This is a guest post by Em, or @DrEm_79 from Twitter – our various discussions on there made me realise she has a lot to say that is important and relevant for police officers responding to mental health crisis incidents. I think there’s a lot going on here and much of it is contradictory: but that seems to me to be precisely the point Em is trying to make – the normalisation of the police as a de facto mental health service is something to caution against and worry about

I’m giving a trigger warning, too: Em’s post contains descriptions of suicide attempts and restraint  that may disconcert some who read this —

It takes eleven minutes to walk to the GP surgery, but I only made it halfway. I don’t remember deciding to die. I don’t know why I chose the wooded embankment, and I’d lost consciousness before the police search helicopter, the ambulance and resus. When you’re unconscious in intensive care, as well as the life supporting interventions, they remove your contact lenses. Several days later, when I woke up, it was to a blur. There was a tube and ventilator supporting my breathing, fluorescent light and blurry hi-viz. The hi-viz turned out to be police, still waiting in the relatives chairs opposite my bed.

I have what are referred to as severe and enduring mental health conditions, and started hurting myself when I was five. Over the thirty years since, I’ve had a lot of contact with police because of my mental health. Police have saved my life more than once. They’ve listened to things no one else has, stepped into my flat when everyone else has walked away, seen me at my most terrified and vulnerable, and selflessly got themselves into trouble arguing for me to have mental health assessments when other services were trying to shift responsibility. They’ve also restrained me for hours, detained me in cells, vans, handcuffs and leg restraints, unwittingly contributed to the destruction of my career, and a hate attack by my neighbours. Police intervention when I’ve been unwell has left me at times too frightened to stay in my own home, with a front door that didn’t close. It’s fair to say our relationship is uneasy. The intersection of mental health and policing is complex, and there are as many experiences of mental health as there are people. I can only speak from my own perspective. Changes to the way mental health care is provided and policed where I live over the last ten years have not helped me. In crisis I need help from clinicians who know me, can recognise I’m ill and respond early. But now early intervention is rare, and crises are left to escalate.

My mental health care plan stated that if I or others call mental health services because I’m unwell, mental health services are to advise calling police if I’m at risk. Sometimes it’s the mental health staff, sensing risk and needing to do something with the sense of responsibility, who call. A “welfare check” by police is now seen as a health intervention. This normalisation of police as the first responders to mental health is stigmatising, distressing, and for people like me who are known to be unwell, just adds to the resource ultimately used in a crisis. I’m not sure police being the planned response to people who are looking for mental health help is a good thing in a sophisticated society. As someone on the receiving end of that shift from health holding responsibility for mental health response to police, it frightens me, and at times has made me more unwell.

Over all of the contact I’ve had with police when I’ve been unwell, there are some things that have helped, and there are others, both at the individual and systems level, that haven’t.

Things that can help –

Beware short term thinking for long term problems –

Many mental health conditions, by definition, are not one-off events. Most people with mental ill health will have more than one mental health related crisis in their lifetime. In responding to mental health crisis there’s a need to consider both immediate need and also the longer term implications of that response. My experience of police in mental health crisis is that they are good at thinking in immediate terms, especially when dealing with someone at risk to themselves, but that this short term thinking can sometimes take over, which can lead to consequentialist ethics – as long as the immediate crisis is resolved, it doesn’t matter what you do to get there. Short term focus applied to a long term or recurring condition can create problems in future.

For example, last year the mental health team reported a concern for my welfare. I wasn’t at home. A police sergeant called me and asked me to tell them where I was and for me to meet with them. They promised I wouldn’t be made to go to the hospital, that all they wanted do was talk. On meeting them, I was immediately put into the police van and taken to hospital. I can see this may seem justifiable; a promise they were never going to keep achieved the short term outcome they were looking for, but longer term what that created was a person with severe and enduring mental health problems, very likely to have further crises in future, who no longer believes the police will tell them the truth. In the long term it has made things harder for everyone. Many people with mental health conditions have experience of trauma and trust in others may be fragile. Expediting an outcome by not telling the whole truth may jeopardise the only opportunity for that person’s trust.

Radios, the third person, and remembering I’m there –

When I’m experiencing hallucinations and delusions, routine aspects of police work can be menacing and frightening. Being aware of this and making even small allowances can help.

For example: radio use. When I’m hearing voices, and may be paranoid that people are talking about me and planning to hurt me, disembodied voices coming from radios or officers repeatedly leaving the room to talk into the radio, often only partially out of earshot, can add to the fear and beliefs I already have. You can’t stop the voices I’m hearing or the delusional ideas I have when I’m unwell, but if you’re able to, explaining what you’re doing and why, as you’re doing it, can help: “I’m just going to speak to my Sergeant on the radio, to let him know where we are..”

I often don’t feel in control when I’m ill. That’s part of what is frightening. You may not feel able to let me have control over what happens, but keeping me informed and talking to me rather than about me in my presence can help. Even if it doesn’t seem like I’m taking in what you’re saying please keep talking to me, acknowledging my presence, and telling me what’s happening as much as is possible. Try not to talk in the third person about me when I’m there, it can worsen feelings of paranoia and threat. Many people’s experience of voices is a commentary in third person. Even if someone isn’t interacting, talking to them about what you’re doing as you’re doing it, letting them know and including them can prevent the situation from becoming worse.

Restraint –

Unless you’ve experienced hallucinations, flashbacks, or other perceptual disturbances, it can be difficult to imagine what it’s like, but we all know what it is to feel afraid, or that you can’t trust someone. When I’m unwell that fear can exist at another level, which is partly why I think restraints can often go so wrong. Whereas someone who isn’t experiencing a disturbance to reality might observe they are being restrained, perhaps in a cell, and realise they aren’t going anywhere, and eventually relax, the things I am frightened of in crisis often aren’t proportional to what is being done to me. When I fear someone is trying to hurt me, that belief doesn’t just go away if my movement is restricted. The fear will likely be escalated by restraint. It isn’t ‘acting up’; it’s terror.

Some of the times I’ve been restrained by police were before anybody even tried alternatives such as talking to me. Restraints have lasted hours, with me becoming more and more frightened, but once restraint is started I become so much more afraid the only option to stop is chemical sedation or further restraint. Restraint while mentally unwell is confusing, terrifying, and traumatic. Where it is not essential, avoid it, or at least know what you are getting into, and have a plan as to how you’ll get out of it.

Stigma; and leaving a life to go back to –

In mental health crisis the focus from police I’ve met has sometimes seemed to be to contain and transport me to the hospital as swiftly and by whatever means possible. This has often involved transport in police vans or cars, handcuffs, even though I’ve never been violent to another person and there has been no crime. Although I can guess some of the pressures that might make the quickest form of transport seem like the best, be aware of the effect very public police interventions for mental health can have at somebody’s home.

For example, I live in a tenement building, when attending my flat, police have had discussions with bystanders including my neighbours where police have disclosed my history of mental health problems. More than once I’ve been filmed by people being put into a van for transport to hospital. There is a stigma to being with the police; people assume you are criminal, dangerous, disruptive, undesirable. I’ve lost professional status and career because of stigma that still exists about mental health. Police aren’t responsible for my neighbours’ intolerance of people with mental ill health, or their subsequent attack when I returned from hospital, but protecting me isn’t just about containing me in a van and waiting with me at hospital until I’m detained, it’s also about being aware of the impact you’ve had on my life and my community, and leaving me a life to go back to.

Think about language –

I don’t expect police to be therapists, or have endless time and full knowledge of a situation, but thinking just a bit about the words you use and the way you ask questions can make a difference to the responses that you get when I’m unwell, and ultimately can make a difference to the amount and reliability of information you can gather to help decision making.

For example, when there has been a call with concern for my welfare and police want to ascertain whether I am at risk. Commonly, officers do this by asking: “Are you planning to do anything silly?”

This tells me a value judgement the officers are making about self harm and suicide. It makes me less likely to think that person understands, wants to help, or can be trusted. It also directly impacts the content of my answer. When I’m unwell often nuance and turn of phrase are lost and I interpret things quite literally, or ascribe them more meaning than I might on a day I am well. I also don’t think suicide is silly, and at times I’ve been unwell I have felt it is the most sensible thing in the world, either because I’ve felt compelled to do it by external forces, or because I’ve felt so depressed it has seemed a rational choice. The answer you get can depend on how you ask.

Other ways to explore suicidal feelings are, if there is time, gradually in a stepwise way. Start by showing you are interested, there aren’t set words, if it doesn’t sound authentically from you that’s easy to pick up, but things like: How have you been feeling today? … Have things ever been this bad before? … You said you can’t cope, are you having any thoughts of ending your life? Ask explicitly about suicide. There’s good evidence it doesn’t put the idea in someone’s head, and there is a lot of stigma, suicidal thoughts may not be volunteered if you don’t ask directly.

If someone does say they are feeling suicidal be aware that’s an incredibly difficult thing to say; it’s taboo in society, and there are even more barriers to talking to police about it. So often if I have spoken about suicide to officers they don’t even acknowledge it, as soon as they have that information their next movement is to press the button on their radio and start talking to their Sergeant “Yes, yes, admits is suicidal..”. It would have taken a few seconds longer to acknowledge to me that they’d heard that and that they wanted to help. Those few words can make a massive difference. In crisis it is easy for the needs of the person who is unwell to become peripheral to service protocols and needs. Try to avoid this.

Say you want to help –

Professionals often implicitly and sometimes explicitly assume when a person is in crisis that the person will trust them because of who they are, and that the person will believe that the professional’s motives are to help. This often could not be further from what the person believes. It isn’t enough to assume that I think you want to help, you need to say that, and act in a way to back that up.

People without mental health training often feel uneasy talking to people who are mentally unwell. Often this comes from a place of concern – they don’t want to make anything worse, but it has an isolating, dehumanising effect on people who are unwell, and in crisis can increase risk. In an acute crisis listening to someone who is ill is one of the best strategies to help them feel calmer and start to trust, and may be the difference in making it possible to help them.

Filling out a form does not make somebody safe –

Beware mistaking following process for mitigating risk. After being called out to me, police almost always have to fill out a form for their vulnerable person database. I’m seen as a vulnerable adult, and coming to my home they’ve often had concerns for my welfare – risk of harm to myself, lack of food and heating, lack of security, risk from others. There have also been many forms submitted to report adult Protection Concerns under the Adult Protection act with concerns about self neglect and risk from others. These forms are sent to social services. Yet despite dozens of these forms, and hours of police time, not one of these concerns has resulted in changes to my treatment or care. There are complex reasons for that – uncertainty over which service, if any, holds responsibility for care and treatment and crisis response. Even when Adult Protection meetings have been held there has often been ambiguity, obstacles, or no outcome. Yet because it is procedure, still the forms are completed and sent.

It seems the process was followed and there was a partnership in place, but nobody had oversight as to what impact that process had on the risk it was trying to manage. Even the fact the forms contained the same concerns over and over didn’t alert anyone that the situation hadn’t been addressed. I don’t know if there are other systems like this, where ticking a box or completing a form gives mistaken reassurance that risk has been managed? Protecting someone may involve a form, but the form alone does not help me.

Planning and prevention –

Although uncertain and frightening for me, and often portrayed by the media as unpredictable and dangerous, there is a predictability to mental ill health. If police are going to be part of the response to mental ill health, could planning and prevention have a bigger role?

For example: When unwell my awareness and perception of the world around me can change. This can lead to me travelling miles and finding myself somewhere, often with physical harm, sometimes unaware how I’ve got there. If police are alerted by somebody concerned where I am, I become a resource intense high risk missing person. Yet there is often a predictability to my travel. In the days or hours before I become unwell I have sometimes tried to seek help but not been able to access it. There are also patterns. I’ve been missing and unwell and hurt a number of times, but for years nobody sat down with me afterwards when I was more well to talk about what the triggers were, the types of places I found myself, or tried to ensure there are safeguards in place so the situation could be managed more safely if it recurred.

I don’t think providing mental health care is the role of the police, but this is the sort of area where working with me has benefitted everyone. A few months ago a local Sergeant spent time talking with me, being reliable and straightforward, and rebuilt some of the trust I had lost in police. He listened (a lot) and started to understand what was going wrong in responses to me, what helped and didn’t. It’s far from fixed, but that time has helped police start to develop a more informed, safer response. They understand more where I am likely to be when unwell and the safest ways to respond, and have saved resource in doing so. It isn’t a high profile media lauded scheme, and that Sergeant has had no recognition; but by gaining my trust, getting to know me and what happens to me, and thinking with me about how police can help me to be safe, he’s helped police to save my life more than once.

Don’t give up hope –

I’ve been critical of police responses to mental health, but there is one way in which police response has been consistently more helpful than many other services, including mental health services. And just now, I’m worried this may soon be lost.

When someone has been ill for a long time, health services can sometimes develop something called therapeutic nihilism, a feeling that nothing is going to help the person. Unfortunately sometimes without realising they then stop trying to help. This is often seen at suicide inquests, when people report clinicians having said to the person who has now died that they could not help them, or other negative or very hopeless statements.

Hopelessness is associated with completed suicide, and this type of response can be immensely damaging. Clinicians also have a different view on responsibility of people who are unwell to the police, again we know from inquest evidence and service user experience that with some disorders in particular, professionals may say things such as: “it is up to you whether you die”, “we can’t stop you” (which may be true, but..), “if you wanted to do it you would have”. Such negative statements may not be said with harmful intent, but that is often their effect.

Yet the response of the police, perhaps because of their duty to protect life, seems more hopeful. They will keep trying to intervene, keep trying to help, and don’t refuse to come to help people as health services may end up doing with some patients. This persistence can be lifesaving. When a person is totally without hope it can help, even fractionally, for someone else to believe they are helpable, and importantly that they are worth helping. People who are feeling suicidal often feel they don’t deserve help. One of the best ways to challenge this is to show them you want to help and you aren’t giving up on them. I wonder if this is one of the reasons service users report contact with police in crisis is often positive, in some cases beyond the time that the police are with them. Just acting as though there is never no hope at all sends a message that may make a crucial difference to somebody.

This is one of the reasons I’m not entirely convinced about some of the current co-response plans between services. I hope they won’t lead to the nihilism some other services show to people with the most complex problems starting to affect police response. Police are good at not giving up in mental health crisis in a way that other services are sometimes not. It can be harder to give up on yourself when there is someone else not giving up on you. I hope that isn’t lost.

Even when I’m most unwell, treat me like a human, talk to me and listen, and be as compassionate as you can to another person who is suffering. Even when unwell I can sense hostility and value judgements and they do not help. Be aware of the effects of stigma that exists around mental health, the assumptions people make about criminality when police are involved, and where you can, try not just to protect my immediate physical safety, but leave me some dignity and a life I can face again after the crisis is over.

IMG_0053IMG_0052Awarded the President’s Medal by
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.

19 thoughts on “Normalisation

  1. Thank you for this -I think it is really helpful plus challenging and thought provoking.

    I recognise the police actions described. Brings the feelings home….

    This blog supports our new project and with the authors support add value to training our volunteers.

    I’ve reblogged this article so I can’t lose it!

  2. What a brilliant post! As a police officer I agree I will never give up helping people who need it, whether they are on the side of a bridge looking to commit suicide or in custody for the umpteenth time because their symptoms have not been recognised by anyone.
    However, police officers are, by nature, fairly cynical and without proper training and guidance and support networks in place from the NHS and local authorities it’s an uphill battle trying to help someone.
    It’s easy to just stick them in the van and deposit them at a place of safety but, as I’ve read on here I more than one occasion, that doesn’t always mean the person will get the help they need and then they’ll be back on the bridge trying it again.
    As police officers we WANT to help, but it sometimes feels as though we CAN’T

    1. Thanks Shaun, glad it was useful. Agree that there is scope to make things better by police working closely with NHS and support providers. I can’t imagine how frustrating it must be to want to help someone and see their need but not be able to because the system is failing somewhere.

      You’re right that attempts to get someone help don’t always work, I think that’s often where things start to go wrong because the person who is ill starts to get blamed for that, which ultimately helps no one?

      My experience has been as you say that most of the police I have met do seem to want to help. I think sometimes people don’t realise how important that is. I hope that isn’t lost by co-response arrangements and that the tendency of health to reject people with some diagnoses. That hope police hold for those people who are excluded from other services is vital.

      For people rejected by health services – whether because they are intoxicated, have a personality disorder, aren’t “engaging” in the way services would like, or have a diagnosis that doesn’t fit well into the way provision is structured locally – police are not just the first responders to mental health, they are the last responders, and may be the only hope that person has. I hope that the “wisdom” from health that some people in those categories “don’t need” or “don’t qualify” for help doesn’t start to affect what police are great at – not giving up on people. I have seen that happen with ST – health saying a person is “known to services” and doesn’t need a response. If police give up too, those people will have nobody.

      Hopefully co-working will bring together strengths of both services and people involved will be alert to less good practice that could be challenged by coworking, rather than being replicated.

  3. A really interesting post with a lot of cross over to ambulance responders as well. However, I continue to be amazed and fail to understand why MH services see the police as the first line service rather than the ambulance service. Yet as shown above and in my experience MH services use, and tell service users to use, the police as the emergency response to MH crisis.

  4. I read this post of Em’s while this morning while a police officer conferred with his and another area’s sergeant discussing what was to be done about me. I could see the irony of the situation.

    Many times I’ve read Em’s tweets with sadness and anger. I’ve worried when she’s disappeared from twitter at times. I didn’t know all her story and it’s brave of her to be so open and honest. But this is real life for some of us service users especially those of us who are squares pegs that don’t even have round hole to squeeze into.

    Yesterday I’d had enough of being in a place which was actively making me more distressed by being inconsistent and not caring among other things. There was no legal requirement for me to stay there. There are times when I feel overwhelmed and with no response from the community team (my cpn was on leave again) I was struggling to cope. So telling the care home that I was not coming back I thought would be ok. I parked up my car in a quiet place and took a few pills to blot out the night. ‘Normal’ people might think that odd but that is my way of not doing anything worse.

    Oblivious to the world there were many missed calls on my phone when I woke, including from the police who of course get called first. I’d spent a week or more trying to tell professionals it wasn’t working and was ignored in fact. Living in my car was sort of ok’d with a shrug. Of course once the police knew where I was, which to be honest I would rather they just took my word that I was fine, they were there sitting round me in a public car park. Hey ho I’m used to people staring.

    Anyway the upshot was that, perhaps because I failed to mention the overnight pills (otherwise a pointless trip to A&A) I was deemed not sectionable so off went the police. There was a little conversation between myself and the crisis team who in so many words said they really didn’t want much to do with me. Ah now the brush offs make sense. So what happens when the next crisis happens, because it will, as I’m far from well and again the police will have to drive to the rescue. And I’ll go round in the same circles.

    Since Xmas eve the police have been called out 4 times I’m pretty sure they must be getting p’d off with me. I’ve been in some sort of mental health care since October. To the police it must seem like rather careless care to keep losing me!

    And this morning I so smiled when I read about not doing anything silly as I’d had literally had those same words said to me with the add on because I’d lose my job if you do anything and I’ve let you go. And mr police officer I really do get it and I’m sorry that I cause so much bother but I’m not getting the right help and I doubt anymore if it exists.

    PS The care home think I’m getting extra support from the crisis team but that’s not what I understood and off I go again because nothing is resolved.But at least my car seats are better for my back than the bed in the care home

    1. I’m so sorry you’ve been dismissed and left without care and they haven’t listened to what you’ve been saying.

      I’m sorry too it was so bad that you needed to get away and knock yourself out with pills, though can empathise that paradoxically sometimes that is the only way to stay alive.

      It’s shocking, but sadly not surprising given what you’ve experienced before that the crisis team send you away with no help. I wish services could understand the meaning and impact that action has, to say “not for us” and turn away from someone who is at the end of what they feel they can do. I admire your resilience, but know struggling on comes at a daily cost, and it’s hard fought.

      It sounds frightening waiting for the next crisis and there being a void where a safety net and help should be. I’m here if it helps to talk, I keep holding a hope that people around you will start to care for you too. You do deserve help and care, though I know when you’re trapped in that circle of services avoiding or passing on responsibility, it can feel that you don’t.

      Thinking of you tonight, it’s snowing here, I hope you’ve found somewhere warm to sleep.

      1. Well there i was sitting in my car last evening and getting more ‘threats’ to call the police if I didn’t return. I had no choice but to return because probably the police would have brought me back anyway. De facto detention maybe with no trained staff here but just a duty of care – to keep calling the police. I seem unable to escape the ‘system’ which seems unable to help but apparently it’s my fault anyway because I don’t engage with them and do what they tell me as that will make me feel better. Last night I had a call from the crisis team who spouted from that little book of ‘what not to say to the depressed/suicidal person’ until unable to bear it any longer I asked if she’d ever been depressed. Well of course she said all of us get sad and unhappy in our lives You need to take responsibility for yourself. I wanted to scream I mean ‘really’ depressed. My friend has cancer 3 years into 5 years she’s told she has left ‘ Cancer is not anywhere near as bad as my mh problems’ she said.

  5. I also worry that with Street Triage the temptation will be to leave vulnerable people to it., as advised by the Street triage nurse. I would love to see detail on how this is working out for the people seen by Street triage. Press releases all seem to say it’s great because fewer people have been detained. As a friend and relation it is one of many things which keep me awake at night.

    1. I share your questions and concerns – street triage is one contact at a point in time and for everyone who is promised follow-up the next day aid love to know how many received it bearing in mind that the teams ST will be referring to are drowning in work. Some of them report a 100% in work and a 25% reduction in staff in 1yr.

      1. I share your concerns too. For some people who are rejected or just as you say, left to it, by health services, whether because of alcohol, complexity, the wrong diagnosis, or because they’ve been labelled as not engaging, or they don’t fit, police attending in a crisis is the only chance of help those people currently have. I worry ST could result in health advising those people are “known to services” and “don’t need” a response. I’ve seen that happen here. It ends up meaning police will abandon the person too. Sharing that nihilistic and negative aspect of health practice with police could be a bad outcome for those with very few other options, who as we know from inquests, are often the most vulnerable.

        The tendency to tell people to engage with services the next day ignores their needs. If in crisis at night is because they often need help then. Just because that doesn’t fit with the way services are structured and provided doesn’t mean their need isn’t real. So often I’ve seen others told they’ll get help the next day and don’t need help that night, then of course nothing happens for them the next day. It teaches people a hopelessness in asking for help, that there is no point.

        ST, like any partnership, needs to share strengths. I’d love to see health learning to not give up on people from the police, but worry the learning will be the other way, and police will start neglecting those people seen as too difficult as health sometimes does. Health services are not getting everything right for people with mental ill health. For certain groups and certain people they are doing amazing work, but for others, they are not. That’s partly why evidence from services users shows such a mixed picture. I hope police will not pick up the “expertise” which leads to services failing people. There is stuff to learn, but not all of it is good. I don’t doubt the motives of those working in these schemes. I am concerned by some of the targets and logic behind commissioning.

        My local team’s target is to reduce the number of people having a mental health assessment. This is obviously for service and financial reasons. They try to justify it for patient benefit by saying people don’t want unnecessary assessments, but in crisis most people’s primary concern is not that they want to avoid an unnecessary assessment, it’s more likely to be that they might not get any help. Service user needs are not central when the target is to reduce assessments. That’s not an outcome that correlates with survival rates, or continued suffering. Targets that prioritised service user needs would be very different.

      2. I am very interested in seeing those results too. It is something we are looking at in my force but because we are so unique in our location it’s causing difficulties. However, if there’s no follow up and no support then I can’t really see there is much point in providing street triage

  6. The elephant in the room is diagnosis of personality disorder with/without substances. Very often, there is no effective treatment for the person and actually intervening /medicalising can make the behaviours and distress worse. Ie. There is no medication or words that is likely to help in many (most?) cases. This is a really difficult message for patients themselves to understand and often even more so for well intentioned laymen like cops to understand who feel that ‘something must be done’. This scenario is very different for others with serious mental illness such as schizophrenia. What would we do if a person with a physical illness with no effective treatment kept calling the police, going to A and E etc. One thing is for sure – specialists would not continue to see the person time and again if it had been clinically decided that no treatment was viable. MH services and by default 999 services do not have that option with ppl who are calling in distress, threatening self harm/suicide etc , but a recognition that professionals are being placed in an impossible position would help to explain why ppl do not always react in a sympathetic kind way and enable an honest discussion about what realistically can be achieved without this send that services are failing if they do not ‘fix’ ppl

  7. I really hope that you never suffer from a personality disorder. I also really hope that you are not a mental health professional. Genrallly the personality disorder referred to is Emotionally Unstable Personality Disorder.

    1) There is effective treatment, both medication and therapy. Have a look at the current NICE gudelines.
    2) Effective treatment for schizophrenia, depression, bi-polar, eating disorders is often long term and not always fantastically effective and is also generally a combination of medication therapy and social support.
    3) In no other are a of medicine would it be acceptable just to leave people suffering without attempting to help. You seem to think that it is acceptable to condemn certain people to a life of self harm and probably eventual suicide because their diagnosis is a personality disorder. In any other area of medicine a doctor would try to tat least ameliorate the symptoms.
    4) If there was more mental health support available then there would be less demand on other services.

    I think the NICE guidelines were entitled ‘ no longer a diagnosis of exclusion’. How heart breaking that it ever was.

    1. I endorse what Judy has said in reply to Luke’s comments and looking his comments they probably are a professional opinion as they are the sort of attitude (attention seeking and manipulative) I’ve encountered many times. And you know what I don’t even have a diagnosis of personality disorder. Ok the theory is that those with a PD should learn to manage their emotions but a distressed person needs help whatever their diagnosis especially if they are at risk of harm. But this is a whole new argument and not one to be discussed here.

  8. Luke….really? Hope and pray you are not a MH professional, good effective crisis care should be person centred, not diagnosis centred and there for all. Furthermore there are a range of effective interventions and treatments for those of us with a PD diagnosis. If you are a lay person then please educate yourself from such a narrow perspective.

  9. Our Medical Centre was told that patients often become distressed on hearing a ‘voice’ call them in the waiting room. As a result The Practice simply changed the system with the doctors now coming into the waiting and showing al the patients into the room. A small change but one which made a big difference.

  10. Michael’s blogs are used by myself and others who support me to remind me that there is some compassion left in the world of MH crisis. To that end my words are being scribed by an advocate tonight as what Em has written is so damn important it should be compulsory reading- not only for all frontline blues and greens but also for those in MH crisis services so very quick to request ‘welfare checks’. Or advise others to do the same. Including in office hours. And would really like the CQC to take a stand on how often these are used in England & Wales.

    As someone subjected to repeated ‘checks’ and no history of harm to self or others (bar 2 planned suicide attempts) these actions terrify me. And that appears to be the purpose of many requests by NHS MH services when /where patients/SU’s/whatever we are now called don’t/wont/cant engage with an NHS that sees police as a legitimate arm of the NHS. And until the police learn to say ‘no’ then this will only get worse. And if they cant say ‘no’ then please charge the MH Trusts that are so quick to call police out when they know the risk could be mediated with an actual crisis plan. Just as the fire brigade do for false alarms in hospital – which of course then remarkably drastically fell once the Trust was called to account

    . I am under the Met in London . Personally would like them to charge some of the professionals with wasting police time. Maybe the police should actually ask what the f/u plan is once they have ‘checked’. Where is the support for the escalation in distress that follows. The person who is now a high risk MISPER because being at home is now too terrifying.

    I too have had the door off the hinges more times than can count. Like right now. I am also physically disabled so even if weren’t cowering terrified in a corner wouldn’t be able to get to a door in time. Plus, the police had a keybox fitted but are either told the urgency & risk is so great that they feel they cant waste time getting keys out or there is no dialogue box on MERLIN/PNC to easily see the code. So I leave the door open. For days and nights on end . Because it either wont shut anymore or whats the point of closing when police will kick in anytime night or day.

    I am older than Em and like @JLpatient77 who died by suicide in December am t the end of what I can cope with. Like both am a woman. Like both it is nearly always male officers who attend. Like both I too have no history of violence/threat/substance misuse. But I do have a psychosis diagnosis which carries the different stigma of the ‘dangerously mentally ill’ so officers are already primed and pumped- and never less than 4 at a time.

    Trust that Michael/Em using this guest blog for training but for some of us the damage is so great we wouldnt voluntarily call the police for anything at all ever. And for me, having only just returned home after several nights sleeping out after the last kick in I know they will be back again and again and again……

    1. I’m so sorry you’ve been treated in this way. I can understand some of the fear, and how it can seem hopeless that things will change. Wish I had more I could offer, but wanted to say I’ve read your comment, and I’m sorry it’s like this.

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