My Health and Yours

My healthcare, and that of my family and friends, is absolutely none of your business. None whatsoever, with all due respect! Yours is none of mine and I’m only professionally interested in a very limited and particular way.

I’ve been asked a few times whether I’m interested in this area of policing because I have personal experience of mental health problems, or perhaps via a good friend or relative? That’s none of your business, as I’ve said. This reply should not be used to construe that the answer is ‘Yes’ and that I’m trotting out privacy rights in order to avoid revealing things. To be honest, I’m trotting out my privacy rights (and those of my friends and relatives) just because I can and because it’s up to me whether I reveal things about my or their health. I’m afraid, I’m a bit like that – private, contrarian and rather fond of my rights as well as being very content with the attendant obligations that always accompany rights. It’s my decision what I choose to reveal about my healthcare and it’s not for me to reveal things about the health of my friends or relatives without their consent or another damned good reason.

If you’re asking, last year, I did have a small health problem and it was my wife who pointed out something I hadn’t realised: that this was part of an emerging pattern which could be a greater cause for concern. Seemed like wise advice from her, so off I trotted and the Doctor gave me some malady-specific advice and medication in addition to one of those fat-man-over 40 MOTs which I’d managed to avoid for three years and it all helped in the short-term whilst putting my mind at rest about a range of other things you start thinking about when you’re a bloke over 40 who rarely goes to the doctor. But when it was more recently suggested I might go to a doctor for another reason, I exercised the right of every sentient person to laugh at the very idea of it, munch on some painkillers and crack on. I have been known to make doctor-related decisions without prompting from anyone else, to take complete responsibility on my own, too – to decide to go to the Doctor without any outside support or encouragement from anyone.

That’s enough of my medical history and it was my decision to share that much of it with you – as was it my decision to keep details about particular maladies private! It’s none of your business, obviously! … I’m sure you’re getting the hang of this already!  This is the thing about healthcare, and other aspects of our personal lives: it’s private stuff and we can all choose from where we take advice, whether we act upon that advice or whether we reject it all and do our own thing; and whether we tell the world. Ultimately, it’s up to individuals to make decisions about their health and their healthcare – most of the time. It’s almost never going to be your responsibility.

CAPACITY AND CULPABILITY

Obviously, there are circumstances where these important principles are compromised. Children have far fewer individual rights in these situations and their parents or guardians routinely act on their behalf. Some adults can’t take decisions about their own health, because of injury or illness – if you’ve just been knocked over and knocked out as a pedestrian in a traffic collision, you’ll probably want your friends and relatives, or helpful police and paramedics to start making decisions about what they think is in your best interests and act accordingly.

You can also imagine that if your healthcare issues are driving your behaviour to a point where it affects others, we may expect the police to step in and then work with healthcare professionals to determine what must be done. Do we prosecute the drug addicted burglar or robber, if they are offending to fuel their chemical dependency? – of course, we most usually do. We also do this in some cases where a person has experienced psychosis, but most usually in those rarer cases where they’ve hurt someone else or been found in unlawful possession of items which could be used to cause harm. History shows we do incarcerate people in prisons and in mental health units who pose a risk to others because of their health and addiction issues.

So you could summarise all of this, more or less, as follows –

Decisions about the healthcare of sober, conscious, non-vulnerable adults who have not broken the law is ultimately a matter for them and not for anyone else.

ADVICE AND GUIDANCE

Most of us reject healthcare guidance to one extent or another, whether that is because we eat too much, drink too much or exercise too little. I’d be genuinely interested to know how many adults of working age could say they moderate alcohol within Government guidelines, whilst taking the relevant amount of exercise, eating their Five-a-Day portions of fruit and vegetables within the recommended calorie limit, etc., etc.. We recognise that our autonomy allows us to reject advice because most of us do on at least one of those areas, even where the advice is based on the best available medical and scientific evidence.

So what’s different in policing or medicine, where someone’s healthcare decision isn’t perhaps what we, as professionals advising and guiding, would hope they do? How many police officers and paramedics attend a mental health incident where things are not so serious as to justify restrictive and coercive interventions but where we find it difficult to accept the decisions of people who are nonetheless vulnerable, even if just in our view, if they are rejecting advice. I’ve recently heard a few police officers talking about how they still have to ‘do something’ in a situation where they’ve (correctly!) established they have no legal powers to override someone’s autonomous and, no doubt, unwise decision.

But here’s the legal nugget of this post: an unwise, even stupid decision can still be lawful – a person does not lack capacity by virtue of wanting to behave in a reckless or dangerous manner with regard to their own health. You want to stop taking medication, or walk out of A&E before treatment is completed; you want to decline an ambulance trip to hospital after you fell – all of this is a matter for you, not me … subject to those caveats of whether you have capacity to take your decision; and whether your behaviour amounts to an offence which is impacting upon the rights and safety of others. (And by ‘rights’, I mean the actual legal rights of others, not the ones we make up to justify a moral intervention that has little basis in law.)

GOOD REASONS

Final point: some people have reasons for healthcare decisions which are profoundly important to them and which are morally and intellectually sound, from their perspective. The fact that any professional may disagree and even think the reasons risible, is neither here nor there. If you doubt this, look at the kidney dialysis / paracetamol overdose case where a lady refused treatment because she didn’t want a live of relative poverty and loneliness ‘in a council flat’ getting old. Doctors at the hospital argued that she lacked capacity to take decisions for herself and the Court of Protection rejected this, citing an earlier case –

“An adult patient who… suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered,” … “This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.”

There are lots of examples in policing where we assume that the right thing to do is to take healthcare choices away from people where we would, perhaps, be better advised to help people make choices for themselves. Once someone is under arrest or detained under the Mental Health Act, things are different, but prior to that or where such thresholds are not met, it’s actually none of our business, beyond ensuring people have been advised or sign-posted to options they may not have been aware of, which they may or may not find helpful.

Your healthcare choices are a matter for you – and that means public professionals should respect your right to make your own choices, even if they can’t respect the choices themselves.


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

Winner of the Mind Digital Media Award.


Advertisements

10 thoughts on “My Health and Yours

  1. I absolutely respect people’s rights to make decision to make decisions about their healthcare. The problem is, police and paramedic colleagues often don’t! I’ve had an incident recently where a very aggressive policeman insisted we detain someone because he had a history of violence. He did indeed have a history of violence, none of it fuelled by mental illness, something that had been established by multiple psychiatrists and AMHP’s over the years. It gets to the point where I sometimes think mental health professionals may as well shut up shop for all we’re listened to

    1. Hence I wrote a BLOG – doing my bit. I would argue your listened to much more than the police on MH – otherwise we wouldn’t see police e-centric police draining solutions to matters which are, according to major reports, mostly about healthcare systems.

  2. Great blog. The case cited is a great example of the challenges involved. Namely a person who is capacatous but wants to die. Who else but the courts can allow that to occur without fear. Hence ‘overreactions’ and unlawful incursions into other’s rights will continue to occur by all public professionals

  3. Thank God for contrarians …..Many front line workers and professionals ( including NHS staff) really do seem to believe that a mental health flag provides automatic exemption from laws and guidance on confidentiality .
    Either because of their own prejudices about mental health being linked with violence or because their need to personally offload anxiety can be then cloaked in ‘duty of care’. Lost track of how many times ‘duty of care’ has been trotted out by police attending my home. When I haven’t called them.
    I have suggested numerous times that they fulfilled that by attending/forcing entry and if they pass back the information gathered to mental health services then this meets the threshold they imagine exists.
    Or I think I have….maybe I give up telling them. But it is a very real issue that many people in society don’t like the concept of autonomy and the right to take unwise decisions. Let alone ones that may end life and where it is known an individual has known mental health struggles. Human beings natural instinct is to believe harm and death should always be prevented at whatever cost. That applies as much in health as it does in police.

    The MCA mess hasn’t helped but the guiding underpinning principles are worthy. Basically I have capacity unless shown otherwise and this is decision specific.

    Final comment: Why does ‘Duty of Care’ always sound more genuine from the police than it does from health based professionals?

  4. One of my jobs is screening reports from the police from incidents which they feel the need to forward to mental health services “for action” .

    My two specific beefs are:
    1) when officers record something which specifically presents on paper as a significant crime but as the officer involved has determined the ‘perpetrator’ has mental health problems there is no crime but a need for MH services to act. I wonder how a person can be a ‘perpetrator’ if there is no Crime and why officers feel they can diagnos. My recent favourite was a man who the officer said ‘had a clear schizophrenic personality disorder’

    2) more specific to this post when officers record that a person has specifically declined support, record they have capacity but then forward a report anyway saying they feel they should have more support without recording any evidence that there are concerns or risks that justify overturning that person’s wishes.

    Sometimes these reports seem to be a way of avoiding police work and seem risky, sometimes they seem overly paternalistic and make work for officers- the forms routinely run to 15 pages.

  5. Completely agree with the tenor of this blog post. As a patrol Inspector, I am forever pushing back against our involvement where unnecessary or potentially unlawful, if a patient simply doesn’t want our help. It saddens me to see the looks of doubt in my young officers faces when I direct that we are not getting involved or that the time of our involvement has ended. I can only sum up the worry and concern as “But, but the IOPC! But misconduct accountability on the balance of probability!”.

    I have also noted the increasing tendency of our MH/NHS colleagues to utter the magic words “we believe them to be a suicide/self harm risk”, when asked about the patients capacity to refuse co-operation. Once the words are spoken, they cannot be unsaid and the spectre of gross misconduct public show trials looms large in officers minds.

    Hence why we are forever forcibly detaining people who have walked out of A&E after they have waited several hours for MH teams to speak with them, or have walked out of mental health wards where they are voluntary in-patients and suddenly become “suicidal missing persons”.

    Officers have in their mind that regardless of what the law is, or what policies support their decision making, a “wrong” outcome will result in PSD/IOPC scrutinising every thing they did or didn’t do, with all the subsequent stress of a system that is heavily weighted against a presumption of innocence. The very word “misconduct” being used to describe honestly taken actions and decisions, is indicative of the blame environment officers operate in daily at multiple high stress incidents.

    This might explain the reason for so many arse covering reports, potentially unlawful detentions or breaches of human rights in this arena.

    Two things are needed to solve this issue. IOPC blame culture and associated witch hunts need to stop. Partner agencies need to be properly funded to carry out their job, rather than relying on an underfunded and understaffed police service which is also at breaking point. The police are simply not allowed to say no, even when we shouldn’t be allowed to say yes.

  6. As another thought (prompted by Jo’s post)…
    I recall a recent debate amongst patrol officers on a shift, re persons who had a wish to self harm to the point of serious injury or death. Now, we are not experts clearly, and I would welcome some input from either trained professionals or those who have been in this position themselves. The question being, is that because someone is suicidal or expresses suicidal thoughts, does that instantly qualify as a mental health illness/issue, requiring coercive powers of the state to prevent this?

    In my muddled thinking, surely if someone has capacity and are capable of decision making, even if we would consider this a bad decision (MCA), then would that not logically extend to a desire to end ones life? I appreciate its not quite as black and white (people making decisions from dark places they might otherwise not consider), but do we as agents of the state have the right morally or legally to prevent a person making their OWN decisions, where it is not as a result of an impairment of normal mental functions?

    We certainly have, to an extent, an obligation to preserve life. When does that obligation become an intrusion into a person’s right to decide and possible breach of their human rights? which trumps which?

    For interest, the general consensus amongst the officers involved in the discussion was that people had a right to do as they wished, within the boundaries of the law. Some argued against, but we all agreed using police powers to regulate non-criminal behaviour on the basis of morality, is a slippery slope.

    1. The Iopc blame culture doesn’t stop at the police. Granted NHS staff aren’t interviewed under caution by the CQC or SUI investigators. There is however an expectation to “do something” when people are displaying clear suicide plans, even with capacity. Services have been excoriated for allowing the person to take their own life, despite it being a choice.

  7. Good to read. It’s scary when people know you are vulnerable but scare you anyway.
    Please please let me find a way to leave this area that’s worthwhile.
    I’m tired of living in this city with its complexities.
    Hopefully no more Groundhog Days.
    Thanks for encouraging people like me.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s