We have seen for some while a story circulating on the internet and social media that “armed police on mental health wards, FoI reveals.” My immediate concerns were raised because the wording of this headline denoted to me either that it was being reported to have happened more than once OR that it was some kind of routine thing to incidents on wards. I suspected both things to be false.
The piece itself follows on from concerns that 48 officers, including armed police, riot police and dog handlers were called to River House in south London, after a disturbance. River House is a medium secure unit in the South London and Maudsley NHS Trust and there are understandable sensitivities around the location and the police being called to it, because this is the place where Metropolitan Police officers responded to another incident which led to the restraint-related death of Olaseni LEWIS. So we can all agree that scrutiny and concern about further police responses to such incidents is justifiable. We can also agree, that preventing the need for further police responses to incidents can never be guaranteed because unpredictable events can always occur.
I’ve resisted for some while the urge to blog on this, as I admit to thinking it something of a non-story, but it keeps persisting in its circulation, so I have given in to better judgement. I stress for the record, that I was not involved in the incident because it occured in another police force and I have no inside information from officers in the Metropolitan Police nor have I discussed it with them. Beyond mentioning things that are contained within information confirmed by the police involved, I reserve myself to other observations and considerations about responding to disturbances on mental health wards and to considerations that go through your mind when you are in command of these events. Following on from this article, some things just appear to need saying, because of the unchecked inferences about what actually occured.
ARMED POLICE NOT ON MENTAL HEALTH WARDS
Firstly – and most importantly: the Metropolitan Police issued a release when contacted with respect to this incident in which it made categorically clear that armed officers were not directly involved in the resolution of it but were in the vicinity of the hospital as a contingency. I will explain more about this later.
Secondly – the Metropolitan Police said that they were called to River House following reports of a serious disturbance involving a number of patients and that staff had been forced to abandon the immediate area of it because of fears for their safety. It was at staff request that the Metropolitan Police were called.
Thirdly -the officers were told that several patients were involved in violent conduct, would have access to knives. At the risk of pointing out the obvious, a medium secure unit is the kind of location where some patients pose “a serious risk of harm to the public” and are detained following criminal trials for serious events.
Fourthly – there is absolutely no barrier in law, protocol or procedures that prevents the police being called to such incidents and no ability to dictate the operational terms upon which police commanders restore safety to a situation and prevent further crime. It is down to the police commander to bear this responsibility.
So take all of these things together and we see a complex, unfolding and dynamic operational environment of some gravity where officers may face serious physical resistance and / or personal attack. But they may not. And we don’t know what resources may ultimately be needed to minimise harm to patients, staff and infrastructure, if any beyond the local 999 response team.
COMMANDING UNFOLDING EVENTS
It is my role in my day job, to lead the police response to these kinds of events and other critical incidents, if they occur. So I thought it might be useful to go through some of the thinking processes with reference to one of my own jobs? I have been that police inspector who asked for armed police to support an intervention in a mental health incident and with this in mind, it outlines why it was perfectly proper for several different reasons to ask for it —
Some years ago, the police were asked to detain and convey a man from his mother’s home to hospital for assessment under the Mental Health Act. The problem was, he’d locked himself in the upstairs front room of the house, with a knife and the man had a significant history of violent behaviour and weapon possession.
It posed a proper problem for the police, because he had committed no offence and the AMHP leading the assessment had not obtained a warrant under s135(1) MHA which would allow the police the right to detain him and remove him to a PoS. It was my position that to act properly and safely, and to then justify the use of any force we may ultimately have to resort to, we would need to firstly, spend an appropriate amount of time genuinely attempting to negotiate a non-coercive outcome; and secondly, obtain a warrant under the MHA which the AMHP didn’t want to get and which would take time to obtain even if I did manage to persuade.
So we had several hours ahead of us and who is to say what would occur during that time, whilst we aimed for a peaceful, non-coercive outcome? The man could decide to leave the room with the knife for any number of purposes; he could have chosen to start using it to hurt himself. There are plenty of other scenarios which could have unfolded. As the police commander at the scene, it is your job not only to start policing what is in front of you, but to think ahead to a multitude of different scenarios. You can call them whatever you like – but I’ll go with “Plan A and Plan B and Plan C”.
PLAN A – PLAN B – PLAN C
You initially plan for and start trying to deliver the most desirable outcome – Plan A. This is the one you would choose from the “solutions catalogue” for mental health incidents. You use the resources initially there to start attempting to deliver it and first-things-coming-first, you obtain whatever support is needed to that situation to maximise the chance of it happening.
So the first two cops on the scene establish the facts of it and start attempting to negotiate for the outcome you need. I start getting a few more officers there for different reasons and one of the sergeants came down. I get a negotiator contacted by the control room. If all things go well, these resources will be able to deliver “Plan A” and all resources for Plan B and Plan C will just be released.
You also then also start taking care of the indirect implications – at an incident like this, there were also concerned family members to manage. Firstly, in terms of making sure that they know what’s going on and what the police are thinking and what they’re up to. Secondly, as they included the house owner, one of them had explicit rights to control what was going on in their own home and this needed to be respected in the decision-making that is needed. I need an officer to available to them – to answer questions and convey messages, and frankly, to stop them controlling me as I have wider responsibilities. And you also start planning for what you will do if and only if Plan A fails – you will resort to the use of force to resolve the matter, if and only if the AMHP secures the necessary warrant, in this particular example. We’ll call this Plan B.
But you also start planning for the outcomes you genuinely hope you don’t have to manage – inevitably, Plan C. What happens if events in the room begin to develop? If there is the commission of a criminal offence, then the legal framework alters and as the incident commander, I then get certain rights to determine how things proceed. Should this happen, what am I going to do? Well it depends on whether the offences is one that requires immediate action or not. If he threats to kill someone, but makes no attempt to try, then we continue as for Plan A and get ready for Plan B. If he actively starts attempting to do so or starts harming himself, then an urgent physical intervention may be required and Plan C kicks in. But if things escalate, am I sending in officers dressed and equipped normally officers to deal with a patient with a knife and significant risk history of violence? No, I’m not. So the sergeant gets an instruction to arrange a unit of officers to get into public order equipment (riot gear) with shields. These officers are maintained at a discreet distance away from the incident. I hope not to use them – they are outside the address as part of Plan C and Plan B, if instigated.
You also then start planning for the consequences of untoward outcomes – what happens if someone gets injured? At what stage do we call an ambulance? This could be necessary in either Plan B or Plan C but we don’t want to tie up an ambulance for hours and hours if our Plan A is patient negotiation. So we set an instruction – 999 is called if events suddenly escalate or fifteen to twenty minutes before we give up on negotiation and move to a use of force. Meanwhile, we’re telling them family all about this – if you look down the street you will see what you think is riot van and officers in riot gear. These people are coming nowhere near your property unless the events here escalate unpredictably and someone may get hurt. They are in that equipment because it is merely protective equipment to stop the officers getting hurt.
THE USE OF FORCE
Once our incident developed to the point where negotiation had failed and force was to be used, we called the ambulance. There wasn’t one available in any quick time because it was a very busy Saturday night for the ambulance service. So I asked for firearms officers to be in the location. Why? Because they are trained in first-aid to a standard that way exceeds the first-aid training given to most of the rest of us AND they can operate in risk environments that some paramedics may not wish to enter. So if an officer was stabbed or the patient injured in whatever way, I want someone with more than a basic first-aid certificate on standby bearing in mind that I was warned by one of the psychiatrists involved that “this is the next death in custody for your force unless you handle it right.” No pressure, then.
The AMHP had been persuaded to obtain a warrant, I executed this warrant on the householder and then directed officers in the correct equipment to enter the room and detain the man under s135(1) MHA. As soon as they tried, after some final negotiation, he repeatedly tried to stab the officers with the knife. It all ended with a couple of minor injuries to officers and a cut to the patient’s foot after he stood on something during the restraint. It could have ended so much differently, if we hadn’t carved this up into Plan A, Plan B and Plan C and determined individually what was required to undertake each.
ARMED OFFICERS ON MENTAL HEALTH WARDS
So what does this tell us about the original incident in London? It tells us that when you see 48 officers including riot police, dogs and firearms you need to break that down into what they’re all doing. And it won’t be easy to tell, because they’re not carrying a placard to show which scenario they are there for. Some were there because they are the local response team who own the job and would have a role to contain the general area, so those officers tasked with their Plan A or Plan B could operate with others focussing outwards from the incident as they focussed inwards.
Some of them were supervisors and commanders. Some of them were “riot police” because entering a hospital to a disorder of the kind indicated could be highly dangerous business and for a mental health unit with dozens of patients, a police public order unit, trained in tactics to sweep and contain buildings, deploy in groups of 25, led by an inspector who would not be the duty inspector for that area. That accounts of over half of the officers present. You also need officers controlling out perimeters of buildings whilst that main group is going in.
Dogs, firearms are all part of the contingency planning as the Metropolitan Police made clear – armed officers did NOT enter the hospital. We can only speculate about the particular reasons they were there, but whatever your speculation: armed officers don’t just point guns at people with a view to shooting them. They are highly trained first-aiders, they also carry “less-lethal options” like Tasers but the commanders quite possibly felt that an armed response might – just might – be required if Plan A and Plan B did not go to plan. This last point is just speculation on my part, but I can imagine what might have been thought.
When I looked at the street after my incident described above, which was on a much smaller scale and only involving one patient, I saw a fleet of emergency services vehicles. I was joined at the end by other sergeants to conduct an independent debrief of the use of taser, to take over the scene so other officers could clear to hospital and start the considerable administration that was subsequently required. It involved nearly two dozen officers and anyone standing in the street watching could have said, “Blimey, they had about nine police cars, vans and they had riot police and firearms there!” All of them, in my humble view absolutely justified – but none of them walking around carrying a banner to explain their particular role and whether it fits into Plan A or Plan B.
When viewed from the outside, it’s all just a mass of flourescent jackets wandering about and why do you need riot police for just one bloke?! Well, having watched the incident unfold when officers entered that room to face active attempts to stab them, I was astounded by their bravery and wouldn’t have been too surprised if one of them had been more seriously injured despite having done everything possible to mitigate against that possibility. It was their bravery that meant a very unwell man was safely admitted to hospital under the MHA.
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