The Mental Capacity Act continues to consume a number of the queries I receive about policing and mental health.  The point of this post is not to repeat the content of those I’ve already written, but just to highlight the ongoing issues which form my focus when I listen to the questions coming on social media.  You can read the previous posts I’ve written in the paramedic series of blogs (which, of itself, tells you that many of these situations involve the police’s interface with the ambulance service) and of course, the Quick Guide on the MCA.  It’s worth bearing in mind also, the Mental Capacity (Amendment) Act 2019 will take effect at some point and this will provide far more words within section 4B of the Act, which you’ll see shortly, is key to many of the problems we continue to see.

I want to emphasise three things here, above what I’ve written before –

• The balance of probabilities
• The least restrictive principle
• ‘Restraint’ versus a ‘deprivation of liberty’.

THE BALANCE OF PROBABILITIES

I may, later today,...

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A short post, to address a question that has come to me a number of times over the years and when it recently re-emerged I ended up double-checking this was covered on the BLOG, but found I hadn’t done a specific post on it.  Such references as there were seemed a little buried within other posts could be hard be hard to find, as such, the question for us to clear up here is whether a patient who is ‘absent without leave’ (AWOL) from detention in hospital under the Mental Health Act 1983 (MHA) is considered ‘unlawfully at large’ for the purposes of the police forcing entry to private premises.

A couple of points of background before I explain why the answer is “Yes – they are unlawfully at large” —

A police officer is permitted in law to force entry to a premises in a number of legal circumstances, for example, in order to arrest someone for an indictable (ie, serious) offence. If you’re a suspect for grievous bodily harm and we think you’re in your house, officers can force entry under s17 of the Police and Criminal...

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I’m sure most people heard of the sickening attack on a young boy at the Tate Modern in 2019 – I don’t intend to cover the details as they are widely available (trigger warning for the hyperlink that follows) and this post intends to focus on nothing other than a key decision for the judge at the criminal trial of Jonty Bravery who pleaded guilty to attempted murder following the attack.  Last week, the judge heard argument from lawyers and opinion from psychiatrists about whether the defendant should be hospitalised or imprisoned, after his guilty plea.  A legal decision of this kind sits solely with the trial judge, who must consider reports from experts and hear the legal arguments, before reaching their decision.  On the one hand, the defendant has a history of mental health issues of a kind which convinced two forensic psychiatrists to provide a medical recommendation for admission to hospital which would allow the judge to consider various kinds of order under Part III of the Mental Health Act, usually a (restricted) hospital order.  On...

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For some time now, I’ve been concerned about the impact on vulnerable people of ‘normalising’ the involvement of the police in their mental health care.  Regular readers will no doubt recall some observations I’ve made based on real cases or things I’ve learned by listening to people.  It’s because of my concern, I decided a blog is called for, despite now writing here much less often.  It follows my reading of a case which yet again makes plain this point, but it actually goes one step further than anything I’ve come across before: the impact of involvement of the police was directly linked in a Preventing Future Deaths (PDF) report from a Coroner as a ‘probable’ cause of death.  Of course, as with all situations involving complex and vulnerable people, there is rarely one single explanation for why someone died and it’s not listed as the only thing which contributed to someone’s death.  There were nine things overall, but remove any of them and would we still have an inquest? … who knows.

Lauren Finch was a 23yr old...

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I don’t think I fully realised last week what a privilege it actually is to have to physically go to work – I get to ride 10miles there, get out of my home for a bit, see other people outside my family and then ride back again in the fresh air.  I’m now on my fourth rest day (of four) and very much itching to get out on my bike for a quick lap of the lanes; and perversely looking forward to my 4:30am alarm call to get out of the house again and off to work.  Mrs B and Master B are working / schooling from home and I can see the restrictions taking effect on them in small ways.  I’m also conscious of my elderly mother living on her own in the North-East who is pretty much locked in and being supplied by others, as required.

So what does the law say (on Monday 30th March! – because it may change later if tougher restrictions are brought in, as may be considered potentially necessary).  There are various reasons I’ve decided to write-this, but all of them rotate around the frustration of misinformation and misunderstanding! —

STATUTORY...

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Last week, I published a post about the temporary amendments to the Mental Health Act 1983 which will be brought in by the Coronavirus Bill 2020, if passed ‘as is’.  That Bill goes before Parliament today, to commence its process towards becoming law and it may or may not change as the process unfolds.  Me being me(!), I was a bit curious about the other health related implications for the police service so I kept reading beyond the Mental Health Act amendment stuff and this post summarises the police related powers in Schedule 20 of the Bill as they relate to ‘infectious persons’.  If you want to read this for yourself, open the draft Bill and go to Schedule 20 on p215 – I will warn you now(!), it’s quite a dense read, hence I thought I’d try to summarise the main aspects of it.

You may quite reasonably wonder what this has to do with policing and mental health?! … potentially nothing at all and I’m conscious of straying outside my domain of interest – this is legislation related to so-called ‘physical’ healthcare...

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First things first: this post is based on reports some social media sources I’m inclined to trust, including from a health journalist but it has NOT yet been confirmed with published materials from the Government. Once the Government publish something that confirms or refutes this, which they will potentially do on 19th March, I will either remove this disclaimer or remove / re-write the post as a whole.

We know the UK Government is introducing emergency legislation to the House of Commons which will temporarily change aspects of the Mental Health Act 1983, including some parts affecting the police. It’s all part of the COVID-19 response, in the Coronavirus Bill 2020. This short post summarises what appears to be coming on the police-MHA changes, based on what certain charity professionals and health journalists are reporting —

In no particular order of importance —

• One Doctor to ‘section’ a patient – where mental health services wish to ‘section’ someone, the Approved Mental Health Professional will now require only one...
  
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On the 01st October 2020, we anticipate the Mental Capacity (Amendment) Act 2019 will take effect, bringing certain changes to the Mental Capacity Act 2005.  Some of the terminology the emergency services may  hear and occasionally wrestle with will change, and the wording of section 4B of the MCA, which governs urgent deprivations of liberty for life-sustaining treatment, will be made more wordy!  Calls to #Team999 occasionally do involve patients who are subject to (the current) ‘deprivation of liberty safeguards’, known as DoLS in the current framework, but from October, these orders be replaced by Liberty Protection Safeguards, following literally years of discussions and debate about the DoLS frameworks introduced just over a decade ago.  It’s never quite worked as hoped and the 2014 Cheshire West case brought thousands more people with the grasp of DoLS and there have been problems and debates ever since.

Liberty Protection Safeguards are the end result of a Law Commission report and the Government’s own deliberations...

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I’m not sure how many inquiries and thematic reviews in to public services have ended up focussing on clear communication and information exchange – this has certainly been said during investigations and inquests where the police became involved in mental health incidents. There more than are a few situations where clarity of communication between organisations tends to be problematic and I want to focus on a few of them, by way of making the same point: that we need to be both clear and precise with each other about what we’re asking and saying as we work in partnership to put those of us affected by our mental health at the centre of decision making.

• Threat / risk assessment – if we’re saying that someone is facing a level of risk and we need to support each other in managing it, what is that risk and how likely is it to be realised?
• Legal context – what is the legal situation within which the request sits? For example, is the patient you’re asking us to return, subject to a legal framework which allows for this?
• What,...
  
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This post comes at the direct request of a mental health professional, touching on matters I’ve written about before but which keep coming up, somewhat resistantly – it follows an incident where officers local to them came to an Emergency Department with a person in handcuffs for NHS assessment around their mental health and where the liaison staff had questions about the legal situation. During discussion, it was suggested the police should consider the application of s136 MHA, but the officers (who no doubt have a perspective to offer that may not be identical) chose not to follow this suggestion. And to be completely fair, they may have had their reasons – many people don’t realise, for example, that the use of handcuffs by the police is not JUST something that is done following an arrest; or even during a detention under the Mental Health Act 1983.

Police officers can and do use handcuffs to restrain people in a number of situations, relying on a number of legislative authorities to do so. For example, it’s not unknown for...

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