Need an Appropriate Adult?

Several discussions and questions recently about Appropriate Adults (AA) in police custody for vulnerable people that I want to quickly cover. In case you’re not aware, an Appropriate Adult is someone who, according to the Codes of Practice to the Police and Criminal Evidence Act 1984 must be called to police custody for anyone under the age of 18yrs or anyone who is ‘mentally disordered or otherwise mentally vulnerable’. They must be present for legal rights being administered, police interviews about the allegations and various other things. Al sounds straight-forward enough, doesn’t it?!  You can just imagine the booking in procedure where the custody sergeant tells the arresting officer, “He’s only 17yrs old, get an appropriate adult on the phone and ask them to come down here.”  Usually this will be the person’s parent or guardian and if there is no-one available, you can ring children’s social services as there is a statutory duty to act as an AA for someone who cannot otherwise be supported.

There are two major problems when we turn this conversation to the circumstances of a vulnerable adult – 1) what does ‘mentally disordered or otherwise mentally vulnerable’ mean? … and 2) how do we handle things if we, the police, can’t secure a volunteer? Absolutely no-one, anywhere has any comparable statutory duty to support that person whilst under arrest! Neither social services as a whole, nor any health or mental health service to which that person may be connected is obliged to fulfill this role in the absence of a relative, friend or neighbour.  Recently, I was at a meeting with Chris Bath from the National Appropriate Adult Network who I’ve heard more than once saying, “If you can’t even find someone from the banana aisle at Waitrose” given that most adults could fulfil this role … it’s merely the case that no-one employed by the police can undertake it.

WOULD YOU CALL?

Would you call an Appropriate Adult for [name a famous, intelligent celebrity with a mental health condition here]? Imagine that person was arrested for something at a point when their mental health is pretty good. Imagine that they are in regular contact with the services who are supporting them; potentially taking medication and / or undergoing other forms of treatment and that to all intents and purposes they appear ‘well’. Would you still ask for an appropriate adult to support them during the process of investigation and interview by the police?

Well first of all, anyone in police custody under arrest would be examined by an approved healthcare professional – usually a doctor or nurse from a contracted organisation who advise on police custody healthcare issues.  Ultimately, the decision about whether ot call an appropriate adult is one for the custody officer, but given that the need for an AA rests on confirming one way or the other whether or not someone is ‘mentally disordered or otherwise mentally vulnerable’ you can see why a medical or nursing opinion comes in handy on these matters. They have the skills and are more likely to have access to information to help make this decision – but it remains with the custody sergeant to resolve any doubts and disagreements.

There have been examples of custody healthcare staff assessing someone and establishing that they have, for example, a diagnosis of depression. Because the person is receiving care from the NHS, taking medication and to all intents ‘well’, the advice to the custody sergeant is that they don’t ‘need’ an AA .. and this is where things start to get difficult.  PACE (Codes) don’t talk about whether someone is thought to need the support of an AA or not – merely that the person either is or isn’t ‘mentally disordered or otherwise mentally vulnerable’.  So are they? … or not?!

LEGAL NOT MEDICAL

The question of whether someone should have an AA is a legal one, not a medical one. Of course, we are going to defer to professional opinion about healthcare issues – but it is a legal assessment that follows and it remains the decision of the police. If someone with depression who takes anti-depressants is arrested they may well be thrown in to one hell of a situation – because actually, anybody who is arrested is thrown in to one hell of a situation! This could be all the more pronounced if the particular investigation has more far-reaching consequences for that person, be that loss of employment, public reputation or any number of other things including marital or key-relationship breakdown. The fact that until arrest that person was working for living, raising their kids and living a life doesn’t alter what arrest can mean and can it do to some people. The safeguard was designed, it would seem, to ensure that people more likely to be vulnerable are supported whehter that is because of a long-term health problem like schizophrenia or situationally specific circumstances.

So what does ‘otherwise mentally vulnerable’ mean?! – could this not also extend to someone who has no history of mental health problems whatsoever but who has been arrested for an alleged offence that could be, literally, life-destroying?  Imagine a school teacher arrested for possessing indecent images of children – I’ve arrested a man for exactly that and you could see the utter panic and terror behind his eyes. He was ultimately proved guilty of it all and rightly jailed, but you have to consider that whilst he’s in custody, not entirely sure of the evidence against him, not sure of where this is all going, as he sat in the cell whilst we searched his house and seized a LOT of his possessions as part of the inquiry, that he must have been contemplating just how much his life was going to fall apart? I’m not suggesting everyone accused of a serious crime needs an appropriate adult, but some might, notwithstanding an absence of mental health problems. This is just one example of what ‘otherwise mentally vulnerable’ may mean.

And remember this: the PACE Codes make it clear that if there is doubt about whether someone is ‘mentally disordered or otherwise mentally vulnerable’ then you treat them in custody as if they are.  So as you think through your examples of high-functioning people who you know has bipolar disorder or depression, keep in mind someone with any other kind of condition. If someone was receiving treatment now for cancer, you would regard them as having cancer notwithstanding how well they may be at the time. However, a decade later after receiving the all-clear and ceased treatment, you would no longer refer to them having cancer or being a cancer patient.

WHAT ABOUT HISTORY

So what about recovery? Many people recovery from mental illness – they lead meaningful lives, often free from medication or further support from secondary care mental health services.  If someone is arrested who lived with a mental health condition years ago but has since recovered, would you regard them as requiring an AA?  This is perhaps where there is more of a judgement call. Keep in the mind the cancer patient analogy: if the person regards themselves as recovered, they are no longer receiving treatment and there are no current indications that the fact of the arrest has caused any particular problems, especially if they’ve been medically screened in police custody by custody healthcare staff or by Liaison and Diversion services, then a history of something would not automatically mean you fail to acknowledge their recovery in the decision-taking.

I’m aware that some custody sergeants are debating this actively and that one force in the south of England has reinforced a policy that has the effect of increasing the need for AAs in custody. I am not without sympathy about the operational implications this sometimes have because I’ve been that duty inspector on a number of occasions where all efforts to secure a human being of any description to act as AA has been tried and failed – a number of times!

In particular, I recall one investigation of a poor bloke who had been arrested for reckless arson, endangering life in what had probably been a suicide attempt. he had been fully assessed in custody under the MHA because of his mental state and his long history of mental health problems.  The investigating officers had spent over 22hrs of the PACE ‘clock’ dealing with the initial enquiries to be made, the MHA assessment and the repeated efforts to find a relative, friend, neighbour or any professional from any organisation anywhere who would be prepared to support him in custody. Nothing. We even left it a couple of hours and then tried them all again. Still nothing. So we interviewed him without an appropriate adult knowing full well this might end up meaning any evidence obtained would be excluded but we had to rely upon the fact that the requirements for an AA is in the Codes to PACE, not in PACE itself. Therefore, according to the relevant court ruling, it is something with which we should comply unless there are ‘cogent reasons for departure’. The cogent reason being: no-one on planet earth except the police and his solicitor we’re willing to try to help the guy and we’re all banned from being his appropriate adult.

Would I seek an appropriate adult for [intelligent, famous celebrity receiving MH treatment]? — there is absolutely no doubt whatsoever in my mind. I would.


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

Winner of the Mind Digital Media Award.


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7 thoughts on “Need an Appropriate Adult?

  1. I recall being asked to assist (as an MHSW) with someone who could not read who was in custody. I was involved in the 90s setting up a volunteer scheme. It should be a statutory duty for the local ASSD to provide an AA service – if only because AAs need to understand they don’t have the confidentiality rights of legal reps – nor are they there to represent the rights of the person in custody – they are purely there as a public official to ensure the police are not accused of misusing the prisoner.

  2. Firstly, thank you for raising this important issue with your audience. Secondly, it’s an honour to be quoted!

    Working out for certain which adult suspects do and do not require an AA is difficult. That’s true even for a psychologist/psychiatrist with several weeks to observe and interact with the person. For a police officer to do it in the context of the time pressures of the custody suite is impossible. Police officers are not, and should not be expected to be, mental health professionals. It’s therefore unsurprising that they refer to colleagues from medical disciplines (and sometimes even DEFER).

    But as you rightly point out , it’s not a medical decision but a legal one. It is not about making a diagnosis. It is about ensuring that evidence is admissible. To make a decision on whether an AA is required you’d need to be fully aware of the PACE thresholds – which is not necessarily a medical practitioners area of expertise. And of course, we cannot assume that the medical colleagues available in custody have received any psychological/psychiatric training at all.

    It’s for this reason (it is an impossible task to be sure who needs one) that the Code C test is “If an officer has ANY SUSPICION, or is TOLD IN GOOD FAITH, that a person of any age MAY be mentally disordered or otherwise mentally vulnerable…”. The Codes do allow that if there is “clear evidence to dispel that suspicion” an AA is not required and police officers are wise to seek input from specialists. The spread of liaison and diversion services in custody (which were instigated explicitly to assess for vulnerability) offers great potential, as long as officers are clear on what question they are asking and what the answers mean. However, the bar is low and the gates are wide precisely so police officers are not expected to make clinical psychiatric decisions via a 7 minute risk assessment.

    The result is confusion of another kind for officers. Does Parliament meant really mean all people who have ANY mental disorder? Even well medicated depression? A bi-polar person who isn’t in a manic phase? How does this relate to mental capacity? Isn’t this just about whether someone understands what is going on? And then there is mentally vulnerable – that applies to most of the people coming through my suite. They’ve not created a statutory duty for AAs so I can’t get someone who knows what they are doing. If I get someone from the supermarket across from the suite they’ll be no use anyway. It’s just not practical. Code C makes no sense. Let’s be pragmatic, put it to one side, and make our own sensible judgements.

    This can result in ‘obvious’, ‘deserving’ and ‘serious’ cases getting an AA (e.g. people who are ‘acting oddly’, are ‘childlike’ and ‘don’t understand what they are told’) while other more subtle, less sympathetic or minor (from the police perspective) do not. What is, or is not, in Code C is part of the problem but so is the culture of the custody suite, the choice of focus by senior leaders, and how recently the Force last had a case chucked out for lack of an AA. I’m told that at least one Force has guidance that means that everyone with an autism spectrum condition gets an AA but people with schizophrenia may well not. Elsewhere it is belts and braces. Elsewhere it is very little indeed.

    An adult needs an AA if because of there mental state or capacity they:
    – MAY have difficulty understanding the IMPLICATIONS for them of the procedures and processes connected with their detention, including their rights and entitlements
    – MAY not understand the SIGNIFICANCE of what they are told, of questions they are asked or of their replies
    – MAY be particularly PRONE in certain circumstances to:
    • providing unreliable, misleading or incriminating information, or without knowing or wishing to do so;
    • accepting or acting on suggestions from others without consciously knowing or wishing to do so; or
    • becoming confused and unclear about their position.

    These are the needs that the AA is there to meet. It is not just whether someone understands what they are told or are oriented in time and space. The AA’s aim is fair justice. I sometimes think of AAs as a ‘reasonable adjustment’ under the Equality Act 2010. Like a ramp that affords a wheelchair user equal access to a library, the AA contributes to equal access to the justice process. It is society’s way of tackling the knotty issue of holding mentally vulnerable people to account for their actions (they are not there to help them avoid being held accountable). The AA seeks to achieve fair justice via two objectives (a) fair treatment / respect for rights and (b) effective participation in the process by the individual. If these are met, a court can be satisfied that evidence was not gathered in a manner liable to render it unreliable.

    We need a statutory duty and the resources to co-ordinate and train AAs because, in order to be an effective safeguard (which is of benefit to the public, the courts and police as well as vulnerable people), we need people who understand mental vulnerability AND the PACE Codes. An effective AA, who is respected by police officers even when they are being a bit of a pain to the investigation, can help the police do a better, safer job.

    Tricky to find in the banana aisle – even in Waitrose.

  3. Very good observations from people clearly in the know and with experience of what a minefield this can sometimes be. For me PACE and the Codes need to be looked look at in terms of custody times as effective investigation time is regularly burned away whilst awaiting for the relevant others engaged to verify capacity and suitability for interviews. It is not uncommon for 6 – 7 hours at least to be lost accompanied with rest periods! how long is left to then conduct interviews that might take a long time, before Warrants of Further Detention kick in. Is there not an argument for the Custody Clock being stopped whilst waiting for these essential people?

  4. There is a massive lack of knowledge about what being an AA entails.
    As a professional I’ve been told it’s a role I can’t undertake without specialist training, a day long, this was guidance from the Community Psychiatric Nurses Association (which dates things considerably, this was around 2000) and given the impression you need to know PACE in detail with (probably) exaggerated notions of what is involved and your powers.

    This seems in stark contrast to the notion that this is a role that any parent or a man off the street can meaningfully undertake. Of course professionals would presumably be held to a higher standard. A post on exactly what it involves would be really helpful.

    One can’t help but reflect that continually inflating figures for those with mental health problems in prison would suggest this is a growing need.

    1. That’s a point well made that I’ve recently discussed in some work the Home Office are doing on AAs – if it needs so much training, should parents be doing it at all, or should we allow parents to work with a trained AA?! Good point, well made – totally agree!

    2. I always find it helpful to start with the intended outcomes and work backwards.

      Could a family member ensure that a vulnerable suspect participates effectively in PACE processes? Some certainly could. They arguably have an advantage over the trained AA because they know the person and their particular needs and vulnerabilities. It depends on the needs of the vulnerable suspect and the skills of the family member.

      Could a family member ensure the legal rights and welfare entitlements of a vulnerable suspect, acting as an effective safeguard against the abuse of police powers? They could likely prevent the most extreme and obvious (and therefore highly unlikely) forms of abuse. But knowledge of the PACE Codes is pretty critical to this outcome and it’s unlikely parents will have this or be able to develop it in the short time available. Plus they are dependent on the police officer explaining the role effectively, which itself is contingent them having the required time, knowledge, inclination etc. This is perhaps even more relevant for voluntary attendance interviews.

      There are other complications with family as AAs:
      – their attitude towards police (overly positive or negative)
      – it can be a highly emotional situation for them
      – there is a risk that relevant safeguarding information may not be forthcoming (the vulnerability markers for people who commit offences are similar to those who are victims of offences)
      – vulnerable suspects don’t necessarily want family members to be in the know regarding what they are being accused of doing / have done

      My own view is that a blanket exclusion of family members in favour of trained AAs is simply not going to happen. Where we can innovate is schemes supporting family members (or vice-versa) in a hybrid approach. Just because you have had autism training does not mean you understand a specific individual’s needs like their family does (though of course it does help if you can develop trust and ask them what their needs are).

      On the issue of information on the role, there is information on our website at http://www.appropriateadult.org.uk. (see particularly the FAQ and Practice/Guidance sections. However, we are intending to start an ‘AA knowledgebase’ on the site fairly soon, which will build into something much more comprehensive.

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