Threatening Patients

When I was a young boy, I can vaguely remember my dear Godmother once saying something about calling the police if I was naughty, saying the police would “take you away”. Without missing a beat, I remember my mother responding quickly and firmly, “Don’t say that to him!” She went on to explain that the police do not, in fact, take kids away for being naughty; that she needed me to understand that a police officer is somebody I can go to for help if I was ever stuck or in trouble; and that she should never, ever say that to me again.  WOW! 😳

It is probably this incident that accounts for my hatred of hearing adults say similar things to their kids. I’ve been known to be the policeman who kneels down next to kids and says, “What you’ve just been told isn’t true – we don’t take young children away from their parents for being naughty because police officers are there to help you and protect you if you’re in trouble.” I then usually explain my reasons to the parents and ask them not to do it in future, because they would probably agree that if I saw their child in danger, they would want them to ask me for help and they would expect me to give it. Hard to do that if the kids are running away, frightened of me.

So there’s a version of this in policing & mental health land and it’s occured enough times this week, in various scenarios, that you will have to let me get this off my chest!

WASTING POLICE TIME

A Twitter conversation this evening has revealed that @MindourMinds has documented six recent examples across England of patients being threatened with arrest for wasting police time, following apparent suicidality. This is not the first time I’ve heard of this and just to be crystal clear: it’s not the police threatening to arrest and prosecute patients – it’s apparently mental health professionals. I regret to confirm I have heard of one example of such a case being brought but, quite rightly (I’ve seen many of the legal papers) it was dropped at court for being fairly ridiculous.

Wasting police time is a criminal offence, of course: but it is highly unlikely that any incident of suicidality, including any attempt, would be considered an example of it. The legal definition is within s5(2) of the Criminal Law Act 1967, “Where a person causes any wasteful employment of the police by knowingly making to any person a false report tending to show that an offence has been committed, or to give rise to apprehension for the safety of any persons or property, or tending to show that he has information material to any police inquiry, he shall be liable.”

“Wasteful” … and “knowingly making a false report”. I admit I’m struggling to understand how a patient ringing mental health services and claiming to be suicidal is a waste of police time? Even if the CrisisTeam felt obliged to then seek an urgent ‘safe and well’ check because of concerns for that person’s immediate safety; how do you prove that this was ‘wasteful’?! But of course, finally: even if the patient actually had told a blatant pack of lies to encourage MH services to provide some kind of service or to facilitate admission to hospital – even then: it wasn’t the patient that rang the police and caused their ’employment’, wasteful or otherwise. 

INHERENT CONTRADICTION

So it’s highly doubtful that there would be sufficient evidence to charge someone in these circumstances and I’ve only known it happen that once – it was dropped at court. How do you prove beyond all reasonable doubt that a person with mental health problems who claims to be suicidal, actually isn’t?! … you can’t prove a negative, as they say.  Even then, there’s the requirement to show that person caused wasteful employment of the police by making a false statement if concerns by healthcare staff were serious enough that they rang the police to check on someone’s welfare?!

That’s the inherent contradiction here: the person ringing mental health services is either making a false claim in which case there’s no need to ring the police; OR they are not, in which case any deployment of the police by other services is not ‘wasteful’ because the concerns have been taken sufficiently seriously to warrant the police!

So: if you are a mental health professional wrestling with these issues, do consider what would need to be proved in a court in order to go down this legal route. Otherwise, if you make these kinds of threats, you risk looking silly if it turns out the police won’t take the action you were hoping for. Of course, CrisisTeams can call the police for any reasons they think legitimate. Whether or not the police then actually do as they’re asked, is quite another matter. It has been a feature of policing research for years (see Policing Citizens by PAJ WADDINGTON) to note that police officers do not have an inherent service-provider relationship with those who call them. They may assess a situation and take the view that the caller is in the wrong and the ‘accused’ is acting perfectly properly.

The police are NOT on anybody’s side – all circumstances turn on their individual merits. 

THREATENING THE POLICE

Meanwhile, in another incident a service-user who has given permission for me to refer to this, was asked to attend a meeting without a clearly defined purpose. Suspecting it would be a Mental Health Act assessment for potential admission, they exercised their right not to attend, for various reasons that are important to them. When they failed to show up, a phone call followed in which the assessment was rescheduled and they were told that if they failed to attend on the next occasion the police would be called. This is not the first example of such a story I’ve heard over the years and I admit it also makes me feel very uneasy.

The problem with this is several-fold: firstly, what are they hoping the police will do? The obvious point to make is that any agreement by the police to attend the person’s home address means creating a situation in which the officers have no legal powers. So unless the request was being described as an urgent welfare check, necessary because of fears for someone’s life, the police could only ever knock the door and see what happens. Secondly, if there’s no reply, the officers would walk away; and if there is a reply, they can only convey the message that has already been conveyed. Thirdly, it is not a criminal offence to fail to attend an appointment with mental health services, even if it is a statutory assessment under the Mental Health Act; and officers would have no MHA powers because the person is in private premises. So why wouldn’t mental health services arrange to attend the address themselves whilst armed with a warrant to enable entry and an assessment that the police are then obliged to cooperate with?

Either way: it’s the implicit assumption that the police are a coercive arm of mental health services, to be threatened and deployed at their whim that bothers me here. It is fair enough to comment that a mental health professional may feel obliged to report a situation to the police in certain circumstances, even with their recommendation or request: but it’s ultimately for the police to decide whether the police get involved and on what legal terms. This is especially true where there are issues around criminal investigation and prosecution.

CARE AMIDST COERCION

There are various circumstances in which threatened coercion is inappropriate and this is made clear in the Code of Practice to the Mental Health Act. When it comes to the issue of patients being admitted to hospital, the Code specifies (para 14.17) that no-one should be told that if they do not agree to voluntary admission, they will be sectioned. The same applies (para 27.38) to voluntary patients who are already admitted: they should not be denied their right to leave a mental health ward under threat of being ‘sectioned’. The Care Quality Commission has referred to these kinds of situation as de facto detention – and they caution against such situations on both ethical and legal grounds.

Attempting to promote patient cooperation with a statutory assessment by threatening to call the police also creates a similar, but in my view, slightly the more sinister situation. No-one is obliged to cooperate with mental health services, unless the requisite legal frameworks are put in place, either to assess or treat their condition. If I, as a police officer, am to respect patient’s autonomy and liberty, I don’t really want to personify a threat made that I may disagree in which I’m refusing to play any part. It’s also not for mental health professionals to determine that a situation certainly amounts to an offence that could be prosecuted. I can’t help but recall the incident I encountered about a decade ago where a mental health nurse rang the police to complain of criminal damage by a patient only for my investigation to reveal unlawful detention by the nurse and the mental health services she worked for.

If the police are to be the guardians that many want to see them be, it means standing up for the rights and autonomy of patients as well as appropriately supporting mental health services. But as I said: the police are not actually on anybody’s side here!


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

Winner of the Mind Digital Media Award


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6 thoughts on “Threatening Patients

  1. “no-one should be told that if they do not agree to voluntary admission, they will be ‘sectioned. The same applies (para 27.38) to voluntary patients who are already admitted: they should not be denied their right to leave a mental health ward under threat of being ‘sectioned’.”

    Wow ! both things have happened to me ( and I am also a HC Prof ( non-MH )) I clearly remember who said this . I hope that I bump into them again in different circumstances( quite possible ) I may give them a recommendation to your Blog. Thanks for all your work on our behalf.

  2. The police may not be “on anyone’s side” but seem increasingly to want to involve mental health services for people where those services may believe they have no serious ongoing role ie. No mental illness ergo no effective evidenced treatment available. Any physical health service (eg oncology) is entitled to say ‘there is nothing more we can do’. We all tend to respect that and there isn’t a crew on twitter demanding access to that service. This does not happen when ppl present repeatedly in distress/ threatening self harm etc and maybe that’s just the way it is However, there are RARE occasions where a person calling emergency services repeatedly and frequently threatening harm to self and /or others ((who may expect MH services to fix that person whether via 136 or otherwise) has been contained by police having a word. The idea that everyone expressing thoughts of harm to self/others is ill and needs a health response is very very simplistic (though oddly understandable!) and is probably responsible ,at least in part, for the increase in s136s nationally. in other words, increasing access to healthcare may support some ppl (particularly those relatively small numbers with psychotic illness) however ,paradoxically ,it may lead to further increases in crisis presentations as ‘normal ‘ human distress is medicalised.

    1. I’m as much of a proponent of the idea that we all over-medicalise things as the next man. That said, oncology don’t just say “nothing more we can do” when they reach a point of thinking there is no further treatment they can offer – they usually either refer back to a GP for further consideration or they refer to palliative care services depending on the reason behind their conclusion. You’ll find posts elsewhere on this BLOG that agree with the idea 999 services and the public often expect things from mental health services that are unrealistic but a cursory look at Twitter reveals there are many people out there with quite reasonable expectations of support who are being let down. (Saying so doesn’t mean the police never do this in a range of circumstances, either!)

      I did not – at ANY stage – say that everyone expressing thoughts of self-harm or suicide needed a health service. Some potentially need a night in the cells whilst drunk and far greater attention to the real problems sitting behind their distress. But what is clear from my own experience, and the conversations I’ve had this week, is that some mental health professionals are inclined to threaten patients with action by my profession that I don’t think would be appropriate in many of the circumstances in which it’s threatened; and on occasions see that ‘the police’ are rolled out as a threat to people who are busy taking lawful decisions about their lives. I admit I object to that as strongly as psychiatrists would if the police were running about telling people we were “going to get them sectioned”.

  3. Well this blog is a big big trigger to me as a service user. I have several times been told we’ll section you if you don’t agree to go informally and likewise while on the ward a threat of Section 5 and I might add also used on occasions.

    I do now have a lot of fear regarding the local police. I have more than once been told they were considering charging me with wasting police time due to my habit of going missing in a suicidal state when distressed (usually having been fobbed off by the mental health services). Yes it must be frustrating for the police but at no point did I ever call the police myself. A few years backs in the space of about 6 months the police had been called about 14 times. I had been discharged from services as ‘unhelpable’ when I was seriously unwell. After 6 months I had a case review where I received an apology from services to say that their actions had ‘exacerbated’ my mental health problems. A threat of a criminal record had not helped those situations.

    Another time when a police car drew up next to me looking for someone else and I drove away I was pursued (I didn’t actually think they were after me so moved over for them to pass). After I was name checked I was told either you come and speak to a nice Dr or we’ll charge you with something like failing to stop (not quite sure on precise charge).

    My worst nightmare was this year when I was in my car in a layby (that is not illegal I hope) in huge pain from a back problem and my car being the most comfortable seat. I had rung the care home I was staying at who took it upon themselves to call the police with absolutely no reason – they perhaps should have been prosecuted. It was cold so I had the engine on. Along come the police first thing they threatened me with was drug driving (what!) – to be fair I had taken an overdose on a previous occasion but not driven. They took me to A&E (???) and when I later got up to go find a nurse the 2 officers were round the corner and said they were going to charge me with wasting police time. Because I’d got off my bed? But they were angry with me and deadly serious. They didn’t but by this time I was getting pretty scared. I didn’t know at this point but I later lost my driving licence as one the officers wrote to the DVLA stating that I had been driving having taken an overdose. After I had challenged them they had to write to the DVLA to say there was no evidence but added I did go missing from time to time. Result being that I still did not get my licence back.

    I am now terrified that with my record even if I do no wrong I will be charged or threatened or worse untrue statements made about me. I shake with fear every time a police car passes me by. I used to work in the community with police. I’m middle aged and middle class how has this happened that I fear the people who I should be able to turn to.

    Even in my own home I don’t feel safe. The crisis team are quick to call 999 for a welfare check and I’ve had my door broken down (at my expense) more than once. I’ve had the mental capacity act used to extricate me from my own home. In short there is nowhere I feel safe from the police. They go round telling fibs about me to my friends as to why I might be missing as well. I’m furious about that and when I get round to that will be getting a copy of my records because exactly what is going on locally where I have this reputation that I take drugs and drive because I never have nor ever would do.

    So please officers think before you threaten. Yes there might be those who perhaps are wasting your time but even these deserve sympathy not to be threatened. Don’t let the fact that you’ve been dumped with an unwell person because the mental health services can’t or won’t do their job properly and it’s been a long shift and this is not the first person threatening suicide. It might be you or your family one day and you don’t know what got them in this state in the first place.

  4. Many years ago I worked for a MH charity. I lived in a small town in Scotland. In my street there was a lady with problems who was informally cared for by others. Time went on, MH services became involved, MH services disinvolved themselves, the local police were left fielding calls from concerned friends and relatives.
    I used to go out and help if I was there. The involvement of a neutral third party always rapidly defused the situation (arrived at a point where the lady was safe and had a reasonable plan for the next few hours).
    This saved everyone time. It reached the stage where the police would knock on my door to ask what was going on. (As I say, this was a small town in a rural area of Scotland.) I could have done without this at 3am, and a subsequent knock at 3.05am to borrow a hammer to gain access to the lady’s house.
    But as I said we always managed to resolve the situation quickly. This continued until a senior officer mentioned this to a colleague from another area, at which point all sorts of health, safety and legal issues reared there ugly heads. I moved away. Tragically, the lady concerned died a few years later in a house fire in a slightly larger town in Scotland.
    The experience leaves me wondering if there is a role for ‘neutral’ third parties in these situations, someone who is neither law enforcement or MH. Mental health is, or should be, of concern to everyone. There are lay visitors to police cells, so why can’t lay people accompany police on welfare checks? Surely all the health, safety and legal issues could be sorted out.
    Keep up your wonderful work.

  5. Locally any community crisis plan will say in an emergency call 999, which effectively means the police . Wonder if the police are ever briefed on what they are expected to do! There seems to be a belief among service providers that people attempt suicide deliberately to get attention. from emergency services. I would always maintain that even if this was true then it would point to an underlying problem, as it is a seriously unpleasant way of spending your time…..I also have a sneaking suspicion that I am sure everyone will deny, that the reluctance to section people, even when they are de-facto detained, might be to do with the requirement to treat people, and then provide s117 aftercare… ……

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