We are hearing stories on social media at the moment, of patients who claim they were told to ‘call the police’ when they have contacted their community or crisis team for support as they recognise they are becoming unwell or at a difficult point. We also know, on some occasions, a patient’s formal CarePlan for crisis is to ‘call the police’ as the first resort. I fully understand, as pointed out by a mental health nurse on Twitter last night, that we have no way of knowing whether patients who claim to have called the police were, in fact, told to do so; and we don’t necessarily have evidence that all the CarePlans which purport to list this, actually do so.
What we do know is this: at least some of these examples are verified and we do know that some of the time that ‘call the police’ is put in to practice, it has involved a CrisisTeam or CommunityTeam themselves making that call on 999, not the patient. In other words, the ‘call the police’ phenomenon is real, even if some maintain it may be exaggerated on occasion. I don’t really want to get too far in to the obvious point raised by the nurse’s skepticism; that an early thought after hearing the anecdote was to assume the patient was lying – that won’t really get very far without getting quite shouty, will it?!
I particularly enjoyed hearing a recording recently of a call to a CrisisTeam by a patient who chose to record their own call ‘for training and monitoring purposes’ and it involved a person asking for someone to talk to as they recognised their own relapse and having tried various distraction techniques of their own, before ringing. To say my gast was entirely flabbered as the nurse sought to quickly get rid of the call and ring 999 is to dramatically understate things: there was just NOTHING there to justify ringing the police. A person wanted to talk: it was bluntly (and rudely) refused and the actual words used by the patient seemingly ignored, the phone went down and the local police received a 999 call.
So this stuff happens – doubt your patients and accuse them of exaggerating if you wish, I have stuff to say about when it does occur –
SELF-HARM & SUICIDE
Firstly, a quick point about ‘suicidal patients’ – if a nurse who is unable to deal with a patient thought to be harming themselves or threatening to do so is in urgent need of a policing or wider 999 response: don’t tell THEM to make the call and assume it will happen. There are lots of things that shouldn’t need explaining about why that could go badly awry – some people don’t want the police to come in and coerce them to ‘safety’, they want to die or hurt themselves and if you’re taking that risk seriously, leaving the reporting of it to the patient is not enough: put the 999 call in and the help the controller by sharing information relevant to the case and be prepared to advise and take things further. Remember your probably sending the cops to something they can’t deal with so don’t just hang up and get on with the next thing on your list having ticked this one off because the police are en route.
This ongoing help is needed for (at least) three reasons –
- Most of these kinds of calls received by the police are in private homes where they have no powers – officers may need to engage you about how to safeguard the person if they turn up and find themselves powerless.
- Officers cannot tell you whether or not your patient is ‘safe and well’ and it is not their job to do so – they may merely confirm whether the patient is dead or alive and offer the obvious helps if the person is alive but injured or obvious ill.
- Safety in mental health is not something that is visible to the police and the officers attending will have a first-aid certificate only so they will need back up from mental health professionals to fully resolve the situation.
Secondly – a point I’ve made before: if a visual assessment by the police and support for that from the CrisisTeam or CommunityTeam is not enough, the police will need support to access or navigate the AMHP process. Because we know some AMHP services are inaccessible to the police, they will need your help and are quite entitled to ask for help, given they were put in the position by the NHS. So if the officers were to say something like, “I’d be using s136 on this person if they were not in their own home, but because they are I can’t do that – you either need to come out or arrange an AMHP / DR because it strikes me that s13 MHA is engaged here.”
What’s your response plan?
If we are serious about partnership working and we are going to write in to someone’s CarePlan ‘call the police’, we should be giving serious consideration to the proactive, advanced disclosure of relevant information to the police service concerned. CarePlans of this kind should be drawn up with patients themselves, obviously at a time when they are well enough to make decisions about their care. If agreement is reached that it may be necessary and appropriate to ring the police, then the patient should be asked to consent to disclosure of information to the local force which will help them get it right.
You could imagine any number of things could be relevant from, “Don’t send male officers, if possible” to “patient has spare key at neighbour’s (no 11) should entry need to be gained and consents to the key being sought and used by the police”. It could also include more safety information, “Patient uses blades to self-harm” or “patient asks that officers be patient and afford him time and space – don’t rush decisions” or “Would be helpful if officers called patient’s cousin Sue to help as patient likes her help when unwell – her number is 07770 770770, etc..”. I’m sure we can all think of even more useful nuggets to have on the system.
If each Community MH team manager contacted their local neighbourhood policing sergeant or inspector (details available on force internet websites), they could easily agree a way to share this agreed disclosure with consent and the police then use it to improve the quality of their response if they are called. This, in turn, makes it feel like much less of a ‘bat’ from MH services who are, often, sending officers in to situations where they have no background, no context, no powers, no training, no abilities to achieve the task implicitly set by their despatch.
I’m sure it can be understood how difficult a position this creates for them and it has been the stuff of deaths following contact in our history.
In case of doubt, I end with my own tale: the last time I went out to such a call –
The CrisisTeam rang 999 to say, “Patient has rung up saying unwell, asking for voluntary admission to hospital and we’ve had to say no as we’ve got no beds. She’s then threatened to kill herself and put the phone down. Can you send officers to do a safe and well check.” This was a Friday evening, just before handover to the night shift, so I was just sitting at my desk to start writing up all the stuff for the nights inspector and all the constables and sergeants were committed with 999 jobs on a busy shift. So I slugged my coffee and went to it on my own, not least because the call was just around the back of the police station.
When I arrived and knocked on the lady’s door, she did open it, but kept the door on the small chain lock so the door could only open about 2inches. She seems surprised to see me, not just a little bit anxious and I explained why I’d attended asking if she was OK? I couldn’t see all of her so it was not possible to tell if she was physically injured in any way, but I could tell that she was Alive, Breathing and Conscious. It also seemed likely she wasn’t Ill, Injured or Intoxicated, but I couldn’t be certain of that, given how little of her I could see. In this situation, I had absolutely no legal powers at all, because she’d answered the door and remained in her own house and the conversation would not have given me cause to think she met the criteria for use of s136 even if she had been outside her house.
SAFE AND WELL
So I rang the CrisisTeam –
“We’re here – she’s alive, breathing and conscious and although I can’t really see her properly though the gap in the door, I don’t have grounds to force my way in. What do you want to do now?”
“Well, as long as you’re saying she’s are and well, that’s OK.”
“Well I’m not saying that – that’s not my job. I’m saying she’s alive, breathing and conscious and that I have no powers to act. That’s all I’m saying. For all I know, she could be actively plotting to hurt herself as soon as she shuts the door because you’re the people to whom she made the suicide remark.”
“But she is safe and well, isn’t she?”
“I’ve got no idea! Is she? – how do you know?!”
Suffice to say this ended by me saying, “I’ve got a horrible feeling you’re going to write in your notes that Inspector Brown said this lady was safe and well, so let me just make clear, I’m about to write this up to say that I specifically did not and that all I’m assuring you of is that right now, she’s alive, breathing and conscious. If you need to satisfy yourself of more than that, you’ll need to come out. If you choose not to do so, you may not say I didn’t alert you to the fact that your apparently suicidal patient could still be at risk. Can I have your name please?”
All of this stuff is way more complicated that ‘call the police’ – and calling the police can make things worse. Unless we think this stuff through, share information and work in a genuine partnership, it’s often little more than trying to deflect demand to cover someone’s backside. Officers should remember the limits of their legal powers and clinical assessment skills – they CANNOT assure anyone that a mental health patient is ‘safe and well’, even if they’re trying to help. Confirm alive or dead and whether there are any immediate emergency medical needs, then refer back to whoever sent you and tell them to now deal in slower time. Escalate to supervisors and if no satisfactory response from whoever sent you, ask for the AMHP / DR response suggested by the judge in the Sessay case. Document everyone’s names in the record – history shows they may be relevant to cite in a Coroner’s Court or IOPC investigation.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – http://www.legislation.gov.uk