Let The Police Deal With It

The media often provides regular coverage of issues in the ambulance service, esp more recent – their occasional inability to manage demand is up for discussion after photographs of some trusts with half their fleet outside Emergency Departments, unable to offload patients and all the impact that has on their ability to manage incoming demand.  We can all see there are plenty of pressures on our colleagues in green and paramedics are speaking out about it, both directly and indirectly.  The BBC has covered the queues as well as leaked reports suggesting hundreds of thousands of patients are (potentially) at risk because of these difficulties and those of us who know plenty of people working at this coalface know how difficult it is.  As ever, they have been unending respect and gratitude for what they do and I worry about my friends’ welfare, working as they must to keep us safe.

Amidst all this, and leading to this post, is a comment by a particular, unnamed paramedic who spoke to the media – it’s obvious from the comment, they are as resistant and frustrated by all this as I am –

“We are called out to patients who have harmed themselves or are threatening to harm themselves on every shift. I can say that without exaggeration. And people say, why don’t you let the police deal with it?”

So, if we really need to discuss this again, let’s go through it carefully – the avoidance of all doubt, I repeat that it’s obvious my comments don’t need to be addressed to the paramedic who spoke up.  They can obviously see the broad implications and issues that I can.  But what precisely do we mean by these three words in the above quotation?! –

  • “People” – who, precisely, is suggesting leaving police officers to deal with vulnerable patients? – who thinks this is the approach we need?!  Are they, as it seems, people who are asking these questions when the police are in the room as part of that discussion … and if so, why are the police not there for it?!  Surely the police have a right to be a part of discussions about what is and is not their sphere of responsibility and I can tell you quite honestly that a number of mental health professionals have told me over the years this is, in fact, what happens – regularly.  “Should the police not be here if we’re discussing [this]?” … “No, this is a matter for the NHS.”  << This frustration isn’t pedanty, it links directly to my next point:
  • “It” – what do we mean by “it”?!  Mental health as healthcare theme is a very broad and infinitely complex topic and, other things aside, it’s not a police responsibility to provide healthcare.  In case it needs saying again, attempts in this direction can just lead to over-policing, which can be fatal, literally.  So if we are serious about human rights – a key tenet of which is proportionality and legitimate aims – then what, precisely is “it” we are proposing should be left to officers? << Providing a little time and reassurance to someone when you’re responding to crime or threats to life is one thing, providing a safe place to be until a crisis abates or further specialist help can be obtained is quite another; providing ongoing support over a period of days and weeks following a crisis incident is something else entirely so what does “it” mean?!
  • “Deal” – obviously, the police don’t provide ongoing mental health care services so what do we precisely mean by “deal”?!  Beyond running around there in a hurry (as both police or paramedics could do), neither 999 service is well placed to deal in anything more than an immediate sense so what, precisely, are we expecting the police to do when they “deal”?  We know from data on street triage, that most mental health emergencies reported to the police occur in private dwellings where the police have no powers, so in what sense could they “deal”, if someone is at risk? … perhaps neighbourhood policing teams could take referrals from officers and start a longer-term programme of some kind?!
  • NB: over-use of the word “precisely” in these points is deliberate.  I don’t want vague answers: I want detail, because it actually ends up mattering in the Coroners’ Courts so it needs to be considered and discussed.

For the avoidance of doubt, the suggestion of police setting up MH services was not a serious suggestion! – it hints at initiatives like “SIM” (Serenity Integrated Mentoring) which gave rise to the #stopSIM campaign on Twitter so whilst I’m not being serious, there obviously are some who think there is an ongoing role for police to be directly involved in ongoing community mental health care structures.  I’ve disagreed with this from the start, and for reasons allied to those concerns, have had more than my fair share of questions about street triage.  And in addition to the above, are we happy that whilst decisions around mental health responses are being deliberately left to the police, other stuff goes undone?  Are we really happy with the implications this has which mean domestic abuse victims wait longer for the police; or fewer patrols happen in areas with anti-social behaviour; or that roads are less policed when we still see 5 people dying a day in road collisions and 60 seriously injured?  I will admit: I’m not.

Where’s the balance and why wouldn’t the police be a part of striking that – it’s not the role of the police to do as their told and over-policing vulnerable people in crisis is under-discussed?  Let’s remember: what the NHS want from their police service is not always the same as what the public want – and that’s not an expression of a personal view, it’s reflected in the national strategy on policing and mental health (2020).  In the end, who can make a judgement about how to reconcile any gap? – it can only really, in the end, be the police themselves and they should do so on a case-by-case basis with reference to the laws, codes of practice (out of date though they are) and other guidance material which relates to all of this.

SO WHAT’S REALLY GOING ON HERE?

As this blog has always said: the police have a legitimate, inevitable and unavoidable role in society’s response to some mental health related matters – by law, there are some things in the Mental Health Act 1983 that only the police can do.  There are other things which are so immediate or so dangerous that only trained police officers could realistically do them – for example, nothing prevents an AMHP or authorised nurse re-detaining a patient who is Absent Without Leave under the MHA to return them to hospital, but where that patient is barricaded in a room with a knife, it’s never anything other than a police job … suitably supported!  We shouldn’t “let the police deal with it?” we should help the police deal with whatever we cannot prevent them having to handle (see chapters 17 and 28 of the Code of Practice to the Mental Health Act).  Whilst it’s true that only the police have the powers, skills and training for some aspects of this, the opposite is also true – they lack powers, training and skills for other aspects.  It’s not ‘mental health’ that they’re responding to and dealing with – it’s the crime, the immediate risk or the threat to life.  Once that is mitigate or abated, over the the individual and their healthcare providers.

I’m really intrigued by this idea that healthcare staff are having conversations about what the police should deal with, in rooms where police officers are not present to understand the discussion and make representations or observations, accordingly.  I’m intrigued mainly because it’s not really a “partnership approach”, is it? – I’m also worried about the legal education influencing whatever views are being expressed because you only need to look at social media to see some of this playing out.  This country has a national strategy for policing and mental health which was produced after consultation at length with statutory partners, other stakeholders and specifically after discussion with the public.  It sets how the police aim to strike a balance between those demands thought relevant for policing by other agencies and those roles the public want to see officers undertaking.  Or not undertaking, as the case may be.  As I’ve written before, policing is not benign, it can have an (often unintentionally) negative impact of the most serious kind.

When this comes up, I often have to remark how unknown it seems to be that over-policing can be fatal, literally.  Actually, even necessary lawful and unavoidable policing can be literally fatal, so it needs to be understand that always and every time the use of police officers is restrictive, potentially stigmatising and criminalising practice – sometimes highly so.  National strategy on policing and mental health includes the need to minimise recourse to policing, because of its unknown and sometimes unknowable implications on vulnerable people.  Uniformed officers attending an address for a welfare check is not benign: and you often won’t know its implications until you have a serious event from which you desperately wish you could extract yourself.

If you’re going to “let the police deal with this”, then there will be stories where officers save lives and help people, no doubt about it.  There will also be other stories and some of them will involve life-altering and life-threatening consequences despite the best efforts of officers to help.  If you got this far in the post and don’t know the cases of Lauren Finch and Sasha Forster, you’ve got some reading to do as just two examples of everything I’m hinting at, above.  Just two examples, there are more and many are available to you via social media because the public have a tendency to make their views known, quite rightly they should as the most important partnership the police service must maintain is the one they have with the public they exist to serve.


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, 2022


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 – www.legislation.gov.uk