Spit Hoods and Child H

That was quite an unexpected day! The IPCC published a summary of one of their investigations along with the recommendations they have made to Sussex Police following a series of serious incidents in which a young person was arrested or detained. Sussex Police have accepted that a total of 12 police officers misconducted themselves and have instigated either disciplinary procedures or have given management advice to those still in service – two have since retired.  The media coverage has been considerable, raising more questions for me than it answered.

It’s clear things went wrong: the Deputy Chief Constable of Sussex Police admitted as much on early morning radio and that has been repeated throughout the day. In addition to undertaking disciplinary procedures and giving advice where thought necessary, Sussex has stated they have reviewed policies and procedures, including around so-called spit hoods or spit guards, suggesting that there needs to be a debate with the College of Policing about these devices. That’s when my phone began to ring and I found myself in a small room at BBC Birmingham talking to Radio FiveLive (1:12:50). Of course, despite the fact that the College Press Office made it clear before the interview that we couldn’t talk about the specific case – after all, we’d read the news that morning but the College isn’t an automatic party to IPCC investigations and we hadn’t known of it previously! – the second question of the interview took us straight to it, “But she was ELEVEN!?”

These detentions clearly involved a difficult and challenging sets of circumstances and give rise to very sensitive issues. Perhaps the gravity of how Child H’s family are looking at this can be seen from the opinion of their solicitor who described this as the most “inhumane and degrading” case of a child being detained in police cells. I can’t stress this enough: stuff went wrong here, although the reasons behind those failures aren’t clear from public media coverage and I know no more about the particular case than you do. I want to read the IPCC investigation report, quite honestly!

SPIT HOODS

The controversy at the centre of these detentions was the use of a so-called ‘spit-hood’ or ‘spit-guard’ and many people will be unaware that a few police forces issue this equipment.  For those who are not familiar with them, such devices are designed to protect professionals from those who may spit or bite during restraint and there are various versions – one involves a more-or-less transparent mesh which means breathing is not restricted but bodily fluids wouldn’t easily penetrate the mesh. In another, an emergency restraint belt mainly intended to be used for restraining people’s legs is also claimed by the manufacturer as being something that can be used as an ‘improvised’ spit guard. Such a device is alleged to have been significant in the case of Thomas ORCHARD which involved a custody sergeant and two detention officers standing trial for manslaughter – and they are due to face re-trial in early 2017.

So we know these devices are and approaches are not without controversy and difficulty.

I’m aware in mental health services of a spit guard which involves applying the device to the professional, not the detainee. It is basically a visor that covers the face and ears and leaves the patient or detainee unrestricted. Each of these devices has different risks and benefits and – obviously, if worn by the professional, the visor can become covered in bodily fluids and restrict the professionals’ view; and there are probably more on the market from specialist companies that I haven’t come across because I haven’t taken extra time to research this stuff. But for all the various risks and benefits, one other point remains true: not using them at all also has risks and benefits. It opens up the reality of what would happen in forces where such devices are not avialable: manual handling of the head and neck and I’ll be honest, I’ve been forced to do that, because I am not going to let myself be spat at during my work.

Most police forces do not issue a spit-guard of any kind to their officers, but I’m aware that many forces and groups of frontline officers, have discussed these issues, because spitting and / or biting – whether by an 11yr old or a 21yr old with a neurological disability or from a 31yr old who has been arrested for burglary – is particular challenging behaviour to accept and manage, despite allowances that are made where officers know the person has a disability. Some officers who have been spat at have subsequently contracted diseases like hepatitis and meningitis and despite all the discussion today about the rights of those detained, especially children, it also remains true that police officers are absolutely entitled in law to take reasonable steps to ensure they are not assaulted at work – they do not have to tolerate the very real risk of being assaulted in any way. I have experience of my own of a detainee wanting to spit at me and I freely admit, in the absence of any other way of keeping myself safe, clean and unexposed to the unknown risks, I used phsyical force with my hands to ensure the face was pointed away from me. This business is not edifying and I’m sure it carries dangers in terms of placing pressure on the head and neck. Such risks are obviated with the use of an effective spit-guard, but it’s about how you trade off the various kinds of risk involved.

DIFFERENT APPROACHES

Of course, discussion on social media today has seen the police heavily criticised for ‘spit-hooding’ a child and Miss H, her mother, has called for the practice to be immediately banned. We can all understand why and when I listened to Miss H’s description of the shock and horror of seeing her daughter in custody, you couldn’t fail to wonder how it must have felt. I am the parent of an eleven year old and the very idea of this happening to him is extremely distressing to contemplate. But it raises broader questions than any individual incident can help us understand: how do we want the police to keep people safe within the laws we ask them to operate? We cannot demand the police remove children under arrest for offences to specialist CAMHS facilities because  –

  • They often don’t exist! – and we see the Government having to legislate to motivate the NHS to ensure adequate provision for children detained by the police under the Mental Health Act;
  • PACE says people under arrest should be taken to custody unless they require A&E treatment;
  • A&E have traditionally had their own views about the appropriateness of taking mental health patients of any age to a busy department, but especially so when they are distressed and exhibiting challenging behaviours – but we also know there are dangers in not doing so!

But this also gets us in to a topic in which I’m increasingly interested and to which Child H’s mother directly referred: by appearing to defend the general principles that sit behind police actions on the grounds that these are difficult situations and that ultimately, the police often keep people safe until situations have stabilised and formal assessment can take place, we see the restriction of a child using three separate pieces of police safety equipment as one where we define safety in purely physical terms. We thereby implicitly disregard this young person’s psychological safety and well-being. What do we think will be her anticipation of future encounters with police officers if she should become unwell in the future? – for some patients with mental health problems, physical harm is less concerning than psychological harm.

OTHER CUSTODY PROBLEMS

For those who have wondered about why no appropriate adult was provided during the various detentions, I would like to say a few things although we’d probably need to read the IPCC report to know why.  All I can say that may go some way to explaining why a child’s mother would not be permitted in custody on all occasions is that in three of the four detentions concerned, Child H was arrested for alleged offences, not detained by the police under the MHA. Perhaps this was a result of police being called to private premises where powers under the Mental Health Act for police officers are not available? … I don’t know.

But I do know that a person who is a victim or a witness in an incident subject to criminal investigation cannot act as the appropriate for the person under arrest. I also know that when Code C to the Codes of Practice to PACE was amended in 2012, the requirement for an appropriate adult where a person is detained under s136 of the Mental Health Act was amended – it now states (para 3.16 to Code C) that there was no role in the assessment process for the appropriate adult. Whilst I’ve always interpreted that to mean an appropriate adult should still be called for children and adults when they are first booked in to custody and their rights and grounds for detention are explained, there are varying opinions about this.

I’ve mentioned a lot over the last eighteen months, various people are confusing the proposals the Government are bringing forward about banning the detention of children in police cells. The proposed ban in the Policing and Crime Bill 2016 is purely a ban on the detention of children who are detained by the police under the Mental Health Act. Nothing will legally prevent the detention of children with mental health problems in custody where they have been arrested for offences and as more people are encountered in private premises than public places, it follows that where detention is necessary to keep someone safe, it will more usually be for offences than under the MHA and that’s what we see in the ‘Child H’ case: three arrests for offences, one detention under the MHA.

WORK TO DO

And of course the discussion that no-one has had here is about the broader health system: why was no health-based Place of Safety available to this 11yr old on the occasion where she was, in fact, detained under the Mental Health Act – a police cell shouldn’t have been necessary on that occasion according to nationally agreed standards on the operation of s136 that were in place in 2012. The medica report from the IPCC is very clear that there were broader failings in capacity and capability not just from the police but also from others that could and should have been involved here. Therefore this raises questions about the IPCC itself: it’s authority is over the police forces and officers where misconduct is alleged or suspected so what happens to the reports of the non-police shortcomings?

So the big questions: do all areas of the UK have in place the infrastructure and mechanisms to ensure that a young person exhibiting very challenging behaviour can be safely cared for, with dignity, irrespective of whether they were arrested for alleged minor offences or detained under mental health law and can we say this kind of thing would never happen again? If you look at the background reasons why this happened at all and then examine areas for their Place of Safety provision as they prepared to deal with the implications of the Policing and Crime Bill, there are some who think it is not possible to achieve and are lobbying for the proposals not to go ahead.

If you remember that there will be no change to the way in which the NHS can distance itself from the immediate or urgent need to provide sanctuary to children arrested for minor offences following a breakdown in their homes where parents are struggling to keep them safe, you are forced to conclude that officers may – yet again – be faced with little or. no option but to start deciding whether they use or improvise a spit-guard or whether they manually handle the head and neck of a vulnerable person to protect themselves from assault whilst trying to keep someone safe who probably needs urgent medical care.

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32 thoughts on “Spit Hoods and Child H

  1. It’s clear things went wrong …
    … I can’t stress this enough: stuff went wrong here

    Are you guys forbidden by law to speak in the active voice about what cops do or something?

    Things didn’t go wrong. A bunch of arseholes in uniform did wrong.

    Try this simple exercise.

    Do police weapons “discharge and the deceased succumb(ed) to his injuries” or do some cops “shoot and kill” people?

    Maybe if you have trouble talking in straightforward simple English about what police actually do you are also morally incapable of taking responsibility for your own actions while in uniform. You wouldn’t be the first.

    1. Yes, I’m totally confident that describing people you’ve never met, whose actions you don’t (yet) fully understand because the details of it haven’t been made public, as ‘arseholes’ takes forward our understanding here. I’m sure they got up that day to violate the dignity and rights of an eleven year and did so wilfully. You’ll notice, once you stop and pause, that no-one here is being prosecuted despite all the allegations of excessive force that would normally amount to assault, if founded.

      1. You have a point about my gratuitous use of the word ‘arseholes’ to describe people who, for reasons beyond my ken, found it desirable to spithood, handcuff and deny parental access to a distressed eleven year old girl.

        But you seem to have used that indiscretion to avoid the central point of my comment, which is the apparent pathological inability of many police to verbally acknowledge police agency in any action that reflects poorly upon them or their colleagues.

        Of course you’re not obliged to answer such questions from a commenter on your blog but I have to wonder if you’ve answered them to yourself. Or even asked them.

      2. I work in medium secure mental health facility and recently involved in a restraint while doing so was asked to take over on head position and was spat at full on in the face which penetrated my left eye since this I have had nothing but problems with my eye no eyebaths available and provided either my employer is denying responsibility and is asking me to prove that what I’m suffering is a direct result of the injury

      3. I’d be considering asking my union to support the bringing of some kind of claim if you haven’t already. Ask for their Health and Safety risk assessment around spitting: it’s foreseeable in restraint encounters and what have they done to mitigate that risk in terms of either systems, equipment or training (of you or others). They should have some kinds of answers.

        It’s quite disgusting at the end of the day and there was a police officer who died some years ago after being spat at. Hope your eye gets better.

  2. “Perhaps this was a result of police being called to private premises where powers under the Mental Health Act for police officers are not available? … I don’t know.”

    Would Mental Capacity Act not apply here, and in which case apply to both private and public ?

    1. MCA does not apply to under 16s.

      Cabrogal You are simply attacking the wrong person here and I don’t know why.
      As already stated we are not party to the investigation results and we fill in the gaps according to our own prejudice and experiences.
      I’m not a police officer but I have in the past had to restrain and medicate people in situations which would now be considered inappropriate and dangerous.So from this limited account I see a bunch of officers placed in a difficult situation with little to no training on how to restrain children or deal with these unusual and challenging behaviours doing their best. Spitting to me is one of the most horrible and potentially malicious things to have to deal with.
      This issue of an appropriate adult is entirely separate and is unlikely to have prevented loss of life.

      Insp Brown is commenting and trying to explain from his perspective some of the procedural reasons that may have come in to play, but more significantly he is acknowledging his own experience of attempting to stop someone spitting at him and how he had little alternative than to apply force.
      He is one of the good guys challenging poor practice, pointing out issues that require training and improvement. There are dodgy officers out there, as in every profession, but attacking him is counterproductive.

      I’m not saying that because I agree with him on everything, but genuinely which other police officers make themselves known, accessible to the public and genuinely do their best to answer questions and educate colleagues and members of the public too.

      1. I therefore stand corrected.

        I’ve followed the story thus far, and I’m not sure how parent’s can criticise use of force when they called for police assistance themselves? If someone is kicking, screaming, biting, spitting and whatever else, they’re going to get restrained. Not bothered how old they are. End of story really.

        Although, obviously, I keep forgetting we are in the UK where everything is a problem for the police, and fault come hand in hand.

        The parents should be working to help their child, not chastising those who were also trying to do the same.

      2. I think the question here is proportionality.

        Although you might hope that moderately well trained officers could resolve such a situation with negotiating skills I’d agree that no-one should be surprised if force becomes necessary.

        But hooding, handcuffing, detaining for 60 hours and illegally denying a particularly vulnerable 11 year old girl the right to speak to her mother or an independent adult? In three of the five incidents – including the first two – there’s no suggestion the girl became violent until police resorted to force.

        Don’t you think that maybe they overstepped the mark a bit?

      3. Do we know that she was unlawfully denied access to her mother? – to respond to some of the other points you’ve made in other comments, if I took a conscious decision to write in the passive voice that “stuff went wrong” it’s because I don’t know – and I’m guessing that you don’t, either – what actually happened to give rise to these circumstances.

        I repeat the point, that there is no right for parents to enter police custody when their children are arrested and anyone who is a victim or witness in an incident that leads to a criminal arrest cannot act as an appropriate adult. I can convectively of a few reasons – all of them hypothetical at this stage – as to why a mother or parent may not be allowed access. Such denial of access would not automatically be unlawful.

        Finally on the point of appropriate adults, I don’t know – and I’m still guessing that you don’t either – what efforts were made to secure an appropriate adult from the local authority and whether or not such a local authority lived up to that responsibility. Can only say, I can give examples from my own career where the inability to secure an appropriate adult for someone was absolutely NOT due to a lack of effort, duty or responsibility on the part of the police.

        So if “stuff went wrong”, it doesn’t automatically follow that this amounts to any shortcoming at all by the police. As the BLOG acknowledges and as the Deputy Chief Constable said, the police are accountable for their conduct and their shortcomings, hence ten people are being disciplined or formally advised, but they are not accountable for the things that went wrong that may be directly attributable to short-comings on the part of others organisations. As the IPCC have hinted, others ‘should’ have been involved and weren’t because they lacked capacity and capability. We will have to keep guessing what that means until such times as the full report is public.

      4. So if “stuff went wrong”, it doesn’t automatically follow that this amounts to any shortcoming at all by the police. As the BLOG acknowledges and as the Deputy Chief Constable said, the police are accountable for their conduct and their shortcomings, hence ten people are being disciplined or formally advised, but they are not accountable for the things that went wrong that may be directly attributable to short-comings on the part of others organisations.

        Yes you did acknowledge that 10-12 police are being held accountable for their conduct and shortcomings. So why wouldn’t it follow that it amounts to shortcomings by police? When is a shortcoming not a shortcoming.

        But yet again you are using language that deflects agency and responsibility from police. ‘Shortcomings’ is a word that strongly implies fault through accident, error or ignorance. While that might describe their failure to document their use of force on the girl it’s a weasley way to refer to their use of force, restraints and detention in the first place.

      5. All I’ll do here is repeat the comment I’ve just made: I’ve now read the full investigation report from the IPCC and cannot share that with you. I stand by what I’ve written and contest your meaning of the word ‘shortcoming’.

      6. Err, no it doesn’t.

        What it says is “Although only 11, she displayed a high level of violence and her restraint was necessary to prevent her harming herself or others.”

        That is clearly a judgement made by the cops themselves (or their union reps, who were no more at the scene than we were). They aren’t claiming she made any threats whatsoever. And don’t forget that although the girl apparently suffered from a medical condition that increases her propensity for violent behaviour no-one is suggesting that she was violent during the first encounter in which police saw fit to use force on her. Her violence in subsequent encounters was quite possibly a reaction to the fact that she’d been taught to expect violence from police regardless as to whether she initiated it.

      7. I think you’ve missed what I’m criticising here.

        I have no firm opinion about the policies, procedures or legislation involved here nor of Insp Brown’s response to them.

        The problem I’m highlighting is really a continuation of my complaints about an earlier post on this blog in which police Newspeak and psychiatric pseudo-science is used to try to alienate police (individually and as an institution) from agency and moral responsibility for their actions. I think this is a vital topic and one of the reasons why no police officer has ever been convicted of an unlawful killing while on duty in the modern history of the UK or Australia. This in turn in an important reason for the us-and-them mentality that permeates relationships between police and non-elite communities and – if criminologists like Larry Sherman know their business – is a component of the procedural injustice that reduces respect for rule of law and increases crime rates.

        In this particular case I was objecting to the use of passive voice in describing not something that just happened but something particular police officers did.

        When you hear police PR departments use passive voice this way when describing assaults or killings by police its obvious they are simply spin doctors doing their unsavoury job. But when active, serving police seem to internalise and use such passive voice themselves you’ve gotta wonder whether Orwell was right in suggesting that by distorting the language you’re actually distorting people’s ability to conceive of things. For ‘concrete’ thinkers at least, if you can’t say it you can’t think it.

        IMHO someone who works at the interface of police and the mentally ill – who are disproportionately the victims of sometimes lethal police violence – should be exquisitely aware of the responsibility and agency police have in such massively imbalanced power relationships, even when the subject isn’t a disturbed 11 year old girl. Saying ‘stuff happened’ is nowhere near good enough.

      8. Hi CABROGAL

        Ref to ” Don’t you think that maybe they overstepped the mark a bit? ” Well, I have no opinion on the specifics as I haven’t seen the report. In fact, I’m not sure if anyone has seen it?

        What I will say, is that I can’t see “hooding, handcuffing, detaining for 60 hours and illegally denying a particularly vulnerable 11 year old girl the right to speak to her mother or an independent adult?” as something that any police officer, or group of police officers would do.

        What I will also say is that if a person, any person, is a danger to me, others, or themselves, they will get hooded, handcuffed and detained until they can be dealt with by having an appropriate adult present. I don’t do spitting, or fisty-cuffs. Anyone that would let such an act continue would be doing themselves and the public a disservice. That goes for any age, and any capacity. Again, for safety. The reality is the police are dumped on as the most ‘appropriate service’.

        Let’s hope all emergency services collaborate – and quickly. The sooner they do that, the sooner the burden can be shared. Separate police ‘forces’ up and down the country, separate ambulance, separate fire etc. – waste of money, and more importantly not providing the most efficient service.

      9. Nope, I haven’t read the IPCC report either. But I read the Guardian article about it Michael so thoughtfully linked to. I’m not one to take what the media says on face value – I’ve worked with them far too much for that – but I doubt that they’d be able to get away with such blatant misrepresentation of an official report without a correction.

        And if you seriously feel that you are likely to be ‘endangered’ by a disabled 11 year old girl perhaps the best policy would be for you to stay away from her – especially when she hasn’t broken any laws and has merely run away from her mother at a shopping centre.

        I agree wholeheartedly that the police were inappropriately dumped on in this case. Personally I’ve never been in a situation where I thought police intervention would be likely to improve matters (despite attending several mental health crises, having been assaulted more than once and having had my home burgled four times) and I can’t imagine circumstances that would make me consider calling them out on an 11 yo girl. However about 18 months ago I called the emergency number in response to a woman suffering a psychotic episode and requested specifically that they don’t send police. Nonetheless that’s exactly what they did and unsurprisingly the woman became even more agitated and distressed in their presence (not least because one of them ‘jokingly’ threatened to taser her for ‘refusing to comply with a police order’).

  3. Yet Cabrogal you say all this without the full ins and outs of the case at your disposal. Then there’s your use of the term “psychiatric pseudo-science” which automatically makes me think you’re some form of extremist who only believes their own perspective and will viciously attack when you’re questioned. The police were called due to the child being violent and harming themselves, or so I’m led to believe, what would you have done to manage this? When verbal de-escalation had failed?

    1. The “psychiatric pseudo-science” comment refers specifically to an earlier conversation on this blog about excited delirium, a condition with no pre- or postmortem physical testing that can confirm or eliminate it which is diagnosed almost exclusively in people who have been killed during struggles with police (i.e. “He didn’t die from repeated tasering, being placed in a choke hold then sat upon by several large PCs. He died of ‘excited delirium’.”) It doesn’t exist in either the DSM or ICD despite heavy lobbying by authorities and Taser International for its inclusion during the drafting of DSM-V. I hardly think it extremist to dismiss a ‘disease’ with no physical evidence, little support among clinicians and a clear political agenda as ‘pseudo-science’.

      If you would care to supply a reference to support your belief that the girl was self-harming before police intervened I will examine it and take it on board.

      You’re correct that I wasn’t there and, like you, can only speculate about the circumstances. However if the summaries of the IPCC that found eleven police have a case to answer for their treatment of her are to be believed she was disobedient but not in danger, committing an offence or distressed during the first incident until police intervened and it immediately escalated – a not unusual occurrence when police become involved in such situations. If true I would suggest the best action to take if negotiation failed would have been to back off and leave her be. Why the police felt it appropriate to intervene in a matter of non-criminal parental discipline – even though initially requested by the mother who later complained about their actions – is beyond me.

      1. And as mentioned before: it is NOT just argued following contact with the police. Academic paper in this from Edinburgh psychiatrist in the 1990s following no police action whatsoever.

        Okay the terminology rages on that, you should see the recent guideline from the Royal College of Emergency Medicine and the Faculty of Forensic and Legal Medicine on ‘acute behavioural disturbance’.

        I’ve now read all two hundred and fifty odd pages in the IPCCs full investigation report on this case. Sorry I can’t summarise or share it with you!

      2. No, not just argued … Which is why I said almost exclusively. Excited delerium is invoked pretty regularly following a death associated with police use of force but you can count other supposed cases on one hand (unless you subscribe to revisionist diagnoses in historical cases which weren’t claimed to be ED at the time),

        And the claims of superhuman strength are nonsensical. It’s very human to get a rush of adrenaline in situations in which you are subjected to life threatening violence. Whether that results in sudden bursts of strength or other physical feats (e.g. being able to gasp “I can’t breathe” while being held in an asphyxiating choke hold) depends on the circumstances.

      3. Fair enough on ‘almost’ – admit I missed that. But it seems fairly obvious why the vast majority of incidents where this debate has occurred involve the police – not too many other people run towards people who are thought to be so unwell that they exhibit very challenging behaviours or are thought very likely to do so. Mental health services in particular are often found nowhere near, backing off and ringing the police whilst asking for the cops to bring tasers (repeated professional experience).

        I’m not saying and never have that there aren’t improvements that can be made to the way and the situations in which the police use force, including an emphasis on not doing so: I also know I’ve been put into invidious positions by the medical system where I would defy anybody to tell how anything gets done without that. For all its passion and validity, yours is just one kind of opinion in a range that end up being debated and which inevitably reach in to territory way above my education.

        So when you’ve sorted out the science, you let us know what needs doing. 👍🏼

  4. Without doubt as Michael explains much went wrong on so many fronts and like many I would like to be able to see the IPCC report on why. The issue of the role of the appropriate adult – particularly where detained under the MHA – applies to children and vulnerable adults alike. That there is apparently no role for them to be present during an assessment appears deeply flawed. I would also question why if once arrested the child was not assessed by a medical examiner with a view to needing a MHAA on the other occasions when she was clearly highly distressed, agitated and the mother had told police she believed she had MH problems.

    This situation leaves a vulnerable young person being subjected to extreme and seemingly disproportionate treatment because the officers involved could not/ would not take the route of passive de-escalation. Doesnt seem like any thought at all given to the psychological harm now caused and the impact that has.Speaking for many who have been in MH crisis – the police are nearly always called to all incidents from safe and well check to supporting paramedics to s135 warrants with very little assessment or risk being carried out. By their own admission and with proposed legislation now backing this up police cells should NEVER be used to detain vulnerably mentally ill people . So why did they do so in this case.

    Any police involvement in any MH crisis situation always escalates the situation to one of high stress and increases risk to the individual – both at the time and certainly afterwards.

    Re spithoods what I would like to know id why some forces use and some don’t – my suspicion is that the potential for/actual overuse is considered by some force’s legal departments to be in breach of various legislations and codes of practice so should be well avoided. Begs the question why all forces not adopting individual faceguards rather than physical restraining spithoods on the individual

  5. Having worked as a custody officer on and off for over 20 years I have obviously dealt with hundreds of detainees diagnosed with mental illness.
    Many are arrested for criminal matters arising from lack appropriate care and supervision by the mental health services. Which is a tragedy in itself.

    Even after years of discussion and debate , some detainees are waiting 24 hrs AFTER being sectioned in a police cell for a mental health bed to be found.

    It’s all down to money at the end of the day and every public service wants a larger share of the decreasing pot.

    Something has to give and that’s why we have untrained Police officers being left to deal with violent , volatile frightened and confused people in a totally inappropriate environment , a custody suite.

  6. ‘Mental health services in particular are often found nowhere near, backing off and ringing the police whilst asking for the cops to bring tasers (repeated professional experience)’… Regarding this statement; is this a mere observation or a criticism of mental health services? I’m an AMHP and have often requested police assistance prior to / during assessments due to the risk of, or actual violence. I don’t have the resources or the training to deal with significant physical violence (I have never restrained anyone and wouldn’t know how to do so safely) so I’m genuinely interested to know what type of reaction you would want or expect from mental health services in the face of violence. Thanks.

    1. It’s a bit of both: there are some situations in which mental health services have a clear organisational duty to be able to deal with resistance, aggression and violence from patients but usually choose not to do so; there are other situations in which it would not amount to a legal duty for them and it would be reasonable to expect the police to muck in.

      I admit to finding it highly unusual that we’ve created a situation in which local authorities send AMHPs out in to the real world in the very real expectation that they may well end up taking legal decisions to coerce others without in any way shape or form preparing for that reality. The Code of Practice obviously talks about the police being requested to assist where patients are “violent or dangerous” and that’s quite fair enough. But it’s also usually true that if anyone resists admission and needs any degree of coercion whatsoever, the police are called. I’m sure that doesn’t happen on *every* occasion, but I’ve seen officers called to it enough to know it’s more than regular. So where the patent is resistant, but not violent or aggressive – for example, by sitting in their chair, refusing to move – is that a police incident or not? I’d say ‘not’, but I know not everyone agrees with me.

      The remark however is more applicable to inpatient settings where the law makes it fairly clear that coercive activity connected to treatment – IE, restraint for medication, seclusion or transfers – is a matter for the NHS or health body who are detaining the patient. Whilst the police may occasionally have a duty in connection with serious risks and threats – IE, patients who have armed themselves with a weapon; an outbreak of serious violence where people are injured – the routine management of patients is for health staff and the NHS should plan and prepared for that reality. Such a view is not my opinion, it is the law of the country, based on legal advice.

  7. I joined the police in 1977. At the training centre there was a young married man with a baby who was fulfilling one of his life’s dreams in becoming a police officer. He passed the training course and after about 2 months at his division he made an arrest. The man who he had arrested turned and spat into his face. The officer died as a result of the infection that was passed through the spittle. This was almost 40 years ago. I am delighted at seeing the spit hoods coming into use. As a child spitting was strictly forbidden. It was considered to be a dirty habit. It sees as if these days it has become more common. Protection is needed in these cases.

    1. From your account there would not likely have been an opportunity – or even a reason – to spithood that man until it was already too late.

      On the other hand, if police started thinking in terms of taking action to protect themselves that didn’t involve inherently abusing or humiliating members of the public the PC (and all frontline police) might have been wearing some basic eye protection that would have saved his life.

  8. ‘Mental health services in particular are often found nowhere near, backing off and ringing the police whilst asking for the cops to bring tasers (repeated professional experience)’…Whilst working as an inpatient nurse over the past 5 years, I have been involved in a lot of restraints (unfortunately) and I can only ever remember us calling the police on a handful of occasions, usually due to the service user not actually requiring an inpatient bed, as they do not have a mental health illness whist having the capacity to know what they are doing and usually as an informal patient. There has also been times when I have called the police when a service user has a weapon and de-escalation techniques have failed, we don’t have any form of protection against weapons (stab proof vests etc.)

    The majority of the time, my team manages to help very disturbed and unwell service users requiring restraint without the need for police assistance. (Repeated professional experience). I would also like to mention, as mental health nurses, our restraints are not pain compliant such as some of the methods the police can use if they are needed, although I do believe there are a small amount of trusts that still use pain compliant restraint and in hospitals such as Broodmoor. We are now phasing out face down (prone restraint) and using face up (supine restraint) to allow the SU’s airways to be free at all times.

    1. I’d like to add that I do acknowledge the police are called inappropriately at times but my experience (in my hospital) it doesn’t happen too often. I also do realise that we, as nurses are able to restrain formal and informal patients under the MHA or in the case of informal patients, under the mental capacity act or common law. Overall, the police I have professionally come in to contact with have been very helpful and kind and a service user sitting in a chair, refusing to move is not a police matter.

  9. This is a genuine question that as a traininee AMHP I think I need to ask – Im not trying to be difficult. If a person I detain under the MHA from their own home refuses to come with me to hospital, and stays in their chair, if you dont think Police should be asked for assistance then my thoughts are as follows: I could continue to try and encourage the person to come with me verbally – may or may not work, but of course will always be my first action. I could ask family members to help, although obviously i dont want to put anyone else in danger. If this doesnt work, do I try to take hold of the person myself? I would be very reluctant to do this whilst in someones home, probably on my own (or maybe only with family/ambulance drivers) and with the possiblilty that they become aggressive or violent (Im assuming a level of physical resistance is likely here as they are refusing to come with me in the first place). Im then in danger because I didnt want to ask Police to attend to support me because it isnt considered to be the Police’s job to assist in these matters. Bearing in mind that Ialtough trained in restraint on inpatient wards, I cannot do this alone and have no protective equipment. What should I be doing instead given that it is my responsibility to get this person out of their home and into hospital safely, preferably without Poloce assistance? If there is a way that I can do this safely on my own in such cases, believe me I will take it as nobody wants to burden police with stuff they shouldnt be doing. However I would also like to be safe whilst doing my job. Any ideas? Thankyou ;o)

    1. It comes back to the point I make about NHS and Local Authority managers commissioning services in such a way as to ensure they can mitigate foreseeable risks. It’s not about addressing the situationally specific problem AMHPs find themselves in where, in reality, the police are probably the only option; it’s about getting in to senior management meeting rooms where we the question about why the police are the only option. There’s certainly nothing in any law or statutory guidance that says it is always the role of the police to do this; there is every clue in law and statutory guidance that this should be possible in just some situations without reference to the police; and finally, Parliament could have legislated in the way that the Irish government did in their mental health where the Garda are obliged to do as they’re told, when directed. Our Parliament didn’t and I’m merely asking why we think this what and what implications we think it has?

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