Much Less Blogging

You guys seemed to use the BLOG a lot last year, way more than any other single year since I started in 2011 and that was really encouraging on one level. However, I couldn’t help but notice the vast majority of the increased use was down to two things —

  • The series of posts which related to the Policing and Crime Act amendments of the Mental Health Act 1983, introduced in to law last December.
  • A series of posts in which I just said again the same things I’ve said for years, only in light of new events, seeking to ram home the same point as before.

There are now well over 700 posts on here – many of them saying the same thing over and over again and I don’t under-estimate that dripping like a tap is actually a necessary part of drilling home a message, particularly one that doesn’t always sit easily or appear straight-forward, but the essential messages in this blog are simple:

THIS BLOG – KEY ISSUES

  1. We need to take responsibility for understanding the law of the country as it actually is, rather than as it’s rumoured to be.
  2. We certainly need to know medical risks associated with any work which involves the compulsion of those of us living with mental health problems.
  3. We need to get on with our work knowing that organisations and their partnerships are not perfect, that we haven’t had enough training – we never, ever will have enough for the range and the complexity of stuff.
  4. We need to know how to police amidst uncertainty and contradiction, in light of all of the above.
  5. We must learn the lessons of history and, where necessary, teach them to others – one situation at a time, if we must.
  6. Police officers need to know how to police: regardless of context, training and partnerships. In fact, history shows the latter may confuse you and get you in trouble – you need to get your own head around this stuff from source material.

I’m going to be doing much less blogging this year: a very deliberate decision because a) I’ve actually run out of things to say, really and b) I actually do have other things I want to do with personal my time and I owe it my family – stuff mainly focussed on my own health and wellbeing, to be fair. Although I work on this now as a full-time job, most of the blogging remained exactly what it is right now as I type these words: personal effort in my own time after my family are in bed with the dog next to me on the sofa, listening to music as I do … my ‘Top Songs 2017″ from Spotify, if you must know – the Verve, if you want to be precise.

BORING MYSELF WITLESS

There simply isn’t much more to say for now – there is only the issue of whether we are going to stop talking about things as much and start doing things some more; examine whether we’re doing the right things and actually bringing solutions to problems – or not. That’s not something I can directly influence by blogging the same material over and over again and something as informal as blogging loses impact with repetition, making the same point again and again – so, feeling that I’ve done my bit, I’m going to try a bit less before I bore myself to tears.

I was told today that it looks likely my secondment to the National Police Chiefs’ Council and the College of Policing will be extended again so what I will be able to commit to doing is working my socks off at work, as I always have and on here, I will do something I briefly tried before a few years ago: a monthly update blog. Apart from that, I will probably restrict myself to particularly interesting developments or cases, any new legal issues that emerge and some stuff around the Wessely Review of the Mental Health Act 1983 as it unfolds during 2018.

I suppose you can sum up where I am with this stuff by the flippant sounding truism: “I can explain this to you but I cannot understand it for you.” I think that’s where my head is, although without any problems flippancy. There’s not much I’m ever asked to explain that isn’t covered on here already – so fill your boots with what I’ve already done.

Best wishes,
.

Michael./


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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AND / OR

Compare and contrast the following two pieces of law –

  • Section 136(2) says someone removed to a Place of Safety may be taken there to be examined by a registered medical practitioner and interviewed by an Approved Mental Health Professional; and of making any necessary arrangements for his treatment or care.
  • When you read section 135(1), it says someone may be removed to a Place of Safety with a view to the making of an application under the Act, or of making other arrangements for his treatment or care.

The bold is my emphasis – does it matter that the apparent purpose of one of these Place of Safety orders is interview AND arrangements, whereas the other is interview OR arrangements? … is this a distinction without a difference, or could it be crucial to something?! Both seem to represent the purpose of removing someone to a Place of Safety and we often think of 135(1) as being “like s136 but after a court warrant in someone’s own home”, but does this pedantry amount to any kind of distinction that has a real effect?

Since the MHA amendments took effect at the end of last year, it has become possible to use s136 MHA in police custody. For example, if officers have arrested someone for shoplifting and it only becomes apparent that the person may have serious mental health problems after they are detained in custody, the custody sergeant could now take a view on whether to bring the criminal investigation to a halt (temporarily or otherwise), and use s136 in the custody area before removing someone to a Place of Safety. The question has arisen about whether this is lawful IF the person in custody has already been assessed under the MHA is, for example, simply waiting a bed. Does the detaining officer have to have it in their mind at the time of using s136 that both parts of the ‘purpose’, as outlined in s136(2), are required?

THOUGHT THINGS

Imagine a situation in someone’s home where services had assessed them under the MHA and decided that admission was required. If they had entered the premises under a s135(1) warrant, made their decision and then hit a problem that no bed was available, the warrant would allow removal of the person to a Place of Safety, whilst that bed search is carried out – this is “with a view to making an application”. That phrase not being a part of s136 does this change anything?! Maybe … this linguistic precision (or pedantry – depends on your view!) has certainly been deployed before to suggest that once an MHA assessment has occurred, police officers cannot then use s136. I’m not sure it’s as simple as that; so let me show why.

Imagine our assessment in private premises had not involved a s135(1) warrant or the police … an AMHP, two DRs and a CPN had attended a patient’s home without the police where either they have been allowed to enter and an MHA assessment has occurred. The view has been formed that an application will be made and they bump up against the ‘lack of beds’ problem. Let’s imagine an all-too-real development, which I’ve experienced several times: the patient becomes concerned at the prospect of admission and leaves their home, implying or even openly stating they will harm themselves. We then see a 999 call to the police, to report an immediate high risk missing person. Are we seriously saying that if police officers find him, no bed having yet been found or MHA application made, they cannot use s136 MHA to immediately safeguard someone who is at immediate risk because they happen to know an MHA assessment has already occurred?!

Of course, not. Apart from anything else, enough may have changed because of that missing person event to change the necessary outcome from the assessment – it could have been the intention to admit the patient on a voluntary basis, but now it may be necessary to admit them on a compulsory basis.

I realise, obviously, there are differences between my almost-hypothetical missing person and someone in police custody who has been assessed and is awaiting a bed, but each gives rise to the same legal question: is it unlawful to use the power outlined in s136(1) because of the supposed purpose of the section, as outlined in s136(2). If the answer to that is yes, then it is also yes for our hypothetical missing person; if not, then it is still no in custody – it’s the one, or the other.

PACE DETENTION

The difference in reality tends to be, that in the missing person situation, everyone is agreed on the urgency of acting and that takes priority over supposed legal pedantry; in the custody scenario, the person is safely under arrest – so what’s the urgency?

Remember this: there is no power under the Police and Criminal Evidence Act 1984 – and there never, ever has been – to detain someone in police custody pending a Mental Health Act assessment OR pending the identification of a bed, to which a Mental Health Act application may be made. This may well have been what we did for decades, since PACE was created, in fact – but it’s not what the law says, nor has it ever. Whilst someone who is mentally unwell is in custody, s34(2) and s37(7) of PACE continue to apply and once we reach a decision that the original grounds for detention no longer apply, we must make that decision about whether to release a person (pending further enquiries or without further action) OR to charge them with an offence. To the extent that MHA processes may be relevant to determining whether there is sufficient evidence to charge someone, you may countenance all that happening in parallel with an ongoing investigation.

But it has always been true, that if someone in custody who is thought to be unwell reaches the legal positions outlined in s34(2) PACE or s37(7) PACE, then it applies to them and their liberty, notwithstanding their health issues. If this point is reached before MHA assessment has occurred, people seem quite comfortable that the newly amended version of s136 can apply in police custody and I already know this has happened many times around the country since 11th December last year. But discussion about this happened in the north of England this week, after an MHA assessment had occurred and a view was given to the police that they could not, legally, use s136 MHA because the MHA assessment had occurred.

Can that be right? – I’m not sure it is. The grounds for using s136 are those contained within s136(1), subject to the qualification now contained in the new s136(1A). Because apart from anything else, nothing actually prevents a person who has already been assessed being assessed again after being safely detained. You might question the point of that, because it may seem fairly ridiculous to suggest it, but we know that many patients are assessed twice during their admission process, for a variety of reasons and sometimes it’s as simple as the passage of time since the original assessment.

URGENCY ISSUES

But go back to the urgency stuff: where a custody sergeant has quite properly concluded on the basis of evidence and public interest that a person should be released from PACE detention, if they are thought to be very unwell and even a serious risk to themselves, if released, then this just creates a new legal problem: it doesn’t justify excessively or even unlawfully depriving someone of their liberty under PACE when we accept the grounds are exhausted.

Section 136 may be used “if a person appears to a constable to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons” remove that person to a Place of Safety, etc.. Nothing in here at all, or in subsequent sub-sections, which qualifies this, except that s136(1A) provides the power under s136(1) can only be used in any place which is not a “house, flat or room where the person, or another person, is living; or any yard, garden, garage or outhouse” connected to it.

I think we’ll learn more about how this new aspect of s136 is going to be relied upon increasingly to get mentally unwell people out of police custody, even though they may not have been brought in under s136 in the first place. This will create problems some people haven’t thought much about yet and whether the NHS has capacity to handle this, we’re still not clear. But we should remember, if we check Hansard, that the purpose of the amendments overall is to reduce the number of people going to or staying in police custody when they are mentally ill. What appears to be an unintended consequence of the reform, helps take us further down that route than ever before, but we’ll need the understanding, the infrastructure and so on to cope with it.


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

Winner of the Mind Digital Media Award.


OBE

I wrote this post in June 2016 and simply forgot to publish it. Having had a bit of a BLOG clear-out over Christmas where I’ve binned about thirty part-written blogs where I found myself just banging on again and again about the same old thing.  However there were a couple I decided to keep and this is one of them, just for personal reasons.


I was thrilled to receive a letter in May, indicating that the Prime Minister wished to put forward my name to Her Majesty the Queen, recommending that I be appointed an Officer of the Order of the British Empire (OBE) for services to policing and mental health. Since the announcement, I have been smiling broadly and have laughed out loud a few times, overwhelmed by messages of support from frontline police officers as well as mental health professionals and members of the public. I was delighted but surprised to receive three very lovely letters from Chief Constables Phil GORMLEY and Simon COLE as well as Commander Christine JONES – the last three national policing leads on mental health. It has all been truly humbling but most of all because of those remarks received from people with experience of the police and our mental health system whilst in crisis – those have meant the most. Thank you to everyone who offered congratulations.

I have been told many times that I must be very proud and I’ve repeatedly replied that wasn’t the overwhelming emotion – I mainly just feel vindicated and relieved; and that I hoped this would allow us to push on with getting some things done in the real world. My own view is that we are still talking too much and doing too little on policing and mental health; that real work needs to start soon or momentum will be lost as it slips from the list of priorities. The College of Policing publishing new APP (guidelines) on mental health in October and we have held events across the UK for police forces to learn how the APP and its supporting training packages will need to be delivered in challenging partnership circumstances. In the second half of 2016 and throughout 2017, police forces should be reviewing their local arrangements and training provision to ensure that they are fit for purpose against the new standards; ensuring they can survive contact with accountability mechanisms like the IPCC and HMIC.

But College APP and training will, of themselves, achieve little – it all needs ‘operationalising’ by police forces and their officers and staff in imperfect situations whilst dealing with vulnerable and often complicated people with many complex, unmet needs in an evolving, challenging partnership environment. My time working on this agenda is coming to a conclusion and I will probably be back in West Midlands Police during 2017, so if I can abuse the opportunity of being honoured to say just two things –

  • Some areas of the country still maintain partnership arrangements which prevent all agencies from fully discharging the duties and obligations placed upon them, in various situations of mental health crisis to which they are invited – they are too often obliged to choose between complying with local pathways or complying with the law or relevant professionals guidelines. (Examples available on request, but many of them documented on this blog).
  • Some police forces are reluctant to challenge this or find it difficult to make progress, despite history telling us it could lead to a disastrous outcome – like a death in police custody – and families affected will never understand why more wasn’t done. I’m still trying to work out whether the police are disinclined to push back against what we too-often see as experts, but I know we need to do more of it if we are to do our best for vulnerable people.

I worry at the moment that the progress we are seeing claimed is not necessarily progress at all – there are still things to learn about how we normalise and over-expose the police to mental health crisis situations where they make things worse, despite their best efforts. That ethical debate hasn’t really begun because we’re still focussed on learning the laws, building basic professional relationships and developing pathways to mental healthcare. To what extent does it criminalise vulnerable people that pathways to crisis care are all too often via the police or with their unnecessary involvement; to what extent does it affect psychological safety and wellbeing of those of us in crisis to be in the ‘care’ of the police for hours or even days, potentially whilst restrained in a cell? We seem to be trying to operate together, but ever-later in the crisis that are under massive strain, as often as possible – we’ve publicly said this is the opposite of what we really need to be doing.

Success in this area should be judged by the improvements seen for those of us who live with mental health problems and when front line officers report that they find this aspect of their job far less difficult to deal with and much less time consuming. So we need to establish whether what we’re now doing works from the patient’s point of view – not from the perspective of organisations.


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

Winner of the Mind Digital Media Award.