Ever Greater Utility

RedlightImagine you are driving your car along a main road in my policing area and you manage to transgress a red traffic light, having recognised too late that you were approaching a controlled junction. I’ve spotted this violation and pull you over just after the junction with a colleague. Imagine the interaction went like this –

  • ME – “I’ve asked you to stop because I want to deal with the fact that my colleague and I saw you pass through a red traffic light.” and we then caution you (as the law requires, having pointed out an offence.)
  • YOU – “Sorry, officer, I admit I hadn’t noticed the light until it was too late and I couldn’t stop in time. It won’t happen again.”
  • ME – “What’s your name and address and are you the registered keep of the car?” (Just so you know, I am entitled to an answer to these questions because you have committed an offence and you are driving a car on a road. Once I get these details, I can consider checking whether or not you are banned from driving and writing out a ticket that gives you three points and a fine.)
  • YOU – “I’m sorry officer, I can assure you it won’t happen again.”
  • ME – “I am arresting you for contravening a red traffic light because you have declined to provide me with your name and address, rendering a summons or ticket to be impracticable, so please now get out of the car.” I start cautioning you, having arrested you.
  • YOU – “Arresting me? For a red light?! Is that really necessary?!!”

At this stage my colleague and I use force to open the door of the vehicle, physically pull you from the front seat whilst you remain startled at the unfolding events and handcuff you because you don’t appear to be willingly coming with us to our police car. (For the purposes of this situation, the force we use is a text-book example of how personal safety and restraint tactics should be used.)

Reasonable? Imagine you weren’t the offender, but a witness to these events … perhaps you’re a passenger in the car or standing at a nearby bus-stop: would you think the police had acted reasonably? The police saw an offence and were going to issue a ticket, because someone declined to give a name there was an arrest and now we’re off to police custody. All lawful, isn’t it?

So it’s all reasonable, isn’t it, because doing lawful things is inherently reasonable?! Of course not. Doing lawful things in unreasonable circumstances is the story behind many incidents that cause massive public concern about what exactly the police get up to.

THE USE OF FORCE

HF3Using force on other people or their property has limited utility: it contains, hurts or kills people; it moves, damages or destroys things. Whether those actions, in turn, create other conditions in which more important objectives are achieved, will depend on the context in which that force was used.

Traffic law is important, but enforcing it in an excessive, intolerant or discriminatory way can start riots. I don’t just restrict myself to traffic, this also applies to stop / search or the application of public order law. We can probably agree, that there will be some occasions where a contravention or incident may be more appropriately dealt with by a gentle word in someone’s ear and a reminder of potential consequences of behaviour?

Actually, some of the best cops can make non-enforcement of the law a way in which public confidence in policing is built, not eroded. This can be done whilst simultaneously achieving the goal – in this case, increased awareness on the part of a driver, leading to improved road safety. Perhaps this incident took place at the junction of a semi-rural road at 3am when there were no pedestrians or other cars around? Why not simply advise the driver to be more careful and wish them well?

Repeat the traffic scenario at 3pm on a Friday afternoon, just outside a primary school where parents are gathering to collect children at 3:15pm and where the nursery children are already leaving. The decision to ticket would be appropriate and if an arrest resulted because of refused details, then so be it. But perhaps we should have spent a few more minutes first seeking to persuade the motorist to give details, on threat of arrest if they don’t? Was that person really refusing to give their details, or did they simply not realise that the question was a legally significant one, which triggers a power of arrest if it is not answered? After all, who knows that you can ever be arrested for such a minor offence?!

What happens if we change the offence? Let’s say it was a hit-and-run road collision where a child has been seriously injured outside the school? The conversation may have been similar, but it would not include consideration of tickets and any decision not to engage in the investigation process would make an arrest by the use of force look justified. It all just looks far more reasonable now it’s a more serious offence and the stakes are higher. If the child had died, the different legal considerations around the incident would mean an arrest may well be justified straight away. Who would question arresting a driver who has allegedly killed a child, if it ensured a thorough, speedy investigation?

What has this got to do with mental health? Well, it is to make the point that doing legal things because you can, does not automatically legitimise them. Very far from it.

And this principle has wider application.

PUBLIC CONFIDENCE

imageImagine the Mental Health Act assessment whereby a resistant patient has been made subject of an application for admission to hospital under s2 of the Act. Having refused to move to hospital, the police have been called to use force to compel the admission. So far, we’ve got no idea whether this will be reasonable, proportionate or justified, because we have only an outline of information. If we learned that the scenario involved a 24yr old male patient, a forensic patient with violent convictions who is now barricading himself in the upstairs bedroom of a house with a weapon, we can imagine it would be. It would not be realistic or fair to expect anyone other than the police to manage the risks that are involved the detention and conveyance of such a patient. Such situations are, thankfully, very rare indeed. (I can count on two hands the incidents I’ve had involvement with, in sixteen years.)

But what if it were a 42-year-old female patient, sitting in the living room and refusing to move? Does this effect the assessment of the use of force? Well of course, it must. For a start, the previous example may well mean specialist officers in protective equipment – sometimes called ‘riot gear’. It may well involve half a dozen of them, because the pre-planned safe restraint of other adults would easily involve the need for an officer for each limb, one for the head / supervision of the incident. But with this second patient, a 42yr old passively resistant female patient, you are going to struggle to justify six officers in riot gear. Two in standard uniform should be sufficient unless things escalate. But some may question whether it is immediately a role for the police. If that 42-year-old woman were in a ward and a decision had been taken to move her to another hospital or to a seclusion room, for whatever reason, the first reaction of staff would not be to call the police.

What if a 73yr old dementia patient with physical health problems including respiratory difficulties and problems walking unaided were resisting admission, passively? How does this mean we approach the issue in the planning stage? (Yes, there should be planning stage!) An actively resistant 73yr old, regardless of gender, is still capable of inflicting damage on mental health professionals. But what if that person is sitting in their living room, simply refusing to move, but not actively resisting detention and conveyance? Is this something that the police should be involved with at all?

If you’ve just answered “yes” to the last question, ask yourself whether this is because you have a strong view that all coercion of mental health patients outside hospital should because of principle, be done by the police or whether this reflects the practical fact that few mental health trusts ensure that trained staff are available for lower level restraint interventions where the Mental Health Act is being invoked in a community setting? I’m referring here to the original detention of someone, or their re-detention after becoming AWOL.

There are no easy answers to this: but what I do know is that seeing the police as the sole agents of coercion in order to administer the Mental Health Act was not the original will of Parliament, it is not consistent in all circumstances with important principles of least restriction in the Code of Practice to the Act and it is not consistent with the important principle of public support for the coercion of vulnerable people. As such, assuming otherwise is to risk compromising the safety and dignity of patients, and ultimately, the utility with which force is used.

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BadgeThe 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

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4 thoughts on “Ever Greater Utility

  1. Hi I would like some help if poss. I am completing an AMHP course and one of the case studies involves a male 48 with a history of mental health illness who has become psychotic in his own home. Police were called by the person found the home damaged with windows smashed and items broken in the house. They entered the house and found cannabis growing in a back room, arrested the person under the PACE ACT. My question is that if person was taken to police station and examined by an FME who stated that it was inappropriate to detain in the cells and an assessment under MHA was needed who would be responsible for any transport/transferals from cells to hospital and would the charges under PACE be held until the person was no longer detain under MHA.

    1. The unhelpful answer is: “it all depends”. Most of the psychiatrists I’ve ever spoken to seem to agree, that where someone is arrested for an offence in the first instance, there are comparatively few situations in which someone would not – legally and medically – be able to be held in the cells for the MHA assessment to occur there. In reality, if such a situation did arise, the only place to which the police could transfer the person would be A&E, because although nothing in law prevents the person being transferred to another, perhaps more appropriate, kind of hospital, it would be highly unusual for a psychiatric unit to agree to receive the person, purely for an assessment. I’ve occassionally asked why the empty Place of Safety could not be used for this purpose, with the police remaining there as the person is still under arrest, but I’ve only once ever known it be agreed to.

      Certainly, the MHA would have to take place before decisions are taken about whether to interview the suspect, or charge them with any offence. At the end of the assessment, dependent upon its outcome, the police then have the choice of releaseing the person from PACE without any further action (usually for a more minor offence), bailing them from police custody pending any further necessary enquiries into the offence and / or more becoming known about that person’s mental health. Finally, the police could decide to prosecuted anyway (reserved for the most seriuos of offences where there is serious risk to the public / health professionals by taking any other course of action.)

      But what is absolutely clear: until an arrested person is sectioned under the MHA and released from PACE, the responsibility for any movement / transfer / security rests with the police. Only when sectioned and released from PACE does it move to the NHS and then, local policies should dictate when the police support our NHS colleagues and when we don’t.

      If you want more detail on this, there are dozens of posts on prosecution / investigation that get into the law and detail of this stuff >> https://mentalhealthcop.wordpress.com/full-index/investigation-and-prosecution/

      Hope it helps and good luck with your course!

  2. Luckily (for all of us) most people assessed as requiring inpatient assessment & treatment comply & come into hospital willingly, if sometimes unhappily – when a bed is found/available. Some people want to come & others take convincing that it’s the right thing to do. Sometimes, not often, others threaten or use violence to resist & some run away while others just refuse to move or use any combination of the above. I often think of myself as a very goog/bad second hand cars sales man i.e. I more often than not persuade people to simply come with me/us to hospital. It takes a fair amount of skill & sometimes luck. But mostly it takes humanity, empathy, humour & effort & that small but under used word please.

    BTW by the time the bed is identified, often the NHS MH Trust staff have disappeared, leaving the amhp to negotiate with the person/family/carer/friends & the ambulance & sometimes the police. Who often both start asking about written risk assessments & warrants, which is not always helpful or indeed necessary. But I take your point, in that there is a gap in mental health service provision & the police are expected to fill it. I will make the point, that it is one of many gaps & that the squabbling over who does what does not help anyone.

    Until it is sorted out & resourced properly we are left to muddle through & that means working together as best we can. We need to “mind that gap” & work together because people in need will & do fall through it & some will harm themselves or others & then we all have to account for what we did or didn’t do & say why. After such an event, all be it with the benefit of hindsight, saying I didn’t have to or someone else should have done it sounds a bit weak. Again luckily for us all such events are rare, but they do happen. Which is why we all have to work together in a positive manner & seek to do the right thing while campaigning for improvements in provision & service.

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