I pen this BLOG post on behalf of AMHPs in England and Wales! â€“ they seem a touch ground down by the Old Bill and I offered to write this as I am rather bored in a London hotel room whilst working down here for a couple of days.Â
I logged on to the Masked AMHP Facebook group earlier to see whatâ€™s happening in the AMHP world. If you havenâ€™t read the Masked AMHPâ€™s BLOG, itâ€™s a multiple award winning insight in to the world of Approved Mental Health Professionals â€“ the elusive Masked AMHP also set up a closed Facebook group which is primarily a discussion forum for AMHP issues but it does include several non-AMHPs who are interested in the interface they have with these under-recognised mental health professionals. I try to â€œskool them in pleecing(!)â€ on behalf of police officers but itâ€™s fair to say they have some really embarrassing stories about how the police service have really left them with it.Â
I often say in presentations I do to AMHP events (like the Yorkshire AMHP event in Leeds in December, if anyoneâ€™s going to that one?!) â€“ I wouldnâ€™t do their job for all the money going and I really think I mean it! They are so often caught as the ring master of a circus: responsible for keeping the whole show going but not really in charge of anything and unable to command resources to ensure things that must be done, are done. Iâ€™d encourage you to read the Masked AMHP BLOG: I really learned a lot from it and it was partly responsible a few years back for me thinking there should be a police BLOG on mental health. Â I disgress â€¦Â
Tonight, an AMHP was asking questions about police responses after Mental Health Act assessments where police support is requested and I now need to ram home something Iâ€™ve noticed is repeatedly said by AMHPs when they ring for police support â€“ and they canâ€™t all be wrong!
BACKGROUND TO THE PROBLEMÂ
Where an AMHP and DRs have attended someoneâ€™s home and â€˜sectionedâ€™ them, individuals who were thought persuadable, sometimes refuse to move to hospital. Efforts are often expended to persuade â€“ perhaps paramedics present may try as well as the AMHP to persuade and influence; maybe the threat is made of having to call the police and all manner of verbal tactics are attempted. It may be that low level physical â€˜encouragementâ€™ is given: Iâ€™ve known AMHPs put their arm around a person and try to walk them to the ambulance; Iâ€™ve known the paramedics engage in what was beautifully termed â€˜proactive blankettingâ€™ in order to prevent someoneâ€™s arms lashing out whilst efforts were made to move them gently.Â
Officers and those involved need to be clear: this is all lawful â€“ once a person is subject to an application for their admission to hospital, they are in legal custody for the purposes of the Mental Health Act and the AMHP may detain and convey the person to shopital with all the powers and privileges of a constable. The AMHP may also delegate these powers to others, including the ambulance crew and / or the police (who have no powers in their own right, under s6 MHA). However, the problem emerges when trying to determine at what point hte police, should be called and the extent to which it is always a role for the police to coerce patients who refuse to comply with the legal decision the AMHP has taken. There are therefore two things going on here â€“
Iâ€™m going to tackle these the wrong way around!Â
NO WARRANT REQUIREDÂ
There is one crucial error made by police control rooms and some officers â€“ I repeatedly hear reported by AMHPs that when they seek police involvement in this situation, they hear a certain reply that is just legally very silly indeed. The Code of Practice to the MHA supports the involvement of the police where patients are â€˜violent or dangerousâ€™ (para 17.13 CoP MHA) â€“ Iâ€™ve always held the view that this is different to patients who are resistant or what the police would call â€˜passively resistantâ€™ â€“ sitting in their front room armchair, refusing to move but not actively assaulting people, for example. This is point Â 2 and Iâ€™ll come back to it.Â
In terms of point 1, the legalities for officers who do become involved, AMHPs report they are all-too-often find a refusal is given based upon the fact that they â€œdo not have a warrantâ€ under the Mental Health Act. Let me be completely clear about this: they do not need a warrant to act. Where the AMHP is lawfully on the premises and has completed a MHA application for admission, they are no longer obliged to leave the premises if requested because the person is in their legal custody and they may authorise others to act through the delegation of the AMHPâ€™s power under s6 MHA. To refuse to assist on the grounds of there being no warrant is to make yourself look very silly because it makes no legal sense at all â€“ warrants become irrelevant after the application was made as long as the AMHP remains on premises.Â
The person became â€˜liable to be detainedâ€™ when the application was made and the patient may be conveyed to hospital on that basis alone: forces can choose to send officers if they wish and they would have all the legal powers they need. That takes us back to point 1 and not something the AMHPs have asked me to raise, but in the interests of balance it seems necessary to do so!Â Â
WHETHER TO SEND OFFICERSÂ
Point 1 is by far, the trickier question: whether to send police officers. Here are some more legal facts â€“
Various things can be said here and it comes back to senior police officers ensuring the existence of good local protocols. It seems unbelievable really but in my last operational job, the local area only had two protocols for hte implementation of the MHA out of the four they should have had. So there was no document, anywhere which helped a duty inspector understand what their responsibilities were for ceratin common MHA situations. I know that AMHPs in that area took a dim view of my therefore taking decisions according to the law â€“ it turns out they were used to police officers often doing as they were told but I took the view that as long as I am acting lawfully, how I expend the various resources my Chief Superintendent has entrusted to me was my professional business, against the objectives I was being asked to deliver, most of which were not around mental health care. That said, there were plenty of incidents during that operational posting where the incidents connected to mental health were absolutely the main operational policing priority.Â
COULD IT BE ANY HARDER?Â
This is REALLY difficult stuff, isnâ€™t it?! â€¦ itâ€™s not (just) legal pedantry that brings me to this point: there is the question of the extent to which it is a responsibility of the police to resource responsibilities that could just as easily sit with mental health services where officers have no legal duty to do so?Â
What about the NHS and LA managers responsibility under Health & Safety law to mitigate forseeable risks and co commission appropriate conveyance services (see Chapter 17 of the Code of Practice)? How are senior police officers and senior health & social care managers agreeing on roles and responsibilities where resistent, aggressive or violent patients are concerned? How are we guarding against the unnecessary involvement of police services in mental health care, to protect against the perception of stigmatisation and criminalisation that attends their involvement for so many vulnerable people in crisis?Â
The detail of this is important because without that level of attention, the risks is that a well informed police officer will pop up and take lawful decisions that donâ€™t survive contact with other profesisonalâ€™s expectations. It is precisely because front line staff should not be improvising that local protocols are crucial and thirty odd years after the introduction of the Mental Health Act 1983, you think we may have sorted this by now?!Â
Winner of the Presidentâ€™s Medal from the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.