Be careful not to over-push – the discussion at the moment is all about police services re-evaluating the response they give to mental health incidents, with an emphasis on responding to fewer calls which do not require a police response. Those who have followed this blog for a while will know I completely agree with this principle – I’ve written about exactly this for more than a decade, cautioning against the over-reliance upon the police to undertake ‘welfare checks’, as well as a variety of other tasks which do not, inherently, require the police and which come at a risk and a cost, if we continue to over-rely. I’ve specifically highlighted particular issues such as the recovery and return of mental health patients where their location is already known; the conveyance of patients between locations, especially where there is no reason to suppose the patient will be violent or dangerous towards others undertaking the task; and of course the problem of expecting the police to plug problems in the process where MHA inpatient beds are required but not available.
All good so far – but there is an obvious risk here of over-pushing. As discussion now focuses upon what the “Right Care, Right Person” scheme is aiming to achieve, we’re hearing of and seeing examples of over-push. By this, I mean officers or staff pushing back against requests which perhaps should be considered for deployment. We know now, for example, that the threshold for police involvement in an incident is outlined in the National Partnership Agreement (2023), published in July.
It states police involvement should occur –
- “To investigate a crime that has occurred or is occurring; or
- to protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm.”
So nothing in this threshold outlines something about “police powers under the Mental Health Act”. It could be, for example, an Approved Mental Health Professional (AMHP) wants to attend a location to assess a vulnerable person who is self-neglecting and has secured a warrant from a Magistrate under s135(1) MHA. That can occur even where there is no suggestion of a crime and no reason to suppose either ‘immediate’ risk is present. Mental Health Act assessments and warrants can be about other kinds of situations. Now, in fairness to the NPA, it goes on beneath the threshold to state that nothing prevents Chief Constables exercising discretion and agreeing to become involved in other situations and it gives s135(1) warrants as one example. But we already know that some AMHPs have experienced resistance and delay in police forces where officers have not been allocated to support in a timely way or even where control room staff have encouraged the AMHP just to attempt the assessment on their own and to ring if there are any problems.
Only a police officer can execute a s135(1) or s135(2) warrant. No point telling the AMHP to crack on – they legally cannot do so.
SHOULD I WORRY?
So I’m starting to wonder – OK, I’m starting to worry – about how far some front-line officers and staff are going to go in interpreting what’s happening now. I’m worried about ‘over-push’ – ie, taking the idea of pushing back against inappropriate demands by taking it too far. We hear of incidents on social media and elsewhere –
Recent examples have included officers being pleased they will not have to search for missing Mental Health Act patients and return them to hospital, especially those patients who were granted leave and failed to return. Things like, “If the patient was granted leave, how can there be so much risk when they fail to return? Surely leave being granted means there wasn’t that much risk to begin with or they shouldn’t have been granted leave.” And then suggestion the police should not attend such calls, because of this outlook.
Several points on this example alone –
- The fact leave was granted and the fact someone failed to return, could still mean there is an article 2 (A2) or article 3 (A3) risk that now needs managing – that needs to be assessed on the merits of the individual patient and circumstance.
- There can be risk to the patient or others after they fail to return, without it meaning the grant of leave was an egregious error by the doctor authorising it.
- In assessing it, we need to remember what ‘immediate risk to life’ means. There is evidence plenty of evidence that many don’t.
- Contrary to certain claims, RCRP is not about the police not responding to missing AWOL patients: it’s about identifying those situations where the A2 or A3 risk is present.
- It may even be about supporting NHS staff in returning someone who could become violent when re-detained.
- And if someone’s location is not known and they are missing, we need to remember certain things required for missing people (and therefore including missing patients) can only be done by the police:
- This includes live traces on mobile telephones, markers on vehicles which may be carrying the person to narrow down their location or direction of travel; enquiries about their financial usage if the investigation to locate them goes on for a while; urgent searches of premises (where the relevant thresholds are met).
We hear of other examples: an NHS member of staff stating police declined to attend a hospital where staff are engaged in a violent struggle with a patient “because it’s a hospital problem”. Bearing in mind the threshold, above, it’s difficult to imagine a situation where such a struggle would be occurring and the threshold would not be met for one or two reasons at least. It should also be borne in mind, the four areas of policy towards which RCRP is directed doesn’t mention the topic of police support in NHS settings for violent incidents – whether that be an Emergency Department or a mental health unit. There’s no particular reason why it couldn’t mention this and a few other things, but it doesn’t.
Again, there are some points to bear in mind –
- What happens if someone makes a decision to decline to attend and we end up with assaulted NHS staff, who then complain about the non-response?
- I could imagine the threshold will be quoted and someone pointing out that two of three criteria were easily satisfied.
- We should remember, 70% of all violence in the NHS is within the mental health sector and much of the rest is in the Emergency Department setting or where ambulance crews are involved.
- It should be borne in mind that two mental health staff have been literally murdered on mental health wards in the last decade – one in Gloucestershire and one in Croydon.
- Some NHS staff now state they are having discussions with their colleagues about whether the police can be relied upon to attend and protect them, where required.
- It’s worth noting the College of Policing appears to have removed from its website, the joint memorandum of understanding on police attendance on mental health wards which was published in January 2017.
So be careful not to over-push – this business is as complex as it is sensitive and we know the debates which follow from untoward events following the above kinds of examples is the stuff of inquests. And be careful what you think – because most of it is wrong.
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 