not as straightforward as the public & my mum might think, unfortunately.

      Social workers end up in all sorts of challenging situations, often encountering very distressed people who may or may not pose a risk to themselves, the social worker or indeed their families/cares or the public. Often the social worker is there alone, with their diary & mobile phone.

      In terms of safe & well checks etc colleagues & I do plenty of these – but again we have no right of access. I can bang the door but if I am so concerned that I need to get in I gotta call the police or seek a warrant. I once went to a door with a CPN colleague & over several days knocked on a door, we even went round the back etc. It wasn’t answered because the chap was dead – he had been murdered. I have also knocked on doors & been threatened with weapons & called all sorts of things that would make my mum blush. I am usually invited in & on occasion even offered a cup of tea. I only call the police when I think I have to. Unfortuantely the response is not always a positive one. Who knows whats really going on behind closed doors?

      Ultimately the individuals & the public at large are best served by agencies that work in partnership. However its one thing to say it & agree policies etc.

      1. ASIFAMHP an interesting view point that you shared in your piece and the points you raised;
        You mention in your piece
        “I can bang the door but if I am so concerned that I need to get in I gotta call the police or seek a warrant”,
        I’m intrigued as to how the police could get you get into the house if the only other way was to get a warrant. If you have no right of access then very probably the police may not have any right either. The police have specific powers of entry which are laid down in legislation. There is an excellent overview of these powers on this blogsite see the main index for “You call us” in the “PARAMEDIC SERIES” and Forcing Entry under the AWOL Patients and s135(2) Mental Health Act 1983 section, it explains the relevant entry powers the police have.
        .” You continue “I only call the police when I think I have to unfortunately the response is not always a positive one.

        I do not know what the reasons were for the calls however as mentioned in this blog the public do approach the police for a wide variety of reasons in the belief they can do something. Quite often they can’t. The reason being answered your next point “Who knows what’s really going on behind closed doors? That’s just it, what goes on behind closed doors is the affair of those people inside. The power of entry and intrusion into a person’s dwelling or home is enshrined in legislation and long may it remain so. From your blog name it suggests that you are an AMHP. If so are you aware that you have powers of entry under S135 of the MHA which the police do not have. See the chapter Quick Guide – s135 or Assessments on Private Premises on this blog for further information.

        There are a number of dilemmas we all face with these issues of detention and use of force and entry into a premises. It’s an issue the police deal with daily. When dealing with MH issues I often will ring my local Crisis Team to consult with them about a patient of theirs I am dealing with. The call may result in a resolution to my situation however sometimes not but it will have afforded me to have consulted with others with whom I can talk to in an attempt to forge a way ahead. In the same vain by speaking to the police may help with a way ahead with some of the situations you find yourself in. It may not be the one which you imagined or wished but it should at the least assist in some sort of constructive way ahead in which some kind of action plan can be formed.

        In response to your comments on standing alone, with your diary & mobile phone and being threatened with weapons & called all sorts of things that would make your mum blush after knocking on a door, may I say welcome to my world. In these situations you can often find yourself dealing volatile and unpredictable people such is the nature of their ailment. If you suspect that you are going to an address where you consider there may be a risk on going alone I would suggest that you go with a colleague or make alternative arrangements in order to keep yourself safe. If there is a real issue with this it should be brought to your manager’s attention and addressed as a safety issue and alternative arrangements made to ensure everyone’s safety.

      2. Just to echo the point made above, a mental health team called us about three weeks ago to force entry to a house to detaina s3 patient where they should have known that both they and we had absolutely no power whatsoever by which to do so.

        But then, I’ve learned a lot in the last few years in particular about just exactly how parlous legal training is in mental health services. Granted, AMHPs tend to be better because of the nature of their role, but even then, it’s consistently below where it needs to be. One you start talking about mental health nurses or psychiatrists, you’re into new depths.

        As previously mentioned: we need an “Emergency Mental Health Law” course! 🙂

      3. “I once went to a door with a CPN colleague & over several days knocked on a door, we even went round the back etc.”

        Police on,y have Section 17 (e) saving life or limb or preventing serious damage to property powers to force entry to an address.

        This was quantified in Syed v DPP

        “12. The test applied by the officers, and accepted by the justices in this case, was a concern for the welfare of someone within the premises. Concern for welfare is not sufficient to justify an entry within the terms of section 17(1)(e). It is altogether too low a test. I appreciate and have some sympathy with the problems that face police officers in a situation such as was faced by these officers. In a sense they are damned if they do and damned if they do not, because if in fact something serious had happened, or was about to happen, and they did not do anything about it because they took the view that they had no right of entry, no doubt there would have been a degree of ex post facto criticism. But it is important to bear in mind that Parliament set the threshold at the height indicated by section 17(1)(e) because it is a serious matter for a citizen to have his house entered against his will and by force by police officers. Parliament having set that level, it is important that it be met in any particular case.”

        So if it has been a week of you trying to get an answer this stage there is only a concern for the persons welfare. I’m of course assuming you wouldn’t wait a week if you had some information however small to suggest there was a risk or threat. So even in those circumstances we don’t have a legal power of entry so we are in the same position as yourself. Well that isn’t quite true because we will still gain entry as it’s the moral thing to do. From a police point of view when I get these calls regarding a ‘concern for welfare’ it’s rare, if ever, the caller has made any attempts at finding out where the person is. No visits to family members, no calls to hospitals etc which I would expect from a others raising the concern on a professional capacity.

    2. Gentlemen (well I think you all are are, with the exception of Ermintrude) thank you for your considered responses. I am also assuming that you are serving police officers.

      Ian – I am very much in your world, unfortunately almost daily, but I try very hard not to accept abuse etc as the norm. Like you I am a pulic servant, try to do the my best in sometimes difficult circumstances. 2bf I am reasonably robust by design & have a very well developed sense of humour. I also remind myself that often I meet people who are warm & welcoming & my job affords me the opportunity to glimpse other peoples lives, often when they are very distressed. I often use the word distressed on purpose, because they may not be ill & in my world being ill does not necessarily equate to dealing with ” volatile and unpredictable people such is the nature of their ailment.”. In my world it is not the nature of the ailment, the vast majority of people (that is 1 in 4 of the population) who have mental health issues are just like you & me & pose no risk to anybody. That is always my starting point, so without being blind to risk issues I will usually knock most doors & I will sometimes take another colleagues armed with their diary & phone also & in our jobs somebody has to go. As for raising issues with my managers I am busy trying to get them to address bigger issues in terms of who we all work together – banging head against wall, but slowly getting there. Also like you I am often asked to interfere in peoples lives when I have no legal right to do so & like you I very much like living in a version of a liberal democracy & not a police state ( I hope you will forgive the example). But as SD states we are danmed if we do & blamed if we don’t etc & to be fair I an fed up with socail workers being blamed for nearly everything. Of course sometimes they are at fault, but often they are part of a complex failure of the state. Navel gazing after critical events always says that we all need to work better together

      Yes I am an AMHP & I am very close to having co-ordinated 1000 MHA Assessments, so I think I understand the MHA pretty well & how to apply it. The 135(1) Warrant actually gives you the power to force entry, but you need me & a medic to be with you. I am always learning & its a very big book (Jones). The only issue I will make is that in certain circumstances the police have certain powers that I dont & SD has clarified these for me. I will also add that police officers have training & equipment I don’t e.g. the big red key, radios & the ability to whistle up back up, stab vests, battons & CS spray etc if it all does go wrong. Which is does sometimes, but not often so I try not to practice in an overly defensive manner.

      Mentalhealthcop – As you know I can give examples of where police officers & others have misused powers or chosen not use them, when maybe they should & def could. But I am not sure that getting into that type of excahange is helpful. Plus I hope that you would agree that my approcah does not usually involve police bashing for the sake of it. I try to be balanced & accept that yours is often a difficult job & in my experince getting the officers deployed is the issue. Once on the there they are usually very good & very helpful. For me it always back to the how we actually work together & acknowledging that we have different roles & perspectives in the same sitaution. But a least we are there, others who should be are often not & we are left filling the gap & squabbling about how we do that.

      I suspect given the football & rugby results yesterday that today is not your best day! I am hoping that those north of the border get it later today 🙂

      So there we go, a snap shot of my veiw of the world.

      take care & keep talking & keep being nice to those AMHPs – they often do know the MHA at least.

      1. ASIFAMHP I am gladdened to read that you are raising issues with your managers in trying to get them to address bigger issues in terms of how we all work together, which is never a bad thing. I would also ask if questions being posed by health trust managers as to how trusts can do more to help themselves.
        As you said you call the police as they have training and equipment. I have attended a number of locations to execute prearranged 135 warrants in the past to find an ambulance has been called up and has duly attended from the local station. The ambulance being a normal paramedic ambulance not designed or equipped to deal with difficult patients who are in MH crisis. The attending ambulance staff who attend are also unprepared and untrained to deal with challenging needs of MH patients.

        In these circumstances I would consider a secure ambulance and adequately trained ambulance personnel would be a more suitable means of transport. If a secure ambulance cannot be sourced within the local ambulance service they are available for use 24/7 from private ambulance providers such as medisec-ambulance.co.uk, who provide secure ambulances along with trained staff who are capable of meeting the needs of difficult patients.
        The police do have a big red key, (A heavy red coloured door banging tool used to force doors open) However it is used sparingly when a door needs to be forced, and only when there is a power of entry such as a warrant execution. We do have radios if we need to communicate with the control room. We can also use the radio as you say for back up if needed. However when attending a job the appropriate officer numbers are considered and factored in prior to attendance. If going to a location where there may be a risk of volatility am sure you would agree it is always prudent to send adequately trained and equipped staff in sufficient numbers. Please don’t take this the wrong way I am not having a go at AMHP’s. We just are where we are.

        You did say that it is awkward to get police to attend such jobs but when they did attend that they were usually very good and very helpful. I would ask if adequately trained and equipped NHS staff would be as equally useful.
        I am curious as to whether private secure ambulance provision is considered by MH trusts when planning MH transport or detentions as opposed to the default “call the police for back” up route currently taken (baring the execution of the warrant). Calling the police instead of a private specialist has the advantage for the health trust in not creating a further cost instead any transportation and supply of trained personnel becomes a cost to the local constabulary. Costs possibly being a major factor in why heath bosses do not wish to address the issue of adequate secure provision for meeting mental health needs in the community.

        For years the health service have relied upon the police to fill this gap in secure transportation and interfacing with challenging patients. If such transport in the way of robust ambulances and adequately trained staff was sourced the reliance on the police would be lessened significantly and situations in which people suffering MH conditions are detained in a cage the rear of a police van may become a thing of the past.

      2. Ian

        In answer to your questions.

        The local ambulance service is commissioned by the CCG (as was the PCT) to provide the means of transport.But you are right as soon as there is an element risk & resistance (never mind RAVE & Red Flags) the ambulance service are unable or not prepared to do the job. Indeed it is often the ambulance service that insist that they will not attend until the police are on the scene. It’s their way of looking after their staff.

        I have used private firms & they tend to be very good, but cost in the region of £5000 a pop. My preference is to keep profit out of this & that also includes private hospitals. People are being placed miles away from home & it is just not right. Remember also sometimes people have actually committed offences & it is appropriate that the police be there – Part IV of the MHA is there for this.

        Trying to co-ordinate a MHA Assessment is a challenge – even with a warrant in hand. We gotta go to court & pay £18.00 (cash), convince a magistrate that a warrant is required & get it. Then attempt to get an AMHP, at least one medic, a HTT, the police & the ambulance there without actually knowing if a POS or a bed is availabe. Often others assume it’s a done deal & are only interested in where the bed is? & not committ resourses until they know where the bed is, they use words like exit startegy. I find myself reminding colleagues that it is a legal process & we should do it well, as we expect it to be done to us.

        My preference is that when required – we should all go together. Indeed the MHA & Code of Practice says that I should co-ordinate it that way. The MHA Act gives me lots of duties & responsibilities & indeed the authority to remove the liberty of people who have done nothing wrong – they are ill. But it does not give me the power to instruct others to be part of the process. Parliament constructed the MHA is the 1950s in the days when it was assumed that the state agencies would co-operate & when there where beds etc. I dont invite you often & when I do it is usually with a warrant or because you need to be there.

        take care

      3. Ian – it is also an offence to obstruct an AMHP & I can think of all sorts of people where I might want that to happen. But I bet you have never arrested anyone for the offence & if I asked you too?

        In moments of frustration I imagine all sorts of people being held to account for not allowing me to do my job 🙂

      4. Ian – Sec 115 gives AMHPs power & authority, but not to force entry n& if we are asked to leave & don’t they can call you. Therefore back to the 135 (1) Warrant.

        As I said its a big book (Jones) so just for fun when you look at Sec 29 try also Sec 137 & 138. I think these are really good sections & help explain why all this is/can be core police business = “A constable or anyother person required or authorosed ………” I accept that it means AMHPs & others, but then we are back to the training & the the equipment discussion.

        Currently I am liking lots Sec 126 sub section (4) (a) & (b) – I am wondering out loud about deliberate omission on med recs i.e. blank forms in terms of where appropriate medical treatment = medics writing forms , especially for Sec 3 & leaving the where blank & disappearing leaving us to squable. BTW The form is therefore not valid. Again I am wondering if a police officer would consider the offence?

  2. Dear ASIFAMHP,
    I believe we seem to be straying well off track here. Please understand that I am not attempting to slight of you or your profession or any of the medical staff who are required to deal with these situations, nor am I attempting to discuss what legislation there is available or how it is interpreted.

    The point I am attempting to raise is how The NHS appears to have provided its practitioners with no way of dealing with challenging patients who are suffering from MH conditions, that may require restraining or to have hands laid upon them whilst being taken into care. My issue is with the way in which the police have been used as the NHS automatic back up when dealing with what could be considered challenging patients. There are RAVE risks as discussed on this blog site in which the police would be required assist with however there are times in which ambulance staff attending require to be able to deal with situations in which firm treatment may be needed. Unfortunately ambulance trusts are unable to offer such a service which leaves AHMPS to call upon the police for assistance. A situation which I imagine causes needless distress to patents having the police involved.

    My issue is that it is very unfair to you as an AMHP, the ambulance crew and the patient that the attending ambulance crew have been provided with no training, equipment or suitable transportation which would be appropriate to deal with the transporting a challenging MH patient to hospital. No Soft restraints or adequate seating but plenty of expensive sharp edged equipment within an arm’s reach to injure one’s self or break depending how hard you lash out.

    In essence what I am attempting to express is my concern in the shortcoming in provision by the NHS and ambulance trusts that creates the need to call for police intervention to deal with situations that are not violent or dangerous but are above and beyond what ambulance staff are currently trained and equipped to deal with.

    1. Hi Ian

      I do have a tendency to stray because very few people actually understand the MHA – I struggle myself sometimes. People understand & get bits of it but interpret other bits to suit their organisation or personal perspective. The MHA is a complicated bit of legislation & open to interpretation.

      I haven’t taken our discussion as a slight at all 🙂 becuse I am really v hp to debate & discuss these issues with nearly anyone. The role of the AMHP is also misunderstood & that is partly our own fault.

      I absolutely agree with you & the NHS & the gaps in service.

      Today I am pleased to report that your colleagues again step up & helped us fill a gap & get a positive & safe outcome.

      take care

  3. What an excellent excellent blog. Insightful of course, given the author but delivered in such a way as to give us ‘general public’ a real sense of what it is to be a Police Officer. Its just makes me respect you guys all the more. I’d love to see a similar blog from @ermintrude about Social Work which is another extremely valuable profession which can be undervalued by the ‘general public’ all too often.

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