I went to a job today where a man had been seriously injured in a car crash. He was trapped in the vehicle and his leg was partially crushed, preventing him from being easily removed. We could tell he was bleeding and in a lot of pain and after the provision of some reassurance and some first-aid, officers gave way to the paramedics who turned up.
The fire brigade also emerged to start trying to extract him from the car. As we started trying to piece together what had happened, I couldn’t help but notice that the victim was screaming in some distress. The paramedic was talking to him and being very reassuring, but I noticed that she wasn’t administering any kind of pain relief to this man.
As the bloke was making a horrible noise, I felt it was appropriate to ask if she intended to give him something for the pain? She opened up her kit bag and I couldn’t believe what I saw next: she pulled out what seemed to be IV morphine and started explaining she was going to get a cannula into his arm to administer it. I know that paramedics carry different kinds of pain medication and it seemed really obvious to me that she should have been giving him IV paracetamol – morphine can have various fatal side effects, can’t it? So again, I felt I should say so. What I didn’t know was the patient had already explained to her whilst I was busy with something else, that he was allergic to paracetamol and so to my utter amazement, she disregarded my advice and did her own thing! Unbelievable – I’ve got a few friends who are paramedics. I’ve even read some of their clinical guidelines and done a few lectures on mental health law on some of their university courses.
Of course the above three paragraphs are utter nonsense – I’m sure you worked that out prior to here! Of course, I did not go to a road collision and tell a paramedic which drugs to administer to a patient in pain. I wouldn’t dream of doing so, as I would predict being told where to stick my traffic ccone and it would be altogether quite ridiculous, woudn’t it? I’m hoping you questioned it and wondered what the hell I thought I was doing! I’m also trying to imagine the disciplinary hearing at the Health and Care Professions Council where the paramedic was facing gross misconduct charges after administering a drug they knew would be inappropriate which had caused serious damage to the patient and saying, “But a police officer at the scene said he thought IV paracetamol would be better!”
It wouldn’t get off the ground, would it?!
ONCE UPON A TIME
Guess what happened? The complete reverse happened, some months ago now. Police officers were called to a house by a man who had indicated he was intent on harming himself. Upon arrival, the man answered the door by opening it slightly and appeared distressed. When the door was fully open, he was holding a kitchen knife in the hallway of his house and pointing it at officers as he backed away, making threats to harm himself. Officers entered the building and having used a taser to control the situation, detained the man in handcuffs to prevent a breach of the peace which they feared was imminent.
The ambulance had been called early in the process and paramedics entered the situation once the man was handcuffed. Attempts to engage him were futile, he appeared to be highly agitated and suffering from some form of mental health disorder. The paramedic felt he needed to be checked out at A&E because of high skin temperature, possible head injury and the after effects of being tasered. He’d also consumed some alcohol. The paramedic also had one other view: the man should be detained under section 136 of the Mental Health Act.
All I can say to that, is you’re entitled to your opinion!?
This is where it gets messy: the officers duly obliged! They did exactly what Lady Justice HALE said you can’t do during her judgement in the case of Seal v Chief Constable of South Wales Police  – she stated that by removing someone from a premises having apprehend a breach of the peace and then by applying section 136, the officers acted illegally. You cannot lawfully detain someone in a house, remove them to the street and then detain them under the Mental Health Act. You just can’t! In no way, shape or form can that be said to involve someone who was “found in a place to which the public have access.”
And if you find yourself getting questioned, grilled or investigated over allegations of unlawful arrest, you certainly cannot say, “The paramedic said we should do it because he needed Mental Health Act assessment!” It just is nothing like sufficient to pass responsibility for legal decisions to an unqualified, untrained professional from another organisation and hope it will provide you with an element of protection. So the punchline of this post is —
YOU NEED TO KNOW YOUR LAW!
You really need to know it – and you have to take responsibility for the legal decisions that you take. As the police often say to the public when investigating allegations of crime, ignorance of the law is no excuse. It may be fair to say that legal training in emergency mental health law is inadequate. It may also be fair to say that the incident being policed was a private premises situation where the Mental Health Act does not apply and where resolution to incidents can be difficult. But given the imminence of someone who may well hurt the officers having pointed a knife at them, you can justify the legal detention and removal to custody of such a person in any number of ways.
It was said to me by an inspector on my second day in the police: you need to know your law, because knowledge is confidence and confidence gives you authority. This is why I’ve faced this very request numerous times in my career and just said, “No!” before proceeding to try for another solution. I recently refused to illegally force entry without a warrant to a patient’s house, too. There are numerous resources kicking around on mental health law, many of them on this blog or linked via it. If you haven’t ever read the parts of the Mental Health Act that apply to the police, or read through the stated cases that are key to operational decision-making, take a couple of hours to do so. Pick a NIGHT shift or a Sunday morning on EARLIES and spend a few hours that represents an investment.
In particular, try to digest the “Part II” and “Part X” of a my short summary of the MHA. And see a short post which amounts to a knowledge check – the latter contains links to things you might want to read more about. And don’t forget, you can also bookmark on a smartphone these “Quick Guides” to a range of different operational situations – there really isn’t an excuse!
Because I will be honest: when I hear of officers using section 136 in a private premises I just think, “How ridiculous – it’s well-known to be illegal and highly inappropriate. There is just no excuse for it under any circumstances.” Just read back the first three paragraphs and remember how ridiculous it sounded – a police officer telling a paramedic which drugs to administer. Well, the same applies to legally detaining people – it is ultimately a matter for the police, having heard whatever opinions might be floating around at the time.
And the same applies to decisions *not* to detain people – it is, ultimately, a matter for the police.
CASE LAW BLITZ —
- D’Souza v DPP (1992) – you need a s135(2) warrant in order to force entry to a premises to detain or redetain a person under the MHA, unless s17 PACE applies.
- Syed v DPP (2010) – you cannot force entry to a premises because of a concern for someone’s welfare. Officers need to have reasonable grounds to believe that life or limb is, literally, at risk.
- Seal v Chief Constable of South Wales Police (2007) – incidental judgement that arrests under the MHA are unlawful if they follow people being removed against their will from a dwelling to a public place under other provisions in order to then be detained under s136.
The Mental Health Cop blog
– won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs
– was highlighted by the Independent Commission on Policing & Mental Health
– was highlighted in the UK Parliamentary debate on Policing & Mental Health