If you have been following the progress of the Policing and Crime Bill 2015, you will have seen it has recently started its journey through the House of Lords. Accordingly, noble peers have had an opportunity to table amendments to the original Bill, for consideration and debate during the committee stage and on the floor of the House.
The main aspects which affect mental health are –
- A proposal to remove the words ‘police station’ from the definition of a Place of Safety under s135(6) MHA – this would mean police stations could never, ever be used.
- A proposal to ensure the right to an appropriate adult for anyone detained in a PoS under s135 or s136 MHA – the amendment fails to specify who would have to provide this adult or who funds it.
- Finally, it is re-suggested that Tasers or ‘electro-conductive devices’ should be banned from use on psychiatric wards – this is a second attempt by the Liberal Democrats to introduce such a ban. It was previously introduced by Norman LAMB MP and defeated in the House of Commons.
There is a great BLOG on this topic by @NathanConstable from Twitter which gets in to the whole debate about tactical options and asks the obvious questions about what will be expected by those who are proposing and supporting this ban? Will they, ultimately, back police officers who shoot an armed patient if a Taser would have sufficed were it not banned by them? Remember, the ‘use’ of Taser in around 78% of incidents simply means it was drawn from a holster and threatened: no-one was touched, at all. Yet we are having a second argument to suggest that police officers should, instead, hit people with metal poles or fire baton rounds or bullets at them. (Assuming in all instances that attempts to de-escalate without resort to force have been tried and failed.)
I want to address another question and it causes me to ask “So what is a ‘psychiatric ward’?!” There are many kinds of environment in which patients may be detained under the Mental Health Act 1983 that I would never describe with those two words. What about the patient who is living in semi-supervised accommodation as a ‘step-down’ from low secure forensic care, prior to being conditionally discharged? – if there were an incident at the location and officers attended, Taser would be permissible because it’s definitely NOT a psychiatric ward … it’s not a ward of any kind! What about a dementia patient, living in a nursing or residential care home, detained under the MHA? – the same argument applies. But surely someone’s vulnerability is their vulnerability; the risk of these devices (all equipment carries risks; as. Does doing nothing) is still the risk whether the Taser is discharged on a ward or not. Are we also going to ban Tasers during the execution of warrants under the MHA – if not, why not?! Such events are often the immediately preceding step in admission to a psychiatric ward so the sensitivity and / or medical risks will be broadly similar. I’ve directed Taser officers to undertake such tasks and would happily do so again, unless legally prohibited from doing so.
What happens where a person who is detained in a psychiatric ward under the MHA is transferred to another kind of location – that could be to A&E for urgent medical treatment or to an acute inpatient setting for whatever purpose. We know that some patients are detained under the MHA to general hospital wards because they require surgery or other treatment for conditions that are associated to their mental disorder. If there were a serious incident – and can think of several, I’ve known – then would the officer be able to use a Taser? What about a learning disabilities hospital or unit – they’re not traditionally referred to or thought of as ‘psychiatric wards’. What about a health-based Place of Safety – I once knew a patient pull a knife an officers in an NHS PoS. They drew a Taser and threatened to use it – gaining compliance without touching the person and causing no injury whatsoever. Thankfully, that seems unaffected by this proposal but if that had been patient who returned to a ‘psychiatric ward’ after a period of s17 leave, Taser wouldn’t be an option.
I can’t help but think: we either issue this kit, accepting its risks; or we don’t. Restricting its use in such an arbitary way really just tells us that those proposing the amendment don’t trust officers to make the appropriate judgement about its suitability.
THE OTHER MATTERS
The reason I’m looking forward to the debate occurring, is that the proposal around police stations will mean there must be discussion about the kinds of circumstance in which opponents to the proposal think stations should be used. Here’s a predication: we’ll hear about people whose behaviour is ‘so extreme it cannot otherwise be safely managed’ – we’ll hear about the capacity and capability deficit that prevents safe management of vulnerable people who exhibit challenging behaviours – as if that somehow obliges the police to put people at risk by incarceration and ongoing restraint – and we won’t hear how the deliberate decision to remove people to custody is indifferent to whether or not resistant behaviour could be indicative of underlying medical problems or something that puts them at raised risk because of the need for restraint.
I doubt whether it will be acknowledge by those who oppose a ban that most of the circumstances in which it is still argued police stations are acceptable places to gaol the vulnerable are actually just deaths-in-custody waiting to happen. We’d know that if we just listened to families whose relatives have died. I obviously hope that police stations are removed from the list of Place of Safety locations, but I genuinely fear that the amendment won’t succeed, not least because the Government could have chosen this reform to begin with and someone will probably point out the impact on NHS services, including A&E which would have to act as the overspill if mental health trust PoS were full and police stations unable to be relied upon. I fear that will be prioritised over more important things.
Finally, I’ll be intrigued to see whether the Appropriate Adult proposal succeeds. This one slightly surprised me, because the role of the Appropriate Adult role is currently one for police custody, for those taken there against their will. That is usually because they have been arrested for an offence and may well need to be interviewed after having their rights explained. The AA role is to ensure people understand the process, assist with communication, see that the person’s rights are being respected and challenge or advocate, as necessary. Where someone has been detained under s136, Code C to PACE makes it clear (para 3.16) that the AA has no role during the formal interview by the AMHP and Doctor, presumably meaning their role is restricted to just the booking in procedure for the administration of rights and to ensure a general understanding of things.
Some people argue that this is broadly the role of the AMHP when they are undertaking an assessment under s136 so this just duplicates things. It also would create the highly unusual situation in which the right to an Appropriate Adult is a statutory right for those detained under ss135/6 whereas it stops short of that for those under arrest at police stations, detained under PACE. And it does raise that question – who is going to do it and pay for it, given the amendment doesn’t specify?