Happy New Year

I started back to work today: plotting, planning and preparing for 2015 and where we need to be by the end of it – there is LOADS to do. We’ll continue to learn hard lessons during 2015 because we saw an Inquest commence today into the police contact in Manchester with Kesia LEATHERBARROW who died after being bailed from court following her arrest during which it is alleged Greater Manchester Police failed to follow various statutory requirements relating to young, vulnerable people.

Next month, West Midlands Police officers will be party to another Inquest following the death in 2011 of Kingsley BURRELL after officers were called by Birmingham & Solihull Mental Health Trust to attend a mental health unit. We should start seeing outcomes from IPCC investigations into various deaths in custody and all of this will be happening as the areas of England start trying to ‘turn green’ on the Crisis Care Concordat map.

GOING GREEN

It took ten months for all areas of England to agree that they can work towards implementing the principles behind the Crisis Care Concordat. The next challenge is to devise an area specific action plan and you’ll see on the CCC map which is updated by Mind, that some areas have already managed to do so.

I’m hoping that action plans will address how support is given by mental health services to mental health emergencies in private premises, now that we know it is the confirmed, 21st century view of our elected government that we should not allow the police service to intervene in mental health emergencies in private premises where the safety and wellbeing of vulnerable people is at risk. We know this following the publication in December of the HM Government review of sections 135/6 of the Mental Health Act.

Up until this published review, it was legitimate enough to wonder whether our model of mental health care had just developed somewhat faster than corresponding laws. We now know that it has not – it is absolutely clear that vulnerable people in immediate need of care or control who are in their own home are not people the police should be taking immediate action to safeguard. This means the legal view of the judge in the Sessay case (2010) has now been reinforced: the route to safeguarding is AMHPs and s12 DR turning up to premises to undertake emergency Mental Health Assessments under section 4 of the Act. I haven’t written about s4 MHA very much, because it’s rarely used – the Sessay judgment and the 2014 Review suggest that it should be considered more often and that mental health services, including AMHPs, should be geared up to do so, more frequently.

DIFFICULTIES IN A&E

Last month, a social media forum outlined a problem in A&E where acute staff and mental health professionals had concerns for the immediate safety of a patient in A&E who was described as acutely unwell, disturbed and threatening to leave. It was almost everyone’s judgement that the person needed to be detained pending Mental Health Act assessment. The problem was, that only the police had the power in those circumstances to do so – under s136 MHA. For reasons I’ve covered elsewhere, there was no ability to use section 5 holding powers or the Mental Capacity Act.

The problem was that the police either wouldn’t or couldn’t attend – it wasn’t clear whether this was a prioritisation problem (because of other, more pressing matters) or whether it was an ideological refusal (because the person was with NHS staff and security who were more or less keeping a lid on it, however questionable that may be in law.)

What this matter highlighted was the view by the professionals involved and those discussing it on the facts given, as above, that the police decision was not acceptable and support should be given because it was ‘obviously necessary’ in the opinions of those seeking police support. It’s important that I state clearly: I have no grounds to question this view.

But I couldn’t help but laugh … out loud actually, at the various ironies at play here.

THE REVERSE ‘SESSAY’

No, this is not a gymnastic manoeuvre – this is the Sessay judgment, in full reverse. Many of us who read the learned judge’s comments in that case view smiled wryly at his reminder that the police should have contacted the duty AMHP out of hours, in the confident hope of getting a response within an hour or two, replete with a s12 DR … and potentially a warrant. I have asked for exactly this over a hundred times in my career and it’s only ever happened once, taking approximately 5hrs and the AMHP concerned didn’t secure the warrant that we pointed out would be necessary because access to a premises was being refused. I can only imagine how long it would have taken, if they’d also had to get a Magistrate out of bed, given the incident happened overnight.

First amongst my observations about the A&E discussion was the belief that those requesting the police support should simply get it, as a professional courtesy, and that representations about it all should be argued over later. I was struck by the inconsistency of this expectation: you want to see the police doing for you what you are not prepared to do for the police, even when sometimes those requests are made by a street triage team where the nurse involved is saying the person needs full MHA assessment and is likely to require compulsory admission. Examples are starting to reach me of those situations too – and the incident which motivated Sir Paul BERESFORD’s Ten Minute Rule motion in 2014 was a clear example of nurses occasionally making little different to achieving what the Sessay judge stated was required.

Thirdly, I was saddened that all of this is about inter-agency wrestling around the resources issue: not about the safety and wellbeing of those at the centre of that professional decision-making. And this mis-focus comes about because services are not and were never built to address the needs of service-users. The implications of twenty-first century mental health law, is that local authorities need to ensure sufficient AMHP coverage and CCGs need to ensure sufficient s12 DR availability, to provide a response to Sir Paul BERESFORD’s incident. They simply don’t, but the 2014 Government Review is a clear reminder of this expectation, even if it’s not explicitly made in the Mental Health Act.

PLOTTING, PLANNING AND PREPARING

So as we work through 2015, those people in Crisis Care Concordat areas who are hoping to turn their areas from yellow to green on the map need to turn their attention to these kinds of issues – how do the various agencies support each other where the one needs to call upon the use of the legal authorities that only other organisations’ professionals have? NOt that this is the most important issue: but it’s will be hard for police officers to feel the CCC is making the right kind of progress if they remain at the beck and call of the NHS and feel professionally isolated when the situations are reversed.

What I know for certain is that whilst agencies are increasingly talking the language of partnership, agencies are also looking at how they can legitimately reduce the demands they face. Police forces are sharing ideas on how to reduce the number of AWOL patients that are reported to them by mental health units; how can they reduce the use of s136 and the use of custody as a Place of Safety; how can they responsibly work out which 75% of all requests to do ‘welfare checks’ they can simply decline, referring the responsibility back to the correct agency?

So police officers need to be clear that the current, elected UK Government does NOT want them detaining people in their own homes during mental health emergencies, except where criminal offences are occurring or where imminently life-threatening medical issues are in play. Officers need to learn about the restrictions that are placed upon them by the Seal case (2007), the Sessay case (2010) and the Hicks case (2014) and that they are absolutely entitled to contact Crisis Teams for known MH trust patients and out-of-hours GPs for those not known to MH services; they are entitled to contact the duty AMHP to seek advice and / or consideration of an MHA assessment. Indeed, showing that you have thought this through correctly, asked the relevant questions despite any sense of futility and documented it all, may well be key in the future, to demonstrating a properly discharged duty of care in the face of untoward outcomes that are, quite frankly, bound to be seen again in future.

We need to watch the inquests we will see this year and learn from them, organisationally and in terms of our strategic partnerships, which need to be sophisticated enough to recognise that it isn’t all about managing agreement – they are often about managing ambiguity and conflict in order to provide leadership.


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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One thought on “Happy New Year

  1. Much of the above is mine & colleagues everyday experience & It seems that everyone wants & needs an AMHP.

    But of course not everyone wants to listen or indeed help/support the AMHP do what is required e.g. even with 135(1) Warrant in hand & a bed/POS & medic ready to go neither the police nor ambo are able/willing to support/deploy.

    The reality eloquently stated by MHC is – “Thirdly, I was saddened that all of this is about inter-agency wrestling around the resources issue: not about the safety and wellbeing of those at the centre of that professional decision-making. And this mis-focus comes about because services are not and were never built to address the needs of service-users.”

    Happy New Year – I can only hope that it is no worse than the last.

    What I do kown – in the last month 3 of my colleagues have voted with their feet & there are now less AMHPs here. That being an AMHP is at times an almost impossible task & that commissioners of services need to visit the front line & senior managers in all the agencies need to think about how we do this together.

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