I today learned of a Preventing Future Deaths report (PFD) from a tragic suicide a few years back, in 2019. Having read the PFD I was convinced it must be relevant to very recent discussions about the role of the police, so I thought it was worth highlighting.
Mr William Moody intentionally entered the river Itchen in Hampshire on 19th April 2019 to end his own life and after the inquest, the coroner recorded a conclusion of suicide by drowning. In the PFD notice, sent both to Hampshire Constabulary and to the South Central Ambulance Service, concerns were raised about the dispute over police roles and responsibilities between the two emergency services.
Mr Moody was 85 years of age and the day before his death he had been detained by the police (in Dorset) under section 136 of the Mental Health Act 1983, because of concerns for his safety – he’d told his family he would take his own life. After detention, he was assessed by an Approved Mental Health Professional (AMHP) and at least one doctor – they deemed him not detainable under the MHA. Having been discharged home there was a further incident at Mr Moody’s address the following day and it led to his daughter and son-in-law calling the police. The PFD notice points out that Hampshire Police declined to attend the incident because of it occurring in private premises where the police would have no legal powers (under the MHA) due to him being a threat only to himself. For this reason, the police call handler triaged out the incident to the ambulance service and Mr Moody’s family had to spend time working their way through a second set of screening questions for the ambulance service to understand what was going on and what they were being asked to do.
This is interesting for one glaringly obvious reason: the ambulance service wouldn’t have any powers either so if the real issue in this tragedy is all about powers – and it isn’t! – then why refer it to an agency who will face the same predicament as the police, legally speaking? Either way, the only people with legal powers of the kind imagined necessary would be an AMHP who would also need a doctor but such professionals aren’t an emergency service of any kind! AMHPs don’t have blue lights on their roof-rack and they can’t always access a doctor to undertake a joint assessment, even when they do accept it’s necessary.
ROLES and RESPONSIBILITIES
The incident involving Mr Moody obviously developed and he left the premises – you might wonder if that was foreseeable in general terms for someone who had already made one suicide attempt after leaving home and then being detained under s136, but the police not being on scene because they’d bounced the incident to their colleagues in green, they would be unable to then consider the legal options which would have been available if they there.
Mr Moody entered the river and tragically, he died.
In the PFD notice, it is made clear that Hampshire Police gave evidence at the inquest: it makes the distinction about the two incidents on the 18th and 19th, between public places (duty to attend) and private places (no powers to act). I’m not immediately clear I agree that this is the way to rationalise it. Just because an incident occurs in public does not mean there is a duty to attend – it does depend what the incident is and how it is manifesting. The police have legal duties where there is a crime in progress or an imminent, ongoing threat to life. Mr Moody had told his family on the 18th he intended to talk his life so I agree: duty triggered but it might not always be the case with all public incidents. It depends what they are.
Equally, the lack of legal powers under the MHA in private dwellings doesn’t mean there would be no duty to attend. The overarching obligation to protect life (Article 2) exists no matter the location of the incident and again, depending on specifics, other powers outside the Mental Health Act may be relevant. Anyone can avail themselves of common law or Mental Capacity Act options where grounds are met (imminent risk of serious harm; OR taking a best interests decision in respect of someone who lacks capacity) so as ever with policing and mental health: matters turn on their specifics and generalisation is difficult. In this case, triaging out to the ambulance service just puts the paramedics in the position the police are trying hard to avoid when in reality both of them are emergency services who have distinct skill sets for mental health crisis incidents – as the coroner ended up pointing out, the incident required both agencies. On occasion, both agencies may agree it needs an AMHP to consider their responsibilities under section 13 MHA.
LOW RESOLUTION
It’s a theme at the moment that police services, under incredible pressure of demand and resource, are looking at how they can tackle the decades-old issue that mental health work is often inappropriately levelled at them because of gaps or omissions in other agencies. I have no issue with that as a general comment – the police face a lot of inappropriate demand (albeit they also generate it, and that often goes unsaid). We know there is work going now on to allow police call handlers to better identify those 999 or 101 calls which are, necessarily and appropriately for the police, versus those which aren’t – but the devil of that is in fine detail. Low resolution thinking which is vague or a little fuzzy, risks untoward outcomes in my experience of giving evidence about tragedy in coroners’ courts over many years. So whilst it’s fair enough to ask the question about what can and should be triaged out to healthcare organisations, you need to get the detail of that in to quite high resolution focus – or risk outcomes like this one.
Do the other professionals to whom such work would be better deflected even exist in that area at that time? – not every area has identical health services and many don’t have a mental health crisis team which can, for example, visit people away from NHS buildings. Does the agency to which work is being actually deflected have the capacity, capability and competence to handle it? – paramedics bring little more to the party than police officers, in many respects because training in mental health incidents is limited in paramedic training (as it is with policing) and they have no legal powers beyond those available to everyone.
We’ve known for over fifty years that policing is what happens when something is needed NOW which cannot happen by other, available means – it’s why we ring the police for so much that is nothing to do with crime. But as many incidents including this one show, the fact of no legal powers doesn’t mean that there is always going to be no role for officers. One could imagine a mental health in private premises incident, for example, where the police turn up and keep the metaphorical lid on a situation whilst reaching out to those agencies who do have legal options in slower time. Perhaps keeping someone safe in a house in a very short-term, immediate sense is justified knowing full well that if the person chooses to leave it admits ongoing concerns about suicide, they can then be detained under s136 MHA because they left the location where the power can’t be used. It would then allow contact with an AMHP or mental health service to discuss how to proceed.
Yes – this may take a few hours and it may even be OK to point out how frustrating that is because other agencies move slower than either police or ambulance, but remembering they are actually not an emergency service may help.
FINE DETAIL
The gaps between public agencies through which some people fall, are very narrow – and this stuff is not all about legal powers: it’s also about legal responsibilities as well as being about human compassion and empathy. Article 2 is a duty to protect life and it exists whether or not the agency concerned has unilateral powers by which to ensure it – joint protocols in all areas of England and Wales should set out how the police can, for example, liaise with an AMHP service about options in private premises where they are needed and we know there are problems with such protocols (even where they do exist) and that there are problems with what the NHS or AMHP services will accept as a referral from the police. The fine margins between these agencies’ responsibilities means they need to be able to cooperate – and quickly – where no single-agency professionals can resolve a situation to ensure someone is safeguarded in the short and medium terms, with appropriate support brought in for them.
I’m trying to learn a lot about Right Care, Right Person – the initiative which started in Humberside and which is mentioned in the recent letter from the Home Secretary to all Chief Constable and Police and Crime Commissioners. I can only hope that in the work being done to develop the new National Partnership Agreement mentioned in the letter understands the reality that policing often does fill a gap – if everyone did what they should and no other agency’s had shortcomings, we’d barely need a police force at all. But progress towards that is probably around improved investment in more responsive, timely mental health crisis services that are not merely on the end of phone. This is not criticism of the ability to secure telephone support, it’s about understanding the fine detail that telephone support is not going to be the answer to every patient’s needs.
Yet again, Coroners have had to point that out before.
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, 2023
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 – www.legislation.gov.uk
Mental Health Cop 