For some while, it has been suggested that the police service need to define what they mean by an incident being ‘mental health related’. You know those claims you’ve heard may times about how X percent of police demand or police time is connected to mental health related jobs? … well, it’s always been true that we’ve never been entirely consistent or sure of what we’re counting.

When I first ventured the 20% figure on this BLOG many years ago, I knew what I was counting: I’d been keeping tallies as a response inspector of things going on whilst I was at work and would often take a snapshot of –

• Detainees in custody flagged as having a mental health condition, or a warning marker for suicide or self-harm.
• What percentage of people who are currently reported missing are absent from mental health care or whilst suspected to be at risk of their mental state?
• Of all the 999 and 101 calls that land in a snapshot period (usually one or two hours), what percentage were in some what ‘mental health related’.

I...

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Today the College of Paramedics produced their position statement on Acute Behavioural Disturbance and it adds weigh to those tomes I’ve previously pushed as authorities or resources on the subject. ABD continues to be a subject of debate, arising recently in another post I did during a pre-inquest hearing in Bournemouth in to the death of Mr Douglas Oak who was 35yrs old. In that matter, Dorset Police called for support from South West Ambulance Service after believing Mr Oak was suffering from ABD and the subsequent issues with ambulance attendance have led to a comparatively rare direction from the Coroner who is inquiring in to Mr Oak’s death at a young age.

Bearing in mind a full inquest is yet to occur and not scheduled to take place until 2019, the Coroner gave the ambulance service two weeks to produce more material on ABD and their policy or response to it, and suggested that unless she was satisfied she may issue a preventing future deaths report prior to the full inquest occurring. I’m not sure I’ve ever known that happen before,...

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Have you ever been given a piece of work to do or faced some decision in your life where no matter what you do, you’ll be criticised? More than that: the vast majority of people will look at your decision and either criticise or comment that things could have been done differently?!

I’ve spent many hours this year, especially over the Summer, in various meetings associated with the Mental Health Act review. In particular, I was recently in the Advisory Group to the Review, chaired by Professor Sir Simon Wessely, past President of the Royal College of Psychiatrists and Regious Professor of Psychological Medicine at King’s College, London. Whilst there, whilst listening to various people talking about the sensitive and important issues which may feature in the report the Professor must submit to the Prime Minister, two things ocurred to me:

• Because of my general effort to blog a bit less often during 2018 than I did in 2017, I have managed to say precisely nothing on here about the review – and I should correct that as soon as...
  
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We don’t have enough inpatient mental health beds in this country – but I might be very wrong about this, though! It is my opinion, that when we take account of the capacity and capability of the community, crisis and social care which is currently available, we don’t have enough beds. Solve that by increasing the community and crisis care by all means, so that there are alternative services for people who don’t inherently need admission, but who need more or different support as an alternative to admission; increase social care by all means so that people currently in hospital who are medically fit for discharge from hospital can actually be discharged in circumstances where their housing, substance use, education or employment needs have adequate support to help them lead independent lives in the community.

But my underlying point is: the balance is not right and it is perhaps we, in the police service, who see this most obviously when patients need beds after a statutory Mental Health Act assessment. Although AMHPs are...

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I haven’t blogged for almost two months!  Various reasons – busy, on holiday, bored of saying the same thing over and over again … there are a few in the pipeline but I decided to put them all to one side to write this one, because the story animated me.   It concerns the concept of Acute Behavioural Disturbance, or ABD – it’s sometimes referred to as ‘acute behavioural disorder’, but the ‘disorder’ word tends to send certain doctors in to an intractable debate because of the lack of research around the concept and the fact that ABD is not recognised in the main medical manuals as a ‘disorder’, implying a greater level of medical certainty about cause and effect. All this has led the ambulance service to be in a bit of a state about it where some refuse to recognise the term and others are all over this issue like a rash.

The wider debate around ABD has been going on for years, albeit conducted under another name. Some of you may be more familiar with the term ‘excited delirium’ and any distinction between...

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On August 3rd 2018, Kaylsey Smithen was convicted of the manslaughter of his 46yr old mother, Janice, which took place in Birmingham more than six years earlier. This short post is a little bit of speculation on my part, based only on media reports of the legal process, but which seeks to outline why such a delay can occur and challenge again assumptions that professionals might make about serious mental illness being a barrier to criminal prosecution.

You may remember this case if you follow me on Twitter: at the start of 2018, Birmingham and Solihull Mental Health Trust apologised to Mrs Smithen’s family for the standard of care he received prior to her killing. There was some debate arising from the Safeguarding Adults Review about whether the police should have been called to a Mental Health Act assessment and / or whether the police were at fault.

Following his arrest for murder in 2012, shortly after his mother’s body was discovered by the police, he was detained under the Mental Health Act (MHA), having been diagnosed with...

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The recent conclusion of an inquest in to the death in 2016 of Mr Luke Leggatt in Canterbury has given rise to a social media debate amongst police officers about the East Kent Hospitals NHS Foundation Trust’s reaction to Coroner’s process. Mr Leggatt had been taken to the hospital by his brother after taking cocaine and having resisted assessment or any treatment for this, had left the hospital. The police were not called when he walked out and he  tragically died of a heart attack, caused by a fatal level of cocaine toxicity.  Faced with an obvious degree of criticism, the East Kent Hospitals spokesperson announced that they have changed their policy on patients who walk out of A&E to make sure that every such patient is subject to a ‘safeguarding call’ to the police irrespective of any assessment of ongoing risk to that person.

Job done – over to the police.  Settles everything, doesn’t it?  I have at least few dozen questions and observations about this, not least because of how it appears to have been done.

Whilst missing...

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A curious thing appeared on the internet recently: a preventing future deaths report from the Warwickshire Coroner, which has been sent to the Chief Executive of Birmingham and Solihull’s Mental Health Trust (BSMHfT). It follows the death of a man by suicide, thirteen days after the BSMHfT street triage (ST) scheme had contacted with a man who ended his own life in a hotel. No details were given about why the contact with ST occured in the first place, but we know from the PFD report that it was contact by telephone. Amongst other concerns the Coroner had about record keeping by ST (there was none), point 5 on the PFD leapt off the page at me when I first read this.

• 5) The purpose of the telephone triage was unclear – it was described as not being a mental health assessment … so what was it, then?!

And if it wasn’t a mental health assessment, what does it mean, if anything, for police officers who have ST schemes across the country where they become involved in police incidents because they believe the person needs MH assessment, often as...

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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...

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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’...

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