Assaults and Medical Factors

A brief BLOG, because nothing I’m going to write here says anything new at all about assaults on NHS staff, it’s just that latest figures on this topic show we’re really still no further forward!

The 2014/15 figures for assaults on NHS staff were published yesterday and they show 67,864 assaults overall, right across our NHS. This involved 1,861 assaults on paramedics – my brothers and sisters in green – and 45,220 assaults within the mental health sector, which is 66% of the total, down from 70% in years gone by.  You can read the NHS Protect spreadsheet if you want a lot more data to consume or a very detailed look at your area.

Assaults on NHS mental health staff has always been a difficult subject: no-one thinks that getting assaulted is ‘part of the job’ but we also know that when people are in extreme distress and fearful, an assaultative reaction to circumstances can be at least understandable, if not a direct manifestation of their particular condition. So the NHS identifying which cases should be reported to the police is difficult enough: we know that only about 1 in 8 of the assaults recorded by the NHS are subsequently reported to the police. Officers then knowing how to investigate them and determine an appropriate outcome has also proved problematic – I still hear anecdoates from MH professionals that when they report matters to the police, the response is mixed.  Some officers still believe you cannot arrest and / or prosecute someone who is detained in hospital under the MHA – well, you absolutely can! … and that you have to have complicated discussions with psychiatrists about ‘capacity’ before they can start doing anyting – you absolutely don’t!

But there is confusion in the NHS as well – and you’ll have to look at the detailed spreadsheet to see this for yourself.  The NHS recording mechanisms ask staff to indicate whether there were “medical factors” involved in the assault – I’m not aware of whether this is specifically defined or whether such a judgement is given tby the victim or by the doctor in charge of that patient’s care. Either way, the outcome is interesting –

  • Oxleas NHS Trust in London and Nottinghamshire Healthcare Trust believe that none of the assaults that occured within their trust involved any medical factors – NONE of them.
  • West London Mental Health Trust and Cheshire and Wirral Partnership Trust believe that all of their assaults involved such factors – absolutely ALL of them.

Now I’m not a medical doctor, as you know – but I suspect that neither of these can be correct!  And as a police officer I can say that this can have implications for the appropriate legal response to any allegation because it will either affect the police / CPS assessment of the evidence; or the assessment of whether it is in the public interest to prosecute.  Imagine the response officer or the hospital liaison officer taking a report and asking about whether there were any clinical issues affecting the incident or whether “medical factors” were involved?  The answer is important: in Oxleas and Nottinghamshire, it’s easier for the officer: they can confidentally tell their supervisor and the CPS that the professionals involved have negated the possibility of a clinical factors playing any role.  But the officer in West London and Cheshire can’t do that, can they?

So it begs the question: if clinical issues affected the incident, how did they affect the incident? Does it affect the so-called ‘capacity’ question (which is incidentally, the wrong question to ask but I’ve covered that elsewhere) or does it affect how we might weigh the public interest? What exactly does “medical factors” mean for this patient and victim?!

I’ll leave the point there – you can (re-)read other BLOGS on here if you’re interested in other things that could be said about all this and you can peruse the spreadsheet to your satisfaction … now who doesn’t love a good spreadsheet?!

IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.

6 thoughts on “Assaults and Medical Factors

  1. hi michael a great blog as always, capacity is a problematic one, the police want it in writing from the consultant that the person had capacity or not (if not then no crime). so someone who gets smashed on drink or drugs and perhaps had a comorbid mh problem then walks away. we do ourselves no favours with this approach and it does not help the patient either.

  2. With regard to your blog on assaults on staff as regards capacity this can be affected by enormous quantities of concomittantly prescribed mind altering drugs. This can obviously affect someone’s behaviour and you should be investigating who is prescribing these drugs and whether proper assessments have been given, why are tests not available here in the UK and patients are prescribed drugs they cannot metabolise when all along they could be rape/abuse victims and staff are allowed to force drugs and a group of staff pin a patient to the floor and restrain them in order to force drug them. How is this allowed to go on in a civilised country and the police do nothing about this. Do the police bother to investigate serious incidents that have happened to the patient? They just cannot be bothered and serious incidents that happen under care are completely brushed aside. My daughter has several diagnoses and now I can prove how wrong everything is as I now have the results from Holland by leading experts in the field of metabolism. So I do not have a good word for this rotten system and I wish you could see the full details – in fact I am going to send some examples to you so you can see my point. There is so much cover-up and self protection and I have proof of this as well

  3. Right on the button here Michael. Quite a conundrum for anyone to try and resolve particularly where there may well be a cocktail of alcohol, drugs, personality disorder, pure and simple aggression or maybe events have turned someone’s life upside down and they have no concept of where they are what they are doing. Sadly, in the incidents those coming to help have very little to go on when they arrive as to what exactly is going on and inevitably the good, the bad as well as the ugly (excuse the poetic license) all get tarred with the same brush. We have working on providing a solution to this issue for some time and consulted with various Police forces as well as the High Security Psychiatric Units. Now, we are just a matter of weeks from bringing front line staff wherever they may be, the means to treat individuals in these situations, calmly, with respect and safely in terms of both the individual and those trying to offer help. NOT a sales pitch! Don’t need to stoop to that level here; merely alerting you and others that there is finally a light at the end of this tunnel.

  4. Michael, the issue is NHS protect provide a definition for an assault which is confusing, they say for an assault it must be the intentional application of force, but how can you prove intent, particularly with some patient groups, can person form intent if they have no capacity ? i feel that the defination provided to Trusts is no longer fit for purpose hence the confusion amongst Trusts recording of incidents.

  5. There is nothing in any guidance to say that it is only the Consultant that needs to confirm the perpetrators capacity to take responsibility for their actions .ie assault on staff. In my Trust , North Essex Partnership NHS Trust, we encourage senior staff to advise police on arrival at unit following a reported assault re presence or otherwise of capacity. We will soon be providing this and other relevant information in an agreed one page form. This enables the investigation process to proceed. If the police or CPS decide to prosecute rather than using an out of court disposal then we are usually asked to provide a Consultants letter at that stage. This avoids a lot of delay all round and works well for all involved.
    We are building very good working relationships with Essex Police to deal with the historic problems associated with crime and mental health. This joint working has increased our criminal sanctions from 8 to 55 over the last 12 months.

    1. The problem with that is, however, that ‘capacity’ isn’t a relevant concept for criminal law – it’s literally meaningless. For some criminal offences you don’t have to have any ‘cognitive’ element: the act itself is enough to prove liability for the offence. For others, there is quite a low level of intent / recklessness / omission required to prove the matter and nothing other than the most profoundly psychotic mental illness is going to affect the evidential test to be satisfied and the prosecution’s ability to prove an offence.

      I’ve always argued that prosecution is under-considered by both police and CPS; that, on balance, more are required and that I fully accept the contribution those two organisations have made to the perception that it may not even be worth reporting because officers and lawyers may not take action and it will be a waste of time. I also have reservations about the ethics of prosecuting vulnerable people for offences committed on wards where the quality of the environment in which some are detained contributes almost directly to the context of an offence. Finally, when you call the police to an incident on a ward, the officers are not on anyone’s side! – I point this out because of the ‘good working relationships’ remark. I’ve been called to allegations only to conclude that it was the staff who were offending – or at least violating someone’s legal rights – and not the patient.

      Complicated stuff: but not made easier if we focus on the wrong things as a route to improvement.

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