Last month, I posted about the inquest after the death of Mr Leighton Dickens in South Wales. I would recommend reading that post before this one, or it risks making no sense, however by summary: Mr Dickens died by self-inflicted injury where his intentions were not clear after what the jury decided was a missed opportunity by the police officers involved to detain Mr Dickens under s136 of the Mental Health Act 1983. The PFD notice published afterwards was sent only to the Chief Constable of South Wales Police, albeit copied to the NHS (who are therefore under no obligation to respond) and I admit being surprised to read nothing about use of that power or about training or guidance related to its use.
The Coroner raises five matters of concern and they all related to the provision of healthcare services which are available to assist, advise or inform the police about matters which may then affect their decision making.
The reason this PFD is unexpectedly interesting is —
- The matters of concern are about NHS healthcare provision but they have been sent not to the NHS, but to the police.
- The matters of concern say nothing – quite literally nothing – about the factor which seemed most highlighted by the jury about the missed opportunity.
The PFD does set out in background the question about use (actually, non-use) of the power, but this mention does not go beyond that, to flag whatever factors are thought relevant to the prevention of future deaths. It’s hard therefore to understand whether the coroner is saying non-use of the power, having been described by the jury as a missed opportunity, is not something which could lead to future deaths and this seems to be something of a contradiction worth discussion.
MATTERS OF CONCERN
The bigger question for me, however, is whether addressing the matters of concern would, in fact, by likely to prevent any future deaths of the kind under examination?
For those who haven’t read the previous post, Mr Dickens was in a vehicle with his girlfriend who was trying to take him to hospital when he grabbed the steering wheel of the moving car. The police turned up and found him wearing nothing other than a dressing gown, with self-inflicted injuries and they assisted him to an Emergency Department on a voluntary basis, without arrest or use of the MHA. After arrival, Mr Dickens, whilst still in obvious distress, appeared to want to leave and I inferred from media coverage the officers were trying to prevent that outcome. He kept asking whether he was under arrest, which I further inferred was because he wanted to leave and was being prevented.
So looking at the five matters of concern which relate to improved NHS mental health advice to police officers, I am left wondering what that advice could amount to in practical terms if officers are ringing up about a man who’s at the roadside having just interfered with a moving vehicle and been found in a dressing gown with self-inflicted injuries; OR is in ED with those injuries. I’m wondering how many nurses, whether they were on a phone or present, would recommend anything other than to detain the person under s136 MHA, irrespective of what background information they had available. The risk involved seemed reasonably significant – interference with a moving car, self-inflicted injuries, barely clothed with no shoes and declining to remain somewhere for thorough assessment.
Perhaps the unspecified hope is professional advice would have led to use of s136 after encouragement of recommendation of that approach by mental health nurses when contacted? As a general point, it’s worth noting we know of cases where nurses have advised against use of s136 only for a serious untoward outcome to follow and for officers to still face questions about non-use of the power. HM Coroners have cautioned against police officers believing that advice from mental health professionals is ‘expertise’ and cautioned telephone advice as well – advice or opinion given about safeguarding a vulnerable person by a professional who is not there to assess them is always at risk of going awry. We need police officers on the scene to be capable of accessing whatever information is available to them, but nevertheless and regardless of the advice given, making sound, defendable decisions about whether it invoke use of legal power which sit with them alone.
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 