Evaluating Ethics

When I read the narratives that unfolded during incidents-gone-wrong, I often find myself thinking “been there – done that – lucky enough that it didn’t go wrong for me.” But not always – I’ve also had an incident go badly wrong and I’ve been left wondering how the hell it was me that became responsible for having to weigh up a fairly blunt set of options to a complex situation that could have been prevented from occurring in the first place. I’ll properly tell that story only many years from now.

FRANCIS DUFFY

Meanwhile, I read about incidents like that of mental health nurse Francis DUFFY – the Independent Police Complaints Commission have undertaken an investigation into “allegations that officers failed to attend an address to detain him under the Mental Health Act” in February of this year.  Two days later Mr DUFFY was found dead in his own flat after further concerns were raised.  Of course, the punchline of this incident can be quickly reached: officers had no power whatsoever to detain him under the Mental Health Act because in was in his own house – and yet there was still a misconduct investigation into a control room sergeant’s decision-making, albeit she was cleared of any wrong-doing.

Paramedics had attended Mr DUFFY’s home address on the 4th February and were there for several hours attending to various concerns whilst he was heavily intoxicated. The attending paramedic formed a view that he needed to be detained for his own safety yet made no attempt to contact the mental health trust crisis team. She stated at the inquest into Mr DUFFY’s death that in nineteen years she had become accustomed to them saying they would not attend someone who was so heavily affected by alcohol. When I read of that remark, I admit to thinking, “Fair enough!”

I fully appreciate why such doubts would emerge, but I also know why it’s regrettable we don’t push as far as we can. I’ve seen for myself disengagement by mental health professionals and organisations from those of us who are intoxicated whilst vulnerable because of mental distress and it’s not unreasonable to assume that the reaction you’ve had the first hundred times you tried to get such support will be the reaction you get when you call again. But we all know that it can create the perception of indifference if efforts aren’t made to do the right thing. The paramedic called for the police and according to the report in local press made “a request to have him detained for his own safety.”

A disclaimer here – the article I’m responding to does not explicitly state whether Mr DUFFY was known to mental health services and / or in receipt of care from them. Reading between the lines of the Coroner’s recommendations, I am assuming he was otherwise his would not be a case that would need clarification about the crisis team’s role.

POLICE POWERS IN PRIVATE PREMISES

So here we go again – police officers have no powers in someone’s private home unless there is a criminal offence, a Breach of the Queen’s Peace or circumstances where the Mental Capacity Act could be applied to a literally life-threatening situation. Accepting completely that I cannot find anything else on this incident beyond the local media coverage which I’ve linked, above – that news piece reads in such a way as to mean it was always obvious there would be difficulty in an approach that saw the police as the solution to a problem. Whilst he was very intoxicated, that’s not illegal in your own home.

Mr DUFFY had rung the ambulance service threatening to kill himself. It was latest in a long series of 999 calls that had seen him prosecuted for an offence under the Telecommunications Act and he was awaiting an appearance at the local Magistrates’ Court. The paramedic found him intoxicated that day and a post-mortem blood test showed that he was over five times the legal limit for driving. Nothing in the article jumped out at me to suggest there was anything there the police could do that a paramedic couldn’t.

This case shows a particular problem that was further compounded by a decision not to contact the mental health crisis team. We know from the Sessay v SLAM and the Commissioner case in 2010 that in situations where detention under the Act is considered necessary in a private premises, the Mental Health Act offers ‘a full suite of options’ – the judge in Sessay made it clear that ‘there is no lacuna’ in the legislative framework.

So there – it must be true!?

MENTAL HEALTH, MENTAL CAPACITY AND ALCOHOL

What about the alcohol consumption? Well, if I had a pound for every time I’ve heard the line “you can’t assess someone under the Mental Health Act who is under the influence of alcohol”, I’d be stressing considerably less than I am about the bill to get my car through its MOT just prior to Christmas.

Chapter Four of the Code of Practice to the Mental Health Act is often cited in these discussions, but even the Code doesn’t preclude assessment in urgent circumstances. If someone were intoxicated whilst detained under section 136 MHA, then by all means let alcohol wear off if someone is safely and legally detained somewhere. But in this situation, Mr DUFFY was in his own home.

The question has been asked about whether such an amount of alcohol could affect his capacity to take his own decisions – and in principle, it could. Whether that could have been relevant would depend upon some particular specifics that aren’t covered in the article. However, we do know that even if the paramedic had been able to declare that Mr DUFFY lacked capacity to refuse medical treatment, it would have still required additional concerns to allow the police to act on her behalf by removing him ‘for his own safety’. You will remember that section 4B of the MCA requires that in order to deprive someone of their liberty it must be considered the least restrictive way of acting in someone’s best interests and “necessary to provide a life-sustaining intervention” or to do “a vital act to prevent a serious deterioration in their condition.” Whether or not these criteria were met, I cannot say and I make no judgement either way.

I can imagine it both ways ’round and I genuine wonder about the sense in which the paramedic thought Mr DUFFY’s safety was compromised – the word ‘safety’ as opposed to ‘health’ inclines me to think that there were no immediate thoughts about life-threatening risks to his physical health, if we even accept a dichotomy between the ‘mental’ and the ‘physical’.  Either way, we do know that if urgent assessment or detention under the Mental Health Act were required, then it would require an AMHP and Doctor to attend the premises. That would be accessed through the crisis team that the paramedic didn’t contact – whilst I can understand why she didn’t, it probably should have been something that was tried.

What we can safely say, taking the description of the incident at face value, is that the police were never going to be the solution in this incident because they don’t have relevant legal powers. This does show, however, the ongoing assumption that the police can coerce people and keep them safe in all the circumstances where we might want them to be able to do so.

Well, we can’t! – and that is actually just exactly how your Parliament wants it. It has always been my view that the law we have is adequate only for services that are not configured as our’s are – we either need to change our services or we need to change our laws. The latter is not going to happen anytime soon and that only leaves one option – which will need to be paid for!


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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8 thoughts on “Evaluating Ethics

  1. I wonder why police deployed at all. This should have been passed to the ambulance service. If they choose not to deploy then they are the “experts”. Deployment of police just leads to this, an ipcc investigation. Police officers are not trained or legally or physically equipped to deal with a health emergency. Perhaps it’s time to only support the ambulance service on this if there is a risk of a breach of the peace? Any thoughts anyone?

  2. Surely based on what is known the paramedic should have attempted to remove Mr Duffy under the auspices of the MCA asking for police involvement if needed to move him. There is no indication this chap was mentally ill so don’t see the need for medicalising his distress. If we start attempting to detain under the mental health act those who choose to drink/drug to excess we’d best open up the old asylums and accept many will be locked up for life.

    1. As stated in the BLOG itself and the article linked within, we don’t ultimately know for certain whether Mr DUFFY was known to services, but there’s a hint towards that in the Coroner’s recommendations. It’s also less than clear the MCA would apply – nothing seems to point to a clear indication of what the paramedic thought the medical risks actually were on the 4th February.

  3. Yep… its time for everyone to get hold of a copy of Szasz “The myth of mental illness”…. take a big grown up bite of the sandwhich….. accept that their is no such thing as the tooth fairy or father christmas….. and have a good think about the role of the state and personal responsibility…..

    Resolving social problems through a medical lens isn’t working out. Not working out. Not working out at all.

    The mental health system is collapsing under the weight of its internal contradictions….. insanity or madness is a legislative fiction. Pure fiction and as such it is a truism that it is not possible to legislate into existence a fiction….. cant be done. The truth will out.

    Society has problems…. always has always will….. some people will need help…. how to get it to them in a way that is consistent and doesn’t cause a lot of contaminant harm and frankly abuse behind closed doors is the million dollar question.

    One thing though imo police shouldn’t have to carry the can. If we want police who are social workers then society should say so and legislate as such if not and we want them to deal with criminals then we need to legislate as such….. having phoney mental health police (mental health workers who criminalise so called mentally ill people isn’t working out…. repeat…. not working out.)

  4. Also I want to make it clear that I cant be held responsible for my comments on this blog becasue (delete as appropriate) i’m mentally ill/ had a lot to drink/ my parents were not very nice to me/ its sunny outside its made my head hot/ its raining outside and its made my head cold/ any thing else I can think of to reduce the chance that anything is my own fault.

    1. I wish mental illness was a myth. Unfortunately it isn’t and people who are mentally ill unfortunately sometimes need the police to save their lives.

  5. @Judy. I get what you are saying. I’m not suggesting that people don’t sometimes need help…. clearly anyone might find themselves in need of help at some point in their lives. The point I am making is that the issue at hand is for the most part and arguably not at all a medical matter. Dressing up human distress as illness is the unnecessary fiction that puts psychiatrists in the driving seat when they have no business being their in the first place. imo.

    Its contentious but a point worth making…. with all due respect.

  6. It may not be, but it is hard for people to get the help they need if the view is that they are just distressed. . Have two relatives with schizopghrenia – it can look like ‘distress’ when you are standing at the top of a multi-storey car park but all the emotional help in the world won’t get rid of the psychosis. People also use drink and drugs to self medicate – which make it look even more like ‘distre
    ss’.

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