Seni’s Law

Earlier this month, Steve Reed MP, introduced a private member’s bill to the House of Commons which is being informally referred to as Seni’s Law – the Mental Health Units (Use of Force) Bill 2017. This follows the death in 2010, of Olaseni Lewis in a hospital in south London – an incident to which the police were called and which involved restraint. Mr Reed is the local MP for Seni Lewis’s parents who have campaigned for justice since this tragic incident and the publication of a PMB in Parliament brings the possibility of legal changes which may assist in protecting individuals whilst they are detained in hospitals under the Mental Health Act 1983.

The Bill has received support in principle across the political spectrum so it’s extremely likely that a version of this Bill will become law in England at some point next year. (It will not affect the other three countries of the UK because health issues are devolved in those jurisdictions).

NHS ACCOUNTABILITY

The Bill is largely not about the police, I am very pleased to say. It is mostly about the NHS having proper systems in place to govern the use of restrictive practices, esp physically restrictive practices like restraint, and that such matters are properly recorded, reported and analysed at both local and national level. For example, there would be a requirement for the Secretary of State to produce a report in connection with the data that would be gathered by law. This for me represents the multi-factorial explanation that the Inquest jury returned in connection with Seni’s death: see my post from the time of the inquest for more detail on that.

My own view is that this law is largely welcome: at various times over the last few years, it has become obvious to me that the scrutiny of our NHS around use of physical force and coercion is at odds with how we hold police, prisons and other arenas of detention to account. The Bill would also call for an independent investigation of certain types of death in the NHS and this is something I’ve suggested should occur for some while. I fully understand that many of the deaths which occur in our NHS where patients are detained against their will are largely deaths caused by natural causes – for example, an elderly patient with dementia who dies primarily as a result of conditions associated with old age and which are nothing to do with the detention of the state. But when a teenager dies in NHS care, unexpectedly and in unexplained circumstances, the approach needs to reflect modern standards we impose upon other agencies who detain and coerce people.

I recently attended the book launch in London for Sara Ryan’s absorbing book which outlines her compelling campaign to secure justice for her son, Connor Sparrowhawk. Connor died in an Oxfordshire learning disabilities unit, contributed to by neglect and at the book launch I was also most fascinated to hear from the family’s barrister, Caoilfhionn Gallagher QC, who argued that were it not for Sara and her family, there would probably not have been any kind of investigation. Part of the ‘Justice for Laughing Boy’ campaign was to highlight how much difference there is in the state’s response to unexplained or unexpected deaths in NHS care, when compared to what occurs in police or prison custody. We may have concerns and questions about the IPCC, but at least they exist to be criticised and challenged. The police weren’t even called to Connor’s death, not withstanding that it was initially unexplained and unexpected.

BODY WORN VIDEO

The main ‘police’ element of this Bill bears some explaining because I want to gather views around it – especially from those with experience of being detained in mental health units. One clause creates a strict requirement that any officer called to a mental health unit for any reason should be wearing body worn video from the point they are called to attend. This is obviously about accountability where the police are called and things have gone awry and presumably is about giving effect to the theory that officer behaviour is modified where the officers know they’re on camera, but for me it raises some further, more interesting questions.

Inpatient settings are supposedly places of sanctuary for those of us with mental health issues when we are at our most vulnerable – we don’t, to my knowledge, routinely have CCTV cameras giving full coverage on MH wards because of the argument that it violates patient privacy principles, but by arguing for body-worn-video on officers, we seem to want such cameras brought in when the police attend. So —

  • How do patients feel about the idea that they or other patients would be filmed in incidents when the police attend?
  • How much consultation has there been with service users about this new law?
  • Why does the Bill only seek to hold the police to account by ensuring their actions are videod? – it doesn’t seek to hold NHS staff to account around whatever may have occurred before the police turn up.

Surely an independent investigation in to a death in NHS care (whether or not the police were involved) would only benefit from CCTV? – I’ve been wondering why the Bill wants the police videod but not NHS nurses who restrain patients. Think about the cases of Rocky Bennett (1998) or more recently Joseph Phuong (2016) to consider NHS restraint related deaths that would not have been caught on body worn video because the police were not involved at the point where clinical staff were restraining patients. Is it any more or less controversial or in need of close scrutiny that someone who died in the custody of the state died following restraint by nurses or by police officers?  I admit to not understanding the difference – at all.

Let me know any thoughts you have, in the comments below – there’s more to it than I’ve covered here, but my time is limited at the moment. Apart from anything else, the NPCC are being asked questions about practical matters of implementation so your views could be represented in the replies given by the Boss if you let us know what they are!

RESOURCES


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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PaCA – The ‘What If’ Questions

This blog is part of the series which will cover, in detail, the amendments to the Mental Health Act 1983 within the Policing and Crime Act 2017. This post is one of several which relates not the amendments themselves, but to the implications arising from them.

For background to the series, see the introductory post which outlines why I’m doing this and what other specific issues will be covered concerning laws that will come in to effect in the next few months. We now know the changes will take place on 11th December 2017.


We now know we are staring down the barrel of the Policing and Crime Act amendments to the Mental Health Act 1983 – they are just four weeks away, as of today. In the last week, I’ve had numerous phone calls from forces and emails from officers asking ‘what if’ type questions … basically, asking what the operational answers will be to situations we all hope won’t emerge, but which history suggests are quite likely. Not all of these problems will emerge in every area, so I’m not predicting that everything will grind to a halt, but I would suggest most of these problems are likely to occur in at least one part of the country OR are likely to occur as an occasional problem in areas where things usually work well.

This post can be added to in the future, because I’ve started off with just those questions I’ve received so far and a few I’ve thought of just during a train journey to London! There may well be others and no doubt some I haven’t though of at all … fire them and we can all get thinking. This post is just to get us to start that process of us thinking about a potential Plan B, for those occasions where Plan A just isn’t possible, for whatever reason —

  • What if there is no-one to consult with prior to using s136 MHA?
  • Then it is not practicable, so you crack on without doing so. You are not obliged to scour the NHS for any old Doctor or nurse, AMHP or paramedic, to run a scenario past them which will likely lead to them wondering why you’re boring them with the story at all! If you areas has a so-called ‘street triage’ service, or an established method by which to consult, fine – you must use it where practicable. If not, just crack on officer.
  • What if the person consulted believes s136 MHA should not be used?
  • The legal power under s136 is for constables and for no-one else – this point is emphasised not to dismiss the views of others, who may have information and valid reasons for advising a particular course of action. However, that is just one piece of information or opinion the officer must take in to account when forming a view to detain. Nothing prevents a police officer listening to any view offered, from the consulted professional or from any family members present, and then taking the action they think they must.
  • What happens if our area has nowhere identified for under 18s to go as a Place of Safety or if the identified location is unwilling or unable to receive a particular child?
  • The only remaining option which will definitely exist in every area is the Emergency Department in the acute hospital. Nothing in law prevents an officer asking ED to act as a Place of Safety for a child, where no other provision exists or where that provision is un
  • The only other alternative is to ‘improvise’ – and this will need careful thought.
  • You cannot use a police station at all for someone under s18yrs of age – this is not just a ban on the use of custody, it is a ban on police stations, including front office interview rooms, the rooms some stations have for vulnerable victims or the TV / rest room. All banned because they form part of the police station.
  • What if the Place of Safety is full and the person detained does not require treatment in the Emergency Department?
  • Historically, police custody was used for many people who did not require ED treatment where the NHS Place of Safety was full with others detained under s136. This is now not lawful, because of the restrictions imposed on these use of Police Stations as a Place of Safety.
  • If the so-called ‘designated’ Place of Safety is unable, unwilling to receive the person and the grounds for using the police station are not met, then you have to find another solution. Nothing in law prevents a police officer asking ED to consider allowing the person to be assessed in the ED. It’s not ideal – but nor is it unlawful, as long as ED agree to this action.
  • Should they choose not to do so (there is no obligation upon them to do so), then officers must consider improvising, as outlined in the previous answer: could that person be taken home or to a family member’s or friend’s home? If all avenues are exhausted, it may be a case of making it known to the MH PoS and / or ED, that there are no viable options and the person will have to remain in a police vehicle until such time as they can be received.
  • What if the NHS disagree with the inspector not authorising the use of a police station and are refusing to allow access for someone they think should be taken to custody?
  • The inspector’s authority is required, by law – no authority given, no using police stations for that person.
  • Of course, the police and NHS should be discussing things, communicating and exchanging information and concerns to allow a swift pathway to be identified that all are happy with. Things to consider, include –
  • Are the NHS pushing for a police station because they have genuine fears about their ability to manage challenging behaviour in someone who is agitated and distressed? – perhaps the inspector or sergeant having a word and committing to police officers remaining in the NHS Place of Safety would suffice to overcome that fear?
  • What if the grounds for searching someone are not met but the Place of Safety insist upon a search?
  • It is worth explaining that under s32 PACE (search upon arrest) and the new s136C MHA (search after detention under ss135/6) that it is not a blanket power of search, that each search must be justified and that the grounds for doing it are far higher than speculation or suspicion someone is carrying an item.
  • All searches under either provision require ‘reasonable grounds to believe’ the person is carrying an item for one of the purposes specified – this means you need to be 7 or 8 out of 10 certain you’ll find whatever you think you’re looking for.
  • What if the 24hrs runs out whilst the NHS are still looking for a bed?
  • The person must, by law, by released from detention if no MHA application has been made which allows further detention. As most of these situation will occur in an NHS Place of Safety, I would make sure I was telling the sergeant or inspector when we hit these milestones: 12hrs, 18hrs, 21hrs, 22hrs, 23hrs, 24hrs and seeking their support for a contingency plan!
  • Sergeant / Inspectors: I’d be escalating to NHS managers from 18hrs onwards and making sure they realise they cannot rely upon the police to be involved in ongoing detention after 24hrs; that the situation of ‘no beds’ shouldn’t emerge; they should look at s140 MHA and s13 MHA in this context and remember that detention beyond 24hrs could violate Article 5 of the ECHR. Press for urgent resolution and escalation by them to CCG on-call directors around beds, etc..
  • This is all subject to the 24hrs limit unless it was extended up to 36hrs under s136B – if an extension has been authorised, then detention may continue until then, when the same considerations will apply.

These are jut some of the ‘what if’ questions: if you have others, please leave them in a comment, below and I’ll answer them if I can by adding to this post. It’s clear just from paying attention on social media that all areas are not going to get this right all of the time from 11th December. Some areas have particular issues (like where to take children) and others may just have occasional capacity problems. Given the restrictions under the ‘old’ system will almost completely vanish, identification of a Plan B and the knowledge required to activate and navigate through it, will be crucial.

This stuff isn’t going to be hard in theory: it’s going to be hard in practice so take the time in advanced of December 11th to get your head round both Plans!


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

Winner of the Mind Digital Media Award.


Inspector to Inspector

I’ve been a police inspector for most of my service – about fifteen of my twenty years so far. Regardless of what happens to me in the future, I will retire from the service having spent more time at this rank than any other. And what a position it is! – it’s an operational enough rank to mean you can still do real police work and see the raw humanity in to which policing offers the most amazing and privileged insight. And it is the most Romantic rank of all – most of the policing heroes we idolise from television and literature, like Frost, Rebus, Gently and Morse were inspectors.  Actually Morse was a Chief Inspector, but you’ll notice he didn’t always tell people about that.  He knew …

The Inspectors’ Central Committee (as it was then called) of the Police Federation of England and Wales were kind enough in 2014 to recognise efforts I’ve made over the years to try to help around policing and mental health: of the various recognitions I’ve had for banging on, that one’s just a bit special because it’s from those I’ve served alongside and who do what I’ve done night after night, weekend after weekend and Christmas after Christmas. We’re usually the sole operational police leader for large areas, sometimes overseeing hundreds of officers and likely to take many of the early big decisions for the largest or most sensitive events in all operational policing.  And so this post is written specifically for the inspectors and the inspectors alone – to help you navigate what will soon become one of the gravest responsibilities carried by our rank and on which much political attention has been focussed.

We’ve been invested with sole responsibility for what I consider to be the single most contentious decision of all, in the Mental Health Act amendments: we will be the sole guardians of the decision about whether police stations should be used as a Place of Safety under the Act and only for those most in need and potentially at the gravest risk. This is the stuff of seminal reports for years gone by: the Equality and Human Rights Commission, the Angiolini Report, the Adebowale Report, the Bradley Review, the Home Affairs Committee report, multiple CQC, HMIC and IPCC reports as well as Coroner’s Inquests and Regulation 28 ‘Preventing Future Deaths’ reports … ALL have touched on this point and it has been the stuff of debate at the very highest levels for the last five years or more.  We – the Police Inspectors of England and Wales – are the safeguard against human rights abuses under the MHA and deaths in police custody in the most time critical circumstances. This could appear a somewhat daunting responsibility(!) but it’s also an immense privilege which I know we can discharge with common sense and compassion to lead police officers and the public. This post doesn’t highlight much that’s new: it just brings existing guidelines together in the context of this new legal authority for our rank and I admit I don’t see this as needing a four-hour training package: we already know most of what will follow in this post.

POLICE STATIONS

Once the Act is amended on 11th December, any decision to use a police station as a Place of Safety requires an inspector’s authority and I think it will be fair to predict that when this call is required, there could well be objections and concerns no matter what we do or why. The decision itself will only be the beginning of our involvement in an incident that may absorb us in to subsequent discussions, concerns or even complaints. I suspect our partner organisations are going to want to speak to us to challenge some of our decisions not to authorise removal to a police station; we may also find custody sergeants fancy a ‘quick word’ with the boss where authority has been given, but where the custody sergeant disagree with it. I suspect a few of us will also find a statement to resolve, where we are not content to authorise the use of a police station but where mental health partners are also struggling to agree to allow an NHS facility to be used.

There is a lot invested in this decision: the IPCC will be very interested, I suspect, in the rationale for a police station being used or not used, in the event of an adverse incident; partners will question the insight the inspector has to the consequences of their decision where they have declined to authorise it and want to persuade some of us to change our minds. And if we don’t, it may well beg immediate questions for how much we are going to ensure the safety of the patient, the NHS staff and the detaining officers by ensuring sufficient resources are made available for the consequences of the decision.

Firstly, a quick reminder about the decision we have to take: under the Mental Health Act (Place of Safety) Regulations 2017, a police station may only be used as a Place of Safety in exceptional circumstances.  This means –

  • The detaining officer reasonably considers that the person’s behaviour poses an imminent risk of serious injury or death, to themselves or another
  • No NHS place of safety in the force area could reasonable handle the risk posed by the detainee
  • YOU have authorised the use of custody, against those criteria.

So you need to be satisfied that the detaining officer is giving you information that says the person poses such a risk. You must then ask yourself what that risk could signify – it will not just be risk of assault to the officers or the wider public, it may also be a presentation that is because of an underlying medical issue or a presentation which gives rise for the need for restraint, which in itself can prove fatal.

URGENT CHECKLIST

  • Your first considerations must be – have we called an ambulance to this. If not, why not? – do it.
  • Does the detaining officers have enough support from colleagues to manage that scene? If not, can we get more officers up there?
  • I’d be directing a sergeant get involved very closely, if there isn’t one already – this incident could go to anywhere yet, I want a first-line supervisor all over it like a rash whilst focusing on nothing else, if at all possible.
  • What is the ‘clinical assessment’ of RED FLAGS – best done by the paramedic, of course; but if they’re not coming or will take too long, it will have to be the cops present to make that call on the basis of their first-aid certificate and personal safety training.

If we have someone whose behaviour is giving rise to the need for a high-intensity or protracted restraint and de-escalation has failed before restraint and following it, we need to think about whether this is a medical emergency. Some highly resistant, agitated presentations can be attributable to underlying medical problems, to the use or abuse of drugs or alcohol and in some cases latent risks can be exacerbated by the use of restrictive practices like restraint. This stuff is documented in many of the inquiry reports mentioned above. This has been repeated most recently in the Angiolini Report and there are medical guidelines and documents which pertain to this, also.

For what it’s worth, this is what I’d be thinking: no-one goes to police custody unless someone in the NHS has confirmed to me or my officers that the person concerned does NOT require medical assessment in an ED. If they want to put their professional registration to that decision based on watching the police detain someone at a scene or outside an ED, then fair enough.  Then – and only then! – will I begin to think about it.

RESOURCES YOU NEED

I’d recommend saving this post on a device you carry with you at work, just in case you get in to real difficulties with discussions and you need to pull out the references for why you’re arguing what you’re arguing —

There are some big words and complicated ideas in that lot – probably best that cops aren’t trying to disentangle this stuff and sort it out, until we know people are going to be safe. My thinking is unable to take me very much further than this: high intensity or protracted restraint = Emergency department unless some paramedic is putting their name to a decision that this course of action isn’t necessary.  They should batting in accordance with all of the above guidance so if they’re trying to argue it: ask them.  “The NICE Guidelines on Violence, the NHS England stuff on post-restraint obs: you’re saying this person doesn’t need attention in an Emergency Department and are safe without clinical supervision from now on?!”

And remember this: your decision to authorise the use of a police station is not the same thing as the custody sergeant’s decision to authorise detention in custody. All that stuff in PACE Code C stuff that we remember from when we were custody sergeants and which we consider when acting as Review Officer then kicks in: does this person require clinical attention? – if so, can they receive it from the custody healthcare staff and if not, call an ambulance or transfer them to hospital. We are trying to ensure the person may be removed to the police station, both legal and medical grounds; the custody sergeant must ensure the person may remain there, on both legal and medical grounds. These two things are quite different, because people can deteriorate in custody, especially after restraint – see the NHS England PSA, above.

So, ask yourself this – how can we tell in the street that someone who is busy resisting or even fighting the police whilst in an acute mental health crisis is not suffering from ABD or any of the various underlying medical problems we’ve known in the past, like serotonin syndrome? Answer honestly: do you even know what that is? – and if you’d heard of it, did you know it’s a rapid on-set potentially fatal condition that requires urgent treatment in ED?! I didn’t until a couple of years ago – and had to look it all up after reading the outcome of a death-in-police custody inquest. And obviously: brief your officers on all of this, so they know what your reaction is likely to be – share the resources with them, if that helps.

Thanks to @NathanConstable for reading this one and ensuring what I’m trying to say lands cleanly!


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

Winner of the Mind Digital Media Award.