Several discussions and questions recently about Appropriate Adults (AA) in police custody for vulnerable people that I want to quickly cover. In case youâ€™re not aware, an Appropriate Adult is someone who, according to the Codes of Practice to the Police and Criminal Evidence Act 1984 must be called to police custody for anyone under the age of 18yrs or anyone who is â€˜mentally disordered or otherwise mentally vulnerableâ€™. They must be present for legal rights being administered, police interviews about the allegations and various other things. Al sounds straight-forward enough, doesnâ€™t it?! Â You can just imagine the booking in procedure where the custody sergeant tells the arresting officer, â€œHeâ€™s only 17yrs old, get an appropriate adult on the phone and ask them to come down here.â€ Â Usually this will be the personâ€™s parent or guardian and if there is no-one available, you can ring childrenâ€™s social services as there is a statutory duty to act as an AA for someone who cannot otherwise be supported.
There are two major problems when we turn this conversation to the circumstances of a vulnerable adult â€“ 1) what does â€˜mentally disordered or otherwise mentally vulnerableâ€™ mean? â€¦ and 2) how do we handle things if we, the police, canâ€™t secure a volunteer? Absolutely no-one, anywhere has any comparable statutory duty to support that person whilst under arrest! Neither social services as a whole, nor any health or mental health service to which that person may be connected is obliged to fulfill this role in the absence of a relative, friend or neighbour. Â Recently, I was at a meeting with Chris Bath fromÂ the National Appropriate Adult Network who Iâ€™ve heard more than once saying, â€œIf you canâ€™t even find someone from the banana aisle at Waitroseâ€ given that most adults could fulfil this role â€¦ itâ€™s merely the case that no-one employed by the police can undertake it.
Would you call an Appropriate Adult for [name a famous, intelligent celebrity with a mental health condition here]? Imagine that person was arrested for something at a point when their mental health is pretty good. Imagine that they are in regular contact with the services who are supporting them; potentially taking medication and / or undergoing other forms of treatment and that to all intents and purposes they appear â€˜wellâ€™. Would you still ask for an appropriate adult to support them during the process of investigation and interview by the police?
Well first of all, anyone in police custody under arrest would be examined by an approved healthcare professional â€“ usually a doctor or nurse from a contracted organisation who advise on police custody healthcare issues. Â Ultimately, the decision about whether ot call an appropriate adult is one for the custody officer, but given that the need for an AA rests on confirming one way or the other whether or not someone is â€˜mentally disordered or otherwise mentally vulnerableâ€™ you can see why a medical or nursing opinion comes in handy on these matters. They have the skills and are more likely to have access to information to help make this decision â€“ but it remains with the custody sergeant to resolve any doubts and disagreements.
There have been examples of custody healthcare staff assessing someone and establishing that they have, for example, a diagnosis of depression. Because the person is receiving care from the NHS, taking medication and to all intents â€˜wellâ€™, the advice to the custody sergeant is that they donâ€™t â€˜needâ€™ an AA .. and this is where things start to get difficult. Â PACE (Codes) donâ€™t talk about whether someone is thought to need the support of an AA or not â€“ merely that the person either is or isnâ€™t â€˜mentally disordered or otherwise mentally vulnerableâ€™. Â So are they? â€¦ or not?!
The question of whether someone should have an AA is a legal one, not a medical one. Of course, we are going to defer to professional opinion about healthcare issues â€“ but it is a legal assessment that follows and it remains the decision of the police. If someone with depression who takes anti-depressants is arrested they may well be thrown in to one hell of a situation â€“ because actually, anybody who is arrested is thrown in to one hell of a situation! This could be all the more pronounced if the particular investigation has more far-reaching consequences for that person, be that loss of employment, public reputation or any number of other things including marital or key-relationship breakdown. The fact that until arrest that person was working for living, raising their kids and living a life doesnâ€™t alter what arrest can mean and can it do to some people. The safeguard was designed, it would seem, to ensure that people more likely to be vulnerable are supported whehter that is because of a long-term health problem like schizophrenia or situationally specific circumstances.
So what does â€˜otherwise mentally vulnerableâ€™ mean?! â€“ could this not also extend to someone who has no history of mental health problems whatsoever but who has been arrested for an alleged offence that could be, literally, life-destroying? Â Imagine a school teacher arrested for possessing indecent images of children â€“ Iâ€™ve arrested a man for exactly that and you could see the utter panic and terror behind his eyes. He was ultimately proved guilty of it all and rightly jailed, but you have to consider that whilst heâ€™s in custody, not entirely sure of the evidence against him, not sure of where this is all going, as he sat in the cell whilst we searched his house and seized a LOT of his possessions as part of the inquiry, that he must have been contemplating just how much his life was going to fall apart? Iâ€™m not suggesting everyone accused of a serious crime needs an appropriate adult, but some might, notwithstanding an absence of mental health problems. This is just one example of what â€˜otherwise mentally vulnerableâ€™ may mean.
And remember this: the PACE Codes make it clear that if there is doubt about whether someone is â€˜mentally disordered or otherwise mentally vulnerableâ€™ then you treat them in custody as if they are. Â So as you think through your examples of high-functioning people who you know has bipolar disorder or depression, keep in mind someone with any other kind of condition. If someone was receiving treatment now for cancer, you would regard them as having cancer notwithstanding how well they may be at the time. However, a decade later after receiving the all-clear and ceased treatment, you would no longer refer to them having cancer or being a cancer patient.
So what about recovery? Many people recovery from mental illness â€“ they lead meaningful lives, often free from medication or further support from secondary care mental health services. Â If someone is arrested who lived with a mental health condition years ago but has since recovered, would you regard them as requiring an AA? Â This is perhaps where there is more of a judgement call. Keep in the mind the cancer patient analogy: if the person regards themselves as recovered, they are no longer receiving treatment and there are no current indications that the fact of the arrest has caused any particular problems, especially if theyâ€™ve been medically screened in police custody by custody healthcare staff or by Liaison and Diversion services, then a history of something would not automatically mean you fail to acknowledge their recovery in the decision-taking.
Iâ€™m aware that some custody sergeants are debating this actively and that one force in the south of England has reinforced a policy that has the effect of increasing the need for AAs in custody. I am not without sympathy about the operational implications this sometimes have because Iâ€™ve been that duty inspector on a number of occasions where all efforts to secure a human being of any description to act as AA has been tried and failed â€“ a number of times!
In particular, I recall one investigation of a poor bloke who had been arrested for reckless arson, endangering life in what had probably been a suicide attempt. he had been fully assessed in custody under the MHA because of his mental state and his long history of mental health problems. Â The investigating officers had spent over 22hrs of the PACE â€˜clockâ€™ dealing with the initial enquiries to be made, the MHA assessment and the repeated efforts to find a relative, friend, neighbour or any professional from any organisation anywhere who would be prepared to support him in custody. Nothing. We even left it a couple of hours and then tried them all again. Still nothing. So we interviewed him without an appropriate adult knowing full well this might end up meaning any evidence obtained would be excluded but we had to rely upon the fact that the requirements for an AA is in the Codes to PACE, not in PACE itself. Therefore, according to the relevant court ruling, it is something with which we should comply unless there are â€˜cogent reasons for departureâ€™. The cogent reason being: no-one on planet earth except the police and his solicitor weâ€™re willing to try to help the guy and weâ€™re all banned from being his appropriate adult.
Would I seek an appropriate adult for [intelligent, famous celebrity receiving MH treatment]? â€” there is absolutely no doubt whatsoever in my mind. I would.
Winner of the Presidentâ€™s Medal from
the Royal College of Psychiatrists.
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