Barricades, Weapons and Hostages

This last week has brought a number of queries about the role of the police in restoring or maintaining order on psychiatric wards where disturbances have occured. This is a difficult and controversial subject because we have seen incidents on wards involving the police which have then become subject to protracted inquiries after deaths in police custody or following contact. Olaseni LEWIS and Kingsley BURRELL-BROWN are just two examples of ongoing enquiries where criminal investigations became necessary after tragic events.

So it is not unsurprising to learn that the police are becoming alive to the to the risks and sensitivities of intervening in medical settings where disturbances occur. And yet, there is an inverted point to be made here about parity of esteem: the police are frequently called to intervene in Accident & Emergency departments, despite the presence of security staff there. The police are often asked to intervene if disturbances occur on wards, whether involving patients or their families. I spent a phenomenal amount of time as a young PC in City Hospital in Birmingham dealing with crime and disorder that arose in those environments. This was a far greater amount of time than I ever spent at All Saint’s Hospital, which was the nineteenth century asylum in my area.

But these debates carry on —

I recently attended an event in another force where a Chief Inspector gave an overview of a situation in an acute admissions ward where a patient was reported to have taken hostages and threatened them and staff. When the police arrived, these two individuals had been released but there was now a barricade situation in the patient’s room. Staff in that unit had called the police and officers were firstly interested in what “tactical options” the NHS staff had.

So this gets in to the debate: to what extent should the response to or the management of disturbance on NHS wards be “a part of the job” for mental health nurses and other professionals? We know that mental health care will give rise to disturbances, because at least some of it is delivered coercively. There are very real legal disputes and frustrations in mental health care, which mean staff train and prepare – to an extent – to respond to that. We know that some NHS staff have control and restraint training. We know that institutions which provide higher levels of security also train to a higher standard and have intervention teams.

But this is not across the board – and for very good reason.

DIFFERENT MENTAL HEALTH UNITS

Mental health units differ in their constitution, their purpose and their levels of security. Even within a particular mental health unit, there are different kinds of wards. In the main local mental health unit – not a low, medium or high secure facility – there will be acute admissions wards as we as rehabilitation wards. There may be individual wards for particular conditions or split by gender or age. There may also be seclusion facilities and in some instances, a psychiatric intensive care unit. As new build facilities have opened in the last ten years or so, financed by various PFI schemes, we have seen the construction of some mixed estates – distinct areas within one building, providing different levels of care and security for different client groups.

So in some instances, within the same building, you have non-secure MH facilities, but one wing or ward may be designed to a more secure specification for a small number of low or medium secure patients. All of this affects who managers and staff will look at their extent of their role in the management of disturbances. It may be more readily expected that PICU staff prepare for the reality of managing disturbed behaviour compared to, let’s say, an elderly adult ward or a rehabilitation ward. So beyond the provision of staff with training in control and restraint for pre-planned interventions to medicate someone under Part IV of the Mental Health Act, there may be little further tactical capability to deal with disturbances in the less secure settings.

Contrast this with High Secure hospitals: Broadmoor, and Rampton; Ashworth and Carstairs – these units are able to mobile staff in protective equipment, much as the Prison Service do with their “Tornado” teams. Of course, it’s a debate to be had, about whether we see this as something the NHS should do or whether it is a role for the police.

There are different views on these issues: quite often genuinely held and argued for good reason in good faith.

TWO DEBATES

The operational tension that can arise from these discussions sometimes occurs because two debates are occurring simultaneously. NHS staff, faced with a disturbance that they assess as being beyond their ability to cope call the police, the police then turn up and ask why it is beyond their ability to cope. In other words, NHS staff are asking for help in their operational reality; police officers are wondering why it is their operational reality and why thought hasn’t been given to equipping and training NHS staff to have options available to them. But this is to massively miss the point, isn’t it? – it’s like the police turning up to a car crash and putting the cause of the collision ahead of casualty management and public safety. You start to investigate the cause of the crash after you’ve prioritised the injured and started first aid, as well as having secured the scene of the collision as best you can. You start getting other 999 services there before you start interviewing a blameworthy driver about due care and attention.

It is certainly my view and that of others that there can always be situations that where there is a need for police support. It is also my view, that regardless of what NHS managers could or should have considered and what they might have done to better prepare or respond, if you have frightened staff and patients asking for help because situations have occured where there are threats or risks consistent with the type of thing the police would have responded to in acute medical settings or other places, then there are certain duties arising from that. I’ve written about this elsewhere. You are where you are, regardless of how you got there.

Suffice to say, most mental health units, that are not High Secure hospitals do not have tactical capabilities to deal with anything beyond verbal, minor or short-lived disturbances. That means it is the job of operational officers to decide how to best police what they are called to, and the job of senior officers to discuss with mental health trusts (and possibly CCGs) what activity is best done by police officers and what is best done by health professionals. I’m confident, if there were ever a scenario where a lethal or near-lethal threat emerged on a mental health ward, we would agree with the principle that the police should be involved. Where disturbances occur of a far less serious nature, there should be capability within our NHS to respond to that.

We know that front line professionals on both sides can get this wrong: stories exist within the NHS of police officers being too quick to say, “This is a matter for you and refusing to get involved.” NHS staff have been known to ring the police for trivial issues like a patient throwing a mug at a wall, breaking it. NB: not throwing a mug and engaging in any ongoing crime or disorder a one-off incident which was over just after it begun.

BARRICADES, WEAPONS AND HOSTAGES

Over the years, I have formed an impression that you can use the three criteria “Barricades, weapons and hostages” as a clue to things. Where any of these matters are present in an incident of disorder, there will be some kind of role for the police, not least because within such events you could well have criminal liability that may need investigating. Let us remember: there are legitimate concerns within the NHS about the police’s competence and willingness to investigate criminal offending. We know that a minority of offences on wards are reported to the police, so it is usually done because staff have thought through the incident enough to believe that the police should investigate.

But where we have barricades being erected in wards by patients stacking furniture behind doors and threatening to harm themselves or others; where we have hostages taken or weapons being brandished towards staff and other patients, this all sounds serious enough for me to want to be involved, even if it is just in support of NHS staff or to investigate the incident if criminal complaints are made. And if certain NHS establishments do have greater tactical ability to resolve disturbances then they can choose not to ring the police or cancel them.

So I’m sympathetic to the idea that senior managers and senior officers could be talking to each other more, about certain situations do not need to involve the police. Other situations are better led by health professionals appropriately trained and equipped and some situations should involve the police just as they would if they occured in other contexts. Within all of that, we need frontline staff to understand how that partnership works so that NHS staff to recognise that part of their role is the management of disturbances and calling the police about coffee mugs being thrown during one-off events is inappropriate. That said, police officers need to recognise that not all criminal justice responsibilties stop at the hospital wall and that it can be unrealistic to leave NHS dealing with barricades, hostages and weapons.

We need to remember: we are policing the world we actually do live in, not the world we would prefer to live in.


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 “Barricades, Weapons and Hostages

  1. Where I live in Fife, Scotland, the psychiatric staff have been in the habit of calling police officers into the acute wards to deal with matters that are far removed from “barricades, weapons and hostages”. In fact it seemed like the police were part of the NHS team, special agents in uniform, called in to restore order in the “asylum” or to bring back the escapees. I am hoping that this has changed since I raised complaints in February 2012, regarding different situations where police officers were getting too involved in mental health matters they had no training or expertise in.

    I agree that often situations are “better led by health professionals appropriately trained and equipped”. And I’d like to see people with lived experience both participating in the training of psychiatric staff and in the creation of the training materials. Nothing about us without us. We’ve been at the sharp end of psychiatric treatment and some of us have always been resistant to the force used, not liking to swallow the psychiatric drugs/medication or diagnoses/labels. For many of us the anosognosia is in the minds of psychiatry and we are experts of our own experience.

  2. Reblogged this on chrys muirhead and commented:
    my comment on blog post;
    “Where I live in Fife, Scotland, the psychiatric staff have been in the habit of calling police officers into the acute wards to deal with matters that are far removed from “barricades, weapons and hostages”. In fact it seemed like the police were part of the NHS team, special agents in uniform, called in to restore order in the “asylum” or to bring back the escapees. I am hoping that this has changed since I raised complaints in February 2012, regarding different situations where police officers were getting too involved in mental health matters they had no training or expertise in.

    I agree that often situations are “better led by health professionals appropriately trained and equipped”. And I’d like to see people with lived experience both participating in the training of psychiatric staff and in the creation of the training materials. Nothing about us without us. We’ve been at the sharp end of psychiatric treatment and some of us have always been resistant to the force used, not liking to swallow the psychiatric drugs/medication or diagnoses/labels. For many of us the anosognosia is in the minds of psychiatry and we are experts of our own experience.”

  3. imho acute wards are really disfunctional, nobodys fault but a reflection on the potent mix. lets look at who comes into an acute ward, age range 18-80 (we keep our graduates). sex mixed. people who have been abused and registered sex offenders. substance misusers and dealers. people who have been victims of violence and violent people. patienst who are so depressed they can hardly walk and talk and people who are so high they spend the days and nights racing around the wards. people who constantly self harm and are on 1-1 care and people who are so quiet they barely register. add in delayed discharges, the occasional patient with ld and think you can see how stressful both for staff and patients it can be. acute wards staffing is in perpetual crisis if mh is the cinderella service then acute care is at the bottom. the majority of staff do the mimimum (if that) and flee to higher grades and pastures greener, agency nurses fill the gap and they are a mixture of the good and some real horrors. bed occupancy at least 100% (95% would be a luxury), matteress in lounge was last years whizz years of neglect of both staff and wards have come home to roost. when police do come it is with great proffessionalism and humanity.
    but as they rightly point out if it is out of control they are not here to assist but to take over. i say this with sadness have worked on acute wards for a long time and still enjoy it but can understand why some patients find it very traumatic and some staff can barely tolerate stepping foot in one. mick

  4. Mick above – you could be describing the acute ward I’ve just spent 4 weeks in. I’m of the ‘barely registering’ variety of patient. Most definitely a very untherapeutic place to be.

    About a year ago on the same ward while I was on section another female patient took an extreme dislike to me after I said one innocuous sentence in the patient kitchen. I retreated rapidly to my room which was at the far end of the ward with her in pursuit hurling abuse and threatening me with violence. Cowering in the corner of my room 2 staff wrestled with her in the doorway (she was a large lady) finally removing her to her room. During this tussle one staff member repeatedly urged me to call the police. I didn’t because it just didn’t seem appropriate. Despite assurances from staff that she was in her room she repeatedly returned to be fought off by staff usually hurling obscenely verbal abuse. Threatening notes were stuffed under my door unnoticed by staff. At one point she tried to break through the wall via the next door bathroom into my locked room but the staff didn’t seem to notice. Nor were they answering the office phone and I was absolutely terrified. Eventually someone noticed but I reckon the incidents traumatized me as I write this I’m shaking. This reign of terror continued for 2 hours or more with repeated threatened assaults and more urging from the same member of staff to call the police. Eventually the patients succumbed to the meds they gave her. The following day I reluctantly was persuaded out of my room ‘to see if she was ok now’. She wasn’t. Staff had to stand between us and I was finally transferred to another ward which I had requested the night before but been refused. The next day my section was removed and I was discharged from hospital ‘we think you’ll be safer at home’.

    My question is should I have called the police? Could they have done anything more than perhaps charge her with I don’t know what as she didn’t actually get to lay her hands on me fortunately? The staff sort of dealt with the situation eventually but at what cost to my mental health?

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