Imagine a world in which the NHS mental health system endures a particular kind of problem which centres around the police consistently not doing their job or not doing it properly. Imagine an issue of some importance to mental health professionals and patients alike, because it concerns their safety and their physical integrity – the potential that they could become victims of crime. The police are not, in the opinion of plenty of people who voice it, competent and consistent when it comes to the investigating allegations of criminal offences committed within inpatient settings. There are other areas, I know, where NHS staff would say that the police fall short of what they would hope and expect, but I want to focus on this particular issue, to make a certain point – the problem is not hypothetical!
Whether staff are assaulted by patients, patients by other patients or patients by staff, it is fair to say that many of these matters will violate our criminal law and bear close investigation to determine whether someone should be dealt with by the police. Whether ‘dealt with’ means advice or a warning, a caution or a conviction – some patients and some staff who offend in inpatient settings will be criminally liable for their conduct and there should be some response by the criminal justice system to this fact.
Did you know, incidentally, that 70% of all violent incidents within our whole NHS, occurs within the mental health system? It is not an insignificant issue, by any stretch.
IMPROVING PARTNERSHIP WORKING
I’ve known various things happen over the years, in response to it being thought that the police had declined to act – formal complaints have made against officers; informal representations by NHS managers to police supervisors at both the level of police inspectors and local police commanders. I’ve known mental health trusts write to Chief Constables asking that formal procedures be agreed between the services so that frontline staff know what is expected of them. We’ve even seen the national NHS organisation NHS Protect agreeing memoranda of understanding at regional and national levels with the police and the CPS.
More interestingly and stretching back for several years, we know that NHS Protect has felt obliged to privately prosecute some offenders for assaulting NHS staff. This has been going on for over fifteen years where the public justice system decided against prosecution. We have seen people sentenced to custodial sentences for GBH where the police or CPS decided that the prosecution, usually of a detained MHA patient, would not be in the public interest because of their current status detained under s3 of the MHA, for example.
Not edifying at all to see successful prosecutions which, by their inherent nature, render the decision-making of police officers and / or prosecutors null and void – the CPS are often directed to pick up the bill for successful private prosecutions where poor decision-making has preceded the inaction of the criminal justice system. So there is a lot that could be said about all this. The typical reaction I’ve known from a range of NHS professionals on this subject – from nurses and psychiatrists to local security management specialists – is that they have found themselves in a position where the felt they had to step in because of a vacuum in the system and that they’d really rather they didn’t have to.
What they really wanted was a positive relationship with the police whereby allegations are taken seriously, investigated independently without presumption as to guilt or innocence and on the basis of some reasonable understanding about what mental ill-health can mean when offences are alleged. Crucially, this is as much about understanding that patients can be victims of abuse where power dynamics are against them, as much as it is about assaults on staff or damage to NHS property.
INCH BY INCH IMPROVEMENT
Imagine a local senior officer charged with sorting this kind of thing out for their area. One response that they could make would be to point out that the reduction of crime and disorder, as well as the management of disturbed behaviour, is core NHS business in mental health care.
There are many grounds for suggesting it is, given the coercive nature of psychiatry and extent to which it has influenced the legal frameworks that govern care in the United Kingdom and elsewhere. But if we accept that premise, we will also point out that it has limitations and we come back to practical suggestions for when disturbed or violent behaviour should resort to being a police issue.
We come up with two ideas: and I wonder which one the NHS would want to argue for, given a choice? —
- We could provide a police officer for a certain period of time each day or each week – they could work alongside NHS staff as they investigate their own allegations, offering advice about evidence gathering and about legal requirements. Initially, this would be a telephone system where NHS staff rang the station and information was shared that would assist. But where more serious issues arise, we could look in the future at the officer attending and then deciding whether to refer the matter to a police team who would deal with it.
- We could train police in mental health and deploy them correctly around the investigation of allegations – they could then proactively and reactively ensure the appropriate action to reduce crime in partnership, investigate allegations made and bring offenders to justice, if appropriate. This would mean that crime and disorder in the context of mental health is managed no differently within NHS walls to how it is managed elsewhere, except to the extent that mental health conditions present certain considerations that we do not see elsewhere in society.
Which would you choose and want to see if you were an NHS professional looking to ensure a proper response to offences against you, your colleagues and your patients? Would you want to be helped to get things right that you don’t see as your core role, or would you like your partners to do their bit, as they are constituted to do? If the only thing on offer was option 1, would you go for it, or would you argue for option 2, partly fearful that if you agree to option 1, the possibility of option 2 becomes less likely than it was before? Or you would see option 1 as a stepping stone to option 2?
This post is absolutely not about allegations of criminal offending in inpatient settings.
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