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 woman diagnosed with a mental illness who had been an inpatient in Greater Manchester’s mental health services more than once – sometimes as a voluntary patient, occasionally whilst detained under the MHA. In September 2018 she died by suicide whilst admitted in hospital and in the lead up to this most tragic of outcomes, Lauren absented herself from hospital and had to be returned to the unit by the police. The Coroner’s PDF report makes mention of Lauren alledging the officers ‘assaulted’ her so it seems reasonable to infer that force was thought necessary to facilitate her return? For the avoidance of doubt, the Coroner does not question or even mention further the use of force in that document and the PDF was not sent to the Chief Constable of Greater Manchester Police – you must make of that what you will.
What the Coroner does highlight, however – at point 3 of 5 in the ‘probable’ causes of death – is “an impact on Lauren’s state of mind, following the police involvement in Lilford Park on 16th September.” So we’re concerned that the impact of policing on a vulnerable person contributed to their death and yet the PFD is addressed only to the healthcare system leaders who control what the Coroner feels needs addressing to prevent future deaths?
This needs unpacking a little —
I’ve argued for years – and the national and local police strategies and policies I’ve authored reflect – that ‘normalising’ reliance upon policing can be dangerous. Isn’t always, but it can be and so it should be minimised because it is inherently restrictive and stigmatising. It can promote in some, fight of flight responses from people who don’t want to be ‘policed’ when they’re ill. It can have a detrimental impact on the mental state of some vulnerable people – and that’s what we’re seeing in Lauren’s case where we’ve seen laid plain a legal conclusion that it partly contributed towards her death. So we need to take this seriously – I’m not sure we’ve yet learned this lesson. There are a few things to add, as we try to absorb it:
We cannot know the impact on someone of being policed until we police them – it may be unknowable until it’s happened and by the time it does, we may wish we hadn’t. Police officers have to make decisions about the situations to which they are deployed and cannot know what impact they will have on someone until that impact has been realised. Hypothetically, if we knew the impact on someone could be so serious that it was life-altering or life-threatening, obvious legal and moral imperatives towards proportionality demand that we don’t take that risk unless we’re managing a situation which is already as serious as that, more-or-less.
The problem we have, as I’ve said before, is not (mainly) policing – the problem is our over-reliance upon the police and the criminal justice system, as well as the wider emergency system, to provide fairly routine aspects of our mental health care. Do you recall the inquest in to the death of Sasha Forster in Surrey a few years ago? Sasha was another young woman whose life was tragically lost and in that case, the police were merely mentioned in the context of returning her to a mental health unit whilst she was on authorised leave and having attempted to hurt herself. The mere mention of police officers contributed to her fleeing an Emergency Department and completing the overdose she’d already attempted and that is precisely why Hampshire Police had often resisted attending her home address when MH services requested it – they knew it could escalate levels of risk. During the inquest, the mental health trust stated the police would just have to accept the need to return patients when asked because they didn’t have the staff to do it. Didn’t seem to matter that the Code of Practice to the Mental Health Act 1983 made it perfectly clear responsibility for returning patients who are absent without leave under the Act sits with the hospital to which they must be returned (in paragraph 28.14, if you’re wondering).
Of course, in Lauren’s case, the police received a report after she had absconded from the ward. Where someone is at risk outside of hospital, it is obviously the role of the police to protect life and assist in locating her before she comes to harm and Greater Manchester Police had been involved in a number of previous high-risk situations with Lauren. But where someone’s location is known already, responsibility lies with the hospital and to involve the police only ‘where necessary’ is to be proportionate and fair to people. I submit ‘necessity’ cannot arise purely because of a total or near-total omission to plan for how this would be done without resort to police officers. All situations turn on their merits and there may be need on occasion to seek support outside of the norm – but in too many areas there is no plan on paper for how this would occur. Ward staff caring for the missing patient will point out they also have other patients to care for an can’t leave; community teams will say the person is an inpatient and it’s a a matter for the ward … etc.!
This case also highlights, however, a set of circumstances which most operational officers find frustrating and somewhat futile. Lauren’s absconding was able to occur because she walked out of the ward through a door, opened by a doctor. That was also listed by the Coroner as something which ‘probably’ contributed to her death. It’s far from the first example of a patient walking through an unlocked door or one which was held open for them, only for tragedy to occur. It points to an aspect of a culture which you don’t tend to find in other ‘locked’ environments like prison or police custody. Before anyone writes in: I do appreciate, of course, that hospitals and mental health units are very different kinds of environment to prisons and police stations. But the general idea that doors be locked so people who should not be leaving are not able to do so without considerable difficulty, is common across them. The purpose of the ‘lock’ may be different – but the idea there is still a lock to minimise risks of (different kinds of) harms is a commonality.
You may recall the case of Nicola Edgington in 2011 – she was admitted on a voluntary basis to a ward (itself a very interesting decision, given her known background) and not long after arriving having been unsupervised, she left through an unrestricted door and murdered Sally Hodkins in Bexleyheath. This was the second homicide Nicola had committed and the case attracted significant attention and criticism, for that reason. It also saw attempts by the mental health trust to blame the Metropolitan Police for aspects of what went wrong – the Metropolitan Police threatened judicial review over an internal NHS report and only withdrew legal action when the report was changed to reflect agreed facts. The point I’m making about it is simple: following criticism of the ease with which she absented herself, a lock fitted to that particular mental health unit main door shortly after the incident and access and egress was restricted.
But I’ll finish by re-making the substantive point: we need to understand at all times, policing can be a restrictive ad stigmatising practice for many, so it needs to be proportionate and it needs to be understood as having unknowable and unquantifiable impacts on the wellbeing and mental state of vulnerable people. I know some people don’t like it when I say that policing people who haven’t offended is ‘criminalising’, but I’m not sure how else to sum it up?! If you can only access certain aspects of your health service via the police, or if it’s do to so; if you are treated in a way that looks almost identical to the way we treat suspected criminals, it’s no wonder people in difficult and sensitive situations with their health are made to feel bad about themselves and their situation.
In Lauren Finch’s case as in Sasha Forster’s case, we see plainly how casual practice around absconding prevention, how over-reliance on the police to bring patients back and how a lack of appreciation for things like proportionality in the extent to which we risk criminalising people and contribute to disaster. It only remains to be seen how many cases like these we’ll see before that is learned and factored in to systemic risk management. I suspect it will be learned eventually … just not sure how many Coroner’s PDFs we’ll have read by then.
The problem is not the police: the problem is the extent to which we over-rely upon the police as a de facto mental health and crisis care provider.
Winner of the President’s Medal,the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.(c) Michael Brown OBE, 2020
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – http://www.legislation.gov.uk