A number of discussions on social media recently have raised the idea that involvement of the police in some mental health situations where there is no crime, (or serious risk / threat to life) can be ‘useful’ for what I will call, promoting cooperation. This post is prompted by a discussion which resulted from a reminder I placed on Twitter about powers of entry to people’s private homes: the police, I noted, have no power to force entry to someone’s premises for the purposes of undertaking a ‘welfare check’. If there is a general concern about someone’s welfare, the police may not force the door off its hinges just to ensure that someone is OK. They can, of course, force entry to premises to ‘save life and limb’ (under s17(1)(e) of the Police and Criminal Evidence Act 1984), but that is quite a high bar to satisfy.
Officers must apprehend death or serious injury to someone, to justify “life and limb” – any generalised notion someone may not be well or that someone may be non-seriously injured is not sufficient. The case of Syed v DPP (2010), reminded us of this. But not everything is about the law, is it? Policing is about more than that – it’s about being human and acting humanely to help people where you can.
Reaction to the legal point made me think further because it was not unfairly observed that sometimes people may be more willing to open the door to police officers conducting a welfare check than they would to a community mental health team nurse or a paramedic. I’m sure that may be true, but here’s a catch: it may also be completely untrue – it may, in fact, be the opposite of true. Some people may be far less likely to open their door to police officers, and for a complex range of reasons which are as varied as the individuals to whom they relate. As with all people in society, some people like the police, others don’t – this remains true of those of us whose lives are affected by our mental health.
FIGHT OR FLIGHT
In my experience, you can never entirely predict the effect that police officers will have on a situation. I’ve lost count of how many ‘pub fights’ and other kinds of disorder I’ve attended in my 22yrs, but at some, the fact that a van of officers has turned up has absolutely no effect whatsoever … literally none. So you then have to start shouting and starting to break things up, physically if need be and sometimes arrests are made. On other occasions, the group immediately disperses on arrival, if not before you arrive when the sirens can be heard and the blue lights seen – the fact of an impending police arrival is sufficient to cause sudden changes in behaviour. Just occasionally, you start trying to manage disorder which didn’t disperse and they all stop fighting each other and turn on the officers! … it’s just impossible to predict with any degree of accuracy and that’s my point. My experience tells me that it’s unpredictable (for different reasons) when you bring the police in to a mental health related situation.
Some vulnerable people find the presence of officers naturally reassuring – they see the police as something ‘outside’ a mental health system they’ve had problems with and are somewhat frustrated or intimidated by: a friendly face not using clinical language is a natural support at a difficult time and that’s always a rewarding time professionally spent. You can probably guess where I’m going next … sometimes the opposite is true. I’ve met people who actively dislike the police becoming involved in their healthcare and see us as a coercive, restrictive and stigmatising factor of living in circumstances which are already stigmatising enough. To have uniformed officers hanging around the situation, in effect criminalising you … some patients have spoken of how regular attendance at their home address, often sought by mental health services asking for welfare checks, has contributed to harassment towards them and damage to their property.
So you never know whether introducing the police to a situation will promote cooperation or give rise to a fight or flight response. And tragically, there are more than a few cases out there where the involvement of the police (or even the merest mention of their potential involvement) have been known to cause a fight or flight response which had serious consequences. We need to take very seriously that many people would simply prefer to have the police kept out of routine responses to their healthcare situation, except where justified by the police bringing something to the situation that only the police can bring. And even then, the tragic case of Lauren Finch in 2018 showed that even policing which is done necessarily and lawfully can have a negative impact – in Lauren’s suicide, the fact she was forcibly returned to the mental health unit after being absent without leave, was listed as one of five ‘probable’ factors contributing to her death – even though the police were obliged to locate and return her.
In other words: we need to understand policing for what it is – it’s an inherently and unavoidably restrictive and potentially complicating intervention, even if only by its implication and it can have tragically negative effects. Remember: we all have various kinds of legal and professional duties to do our work by the ‘least restrictive’ principle.
FORCE versus RESTRAINT
We must remember a key difference between the legal use of force and the legal use of restraint:
If a police officer says to you “Stop swearing and threatening people or I’ll arrest you [for a public order offence]” and the person then complies with that instruction, this does not lead to the officers recording any use of force. It was verbal warning, not coercive force. However if an officer said to someone “If you don’t get on the ambulance and go to [a healthcare venue] for assessment, I’ll detain you to ensure you go” then the law would regard that as a use of restraint and restriction. The Mental Capacity Act 2005, for example, regards restraint not just as the use of force, but the threatened or implied use of force (see 6 MCA). The Mental Health Act Code of Practice says some roughly similar things about not threatening to ‘section’ patients to promote their admission to hospital – people should exercise free choices around their healthcare decisions and coercion should only be done where such free choices give rise to the grounds for restrictive interventions.
This begs difficult ethical questions, in my view, and they’re more difficult for officers who have to swap attitudes from context to context; and it means something specific about use of the police to promote cooperation with mental health services. Of course, many may argue that engaging with mental health services is an important part of ‘help-seeking’ and support for vulnerable people – I’m certainly not saying that’s untrue. That point accepted, if you listen to patients and survey social media, you will find that many people have their questions and their difficulties about engaging and seeking help, some of which has caused them a reluctance to do so again. This is not true of everyone, or even of most patients, but it’s true of enough to mean the police need to understand that adults with capacity to make decisions are allowed to take their own decisions about their health, even where those decisions may be considered unwise by professionals and that many people have reservations about the care offer made by the NHS. Don’t take my word for it: this stuff is all there to be seen on social media and by talking to people and at the risk of being blunt: some people don’t find the ‘help’ to be helpful and that’s their analysis to make.
In many cases which have appeared before the courts (including recently), the fact of an unwise decision is sometimes offered up as the basis for suggesting a lack of capacity – and this is expressly denied by the Mental Capacity Act.
So what I’m resisting here is two things, in the main –
- The oft suggested notion that the police have a general role to promote cooperation with the health or mental health system – the police, I would agree, have a role to ensure that people realise there is a system there which can potentially support them and to offer signposting towards it, where relevant. But we all need to realise that whether someone wishes to engage is a matter for them as long as they have the capacity to make that decision.
- I’m also expressly concerned about the idea that the presence of the police promotes cooperation – I fully accept that it can do this (irrespective of whether it should), but I’m also experienced enough to know it can and does have the opposite effect, on some occasions and that this can have serious, even fatal outcomes. And there is often no way of knowing which effect it will have until you’ve turned up and caused it.
RESTRICTIVE PRACTICE
Policing is inherently restrictive, it could hardly be otherwise – police officers carry a range of coercive powers and the potential for their use is ever-present, if required, in every encounter they have. It therefore needs to be justified as an implied use of force when it comes to responding to vulnerable people who often feel criminalised and / or stigmatised by their condition, their circumstances and the responses they receive. Add policing to that and we can start to understand how toxic this becomes, even if just in terms of perceptions. We need to fully understand and accept you may not be able to predict the effect officers have until it’s too late to do anything about it.
Even if we could be sure of a positive or neutral effect for most, can we discount the negative potential for some? … this stuff involves can include stress, trauma and distress as well as coercion and prosecution. Of course, the police cannot always remain uninvolved in crisis care responses and that’s expressly not what I’m arguing: it’s just about observing the inherent qualities and coercive potential of policing and suggesting it needs to be justified case by case. This is what we do every day with the deployment of police to firearms incidents – just because the word ‘gun’ features in a 999 call, it doesn’t mean we automatically deploy armed officers. It’s more subtle than that, especially where time allows to consider other approaches that minimise resource to the use of potentially lethal force.
Armed officers are deployed in policing every day, of course, but it’s reserved for those situations where specific assessment can justify that as proportionate to the threat and risk in the incident and where the risks of firearms officers discharging their own weapons at the public could be capable of obvious justification. Proper assessment of risk and threat is about much more than what is posed by those involved in the incident – it also involves consideration of the risks posed to those within the incident, if police are deployed. Responses need to be justified case by case and that’s all I’m arguing for here:
When we consider policing vulnerable people in crisis, we need to minimise the recourse to policing – not for the benefit of policing, but for the benefit of the public we are all attempting to serve.
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
Mental Health Cop 