I’ve been thinking for most of this week about the findings and conclusions of His Majesty’s Coroner for Northern Ireland (NI) in the inquest in to the deaths of Mr Michael and Mrs Marjorie Cawdery and I suspect there may be a few posts flowing from different things which were said, this being the first. It’s the question of joint responsibility I want to emphasis here, this is something the Coroner said towards the very end of over five hours of findings and summaries and she stated that whilst the police service in Northern Ireland had a lot of work to do to provide training, there was a responsibility on individual police officers to make sure they were aware of the various things that have bearing on their responses to mental health incidents.
This is a difficult topic, without a doubt – because the Coroner herself made it obvious the force had provided some training, but even where officers had received it, it was inadequate to the objective of ensuring they had relevant insights in to guidelines and local protocols which had bearing on their potential use of article 130 Mental Health Order (Northern Ireland) 1986 – for my purposes in this post, it is a power which is exactly equivalent to section 136 Mental Health Act 1983 in England and Wales. There is also the problem of accuracy and detail in these matters, which is what this post is about – the complexity of the considerations which is relevant to how realistic it is to expect such detailed understanding in all officers, when they may exercise powers under a130 or s136 only very rarely.
In cases where non-use of police powers comes under scrutiny, we tend to see a few debates emerge. So this list is not about the Northern Ireland inquest specifically, but about other situations which have led to inquests or inquiries.
CHECKLIST
- Are you aware, the kind of mental health assessment which occurs when someone attends an Emergency Department is not the same thing as the assessment which follows a130 / s136? –
- in ED, a patient would be seen by the ED triage nurse and then potentially by a MH nurse from the psychiatric liaison service.
- Subsequently, other decisions can be taken about whether to call for a statutory assessment involving an Approved Mental Health Professional and a DR (or Approved Social Worker / DR in NI).
- If the statutory powers are used to detain someone, regardless of what ED decide, there will always have to be an AMHP/ASW assessment with a DR.
- The Coroner seemed concerned officers did not realise the difference.
- Are you aware of how to think about whether to deal with someone on a ‘voluntary’ basis where there are concerns about their mental health, for example by assisting them to ED or signposting them there?
- You should not only rely on someone’s willingness to go to hospital at the moment you invite them to do so, but should also consider whether they have capacity to make that decision and how reliable it will be they remain at the ED for the many hours it may take to see the ED-liaison staff and then potentially wait for an AMHP/ASW and DR and then wait further for any inpatient mental health bed that is required.
- Such bed searches can take days and there are other inquests where officers have assisted someone on a voluntary basis, only for that person to predictably walk out of ED within a short period of time, after the police leave.
- Indeed, examples have been raised to me by healthcare staff of people arriving at ED in handcuffs, under restraint only for officers to insist the person has attended voluntarily, which is not really credible.
- One way to think about proceeding on a voluntary basis is to think about whether you would be happy to walk away from the person once they arrived at ED –
- If you’re not because you worried what may happen if you do and you’re going to want to remain there to ensure the person is seen, it’s not really voluntary, is it?
- So if you’ve originally encountered the person in a place where s136 MHA / a130 MHO can be used, you might want to think about formalising your powers;
- … and if you originally encountered the person in a private premises, it’s worth remembering that nothing prevents powers being applied later if the person has voluntarily left the location where the power could not be used.
- If a statutory power is used, are the officers familiar with the process which follows on from its use?
- This would include the need to call an ambulance, but also considerations around when it would be appropriate or necessary to crack on without an ambulance.
- When should someone go to an Emergency Department, when should they go to a health-based Place of Safety and so on?
- What does the local protocol or guidelines say about all of this? … and here’s a really crucial question:
- Are the guidelines and protocols actually any good?!
- There have been plenty inquests which reveal the inadequacy of joint protocols between police and mental health trusts.
WHERE’S THE LINE?
I’ve followed the detail of many complex, sensitive inquests on policing and mental health as well as having been an expert witness in several of them. If there’s one thing that stands out from all of that work, it’s that in the end, officers are responsible for their actions / inactions according to the law. Defective policies, procedures and training only go so far in providing a ‘defence’ where it is being suggested something went wrong and in any event, even if a deficit in leadership or training largely accounts for the decisions we see or the outcomes we experience, the accountability processes (like a Coroner’s Court) is not going to leave un-examined, the actions of those involved and it may well still be very stressful indeed, to say the very least.
Let me give you an example –
During the inquest in to the death of Leon Briggs (Bedfordshire, November 2013), the barrister representing Mr Briggs’s family wanted to question one of the custody officers about chapter 10 of the (then) Code of Practice to the MHA (the 2008 edition, in force at the time but since replaced – it’s chapter 16 of the current Code, if you want to read after what I’m about to highlight!). The sergeant was asked some very specific questions about the content of the chapter and it was quickly apparent, they did not know the answers. The barrister explored this and it was as equally swiftly revealed the sergeant had not read the chapter, hadn’t heard of the MHA Code of Practice and was entirely unaware it contained material relevant to the police use of custody. The relevance of the Code and by implication the chapter was mentioned in the 2010 national policing guidance on mental health, but nothing in the training records for that force suggested the officers had been trained in that, specifically. So it having now being firmly established the officer hadn’t read the content or known of it, guess what happened? – the barrister just read out the relevant paragraphs and asked his questions anyway because the remained relevant to the interests of the Mr Brigg’s family at that inquest.
In other words, statutory guidance is statutory guidance even if you’ve not read it or never heard of it. It’s still relevant legal material that should shape things and ultimately, as the police themselves would say, the law is the law and ignorance is no excuse.
So if you are a front-line police officer, quite possibly newly exposed to the extent of mental health related demands on policing, you need to make sure you’ve prepared yourself for the reality of the work you do and this remains true whether your organisation has tried to do so for you, or not. This blog is a good start – it contains a number of resources, summaries and highlighted cases to help understand why it just won’t be enough to bounce you’re way through something on the basis of custom or practice based ignorance and then say you weren’t aware.
See the main resources this blog can offer you then get yourself a cuppa, settle in and get reading.
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, 2024
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 