What *Are* You Doing?!

Imagine this: someone rings the police to express concern for a friend or relative’s mental wellbeing, asking the police to ‘check on them’ to see that they’re OK. The officers attempt to do so, ringing a phone number that the friend provided and knocking on the person’s front door.  No reply and no response. There was no information to suggest the person was suicidal or self-harming, just that the friend or relative had non-specific concerns. Phone calls are put in by the police control room several times, including in to the early hours of the night and a note with a reference number is posted through the person’s front door.

What is going on here, precisely? It all falls back to that whole discussion about ‘welfare checks’, sometimes known as ‘safe and well’ checks and I’ve written about them before. Whether or not the police realise it, they are going to struggle to do them even if they do locate the person concerned; so let’s remind ourselves of the problems where the safe and well check is connected to mental health issues.

  • Ability – on what basis will the police make their decision about whether someone is, in fact, safe and well? Will they do a mini-mental state examination or use some form of risk assessment tool, perhaps using their psychiatry or nursing skills? – of course not. We know from history, that trained mental health professionals have massively mis-identified risk issues connected to mental health problems and suicide has followed contact with trained, experienced mental health nurses. It’s no sillier to expect the police to always get this right than to argue that because nurses are trained in restraint and personal safety, that they should deal with patients on wards who threaten them with knives. There are some things that are just way beyond the skill set of the people involved and it needs different professionals to handle a situation they are specifically trained for.
  • Location – even if the police find a person and can tell that person has obvious and serious mental health problems, they may be quite powerless to do anything about it. Remember, the police service in the United Kingdom has no legal powers in private premises, which is precisely how your Government want it, having reviewed police-MHA powers in the last two years. We should also remember, if we believe the data that street triage teams produce, that private premises is precisely where most of the mental health crisis incidents occur. Therefore, does it matter whether the police see someone in person or speak to them on the phone? – to an extent, it might. Police officers may see things during a personal encounter that may influence whether they detain someone or not – but if the person is in a place where they cannot lawfully be detained, does that matter or add anything?
  • Power dynamics – when a uniformed police officer asks you if you’re OK, do we think we get consistently accurate answers which assist in assessing the level of distress someone is in, or the risk they may pose to themselves? This isn’t a point about telling lies to the police – it’s a point about vulnerable people having often had difficult experiences before, being detained in police custody, for example and we’ve seen more media about that today. Many people are perfectly aware that if police officers have serious concerns about someone’s wellbeing, they may find themselves removed to police station or NHS factility for assessment by someone who has access to background records and does actually have the professional skills and responsibilities to assess. So knowing concerns on the part of an officer may mean removal to a police cells or Place of Safety and possibly being strip searched or constantly monitored, do we think people are always upfront about their mental state?!

The problems go beyond this, however: they also need considering and a recent experience highlights a few of them –

  • Feeling stigmatised – some people just don’t want to have contact with the police when they are unwell, for various legitimate reasons. It may be previous experiences of contact made things worse; it may be that being in contact with officers makes someone feel criminalised; and it obviously raises the potential question, “Are they going to detain me?!” with everything that involves. Remember, even where people find that officers were as kind, patient, compassionate as they could be, it is often factors beyond the control of the police that mean the whole thing, overall, was seen as a negative experience. I’ve lost count of the times service users are quoted as saying, “The officers were great, they made a bad situation much more bearable for how kind they were, but at the end of the day, they had to lock me in a cell because there was nowhere else to go” … or similar.
  • The police as a ‘stick’ – the police are, on occasion, used by mental health professionals or services as the ‘stick’ with which to threaten patients with coercion unless they comply with professionals wishes. You only need to look at Twitter to see how many people have had this experience. “If you don’t come to be assessed under the MHA at 10am, we’ll call the police!” To do what, precisely?! … it all goes back to the above: call the police to find someone and conduct a ‘safe and well’ check and you might find the police stuff that up, despite their best efforts. Let’s imagine that the call results in a missing person inquiry and the person is found at 8pm that night: will the MH service who called now turn out to support the officers, especially where the officers find themselves powerless in the circumstances?
  • Adding to distress – and how does all of this affect the mental wellbeing of someone who may be unwell, whether acutely or otherwise? – is it actually helping?! I worry that the intuitive need to ‘do something’ means police officers and services sometimes start down a path without understanding the difficulties they unleash for themselves and for the person concerned later down the line. What are you going to actually do once you find the person – what can you actually do to help that person? Is the process of attempting to find or meet them, making the situation worse, potentially to the extent that you decrease the likelihood of finding them at all, whilst simultaneously raising the risks to that person by increasing their distress?

Obviously, where the police receive information that a vulnerable person may be self-harming, suicidal and or a serious risk to themselves, they have a clear duty to protect life – but not all situations are like this. Also important to acknowledge that an accurate risk picture may not be known when a member of the public or a mental health professional chooses to report a concern. But it seems to me a legitimate public policy question about whether the police can actually do what is asked of them; and whether the police themselves realise their limitations? I’ve seen more than one report investigating an untoward outcome – including reading another one just yesterday! – where the decision of police officers to fully absorb responsibilty for asserting someone else’s wellbeing, without calling upon others and amidst a lack of ability to do anything other than refer the matter to others, has taken them in to gross misconduct territory.

This post doesn’t say anything I haven’t already said but the message bears repeating: police officers are NOT mental health professionals and cannot always do what mental health professionals can do, or what various people think they can do. This is not about a lack of training – it is about unreasonable expectations being placed on officers which do not always seem unreasonable. If we are going to rely upon the police in terms of searching for or checking on people, officers and police services need to feel entitled to say, “OK, we’ve found this person – others now need to support us in making sure we get this right.”

IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


6 thoughts on “What *Are* You Doing?!

  1. When you say, “Obviously, where the police receive information that a vulnerable person may be self-harming, suicidal and or a serious risk to themselves, they have a clear duty to protect life” that is what Police are frequently told by health partners as they know police are then likely to respond. But one of the difficulties that arises is when the officer meets the individual and doesn’t perceive they are at risk any longer. This causes real conflict between services (and the individual and the officer) when in fact the ideal scenario would be for the MH Practitioner to meet them face to face themselves to decide the true level of distress themselves.

  2. After 13 years of involvement with mental health service the word police equates to fear in my mind. I fear the consequences. The last sentence in yr blog says it all but all too often mental health services have passed responsibility to the police for whatever reason and in particular the crisis team do not want to take it back.

    I know that the police coming to my house or finding me elsewhere will mostly not result in the help I require in that moment of crisis that is usually why I’ve rung my crisis team. I refuse to go round in circles within the system yet again. Also with my long history of sectioning and hospital admissions it’s hard for officers to see beyond that and not go down the path of ‘just in case’.

    Calling the police has many times been used as a threat (last week for instance while talking to my CPN) and is actually likely increase my risk of harm not decrease. I agree with each and every word written above. Just do what the Concordat asks and get me timely support from the NHS not the police yet again sitting outside my house again.

  3. “Obviously, where the police receive information that a vulnerable person may be self-harming, suicidal and or a serious risk to themselves, they have a clear duty to protect life –”

    Is this true?

    If I am self-harming, in my own home, but not so badly as to threaten my life and I am doing so in full knowledge of what I am doing and the possible physical harm it may cause do the police really have the power, or indeed the remit, to stop me?

  4. I wonder if I could post here one of the regular contributions by Dr M Alexander (a “whistleblower”) who delves into the workings and non-workings of the CQC and NHS. Her posts are well worth reading for comparisons between what is stated to occur and what actually occurs in our health services : –
    : http://wp.me/p7VBpJ-Ac

  5. Agree with the comment above by JL but would like to extend it further.
    It is a complete fallacy that there is partnership working on this front re Safe and Well checks. MH Trusts simply know they can use the police as an extension of crisis services to tick a box on their forms when they dont provide adequate crisis care and/or a pt/SU simply can not/will not engage any more. And for many pts experiences of crisis teams are so very poor that it is unsafe for them to continue contact.

    Crisis teams are quite happy with this – after all the pt has chosen to ‘disengage’ (a misnomer if ever there was one) as a service they are under little obligation to make any attempt to repair relationships ( as there is no choice of crisis care provider in MH) and all they have to do is ring the police to cover their backs.And if police find someone they dont want to leave crisis services will not be rushing to send out a crisis team/AMHP as after all there is no urgency now as the poice have the situation contained.Therefore it is now safe.

    What they will of course do is try and get the police – with paramedic input – to assess capacity and advise that route. As if this is automatically legal . At which point every police officer should be thinking Sessay ( but no doubt wont be as after all not health professionals).

    Bottom line in all this is while crisis services calculate that they can infer high risk when there is none, can give misleading information to ensure police feel duty bound to attend and talk about pts when they havent risk even assessed themselves this situation continues. And puts more and more people with vulnerable MH at increasing risk because what do you as a police officer think happens to that person’s state of mind when they are subjected to multiple ‘welfare checks’.

    At the end of the day it wont be the crisis team forcing entry and finding the body of someone now too terrified to summon help. Neither will the Trust be called to account at coroners court . It will be the officers and the pt’s GP. Police need to ask very tough questions when repeatedly asked to call on people by the same MH Trust. And then consider billing them for wasting police time. As for most of the time MH services know EXACTLY what they are doing

  6. Couldn’t agree more with this post from a patient POV. The distress caused by having to cope with police, nosy neighbours due to the police, being taken off to A&E to wait for hours, or having cops force their way (well they threaten force, so…) into your home to wait for the triage team to do nothing at all, is too much to cope with on top of already feeling so horrific. I mean, it’s actually traumatic. I often joke bleakly that were it not for NHS mental health care (and associated horse manure) I’d have been better years ago… but it’s actually true. The complex trauma, overwhelming horror and helplessness in the face of it all, is what has broken me – and this particular issue is at the heart of it.
    It’s very much “look like you’re doing something”, isn’t it? Ignore someone until you think you might be in toruble if they die, then pass the buck to the police.

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