A new Preventing Future Death report to Watford General Hospital highlights the importance of constant supervision of patients at raised risk. In 2021 Mr Paz Ogbe-Millar attended an Emergency Department accompanied by police officers who had been called to his home by his mother after a psychotic episode linked to his use of cannabis. His mother also attended the ED and he was left in the care of NHS staff after a handover of background information by the officers involved. Having been triaged, he was advised to await assessment by a mental health team and somewhat inexplicably, his mother was than asked to leave the ED by NHS staff, contrary to their own policy. Shortly after that, Mr Ogbe-Millar left the department and travelled to London where he died.
His Majesty’s Coroner for North London has written to the hospital, outlining various matters of concern and they are worth listing because despite not setting a binding precedent, they touch upon what might be considered a reasonable expectation and I can imagine this resonates with police officers who attend Emergency Departments with patients on a voluntary basis.
- Lack of records about information from the police handover.
- Lack of constant observations once a raised risk of self-harm had been identified.
- Removal of an obvious protective factor when his mother was asked to leave.
- Inconsistency between hospital policy and hopsital paperwork about what the required level of observation would be for someone at medium risk (whatever that means) of self-harm.
For the avoidance of doubt: the police had first encountered Mr Ogbe-Millar in a private dwelling where section 136 Mental Health Act 1983 cannot be utilised. Neither the media coverage nor the PFD notice itself directed at any criticism towards the police, so an inquest having occurred I must assume there were no concerns about their decision to leave the ED given they obviously attended and provided a full handover. In fairness to the officers, the presence of the patient’s mother along with their reasonable expectation of relevant observations by NHS staff may have contributed to their decision it was safe to withdraw (and I’d always recommend those discussions be had out loud, so no-one is in doubt about who is doing what, or why).
We are hearing chat at the moment about “Webley handovers” (about which there is a blog pending), but this is not obviously such a situation because it didn’t involve legal detention and it obviously did involve police provision of known context and background.
EMERGENCY DEPARTMENTS
When the latest statistics were published for use of s136 in 2022/23, we saw that Emergency Departments are used as a Place of Safety (PoS) under the MHA around 35% of the time. My experience is that most of the time, this is not because of additional injury or illness which specifically requires ED treatment, but because of a lack of provision in other kinds of NHS location to act as a Place of Safety. Some police forces have less MH-PoS capacity now than they did fifteen years ago despite the fact use of the power has more-or-less doubled in that time — no wonder ED is over-relied upon for detention under s136 MHA.
Of course this situation did not involve detention under the Act – Mr Ogbe-Millar was transported on a voluntary basis, having been encountered in a location where s136 could not be utilised. Of course, this doesn’t always mean the police should deliver the person and then leave. That may have happened here and I remind you there was no criticism offered on this occasion of the police decision to withdraw but all cases turn on their specific merits. Reading about this case and learning the PFD was only directed towards Watford General Hospital should not be taken to mean it will always be appropriate to withdraw after a handover period.
When someone encountered in a location where s136 MHA cannot be used exercises a free choice to leave such a location, police use of the Act opens up as possible, assuming the grounds are met. So where someone is transported on a voluntary basis – whether by the police service or by the police and ambulance services – it may be necessary to think about risks of self-harm, suicide or absconding and factor that in to any decision to accompany to an ED or remain there pending suitable arrangements for supervision. That appears to have been sufficiently through-through in this particular case, because the PFD is not addressed at the Chief Constable.
ALL CASES TURN ON MERIT
When I first read this PFD, addressed as it is only to the NHS, I wasn’t inclined to write a post about it – yes, there was police involvement but there has been no criticism of it so what is there to learn? Well, it struck me that what needs reinforcing is that the approach taken here seems to have been justified for the situation faced here – this does not mean it would be appropriate or justified for situations which may appear superficially similar, but differ sufficiently to warrant another approach. Last year’s inquest in Northern Ireland makes this point loud and clear where transportation and police withdrawal from ED were heavily criticised as contributing to an “entirely preventable” tragedy where two people were killed.
Those of you who saw this week’s episode of BBC One’s Ambulance will have seen paramedics wrestling with these issues of transporting mental health patients on a voluntary basis who may or may not be ‘agreeing’ because they are being strongly encouraged by lovely paramedics trying hard to keep them safe. We saw the ambulance crew having to ask for the police in the end, because the patient eventually became sufficiently anxious about attending hospital that she walked off and officers were required because paramedics have no legal powers to keep people safe, beyond immediate risk situations. Police use of s136 was required.
In situations where that absconding risk seems obvious because the ‘agreement’ to attend ED is in a context where we cannot be entirely satisfied that is entirely willing cooperation with someone who has capacity to understand what they are agreeing to, it may be police involvement in conveyance (rather than leaving a situation to paramedics) is required OR that police remaining in an Emergency Department until such time as risk management is in place by the NHS.
So the lesson from this PFD is this — it’s only a PFD about this and it doesn’t necessarily have obvious application to other situations which will always turn on their merits.
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 