Team Talking

We now seem to have a real ball rolling, pushing back against various kinds of demands that the police have been inappropriately facing. I’m always happy to learn that officers and staff have built the knowledge or confidence to question things more or push back a little bit, where appropriate. This is partly about ensuring that vulnerable people aren’t criminalised by inappropriate involvement of the police and partly about ensuring that police officers don’t find themselves having to answer questions to which there aren’t any particularly easy answers about why they were doing things they shouldn’t be doing.

But there is a danger here and this is what I want to explore here –

We need to be sure that in our new-found confidence, we don’t push back too far, declining or refusing to do things in circumstances where people are left at risk. We need to be sure that when control rooms supervisors are contemplating a decision, that it is reached after knowing as much as is necessary to ensure the decision is informed. There are also duties for our partners and colleagues here too – you need to ensure police officers are fully informed of the reasons for requests.

DO AS YOU’RE TOLD!

I often have the chance to talk to groups of paramedics and did so recently. I was told in advance of one such input that the group were keen to explore why the police don’t do as they’re asked when paramedics have had to take decisions connected to someone’s mental capacity. This usually means an incapacity to take an informed decision about declining medical care. So here are two circumstances from my experience: one connected to insufficient information from paramedics and one connected to refusal by the police to assist in circumstances where it would have to be wondered how else someone would be safeguarded.

A middle aged woman who has been drinking has dialled 999 after falling down the stairs and hitting her head. Paramedics attend to her and by the time they’ve arrived she no longer wishes to receive medical care and won’t say much about how the incident has happened. There is no external indication of trauma but she does appear slightly confused and disoriented, which may be caused by her alcohol consumption, but it’s hard to tell. She can’t be safely described as ‘drunk’, but has had a few. Paramedic tries to explain if she’s fallen the whole height and length of the stairs and hit her head, it could have generated a very serious injury but by now abuse is starting to flow. Paramedics asks for the police to be contacted to coerce this lady to hospital. Upon the arrival of the police officers their briefing is, “She’s fallen and hit her head and needs to go to hospital because she’s been drinking and lacks capacity.”

This is not enough information for the officer to be confident that such action would be legal and should be declined unless more is forthcoming. What does she lack capacity for, what are the implications of doing nothing: why is this action consistent with providing a life-sustaining intervention or preventing a serious deterioration in her condition? These questions are based upon the MCA itself, in particular the section on restraint (section 6) and the one on urgent deprivations of liberty (Section 4B). This is what the police would need to be able to justify so it needs to be explained as part of the request.

DO SOMETHING!

Do you remember the scene in Zulu when one of the soldiers, contemplating the overwhelming numbers about to attack them asked Colour Sergeant BOURNE why they were the ones who had to fight this battle. “Because we’re here, lad!” came the straight-faced retort. In many respects the answer is the same about why the police are often drafted into situations which we would prefer to have been handled before they became crisis incidents or before there were a limited number of blunt options to address a complicated sensitive situation. It brings us back to BITTNER’s description that policing is what happens “when something’s happening that ought not to be happening about which somebody ought to do something now!”

We would probably all prefer to live and work in a world where the health service and our social care system would always have sufficient resources to ensure that where patients lack capacity to consent to treatment or make broader decisions about their lives, any restriction or deprivation of liberty and / or any use of force that were required could always be therapeutically delivered by trained professionals, wherever is was required. My only observation is: that’s not the world I police. So it is with some awkwardness that I learn examples like this —

An adult man with alcohol addiction problems is in contact with paramedics who have been called by a GP. His presentation is concerning to them and queries are being raised about whether he has a bleed on the brain. Discussion has occurred with a hospital consultant who has previously treated him who agrees the situation is serious and that he needs to be in hospital. It is considered necessary to prevent a serious deterioration in his condition and having explained at length their concerns, the man is declining medical treatment. The conversation fails to convince the paramedics that he has capacity to take this decision and he is aggressive and threatening, through his confusion at the idea of being hospitalised. He is suffering an impairment of disturbance of the mind or brain (the presentation indicates a potential brain bleed and he’s consumed alcohol today – his manner is confused and disoriented.) He appears unable to understand the information being presented to him or to retain and employ it. However, the police have repeatedly refused to attend this incident saying it is “a medical matter” and that the paramedics should sedate him. Interesting!

WORKING TOGETHER

At this time, our pendulum is swinging from the start of the century where two-thirds of detainees under s136 went to custody, where PoS provision was limited and where demands around mental health or capacity laws were limited. Indeed, we had no Mental Capacity Act until I was an inspector and these kinds of jobs just ‘got done’ where they occurred. I’ve wondered for a while whether or not a combination of the newer legal frameworks, confusing as they can be, with the drive to better manage the kinds of demands we’ve seen increasing over the last ten years now means we’re over thinking this?! “Big bloke with a brain bleed who’s been drinking; might seriously deteriorate or die if untreated; aggressively resisting paramedics who can’t physically make him go – can we send a couple of PCs to get him shifted for his own sake?” It used to happen fairly straight-forwardly because it’s something that just needs to happen.

Of course, now there are these legal structures to navigate – my view about the police reliance upon the MCA to justify restraint or coercion is that officers need to understand sections 6 and 4B before acting. And they also need to have tried and failed the other ways of approaching things, accepting that paramedics will often have done so first. But if my colleagues in Green are asking for someone to be removed to hospital ‘under the Mental Capacity Act’, then I need a briefing that let’s me know the following things –

  1. What does this person lack capacity for
  2. Why does he lack capacity
  3. What else could be done that does not involve restraint or removal?
  4. Why is this intervention ‘life-sustaining’ or something that will ‘prevent a serious deterioration in their condition’?

Without knowing all of that, the officer cannot be sure that they are acting lawfully. In that respect it’s no different to me telling a police constable, “Nick that bloke for burglary.” With such information, the officer would be obliged to say ‘no’ – not until I’d given them sufficient information. “That man’s blood was recovered from [an address] where a burglary took place last week and it is now suspected he was involved in the offence – nick him for burglary.” Now we’re talking!


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 “Team Talking

  1. Me v muchly liking this blog 😆

    As an AMHP, who was an ASW I have experienced this “push back” & to be honest for a while held you personally responsibily for some of it.

    But in a world where austerity & budget cuts are the driving factors I can understand why the police identified an area where saving could & should be made & an area where others were not doing what they are supposed to do be doing. Further more, even if it has not saved £s off police budgets it was on many levels the right thing to do. I acknowlrgde that the police have & to an extend continue to fill gaps, that in terms of the MHA reflects legislation that was drafted in the middle of the 20th century & commissioning arrangements that do not meet demand (that is predictable). These gaps are still there & other organisations have faced budget constraints & operationally we need to “mind the gap” using the common sense approach you have alluded to. Of course that approach must be based on what we legally can do, not what others think we should/must have to do, there is a difference & I know you get that. The MCA legislation might be ok when you are a BIA & have had the benefit of being supported to go to uni to do a PGDIP. Even then I hear lots of discussion amongst them & I v much doubt a police officer gets more than a handout & a few hours training?

    Soon after meeting you & reading your stuff I realised that officers were sometimes either deliberately or otherwise misinterpreting & misquoting, with confidence, the bits of knowledge that they were gleaming from your blog & saying no to things that they might have done previously, but also to things they still can & should do & things only they can do e.g. In the last couple of months I have had to go head to head with officers regarding the execution of 135(1) Warrants! It has both amused be & frustrated me & made me think about big blokes with little brains or training or common sense. Given that this is a public forum I will balance that bit of my humour – very often the police officers when deployed to support my colleagues & I do a difficut job very well & with compassion.

    We have to get this right together & please continue doing your bit.

  2. The last scenario would have me asking even more questions before I stepped in:
    1) Why can’t the ‘vital act’ be done at the males home (do observations count as a vital act?)
    2) In the time it has taken for a GP, Paramedic and consultant to reach this conclusion has anybody considered a DoLs?
    3) Once we get to hospital what measures are in place to stop him leaving or refusing treatment (are police expected to waiti with the male or assist with forcibly treating him?)
    4) Who is contacting court and when.

    Even then it sits uncomfortably with me as a police officer, because once we start on lower scale of force it can escalates very quickly. I’m guessing the medics, GP and consultant wouldn’t want use Taser, Baton Strikes and CS spray but if the males that determined not to go that’s wher it could lead.

  3. Yes we’ve certainly seen push back in our local s136 suite. Officers confidently ( sometimes aggressively) stating “you cannot refuse” . This has included male brought in by 10 officers in leg shackles violently resisting. The 136 suite is staffed by 1 nurse. Flip side of no refusal policy in London. Result – serious assaults on nurses ; 2 on long term sick leave and a feeling of general hopelessness and to be honest fear.

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