I woke up this morning to a tag on Twitter from Australia drawing my attention to questions being asked following an encounter between Victoria Police in Melbourne and a mentally vulnerable man referred to as ‘John’. Police officers had been requested to undertake a ‘welfare check’ by a psychologist who was concerned about John’s mental health. In the link that follows, there are various short video clips and extended footage from security cameras at the front of John’s property which show a use of force incident. It involves some footage that may prove difficult to watch, so please consider whether or not you open the link. The debate obviously focusses on the use of force by the officers, as well as the fact they have hosed down a handcuffed man whilst filming it. Accepting that there appears to have been an investigation launched, that no CCTV footage of any incident shows all that one would want to know to form a judgement about how things were handled, it does seem fair to say, even at this early stage, that it would be difficult to conceive of additional factors, currently unknown to the journalist or the public which would allow the footage to be seen in a light where concerns were completely negated. It is reported John has sought legal advice over the matter.
I’m becoming more familiar with the debates on policing and mental health in Australia in recent times: several years ago, I became aware of work done in Queensland and New South Wales to improve police responses and training to policing and mental health incidents and looked at them from afar via the internet, some Skype discussions and I met a few Australian officers at conferences I was attending or when they visited the UK on fellowships. More recently, this has expanded further: a week or so ago, I gave evidence (via a live-link) to an inquest in Sydney where a Coroner’s Court is examining the police response to incident which ended with the fatal shooting of a young woman called Courtney Topic in 2015. It was the kind of incident to which the UK police would be very unlikely to send armed officers and therefore the court was considering whether different tactics and considerations may legitimately have been expected to prevent a fatal outcome. Difficult stuff indeed and the outcome of that inquest is still awaited. In August of this year, I’ve been invited to attend a conference in Adelaide to talk about policing and mental health issues and as I’ve learned more and more, it’s obvious that we have far more in common than the issues which distinguish us from each as countries or police services –
- We’re making the same mistakes – and this is not a specific point about Australia and the UK: to the extent that I’ve understood problems in other countries, they are largely the same everywhere with a few distinctions about local issues which alter the order you’d prioritise the problems.
- We’re seeking the same solutions – no matter the differences, we see everywhere reaching for co-responder models where mental health nurses are deployed with the police; and we hear much talk about the need for more and better training for officers: this begs as many questions as it answers, in my experience.
Let me tell you why this is simply “doing the wrong thing righter” and that we need to remember what we say we ask our police service to do.
The incident of John in Melbourne could have happened in Manchester – in the sense that UK and Australian police are asked by mental health professionals to check on the mental health of vulnerable people for reasons that I still don’t always understand. I’ve written before about this: how on earth would a police officer be expected to do this? It’s just not possible to achieve, if we actually THINK about it! No police officer can assure anyone else as they walk away that someone is OK and this is about much more than whether or not officers are trained –
- Where the police turn up at someone’s home, even two of the friendliest officers on the planet with the best training going, it could still be problematic – we know that some patients have an intuitive fear of the police because of their clinical condition, we know some automatically think the police means they’re being criminalised or stigmatised as violent;
- We also know that the power dynamics between officers and the public are not equal and some people may fear the encounter will end in coercion of one kind or another – and coercion doesn’t always mean being physically coerced.
- Police officers have all the accoutrements and authority of the state to coerce people and in Australia their reach does extend to your private home and front garden, unlike in the UK. (What happened to John, assuming it was a detention under mental health law, could not lawfully have happened in the UK because he was in his own house and then his own garden.)
- So where officers turn up and say, “John, your psychologist has asked us to check on your mental health – how are you? Do you need our help?!” … what do we think this may mean for John himself?
- If John says or does anything that implies his mental health is difficult for him, or that he may be at risk from himself, what do we think the officers will then be contemplating? – can they ring back the psychologist and say, “Look, he says he’s not at all well and we can sense that, too – you’d best get yourself or a colleague ’round here sharpish to help him?” Invariably, we can’t.
- And if John says he’s fine and doesn’t need police help, should we believe him where there is no obvious reason to disbelieve him? – we know there are reasons why some people lie to the police about their mental health: because the public tell us this when we ask about how we can improve our responses. Telling the police the truth is to risk being coerced, one way or another.
- We are then cops on someone’s threshold carrying a professional responsibility for ensuring someone’s immediate safety, so what will we do if someone is unwilling or unable to seek help on their own or via their support services, where they have some? It’s got ‘detention under the Mental Health Act’ written all over it.
So before we get anywhere close to the questions that emerge about how these officers on this day decided to discharge their responsibilities – and I have loads! – we need to be asking the question most forgotten: why do we rely upon the police to the extent that we do and task them with things they couldn’t possibly do, even if they wanted to help? Remember, officers can’t be expected to reliably rate likelihood of self-harm; advise on anything to do with medication; they can’t always force a person to another location for an assessment by qualified staff and what many co-responder models demonstrate is that the person probably just needed access to healthcare services anyway. Did John actually need something from the police? – there could be more to know about this incident, but as things stand it seems unlikely.
This the original mistake: to assume that demand faced by the police is unavoidable, unpredictable and unpreventable demand and that the task is merely to ensure that the police are trained and equipped via partnerships to handle it better. Frankly, this is complete rubbish. Of course, there are incidents coming to police attention which were completely unavoidable, unpredictable and unpreventable but many (or most?) of them are not; and where they are not unavoidable, unpredictable and unpreventable, that doesn’t mean it requires a police officer to respond. Whether we examine some particularly high-profile untoward events like deaths in police custody, or whether we take a broader view over population level data, like s136 detentions or ‘triage’ encounters in UK police forces: we come to learn that much of this demand involved people needing and often wanting a healthcare service and being unable to access it or for whatever other reason not receiving it. Thereby, we create conditions in which police (and for that matter ambulance services and emergency departments) become more likely to be relied upon as a blunt tool to provide some kind of ‘care’. Remember, two things ‘more than minimally contributed’ to the death of Sean Rigg in London 2008 and the first of them was neglect by mental health services. Had that not occurred, it’s quite doubtful the Metropolitan Police would ever have met him. In Sydney earlier this year, a a young man called Jack Kokaua walked out of an emergency department where he had been detained under mental health law and when re-detained by New South Wales police, died following restraint. Of course, we may yet learn that officers could have handled that situation better, but it will still leave a question unaddressed: why was a detained mental health patient, previous sedated by the ambulance service and removed to an emergency department, able to walk out more-or-less unchallenged?
Most crucially though, this is not an argument against better training and leadership in policing; or against efforts to cooperate with mental health services – those things are very necessary for those occasions where we are responding to unavoidable, unpredictable and unpreventable demands. But like all the best medicine, prevention is better than cure. If we can ensure that those who simply need timely access to relevant services get it, we might reasonably expect to see the police responding less often to people in crisis and where they do, making a more positive difference because they’re better trained and supported – the real partnership issues to be address between policing and mental health services is not the day to day efforts between frontline cops and front line nurses; but the strategic relationship, the population data sharing, the proactive addressing of repeated and more difficult problems which is best done in meetings by knowledgable senior managers and analysts. We do this for domestic abuse and child sexual exploitation – we’ll start doing it more systematically on mental health eventually.
Other mistakes –
- We give the police tasks they can’t actually do – like making suicide or self-harm risks assessments of vulnerable people during welfare checks. I can tell you whether someone is alive or dead, whether they’re conscious and breathing, but whether they’re likely to hurt themselves in the next 6hrs is something my psychiatric training didn’t touch, I’m afraid. You want to know that someone’s OK – you’ll have to come and check that yourself.
- We give them tasks they can’t legally do – police services don’t always have legal powers to ensure a contact occurs between a vulnerable person and a mental health professional: the UK limits its police powers under mental health law and prevents their use inside private dwellings but even in countries like Australia where this is not the case, there is a threshold for using police powers. By definition, thresholds are not always met.
- We give them tasks they can’t morally do – calling officers to psychiatric units to undertake tasks normally expected of mental health professionals gives rise to ethical questions: I can’t be the only police officer asked to undertake tasks in a hospital where gender of staff wouldn’t matter but where analogous tasks in police stations, gender of officers would be controlled by law. I’m not forcibly removing a woman’s clothing for medication unless her life is quite literally at risk (and it wasn’t)!
THE ROLE OF THE POLICE
I’m not going to defend for one moment what I saw watching footage of a man wearing the word ‘POLICE’ on his back hosing down a beaten, mentally ill pensioner kneeling in handcuffs in his own front garden whilst one of his colleagues smiled and filmed it. Feel free to try and convince us, gentlemen, that this was reasonable, proportionate and necessary, but you’re going to have work damned hard and show me a detailed argument that negates suggestions this amounts to torture or inhumane and degrading treatment. But I do insist that whatever investigation gets going in to this, it should also ask the forgotten question: what the hell were the police doing there in the first place; and if it were thought unavoidable necessary because of urgent circumstances, where was the back up for the officers to address the questions that will necessarily arise for the psychologist after the officers have said, “Yes, he’s here: alive, breathing and conscious. What do you want to do next given we cannot assure you of anything else?”
Police uniforms, power dynamics and implied threats and coercion from even deploying the police can be a game changer: it is not benign and this is all too conveniently forgotten by those who over-rely upon the police to ensure adequate coverage of crisis ‘care’. If you doubt these subtle implications, ask yourself whether a police car suddenly pulling behind you at speed with lights activated makes you instantly check your speed? – whether an officer knocking your door unexpectedly makes you worry what they’re about to tell you that you might really not want to hear? Now imagine that whilst you’re struggling with your mental health, whilst you’re frightened or where you worry about being touched or coerced by people you know have limited training on mental health, even if they are attempting to communicate effectively and compassionately. Policing in mental health ‘care’ is, by default, an implied use of force – because it carries the implied ‘or else’ of the entire state right behind everything it does and that can be frightening to any of us. Some have looked at this footage and said it was all a police reaction to the officer being assaulted: all I saw was a vulnerable man pull away from being grabbed, which we can probably agree, is just human instinct.
We’re not going to see the elimination of adverse incidents until we stop tasking the police inappropriate with stuff they cannot do: so whilst no-one is defending anything on the footage relating to John or any other incident where police actions are rightly questioned, society needs to ask itself more keenly how it wants its police service to spend its time and then train officers properly for the tasks that are legitimately within their competence and capacity. ANything else is doing the wrong thing righter and making the mistakes history has already told us not to make.