A story about the difficulties of de-escalation –

With two other officers, I once had to try to urgently ‘de-escalate’ a situation involving a suicidal man – most of us have had to do this at one stage and I’ve done it more than once. All the other efforts, thankfully, were successful, but this one wasn’t. The incident took place many years ago and I suspect it will be one of the few incidents from my career I vividly remember for the rest of my life.

The man involved had covered himself in flammable liquid and was suggesting he’d set himself alight – we knew he had a history of serious mental illness and were primarily concerned about his welfare, but what we couldn’t do (as police officers) was the one thing he wanted in order to be persuaded to put the lighter down: a guarantee he wouldn’t go back to prison for the serious offence he’d recently committed. And the offence was very serious, committed shortly after his release from prison after serving a sentence for a very similar offence, towards the same victim....

Continues, Read More...

When I started proper work on the subject of policing and mental health, I had not the first clue where to start – there was no course you could ask to go on.  I came to this agenda originally precisely because of my professional ignorance, but also my uncertainty and my fear – there was no personal agenda in the background of this.  I’ve been asked more than once whether I used to be a mental health nurse – no, I didn’t.  I’ve been asked whether I, my family or close friends have experienced mental health issues – actually, none of your business, frankly but I’ll restate that the essence of my curiousity fand frustrations was professional.

Without that first clue, I did what seemed instinctive to me as a police officer: I picked up the Mental Health Act 1983 and read it – then I read it again.  I also read the Code of Practice to the Mental Health Act – and yes, I do mean all of it.  When the Mental Capacity Act received Royal Assent and when it’s Code of Practice came out, I read those too – I’m a policeman: I look at...

Continues, Read More...

Earlier this month, Royal Assent was given to the Mental Capacity (Amendment) Act 2019. This is a very short piece of legislation and it is, as the name suggests, merely amending legislation for the Mental Capacity Act 2005. This post is a taster of what it means for police officers and paramedics in particular, especially in light of previous posts I’ve done which attempt to clarify terms like ‘deprivation of liberty’ and to explain the current section 4B of the MCA.  This is the thing which talks about not depriving someone of the liberty where they lack capacity, except to provide a ‘life-sustaining treatment’ or do a ‘vital act’ which prevents ‘a serious deterioration in someone’s condition’.

This amendment stuff is not yet law – we don’t yet know the commencement date and this post is just an early heads up of what’s coming towards us!

#TEAM999

I’m hearing estimates it may be late 2020 before this stuff takes effect and if history repeats itself, there will be little explanation about...

Continues, Read More...

You may remember from late last year, I’ve made a large noise about the inquest in to the death of David Stacey in Leicester. David died in late 2017 and the inquest just before Christmas last year, concluded that his accidental death in road collision had been contributed to by the neglect of NHS services.  In particular, it was alleged that non-compliance with s140 MHA and there being no beds available for urgent admissions, was such a problem that it required a Preventing Future Deaths report to the Secretary of State for Health as well as to the relevant Leicestershire mental health services and clinical commissioning groups.

This post is just a short addition because yesterday Leicester City Council published a Safeguarding Adults Review report after a learning event held in the city last year. The report is now a public document and it speaks for itself.  However, I want to make three quick points in respect of it and leave you to your conclusions.

• You’ll notice that it is dated ‘September 2018’, having been written by an independent...
  
  Continues, Read More...

“Is this a house, a flat or a room where this person or another person lives?” … THAT’s what you have to ask yourself when trying to determine whether section 136 of the Mental Health Act 1983 can be used in a particular location. As this 2017 amendments to the Act were being drafted, along with guidance from Government about its application in practice, the alteration from “any place to which the public has access” to the new restriction which focusses, more or less, on ‘private dwellings’ caused debate on the matter of non-traditional homes. And there are a couple of aspects to it worth consideration.

What does “lives” mean? I live in my home in Bromsgrove – it’s a traditional house. But a former colleague in West Midlands Police decided he was going to retire to a canal boat and he sold his home. A friend from university lives on a houseboat in south-west London. These things are their homes in the way that my house is my home – our possession are here, we eat our meals in these places and sleep there most...

Continues, Read More...

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...
  
  Continues, Read More...

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...

Continues, Read More...

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...
  
  Continues, Read More...

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...

Continues, Read More...

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...

Continues, Read More...