Overcoming Inertia

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.


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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4 thoughts on “Overcoming Inertia

  1. I’m all for anything that includes more public sector training in mental health and that, sadly, includes ambulance staff (and probably other NHS staff) as well as police. So your second option is the one that jumped out at me. (Speaking from an NHS perspective).

  2. It would not be a bad thing if police were on the wards for certain time periods so they can get to know the patients and see what they are going through.

    As for training – to really understand what a patient is going through you need to have full knowledge of the workings of the drugs for a start, unlike many of the professionals themselves and listen to the patients as to how the drugs make them feel unlike the professionals who ignore in many cases when a patient complains of serious side effects. If someone has had a change in their drugs this could be the cause of the psychosis of adverse behaviour and so in light of this that person should not be punished as that person has had no choice but to take the drugs forced into it by a psychiatrist and team regardless of whether the drugs are doing someone any good or not ie someone could be treatment resistant like my daughter. My daughter was put on contra indicated drugs for three years until I challenged this and got 500mg a day of Metformine taken off and this calls into question how things are not being done properly. To bring someone to justice who is made ill as a result of enforced drugging by psychiatry where there is no evidence of their so called diagnosis and no proper tests done to see if there is a physical condition is a disgrace in my opinion. Nothing is being done properly in the UK and I am going to pay for every single private test necessary for my daughter as I dispute the diagnosis given by a team who cannot provide me with any scientific proof as to how they came about such a diagnosis and who have experimented on my daughter with 14 mind altering drugs that have not worked. They then stick with this diagnosis despite the fact I have a report from a psychiatrist of many years experience of PTSD – there is no way on earth that I as a mother am going to sit back and do nothing about this and I have suffered threats, harassment and you should see the contents of what has been written behind my back in the files. This is a system that is rife with dishonesty and bullying and you should not be looking to prosecute and bring to justice a patient unless you properly look at what treatment is being given to that person by the psychiatrist involved.

    I know there are some good people working within the Profession but that does not apply to many.

  3. I see what you did there. Option 1 is the kind of response MH services give the police in responding to MH crises. And you are not impressed.

  4. Of course, we are all aware that the primary function of the police is the PREVENTION of crime rather than it’s DETECTION. The Peelian principle being that the sign of success of a police force is the ABSENCE of crime rather than the number of offenders brought to justice.
    I have often wondered whether criminalisation of patients is the right way forward. What we are doing is dealing with the aftermath of an event and seeking punitive recourse.
    Surely the main objective should be to create an environment where these incidents don’t happen in the first place.
    Some Trusts take great pride in the number of successful prosecutions they have had against patients.
    This just makes me wonder – what kind of environment exists in the hospitals which makes this level of offending commonplace?
    What risk assessments are being done?
    How are patients being managed?
    Are there enough staff to keep a ward safe?
    For me – the answer is not to deal with the problems AFTER they have happened but to do more to STOP them from happening at all.
    Police would call this “Crime Prevention” – it’s cheaper and ultimately leads to a safer and more pleasant world.

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