One Great Thing

I’ve just deleted about half a dozen draft blogs, none of them finished … I tried to write a few things over the last fortnight and just became interminably bored, quite honestly, for the fact that I was just saying the same thing, over and Over and OVER again. This is what I was going to cover, as each post was centred on something new, if not hot off the press –

• Some more thoughts on the Wessely Review in to the Mental Health Act;
• Thoughts after the misconduct proceedings which saw a West Midlands Police officer dismissed after the death of Kingsley Burrell in 2011;
• Thoughts ahead of going to Manchester last Monday to discuss s140 MHA with the CQC;
• Thoughts about the progress of the Mental Capacity (Amendment) Bill 2018 which will alter the MCA 2005.
• Thoughts after the Inquest in to the death of David Stacey in Leicester in December 2017 which has just concluded a verdict involving neglect by mental health services.
• Thoughts after the Inquest in to the death of PC Sharon House MBE – one of my colleagues who suicide was contributed to by neglect by mental health services.

Half way through writing about each of those things, I’ll be really honest – I lost all sense of making any point that felt new and I became wary of boring those who are kind enough to read this blog. I’m also wary, after some discussions this year, of appearing to harp on about negatives all of the time, especially where it is me highlighting negatives about mental health services. I’ve been accused many times over the years of being ‘anti-mental health services’, which is criticism I have to take very seriously. This has happened again in the latter part of the year and caused me to wonder how balanced and fair I’m being. I’ve resisted posting partly because I’ve been genuinely reflecting and discussing with people whether or not I am being as fair as you could expect a police officer to be.

I was asked by Leicestershire Police to prepare a report, potentially for use in the Coroner’s Court, after the death of David Stacey. It ended up not being used in part because it was suggested the report was ‘not independent’. Of course it wasn’t! – I’m a serving police officer and I was asked by a police service to write a report which was, in part, a request to comment on a psychiatric report with which they already disagreed. Of course, I attempted to do this as fairly as I possibly could, evidencing the critique as much as I could – but it was never going to be independent, was it?! – I’m a police officer and I’ve never been, wanted to be a mental health professional. I do what I do because I have ideas about how things should be, and those ideas are fashioned by what I passionately believe is an under-appreciated and under-studied perspective that has a nasty habit of seeing things different to received wisdom in politics and in mental health services.

WORKING TOGETHER

So for me, conflict is the starting point: things are not as they should be and that needs to change – so says every thematic report ever written, including the recent MHA Review and the HMIC report, Picking Up the Pieces. Events don’t unfold as they should – and some (NB: not all) of this stuff is nothing whatsoever to do with politics and funding, directly. Of course, politics, strategic leadership of public services and resources available to them are all very important issues, but they’re not the only important things. We had problems at this interface when I first started working on policing and mental health, when we had – comparatively speaking – plenty of money as the government of the day pumped in the cash. Some of the problems we had in 2009 – 2010 have improved since the coalition government took office; others have worsened. But many things have remained constant issues, not withstanding their frequency.

The biggest frustration I have had during 2018 is having to listen to people telling me that everything that is wrong is wrong because of government funding. I’m not naïve: I’ve seen the difference made to my police force over the last eight years, but I also know during that time, they have done things which have received acclaim for forging real progress – so have many other police forces like Merseyside, Northumbria and the Metropolitan Police (to name just three – don’t write in). The particular frustration is not that I mind hearing the argument about funding and resources, I just don’t want that to prevent us focussing on issues which are – right here, and right now – things we could do something about.  We have some big problems with public services, no doubt – but that simply doesn’t mean there is nothing we can do about things we see going wrong.

So what I decided to do instead of half-heartedly finish those posts, was delete the bloody lot of them, whilst reflecting in a new post what they commonly shared. They all relate to what I’ve always considered to be the big issue that remains entirely unaddressed at this interface: a shared knowledge of, appreciation of the importance of, and implementation of the law. Professor Wessely’s review of the Mental Health Act is all about legal reform, but as the report itself makes clear, some of the calls for reform arise from the law not being properly applied as it stands. Services have in some respects decided to operate outside the legal frameworks and the argument follows that the law is out of date. Form your own view, of course, but it could equally argued that services should be bent to the law until it’s changed and not operating outside of them.

THE CENTRE OF THINGS

When Professor Wessely’s review was launched, one of the vice-chairs, Sir Mark Hedley commented, “No Mental Health Act ever made ill people better – skilled care did that”. But he pointed out that the law can set the framework and affect the culture of the way in which that is done – and so it should; not just the MHA itself along with the MCA, but also the Human Rights Act and all the health & safety, negligence and other laws that sit around and alongside our main mental health and capacity frameworks. Look at the other topics I nearly blogged about:

• Misconduct proceedings – officers called to a mental health unit because of a violent disturbance; fair enough so far. After weapons were removed and immediate safety restored, the NHS decided to direct a transfer to another mental health unit and the way in which this was done breached the MHA, the Code of Practice and contributed to the reasons why junior police officers would have found themselves in the most invidious position. I can tell you for free: had I been those officers, knowing what I know, I’d have simply refused to do it. The least that would have had to happen was the provision of a lot of clinical support and legal clarity. THEN and only then, might I have agreed to do more than simply contain the risk situation in to which I’d been suddenly invited.
• Section 140 MHA – this again is an area of activity which directly exposes that we don’t have sufficient grasp of the law. Many CCGs don’t comply with the duty to specific hospitals in to which patients can be admitted in circumstances of special urgency. Attempts to find examples of good practice around s140 didn’t get very far – we only found one trust with a policy on it and my eyebrows went through my head when I read it.
• The Mental Capacity Act – this has always been considered problematic to understand and Parliament is currently trying to make it better … or worse depending on your view! And whatever happens with that, Professor Wessely has suggested even further amendment and my best guess is that this will not make clear in the minds of all 999 and EMergency Department staff how the legal framework applies to their operational reality.
• David Stacey – this tragic inquest related to an accidental death contributed to by the neglect of mental health services. Police sought MH support and MHA assessment for a vulnerable suffering his first psychosis in his late sixties. Following MHA assessment, the professionals left a man in need of admission to hospital in his own home whilst they sought a bed and before it was found, he was involved a in vehicle collision. The inquest revealed real problems in legal understanding amongst mental health professionals (inc the outside ‘expert’) and legal compliance by services.
• Sharon Houfe MBE – another inquest finding of neglect, this time in respect of services being unable to support a serving police officer who had become suicidal.  In that case, the officer presented to mental health services several times in the week prior to her tragic death and actively asked to be admitted to hospital. At least one nurse involved has been referred to the Nursing and Midwifery Council around professional conduct issues with decisions pending on whether two more nurses will be referred.  The legal point here being that we seem to need a keener understanding of what amounts to ‘neglect’, in law.

MAKING PROGRESS

So it seems to me, if we are to enter 2019 with a determination to do better in the future and forge some progress, we need to do one thing in particular – improve legal literacy across the whole emergency mental health care system. It shouldn’t need saying that this whole interface of policing and mental health involves high stakes, high risk business: not knowing the duties and obligations across this partnership risks practice which fails to take account of the rights of patients. That’s the most important aspect of this for me: patients are people who have rights, organisations have obligations and duties in respect of them and this includes respecting and upholding the legal rights.

There have been reports published and inquiries held this year, which have had to point out that police officers, mental health nurses, psychiatrists and others do not know the legal frameworks in which they practice. And I’m not talking about obscure aspects of it, which might reasonable be the knowledge of people deeply versed in mental health law: I’m talking about police officers not knowing s136 MHA; mental health nurses who work on wards not knowing their s5(4) powers; AMHPs telling me that they have no powers to return AWOL patients. Some of this stuff is about the blurring of organisational policy or inherited thinking, with the actual legal framework. And I can’t stress this enough: the police are as guilty of this as any other organisation or group of professionals.

The One Great Thing we can all do to improve things next year that costs NOTHING – learn the law – and do this by just reading it. It’s available for free, on the internet and there are various other places to help understand what’s been read. It’s the best free training you’d ever receive – as an inspector at the start of my service told me: “knowledge is confidence and confidence gives power”. My addition to that advice is that power, wielded correctly, is really about protecting the public and respecting their rights. This is territory, when it comes to mental health, that patients and the public tell us all we need to be better at.

• The Mental Health Act 1983
• The Code of Practice to the MHA  (2015, England)
• The Code of Practice to the MHA  (2016, Wales)
• The Mental Capacity Act 2005
• The Code of Practice to the MCA
• The Human Rights Act 1998

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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, 2019

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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

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