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Acute Intoxication is a Mental Disorder

The longer I work on policing and mental health, the less frequently I experience certain things which used to hit me square in the face every time I went near the topic as a PC: a new piece of knowledge that leaves you entirely confused and thoroughly re-examining the paradigm you’re trying to get your head around. Having done a fair few talks over the years to professionals in policing and in mental health, I thought I had it fairly squared away in my head how to answer the questions that arise when discussing intoxication by drugs or alcohol, relative to police decisions about things like section 136 of the Mental Health Act. And then, Wiltshire Police rang for an opinion on a psychiatric report they’d received ahead of an inquest.  I’m still thinking this through, several weeks later, because it’s almost entirely beyond comprehension this hasn’t come up before.

In February 2017, the police were called to an incident in Salisbury where they found a very drunk individual who had involuntarily expelled urine and could seemingly not stand or talk. Officers spent considerable time with him, calling an ambulance and whilst the paramedics did undertake some level of assessment, no records exist to show exactly what that entailed. Having made a decision the man did not require conveyance to or treatment in an Emergency Department, they left decisions about his safeguarding to the police. For reasons I’m still unclear about, the officers left him in situ on a winter’s evening and he died of acute alcohol intoxication and hypothermia. The Coroner’s verdict ruled this was an accidental death contributed to by the neglect of both paramedics and police officers. You might be wondering on the basis of that summary what this has to do with mental health?

The Coroner in this case commissioned an independent psychiatric opinion, seeking answers to certain questions. The pertinent ones for this post are –

  1. At the time of police and paramedics contact, was this man suffering from a mental disorder?
  2. If so, could section 136 of the Mental Health Act have been used.
  3. And if so, should s136 MHA have been used?!

I’ll let you have the punchline before making the points I want to make: the answer to all three questions was ‘Yes’ – he was mentally disordered (acute alcohol intoxication); ‘Yes’, section 136 can be applied to any mental disorder that is not a disorder related to dependence upon alcohol (abuse / misuse being different to dependence and addiction); and ‘Yes’, in preference to leaving the man in a public toilet, the officers should have used section 136 to safeguard him, notwithstanding the paramedics’ opinion.

WHERE DO I START?!

I decided I would write a post on this inquest when I had time, but I’ve been motivated to make the time, based upon a conversation on social media only this morning: the AMHP forum on Facebook are currently discussing whether there has been a real and steep rise in the use of s136 MHA since the legal changes last December. Several contributors to that discussion are lamenting perceived over-use of the power by police officers when people are ‘not mentally ill, they are just drunk and disorderly’. Haven’t we always been told that drunkenness is not a mental illness and that the Mental Health Act can’t be used on someone who is intoxicated?

I have spent fifteen years doing policy related work and I will be honest: I’ve had psychiatrists, mental health nurses and others shout at me(!) when discussing issues around s136 and Places of Safety because of their no-doubt genuine belief that drunkenness should be dealt with in a different way. I’ve heard argument that where s136 is used on drunk people where there is no known background of mental health problems and no context on first contact that showed any evidence of self-harm or suicide, that most people are assessed as having no extant medical needs. They might need a bacon sandwich and a cup of tea to sort their hangover, but no referral to a GP or community mental health team.

And let’s not forget this: the much-lauded concept of street triage started in the Cleveland Police are in 2012 and that began after frustration in mental health services that their local officers were using s136 too frequently on drunk people who had no ongoing care needs at all once they’d sobered up. Having approached local senior officers to offer training, they found themselves rebuffed and street triage, to quote an AMHP from Middlesbrough, “is all about stopping the police from getting it wrong.” They found that over 95% of drunk people just sobered up and went home; the other 5% were those drunk people known to have a background of serious mental illness or who were found hurting themselves or in a precariously suicidal position. So, we’re now spending millions of pounds of public money on triage schemes which, amongst other things, aims to stop an over-medicalised response to the social issue of alcohol abuse.

NATIONAL POLICY

For all of these reasons, national guidelines in policing advise officers away from using s136 on drunk people unless there is that known background or context, because it plays the percentages in a realistic way if people are either conveyed to A&E for potentially toxic levels of alcohol consumption and, if people need legally detaining, arresting someone for being drunk in a public place or drunk and incapable does not preclude a MHA assessment for anyone who sobers up and who is still thought to be exhibiting unusual behavioural signs that may mean an underlying disorder. Remember the story of the bloke in Walsall who bought over-the-counter products to help him stop smoking and then drank a load of red wine? – he ended up sectioned under the MHA in hospital because after sobering up, there was a lingering effect of the alcohol and the medication that took three days to wear off.

But, it turns out it really is true that acute intoxication (by either drugs or by alcohol) is listed in the International Classification of Disease, 10th edition, published by the World Health Organisation as a mental disorder. The MHA can be applied to any mental disorder that is not a disorder related to dependence; therefore s136 is ‘in play’ for drunk people or those experiencing a drug-induced psychosis. I should imagine any mental health professionals reading this are starting to panic at the potential their local police officers may start scooping up nighttime economy punters and pouring them in to Places of Safety and Emergency Departments! …

Well, in his oral evidence to the Coroner’s Court, the expert psychiatrist did say that he was not arguing the police should be detaining all very drunk people under s136. What I left the Courtroom without, however, was a clear understanding from him of how a police officer could or should tell the difference between the very drunk person who should be detained under s136, from the very drunk person who should not. Maybe that detail will follow later. But what did become clear is that the reason for suggesting the use of s136 was merely as an alternative to leaving someone where they were. In reality, of course, those were not the only two options available – the officers could have removed the person to A&E under the Mental Capacity Act, they could have arrested for at least two criminal offences and in other incidents involving very drunk people there may be other offences committed or friends / family on hand to help that person without the police needing to act.

DECISIONS, DECISIONS

My final point is to ask what standard we are holding the police to in these matters? Having seen a copy of the psychiatrist’s report, I rang a few mental health professionals. “Did you know that acute intoxication (drugs or alcohol) is a mental disorder in ICD-10?” I also asked this on Twitter: literally no-one knew! I must have canvassed over a century’s worth of experience and none of them knew this. When that was explored in the Coroner’s Court, the psychiatrist also admitted that he’d shown his expert report to a Professor of Psychiatry who had apparently exclaimed, “Ooooh, I didn’t know that!” The expert went on, after that admission, to say he thought the fact Wiltshire Police officers didn’t know this as a ‘serious concern’.

I’m just going to say that one more time: two frontline police officers not knowing something was a mental disorder when a Professor of Psychiatry and a raft of mental health professionals with over a century of experience between them also did not know this is, apparently, a ‘serious concern’ … seriously?! What standard are we holding the police to here?! It is – quite frankly – completely ridiculous!

But let’s imagine these officers did know something that a whole mental health system (almost) full of professionals with postgraduate degrees appears to not know: how does that change any real-world decision-making?! What do we think a place of safety nurse or AMHP may say when we ring them up and explain, “We’ve detained this guy whose name we don’t yet know: he was lying drunk in a puddle of his own urine, unable to walk or talk and there was no background known or context of self-harm or suicide and we’ve brought him in under s136.” One professional admitted, perhaps because they know me well they felt they could speak freely, that they’d probably just say, “Michael, you’re taking the p*ss mate, you can f*ck off with that!”  Seems fair enough, to me.

MEANWHILE IN THE REAL WORLD

I just can’t my head around any of this – it’s simply too weird for words. But if you are a police reader, you can have some fun with this: next time someone mentions the police should not be using s136 MHA on drunk people just say, “The ICD-10 lists acute intoxication as a mental disorder and as abuse of alcohol is not the same thing as dependence, the MHA can apply to it.” And then just watch their face – you’re welcome.

My opinion remains the same: we should stay well clear of s136 with drunk people unless we know from their background or the context we’re responding to that we need to have concerns about their mental health. This means (amongst other things) where someone is known to mental health services, currently or recently; where parties connected to the incident are telling you they have a history of mental health problems or where you find them hurting themselves or in suicidal state. Otherwise, safeguard that person in a different way that does not involve leaving them in a public place to freeze overnight.

Choose from letting family or friends help them; let another agency help them, if willing; use the MCA to remove them to A&E, or you could even arrest them for being drunk and incapable in a public place – just don’t leave them where you found them face down in a puddle of their own waste in the middle of winter. It’s a real shame that needs saying, isn’t it? – whether that’s to the police or to paramedics.

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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Accountable to the Law, not the NHS

On 12th November 2013, I wrote a blog entitled ‘Here We Go Again‘, following the death of a vulnerable man in Bedfordshire who we now know was called Leon Briggs. His death is subject of an ongoing criminal inquiry, more than four and half years later and that means, regardless of what happens criminally, there is still a potential disciplinary process to come, certainly followed by a Coronial hearing to establish all the issues around Mr Briggs’s unexplained and unexpected death on 4th November 2013. The full circumstances around that incident are yet to emerge and be tested and my best guess is, the legal process for that will run well in to 2019, if not the next decade.

But on 12th November 2013, I sat down in the evening to write that very general post, trying again to point out to police officers the various factors that can combine together to create conditions in which a death in police custody is more like than otherwise. The idea was to sound a reminder alarm through social media and that might prick officers’ attention. Little could I have possibly known, that on that very evening, Terry Smith came in to contact with Surrey Police and died after being detained under s136 of the Mental Health Act, restrained and removed by police vehicle to police custody. This is very broadly what we already know from news reports happened to Mr Briggs. Having written that post, it shocked me to think, only a few days later when learning of the incident in Surrey, that I’d written this so confidently –

“Let us be clear about this, yet again — another death in police custody or following contact could happen tomorrow in any area where the procedure followed by the police is not built to mitigate against unlikely but highly significant risks.  Some police forces work in areas where their MH trusts work very closely in developing proper procedures, other police forces don’t.  But the duty of care owed by every officer and by every police force, is the same irrespective of where in the country they are.”

– MentalHealthCop Blog, 12th November 2013.

And it did happen again, didn’t it? – not ‘tomorrow’, but that very evening! As I wrote the prediction it was busy happening. The death of Terry Smith, we now know, was contributed to by the neglect of Surrey Police after prolonged and excessive restraint and a serious failure in the duty of care owed. This is very sobering judgment to take in and it needs to be taken seriously by every police force in the country: without taking anything away from that verdict, it is also about a few other things that were discussed in the inquest itself that I want to highlight.

HERE WE GO AGAIN

The most tragic thing of all, is that the deaths of Terry Smith and Leon Briggs echoed other cases: Thomas Orchard died in Devon and Cornwall custody in October 2012; Toni Speck in North Yorkshire police custody in July 2011; James Herbert died in Avon and Somerset custody in June 2010; Sean Rigg died in Metropolitan Police custody in August 2008 and Michael Powell in West Midlands in 2003. Not all of these cases were legal detentions under the Mental Health Act, but they were detentions of people known or thought to be suffering mental health problems, who were then resistant to detention (probably due to fear rather than anger) and removed by a police vehicle to police custody.

And it’s an obvious point: the decision a police officer about which law they will rely upon to justify their intervention is in no way, shape or form related to the clinical needs of someone detained or how those needs are exacerbated by any restraint applied. The charity Inquest who support the families of those who die in the care of the state have repeatedly said that the accusation of which the police stand accused is not failing to learn lessons, but of repeatedly failing to learn repeated lessons – and here we go again. Since the deaths referred to so far, we have since seen others which are still at the early stages of being investigated.

In December 2017, the law on s136 changed around the use of police custody: Regulations were introduced which now define the ‘exceptional circumstances that we’ve seen police, mental health and emergency departments as well as ambulance services arguing over for so many years. And on one viewpoint, they don’t help! – the regulations state that only people who pose “an imminent risk of serious injury of death to themselves or another” may be removed to custody; and only where no NHS facility can manage that risk and when authorised by an inspector. Which inspector in their right mind is going to authorise the use of a police station for someone “at imminent risk or serious injury or death” because of a suspected mental illness?!

Hopefully none – ever! … but guess what?!

I’m wrong about that. It still happens.

INQUEST EVIDENCE

It is a matter of public record that I gave evidence at the Inquest for Terry Smith, having written a report for the Coroner who had requested a non-Surrey police expert view of the various issues. So I’ve read the various statements and other documents. There’s nothing I need to say here that you can’t glean for yourselves by reading a few things:

  • Inquest has produced a press release, including a statement from Terry’s family, which is heart wrenching to read.
  • Surrey Police has publicly responded to the verdict on their own website.
  • There is also a useful four-minute video piece from Channel Four which includes an interview with Terry’s father, Leslie.

There has been little mention of the local s136 protocol in the coverage: although I faced questions about this for almost half of the time that I gave evidence, several barristers, including the family barrister focussing upon it. The joint operating protocol that was in existence between Surrey and Borders Partnership Trust and Surrey (and Hampshire) Police in November 2013 was, in my own professional opinion, awful. And I said so in court – had Surrey Police sent a final draft copy to me for an opinion, I would have advised against signing it because it was legally, clinically and procedurally deficient – in my view. I admit to being surprised that it got through Governance in an NHS trust, not least because it managed to get the Mental Health Act wrong (on a legal point unrelated to the inquest, but suggestive of a casual level of checking).

Secondly, there is the issue about national guidance in policing, versus local policy: obviously no police should ever really have to ask themselves “In my handling of this case, should I comply with local or national guidance, given that they’re do not say the same thing?” Police forces need to ensure their procedures are compliant with national standards on s136, the Code of Practice and all the lessons which need to be learned again from cases like Terry’s.

THIS COULD HAPPEN AGAIN

So let me be completely clear about my position now that we’re in July 2018: this could happen again tomorrow because the learning is usually just done by the force affected. One can imagine Surrey Police will have had a Gold Group running on this matter and it will continue to meet to handle the fallout from the verdict. I already know that Surrey have made strides in their approach since 2013 and continue to do so – but I went on the internet an hour ago and the joint protocol on s136 between the police and the MH trust still talks about people who are ‘violent or unmanageably disruptive’ or where they are suspected to have consumed drugs or alcohol or been subject to CS spray being taken to custody. << Some of this stuff has no basis in law at all! It’s almost as if Terry didn’t die in custody at all.

Despite the law being changed last December on the use of custody, I’ve had passing conversations with middle ranking officers who head up custody for forces who have remarked about the changes, things like, “We’ve only had a few coming through, but I’m satisfied that was right because they were really violent.” But were they violent or frightened? – and on whose judgement?! If no-one has given consideration to the fact that a ‘violent’ or agitated presentation can be attributable to any number of serious medical maladies, how do we know this person is safe and fit to be detained?

It was only very recently that I got to hear again from Dr Tony Bleetman, an emergency department consultant and from Rob Cole, consultant paramedic from West Midlands Ambulance Service. The three of us present on an Advanced Paramedic Master’s course at Warwick on policing, mental health and ABD. I was sitting there again listening to Tony list the very serious medical conditions that can threaten life that are often associated with symptoms that could be ABD and just reminding myself afresh: no police officer, anywhere, is going to be able to sort this or make the clinical judgements. You need to get ABD candidates to ED, allow for rapid triage and then potentially quite severe clinical management. What that looks like is up to ED and if the do wish to turn you away, don’t move, escalate to your and their supervisors, expressing your concerns in the strongest terms. Let the bosses row it out and don’t back down from asserting this is a medical emergency until formally declared otherwise. And that person’s name goes in the record!

STRATEGIC CONTEXT

As with all NHS or healthcare professional opinion offered in the context of your legal duties should be considered as ‘intelligence’. It may need further developing or corroboration, it may be as sound as a pound. Forces obviously carry a huge responsibility here to ensure that whatever local procedures they are signing up to, are checked. I don’t know whether Surrey Police legal services signed off the s136 protocol that got the MHA wrong, but I’m hoping they didn’t, because by missing that very basic legal error, it would cast doubt on what else they may have missed.

We know today, that some NHS organisations still dispute and argue about the term ‘acute behavioural disturbance’ and ‘excited delirium’. No – those terms are NOT in the medical manuals classifying mental disorder – manuals like ICD-10 from the World Health Organisation; and DSM5 from the American Psychiatric Association. That said, there are a number of legal rulings, of which Terry Smith’s is just the latest, where Coroner’s, having heard medical evidence including the disputes, have ruled caused death. Add to that three documents all duty supervisors need to know about if we must police alongside organisations who may not provide care in a way that complements the legal reality of our work –

All of these publications have come out since various deaths mentioned here and represent serious authority for the proposition that ABD is a thing or a cluster of things that amount to a life-threatening medical emergency. I know, because I’ve tested this theory, that not all ambulance service or ED staff know about these documents. You may have to explain it to them.

GET IT RIGHT

Following use of s136 MHA where someone is presenting challenging behaviour, probably because they’re already half frightened to death by an experience that even before the police has turned up has got them in a compromised medical state, you do this and you do it every, single time regardless of advice to the contrary –

  • Arrest – make your ‘arrest’ under s136 (or your re-detention under s18 or anything that commences a detention of a person thought to be mentally ill.
  • Ambulance – call an ambulance every single time. Whether they come and how quickly is up to them, you then make your conveyance decision based on their response.
  • Assessment – make an assessment of any critical conditions, sometimes known as ‘RED FLAGS’ which may require ED care before anything else: this will include ABD or anything involving highly agitated, challenging behaviour, especially where prolonged or where restraint is required and ongoing.
  • RED FLAG = ED – remove anyone presenting with a ‘RED FLAG’ to the nearest Emergency Department, preferably by ambulance but if they can’t or won’t play: do it yourself ASAP.
  • NO FLAGS = MH – remove anyone not presenting a ‘RED FLAG’ to the identified Place of Safety for MHA detentions in your area.
  • Escalate – to your sergeant or inspector if you experienced any problems in proceeding through those five steps. Let the bosses take up the dispute and you focus on de-escalating, restraint reduction and the person you’re caring for.

Therefore, if I may end with something of a rallying cry: I couldn’t give a toss what a particular ambulance service or any Emergency Department thinks about the concept of ABD; what they do or don’t recognise as a medical term or whether they believe they are a place of safety under the Mental Health Act. They don’t have to be legally accountable for your decisions and it’s easy to deflect officers with limited training in other directions. People have died because these debates and individual professionals’ or organisations’ opinions have been allowed to influence local policies away from national standards; creating an entirely unjustifiable ambiguity about what is required. In actual fact, this stuff has been crystal clear since the NPIA guidance on mental health in 2010 which made it clear that ABD or excited delirium was a medical emergency and it should be remembered: that guidance document was overtly badged and supported by the Department of Health – it wasn’t just police guidance, it was formally declared consistent with DH guidance and I personally flogged around the country in late 2010/2011 running seminars for all police forces on those new guidelines and they have only since been strengthened in College of Policing APP, partly because of the obvious immediate learning from these cases and because of those three clinical documents, above.

We have no absolutely excuse – and this is will happen again if only Surrey Police learn from this. We all need to learn from this and that doesn’t just mean the police.

This is at least partly about why NHS organisations write and put forward policies which contradict their own national standards. I’m afraid this is widespread, having seen meetings where I’ve watched some NHS managers scream down senior police officers for daring to suggest that we need to remember the whatever we do: it must comply with the law.  Remember the narrative we normally hear on the news whenever they’re describing initiatives like street triage or liaison and diversion is “Here are the highly trained experts to help the [poorly trained] officers”.  I’ve never been sure how it ‘helps’ when local NHS preference or practice deviates from national clinical and legal standards.  Irrespective, the final point is this –

As police officers we are accountable to the law, not to the NHS.

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

Winner of the Mind Digital Media Award.

Exacerbating Tensions

I’ve had to ask myself recently whether I’m guilty of potentially exacerbating tensions or conflict between the police and mental health services, after a number of suggestions on social media and elsewhere that this is the effect of what I am doing. It didn’t take long to work out that this is precisely what I am deliberately doing, on just some occasions. I would argue this is of necessity, other options being unavailable or unacceptable. In addition to thinking that the management of mental health demand cannot just be about what the mental health system thinks the police should do, I have also come to believe very profoundly, the key to determining the role of the police lies in the rights, protections and views of those of us who live with mental health problems. And somewhere in there, even without us considering the roles and realities of policing, lies tension.

I have always listened very keenly to a number of mental health professionals who have helped me over the years, people to whom I will be indebted for all the coffees and beers shared and the books loaned and read; and incidentally, it’s clear that front-line mental health professionals also see difficulties, tensions and conflicts on a daily basis, whether or not it’s something that involves the police. But I am really clear that most of what I’ve learned about mental health and policing I got from talking, often at length, to those of us who have lived the system – that and actually reading the Mental Health Act 1983, the Mental Capacity Act 2005 and the Human Rights Act 1998.

It makes you realise there is conflict there already and it needs resolving, if possible – or managing, if not. When conflict borne of disagreement or ambiguity exists between two different professionals or organisations, you have just two choices about your reaction. You can stand your ground and hold your position, or you can compromise. But here’s the rub for me and for the police: we cannot compromise on certain things – and THIS is where suggestions arise that I have ‘exacerbated tensions’. I would and will here argue, that it is my legal duty to do so and that I have always thought this because of the Oath of Office swore when attested in 1998. And this is why we sometimes see other police officers, including very senior police officers, doing the same thing.

Let me tell you why, for those who are worried about my approach –

CONFLICT ZONE

Early on in my career and repeatedly since then, it was obvious to me that by doing as told or by ‘the system’, I could on just some occasions risk jail, the sack or be killed. This all sounds very dramatic, doesn’t it? – it’s not intended to be falsely so – like several others, I have had the experience of being under criminal and gross misconduct investigation, overseen by the Independent Police Complaints Commission (now the IOPC), for doing my job as well as I could after a man died following my contact with him. And like those other officers, I believe my officers and I were just trying our damnedest to get him out of the situation alive. Our efforts didn’t prevail, albeit not just for reasons to do with us and I will remember his screams until the day I die when he set himself on fire right in front of us.

This is intended to convey the reality of what we deal with and how I see some (but I stress again, not all) operational police work to which we often send junior police constables with a few years’ service at most. The examples of this kind of stuff are included all over this BLOG and are in the news for all to see. There are yet more cases under investigation and within the Coroner’s Courts of the country as I type this, highlighting this again and again. One of the most precious bits of feedback I ever had from a frontline police officer followed me interrupting his willingness to do what an AMHP wanted them to do. The officer, a really keen young lad, admitted to me that he had told his partner that night, “The fucking boss has gone off on one AGAIN about fucking warrants and mental health – let’s just get in there and get this sorted!!” Suffice to say at the end of the shift when he was kind enough to admit this because he wanted to add, “But if you’d let me, I’d probably be dead now. So cheers.”

There is conflict and tension inherent in this business – it was there before I joined the police and it continues to this day. It needs addressing in some way because ignoring it is not an option, but here’s the thing: when there is a disagreement between two people or two organisations and you cannot find a way to compromise that is acceptable to all, you are forced to a decision. Do you set aside your concerns and queries and do as the other party would wish, or do you …. not do that? I know that in the last twelve months I have been called to appear in Coroner’s Court four times as an expert witness (and there are other legal proceedings pending for other cases), where these issues are at the forefront: why did the police just do as locally expected, why didn’t they push back in accordance with national standards?

CONFLICT RESOLUTION

A difference of position or opinion between professionals or their organisations may have various things underpinning it. But in my experience it is most usually a clinical or legal issue – if I wanted you to do something which breaks the law or puts someone’s safety at serious risk, you are obliged to decide: will you be doing as expected or are you going to resist? You may well wonder about the context and the risks versus benefits: if this request were me telling you to drive the wrong way up a motorway entry slip because I had established a controlled way doing this to help you escape a massive queue caused by a serious collision that will close the road for most of the day, you’re going to set aside the law prohibiting this manoeuvre because a police officer told you to do it. If I ask you to unlawfully and inappropriately sedate patient who won’t “calm down” or ‘section’ someone because “it would be better that way” you’re going to say “No way!” or something similarly blunt.

Real example, presently apposite if you use Twitter to follow what’s going on: if someone needs to be ‘sectioned’ but there’s no bed available and the timescales have run out so detention is now unlawful under domestic and international law. Do the police just continue to sit there, unlawfully holding people, saying nothing and getting on with doing as they’re told? Or do they start potentially exacerbating these tensions by escalating to senior managers, agitating for a solution, or even considering legal action, which has been known? We know that some senior officers have gone public about these matters and one can only imagine what senior NHS managers thought of it but no one should doubt that such situations are at least one kind of human rights violation, if not more than one. Senior police officers are bound by s6 of the Human Rights Act 1998 – as are all police and mental health professionals.

What we do know from history is, if the police don’t escalate, agitate and consider all their options, delays can continue for days and days; and if they choose to start pushing back against the assumption they should just help out by acting unlawfully, solutions are often found shortly after the escalations are assertive enough. No-one wants to work like this, do they?! – I’m sure we’d all say we want to work in partnership and work collaboratively and jointly make the world a better place. But the opposite of a world where the police service now know nearly-enough about the clinical risks, legal threats and other risks because of a decade of to understand reality is not a world where things are naturally collaborative and tension free.

CONFLICT MANAGEMENT

There was conflict in this entire agenda before I joined the police. I merely walked in to it in 1998 wondering how it can be police officers can find themselves under criminal investigation because they tried their best to handle a situation where the over-arching infrastructure and policy framework, not to mentioning the legal and other training, was woefully inadequate? I could also see tensions within the NHS from the start: are there many NHS professionals who don’t think that they could do with more staffing, more services and facilities and that the absence of them doesn’t, on at least some occasions, lead to requests for police support that should not be necessary and they’d prefer not to ask for?

Here’s the reason my approach could quite reasonably be accused of being conflict based: I don’t look at mental demand on the police from a clinical point of view. I take the view that people’s health is a matter for them up until the point where the state must intervene to keep them safe or until they break the law. That’s my threshold for getting directly involved. More than happy, following any contacts I have where someone may have health or social issues that have not put them at direct risk or on the wrong side of the law, to suggest things that may help them and signpost or refer accordingly. But how people live their lives is a matter for them.

My own view over the last decade is, that the we’re trying to fix the wrong problems and in so doing, the solutions we’ve come up with to the problems we think we have are more resource intensive on the police than the real problems we should have been trying to fix. So as things stand, I see my role at least in part, to slow down the acceleration of the problems we’re perpetuating because we mis-focussed in the first place. So conflict management is necessary, because conflict resolution doesn’t seem possible for as long as all services are doing more with less and in objective agreement that all our systems are under significant pressure.

CONFLICT MINIMISATION

You can’t ask me to break the law or risk people’s safety and then object that any resistance is exacerbating tensions, because I’m just going to point you to s6 of the Human Rights Act and remind you I’m a police officer. I’m not on anyone’s side. You can’t object that I’m planning for how best to handle those situations either, by raising difficult discussions about things that should not and cannot be compromised because such discussion is about effecting change demanded by law.  That’s about seeking conflict resolution and, if that’s not possible, conflict minimisation. And in any event, “we were told to do it like this” just doesn’t wash in Coroner’s Courts.

I’m very motivated around this stuff and have spent the best part of fifteen years trying to understand all perspectives on this – I remain willing to learn: but having deliberately driven my career in a certain direction to be able to focus on it, I am actually fighting for something here – and this should only represent any kind of challenge to those who would over-use the police in a way that makes things worse or have them assist in undermining the law.  It’s outlined in something like 750 posts on this BLOG written over the last seven years: I couldn’t have been clearer about what that is – the right of the public to take their own healthcare and wellbeing decisions; and the protection of front-line police officers from risks and liabilities that may cost them their jobs, or more.

I look at this from a legal point view, not least because it’s what I largely think is missing in our approach to mental health matters. So I’ll end this, by re-affirming that Oath I took over twenty years ago, by way of illustrating precisely where I’m coming from. (The bold emphasis is mine.) –

“I do solemnly and sincerely declare and affirm that I will well and truly serve the Queen in the office of constable, with fairness, integrity, diligence and impartiality, upholding fundamental human rights and according equal respect to all people; and that I will, to the best of my power, cause the peace to be kept and preserved and prevent all offences against people and property; and that while I continue to hold the said office I will to the best of my skill and knowledge discharge all the duties thereof faithfully according to law.”

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

Winner of the Mind Digital Media Award.