Bullying and Intimidation

Did you see the recent piece by an anonymous NHS bed manager in the Guardian about being scapegoated on behalf of the NHS for the ‘beds crisis’? – if not, it’s worth pausing already to read the link before going any further. It really did set me thinking because of the various references to the police bullying and intimidating the writer, in the context of various difficulties ensuring the efficient admission of a patient to hospital. Then I had that horrible period of reflection, wondering whether I’ve bullied and intimidated NHS professionals, too? – I couldn’t help but conclude that I probably had been perceived in that way; and that I had once received direct feedback to that effect from an NHS CrisisTeam nurse who said they felt pressurised.

My job is, at the end of the day, about conflict management and conflict resolution, set against the backdrop of having various legal responsibilities. Police officers use a range of tactics to go about their business and it can look and feel unpleasant: we use coercive force, we threaten the use of it; we arrest and prosecute people – sometimes we threaten such a course of action to promote compliance with less restrictive outcomes such as drunk people going home quietly and so on. I can’t truthfully say that in the course of my work I have never raised my voice to a member of the public as a tactic in making my communication understood and impactive. Within the arena of mental health, I can’t say I’ve never done this either.

Maybe this makes me an intimidating bully in the minds of some?

ANONYMOUS HIT AND RUN

I can almost understand why a bed manager wishing to write such a piece as this would do so anonymously.  Those castigated within it have no ability to reply and the piece itself raises questions about legal compliance of individual professionals, mental health trusts, CCGs and local authorities. Whilst it doesn’t tell us anything we don’t already know, it re-emphasises the pressure in the acute mental health system, which is something we know is also far worse in the CAMHS and LD systems. But I got to the end of this piece and wondered whether or not the author had escalated these concerns via the appropriate channels to the Trust management, the CCG and the CQC.  Maybe they did – writing this piece under the cover of anonymity did make me wonder whether this was their preferred way of doing so.

I want to start by focussing on that nugget of misunderstanding in the third paragraph of the piece which makes me think they author doesn’t understand the implications of the points they raise and why their protest is mis-directed.

“I’m often faced with harried community mental health professionals, struggling to manage a newly-detained unwell individual while surrounded by exasperated police and ambulance workers, collectively waiting for the private sector to decide whether they’ll provide a bed halfway up the M1.”

So here’s the major problem that might let us see this bullying and intimidation in a new light: if the harried professionals in the community haven’t yet been supplied with a bed by our scapegoated author, then the person is not ‘newly-detained’! AMHPs never cease to remind us all that you cannot make an MHA application without knowing where the bed is and will most likely refuse to do so until the bed manager has identified it on behalf of the first-assessing DR. It’s far from unusual that AMHPs who are struggling in that context would have requested police support, otherwise I’ve known scenarios where they remain unharried at the premises until the bed is found.

MURDER

In my favourite example of this kind of problem, I had been contacted at home by a Detective Inspector who was the Senior Investigating Officer for a murder inquiry. His suspect had been in custody for 27hrs after a superintendent’s extension of detention and it was now 5pm. A recent assessment of evidence had revealed that they did not have sufficient evidence to charge a young man with any offence and he had been assessed by professionals as requiring admission to hospital under s2 of the MHA. One of those discussions began where the medium secure unit refused to admit him unless the police charged him with a crime and the psychiatric intensive care unit refused because he was too risky, having probably killed someone.

That impasse had run it’s course for a few hours at the point where I was called. The DRs involved had told the custody officer at 5pm that they would be back the following morning at 9am to re-start their search for a bed and looked fairly blank about what the sergeant should do at 2am when his ‘PACE clock’ ran out! I remember getting out my laptop at home and writing a letter for the DI. I advised him to whack it on a job letter-head and give a copy to the DR and the AMHP going through all the standard explanations and requests for this kind of situation and meanwhile, I took advantage of knowing a senior person in the MH trust who helped resolve the impasse. Bed found within an hour – murder inquiry derailment resolved.

I’ve absolutely no doubt that those involved in the MHA assessment felt pressured – that was absolutely the intention of it. I suspect that ACC Paul NETHERTON also intended that when he took to Twitter and made national headlines in November 2015 in respect of the 16yr old girl from Devon who had been languishing in police custody for two days. Making views firmly known, issuing threats of non-passive reaction to unlawful situations and warning of consequences is absolutely a part of making headway in some situations and I’d want the police doing all of this if it were my relative whose rights were being denied to them, whilst holed up in some police custody area.

TACTICAL COMMUNICATIONS

In the case where I was firmly informed that I was pressurising and intimidating, I had been caught out by a CrisisTeam nurse ‘interfering’ in the processes of admission for a patient who had been in police custody after arrest for a minor offence in excess of 30hrs. I had decided I should probably start ‘interfering’ and ‘initimidating’ people having commenced work at 2200hrs that day as the duty inspector and found an undoubtedly illegal detention in my cell block. An AMHP was unable to comply with s13 MHA because of there being no bed from the trust and so they had become an unwitting party, along with the CCG and the NHS trust concerned, to an Article 5 ECHR violation – they were insisting that the police do not release the patient despite having been told by the custody sergeant that he had run out of lawful grounds on which to detain them.

The conversation was an awkward one: I re-hashed that old stuff about the Mental Health Act Commission’s guidance about section 140 MHA and applications in circumstances where there is no bed available; I pointed out that I would be recommending to the early shift that they asked police legal services to consider High Court action to expedite the onward discharge from police custody; I asked for a mental health nurse to be deployed to police custody overnight, to ensure the wellbeing of the patient, bearing in mind the distress they were in and our concerns for their welfare after more than a day in dark concrete cell. I will be honest: I didn’t expect any of this to go down terribly well! That wasn’t the point – but it did appear to result in progress and a bed found within two hours.

We all understand that MH trusts say they are struggling: I know from colleagues and friends in those professions that budgets have been cut in some trusts by 20% despite the overall protection of the NHS budget in the last paraliament and I’ve seen for myself how both NHS England and individual CCGs have cut providers’ budgets. I’m not unsympathetic to that. But when a police officer is aware that laws are being violated in respect of a vulnerable person in custody or at risk in the community and especially where the police service are being expected to suck up the consequences of that in vacuum of legal powers to ensure safety, it’s not unreasonable that concerns are raised, that threats are made about counter-reaction to those unacceptable circumstances. It’s less then a handful of times I’ve ever told an NHS professional that I was going to contact a solicitor with a view to considering legal action to protect a vulnerable person and the custody staff caring for them and on each occasion, it has brought a solution to the impasse.

UNPROFESSIONALISM

Policing is about conflict management and conflict resolution: various tactics are deployed to manage and resolve the various conflicts in which we become engaged and whilst no-one is going to defend bad manners, aggression or unprofessionalism, it has to be accepted that assertiveness, exhibiting frustration and declining to accept that which should not be tolerated are quite different things.

It was the US police chief Charles RAMSEY who recently said that when you stop viewing police work as law enforcement and start viewing it as the maintenance of constitutional and human rights, that you start to understand how the police can be on the same side of the community in the various struggles that it faces. Sometimes, public service organisations will find themselves in conflict with each other and I’m aware of situations which reverse this principle, where the police get things wrong. However – and without wanting to to over-egg the pudding here – our scapegoated author is referring to various situations that can and have been found to amount to human rights violations.

I’m not quite sure why they thought the police would keep quiet about that or do nothing?


IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


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14 thoughts on “Bullying and Intimidation

  1. An enlightening read. Having shared the original post on “auto-pilot” in support of underfunded resources, I am so pleased to have bee alerted to your response. Context is a wonderful thing and it is clear to me that there is little point in professionals with the same end goal turn on each other. Chronic underfunding is the issue, not bullying and intimidation. Lesson learned for me to make sure I read what I re-tweet rather than blindly re tweet based on a headline.

  2. As a mh service user I’ve had several occasions where I’ve been grateful for ‘bullying and intimidation’ by the police on my behalf. Thank you. I just regret that it’s necessary at all but that is the reality of services available for the likes of me.

  3. In my experience the police can be terrible bullies and I have been shouted at and threatened on numerous occassions when, mainly at night, police officers have turned up at a mental health unit with someone they think needs to be admitted without any attempt on their behalf to use processes that are in place to achieve this aim.

    1. Were the processes lawful and reasonable? – they often aren’t. I’m not defending outrageous behaviour like you’ve described, but you also need to recognise how often the police are really left in invidious positions by the processes that the NHS operate with nothing but unlawful options in front of them. As I’ve said, we’re often referring to things like human rights violations which no-one can defend without the obvious come back.

      1. I agree the police are often left in an invidious position and local agreements and processes are not always fit for purpose or indeed lawful but verbally abusing and threatening health staff in order to circumnavigate agreed processes is not helpful.

      2. Totally agreed .. my purpose isn’t to defend that for a moment but to make a separate point about assertive and if necessary frustrated agitation and non-personal threats of reaction or consequence for decisions taken and liabilities incurred … it can be very necessary and appropriate because too few people – including the author of this article, it would seem – actually seem to understand the situations fully.

      3. My experience as a service user is that police r frequently fobbed off and dumped upon by mental health services. Is it any wonder they lose their rag although I agree rudeness is not acceptable. Often due processes don’t work and I’ve been left high & dry by mh services more than once. Police are left in the position with an unwell person who no-one wants to take responsibility for who may well come to harm yet mh services say what do u expect us to do. Been there got the badge. Thanks for helping police. Mental health services often it’s thanks for nothing ie no bed and crisis team too busy

  4. I hope the Trusts make it clear to whoever can help that the present situation of a chronic shortage of beds, ioth acute and longer term and staff, puts peoples lives at risk. From the receiving end as a ‘patient’ I think it can often feel like you are a very inconvenient parcel being passed around the system.

  5. I don’t necessarily disagree with any of the previous posts and I do sympathise with the difficult / impossible situation of any NHS bed manager ( especially any working in MH services).

    BUT – the police are frequently the only service genuinely keeping their eye on the law & human rights of vulnerable people with MH problems in crisis in these situations, without trying to “fudge” those responsibilities for expediency. I do not mean by that, that many health & social services personnel are not trying to do their best to balance resources with hoped for outcomes for individuals & their families, against very difficult constraints. AND I do believe all, mostly, do have risk and best outcome in mind.

    The reality is “bullying & intimidation” starts when: any MH professional doesn’t make a formal complaint against a manager, Trust official, the CCG/ CQC, or to their professional registering body about their inability to do their job/role ethically ( YOU have a professional obligation to do so) and legally due of a lack of resources, funding, inappropriate policies, lack of training for themselves or others about essential MH law because of fear of the consequences.

    If every MH professional, and frankly many of the support staff often recruited to work above their “official” training and pay grade who often keep over-stretched services functioning, challenged the systems they knew to be understaffed, under-resourced, failing to support people, failing to manage risk, etc. the “bullies” couldn’t keep maintaining this myth that they are doing enough.

    We all need to make clear about where the real problems lie – and in my opinion be very grateful that the police are doing as much as they are to make our situation better. Because, honestly they are the ones leading what should be our fight and if they (the police) get loud & “shouty” I don’t blame them.

  6. Oh dear,to live in utopia.Frontline MH profs,especially bed managers, are the true frontline of MH acute care.Police may encounter difficulties but bed managers in many trusts encounter this every minute of every day. Encouraging discharges of ppl who should probably stay in hospital,encouraging home treatment teams to work with ppl who probably should be admitted etc as there are NOT enough beds. They work in a system where they are charged with making the best of a bad job on behalf of all us (we all vote) and the knowledge that beds continue to be reduced despite this. Some how blaming individual bed managers,or trusts for that matter,is completely missing the point. Police perhaps have the Luxury of quoting the law, frontline MH workers have to cope,daily,with the realities of the scant resources on offer.

    1. That’s fairly patronising: if you don’t think that ALL of policing is making the best of a bad job, then you mustn’t have the first chuffing clue what we do all day! Almost everything about policing is making constant choices amongst options you usually wouldn’t touch with a barge pole.

      Everyone fully understands that MH service shave been cut; they struggle to recruit, managers are often too distant from the reality of how service is provided and – of course – you have that fairly ridiculous provider / commissioner distinction that allows everyone to blame everyone else and yes: bed managers are probably those most in the cross fire.

      But if you’re asking me suggest that police officers should not professionally assert themselves by frustrating and agitating whzen the overall impact of the NHS is to inflict a human rights violation upon a vulnerable person in circumstances where they are actively soliciting the law being broken, then you’re having a laugh, my friend! You’d be better off directing these concerns to the managers and commissioners who created these conditions by the choices they made about their priorities.

    2. No-one who has any role in frontline MH work has any doubt about the difficulties faced by any worker in this field. But the real victims are those needing the services- individuals, families, carers (including young people), friends, neighbours, communities, ambulance, police, Health professionals – I could go on… Bed managers are NOT the only ones dealing with the reality of scant resources. And if they are having to make unethical decisions about who to give leave from or discharge from in-patient services when this is not clinically determined then they have every right to report /refuse or make representation to their professional bodies/ CQC etc. In fact your registration requires this of you. However unfair it might be to put you in this impossible dilemma, the fact is your registering body will never (OK very very rarely) accept a “Nuremburg defense” i.e. I was only following orders, I was bullied into it. Do you truly think that any police officer has a “luxury” of quoting the law? IT IS THEIR JOB AND UNDER ANY OTHER CIRCUMSTANCES YOU WOULD CONDEMN THEM FOR NOT UPHOLDING IT!- BUT you should know that if they’re telling you what the MH law is, you should already know and be abiding by it. And it can support you!
      If you don’t already know it -you should. Learn the MH law so YOU can quote it to your bosses and use it so your professional body, union, legal representative – if it should come to it – can use it to support you. Don’t allow bullies, at whatever “rank” make you behave unethically, illegally & be clear that you know where those boundaries are. AND don’t blame police officer/s for holding the line on this, you and yours may one day be grateful that they did- and they may be the ones who actually get changes to MH resources cos Health & LA personnel have patently failed to challenge authorities as effectively!!!

      1. Meanwhile in other news: a police force in England is being sued for one of these situations. Note: it’s not the MH trust or CCG being sued because a bed wasn’t available, it’s the police being sued because the NHS didn’t have a bed available.

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