We hear a lot about partnerships in public services, the need for various agencies to do them, to have them or the need to improve them. Simplifying horrifically, the narrative seems to be that there are gaps and overlaps between different public agencies and if only managers could bridge the gaps and cooperate on the overlaps, all would be well. Indeed, you could argue that this is what sits behind the Crisis Care Concordat, one of the most significant â€˜partnershipâ€™ documents weâ€™ve seen on the issue of mental health crisis care. Donâ€™t forget: the Concordat came from discussions specifically about policing and mental health, following the tragic case of Olaseni Lewis in south London in 2010. The concern was that it was a failure of the police and mental health services to work in partnership that caused the death of this young man.
Of course, we now know thatâ€™s only a part of the story and legal processes rumble on regarding the various parts. What this and several other cases have recently caused me to wonder is whether this simplistic idea of â€˜partnershipsâ€™ between agencies misses out some very important people AND puts the focus in the wrong place, on occasion?
What about the partnership between the police and the public?! â€“ those of us who like the Peelian Principles know a part of the seventh principle very well: â€œthe police are the public and the public are the policeâ€ and this is etched in stone, literally, at the new headquarters of the Metropolitan Police in London, New Scotland Yard. What we see many times over is police officers, usually junior and frontline officers and staff, effectively advocating for the rights and welfare of vulnerable people: to access support which might otherwise be denied, or resisting requests by mental health services to undertake tasks which should not be for the police because we risk making the outcome worse for that person.
A duty inspector from a police force rang me a few weeks ago on a weekend evening. He had a young woman in police custody under a s135(1) warrant, officers having attended the ladyâ€™s home two days earlier with an AMHP and a Doctor to assess her under the Mental Health Act 1983. Her clinical history and presentation on the day indicated it would be necessary to remove her to a Place of Safety for assessment and they took her to local a mental health unit. Whilst waiting for the second doctor to arrive for a full MHA assessment, the lady, in her distressed state, proceeded to cause damage to the PoS unit and the decision was then taken to transfer her to police custody. Following assessment, it was decided admission under the MHA would be required and the usual hunt began for a bed â€“ this time, a psychiatric intensive care unit bed. Around two days after the warrant was first executed the bed emerged and the application was potentially able to be completed.
The logistical problem which caused a delay to the AMHP completing the application was how to move the patient almost 300 miles to the hospital where the bed was identified?! â€“ nowhere any nearer could accept the patient as she was still exhibiting challenging behaviour whilst acutely unwell. The journey would obviously take a long time to complete, there was the question about food, drink and access to toilet facilities along the way and the issue of medical or nursing supervision. Officers were told that a 999 ambulance was not appropriate, the patient would ideally need to be sedated but that this couldnâ€™t happen in her case because of other medical factors beyond everyoneâ€™s control. A private, specialist ambulance contractor had been contacted but the police were told this could not be sourced for well over 24hrs â€“ so could the police undertake the transportation on behalf of the AMHP?! â€¦ and unfortunately, no medical or nursing support could be provided either in custody or during that journey.
This shouldnâ€™t really be a hard decision, should it?!
The answer is just a plain and simple, straight-forward refusal: point blank. Thereâ€™s all manner of danger and illegality within that request â€¦ but shouldnâ€™t we be working in partnership with each other?! My colleague stated openly he felt under significant pressure to agree to this and could feel in the pit of his stomach that it was the wrong thing to do but he was reluctant to say, â€œNo!â€ in a way that didnâ€™t expose the patient to further risks or delay in custody. But this is where my point comes in about the important partnership: that which needs to exist between the police and the public, around how we handle these specific and sensitive requests. If the request had been something which roughly met the police half-way in terms of resources, risk and safety, then it there could be a discussion about things. But not otherwise, because it puts people are legal and clinical risk.
You can imagine what would happen if that had been agreed to and reviewed, either by the IPCC, a civil court or heaven forbid a Coronerâ€™s Court after an adverse development? Why were officers moving someone three hundred miles on their own, when it was known they needed medical or nursing supervision because they ultimately needed intensive NHS care not readily available in the back of a police van or on the hard shoulder of a motorway?! â€¦ what role here does the law play, in terms of mental health services? Well one of the first ones is itâ€™s up to the NHS to commission healthcare services; it is up to AMHPs to make legal applications under the Act, once the grounds are met; and to detain and convey people to hospital as a result of all that. All of this MUST, by law, be able to occur in a way which survives contact with health & safety legislation and with human rights frameworks, such as Article 3 which prevents inhumane and degrading treatment, and so on.
The role of the police, where these things are being compromised because of pressure on the overall mental health system is to weigh up whether they should provide assistance that may not necessarily make things any worse, indeed it might assist in not aggravating things â€“ or to resist doing so because they absolutely think it will. For example, the Code of Practice indicates (Paragraph 17.14 in England; 17.18 in Wales) that the police may be called upon assist in ensuring safety during admission where someone is â€˜violent or dangerousâ€™ â€“ but this doesnâ€™t mean that where such an assessment may reasonably be formed, the police should be doing this entirely alone! Indeed, it is one of many factors that should be considered and both Codes refer to the need to preserve peopleâ€™s rights and their dignity, in conveyance. Not sure how thatâ€™s achieved if officers end up frog-marching a distressed patient in handcuffs in to motorway services to use the facilities.
The issue here between the organisations is not about partnerships and how we work together: itâ€™s about each organisation ensuring we donâ€™t make unreasonable requests of each other, causing undue and intolerable pressure, beyond their ability to cope. Itâ€™s about ensuring the legal rights of the patient and the legal duties owed by the non-police organisations in the particular example â€“ of course, there are other examples where the police need to be careful theyâ€™re not doing that to AMHPs and NHS staff. Officers could, in theory, have said, â€œGo on, then!â€ and tried their best, but we can all imagine what would have been said if a clinical emergency developed en route and / or restraint was used and / or a predictable set of degrading circumstances emerged? We would be back to the sorts of things we saw in the Seni Lewis, Sean Rigg and other cases where scrutiny would be on those using force and not on those who created the conditions within which it became more likely to be used.
In the operational police work Iâ€™ve done, Iâ€™ve often found that the important partnership that needs to be forged is actually between the police and those of us with mental health problems â€“ or their families and friends. It is genuinely gratifying to become involved in something and find that the police have been able to help the public directly and where this is consistent with good partnership working with the NHS, thatâ€™s all very well. It should always be borne in mind, however, that the police are not on anyoneâ€™s side, that they have a duty to the law, first and foremost and that we cannot always be expected to act a certain way when we are invited in some way, shape or form, in a conflict that exists between NHS resources and patientsâ€™ rights.
It should always depend on specifics as to how any situation like that is resolved because, I repeat: as police officers, we are not on anyoneâ€™s side during a legal conflict. But enabling the police to do the right thing so they may professional acquit themselves is usually the same thing as ensuring the rights and dignity of patients â€“ unless something gets in the way.
Winner of the Presidentâ€™s Medal from
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.