Many times over the last twenty-odd years I’ve heard it said that police officers, when it comes to risk management of mental health, are “risk averse“. For example, faced with someone who has expressed suicidal ideas, it has been known for feedback to be officers are sometimes too quick and too keen to resort to use of section 136 Mental Health Act 1983 to safeguard the person from that risk by detention, and to show they’ve “done something”, whatever that means.
The implication when this is said appears to be that officers should be more willing to accept or tolerate risk of things like self-injury or even suicide and I find this curious for at least two reasons —
- Police officers are not mental health professionals — it’s not for them to assess and determine clinical risk, but to protect people and their legal rights, sometimes by the application of relevant legal powers and the discharging of certain responsibilities.
- To what risk aversion standard are we wanting the police to move? — whatever the answer is, I just hope it’s not the same standard applied in risk management by too many mental health professionals.
Let me explain —
For all of what we may see in policing, we see plenty of risk tolerance in mental health – and indeed, over-tolerance. Yes, you could easily analyse a load of s136 detentions from an area and probably point to several which amounted to officers acting too quickly to detain someone when other approaches may have been preferred – just make sure if you do that analysis, you’re holding the officers to the standard of what a police officer should do, not the standard of what a mental health professional would do.
But equally, keep in mind the tendency of mental health professionals to tolerate levels risk which often attract criticism in His Majesty’s Coroners’ courts. We know of plenty of s136 detentions where the police were astounded someone was not further detained in hospital, even if mostly for their own immediate safety, and following discharge from the provision, they are dead by suicide not long after. We also know of street triage nurses advising against use of s136 MHA, only for tragic outcomes shortly afterwards.
KENNETH BAYLIS
I recently read a very sad Preventing Future Deaths report, after the suicide or Mr Kenneth Baylis in Nottinghamshire in January 2023. Mr Baylis had been severely depressed for a number of years and between 2021 and January 2023 had made four serious attempts on his own life. Immediately prior to his suicide, he had been an inpatient in a mental health unit. He chose to leave the unit and was subsequently found deceased. His Majesty’s Coroner for Nottinghamshire has been critical of the decision to allow him leave and of the lack of discussion or consideration which was had for his family’s input.
Ultimately, the coroner found his leave should “never have happened”.
First things first, voluntary patients are entitled to leave hospital so you might be wondering on what basis a voluntary patient can be denied the right to leave if they wished? Indeed, some of the coverage of this implies some staff thought they had no power to do so, because of his legal status. Section 5 of the Mental Health Act 1983 (MHA) relates to the powers of doctors and some nurses to detain patients in hospital for a MHA assessment. It seems implied from the PFD this should have been done, with a view to Mr Baylis being ‘sectioned’, at least for his own safety and to enable recovery.
So there are two things to think about, in all fairness — legal knowledge around the application of holding powers, but also the issue of risk tolerance.
Mr Baylis’s sad case is not the only one where we might wonder about allowing risk to predictably manifest itself.
OTHER PFDs
Sally Mays and Melanie Rabone —
Patients whose risk was known to staff and deliberate decision was taken not to mitigate risk. Sally Mays had presented to a mental health unit crisis centre in Humberside begging for help. This was denied and staff call the police to remove her from the premises. Officers actually had what the coroner called a ‘stand up row’ with staff, advocating for her to receive the help she appeared to desperately need and despite their efforts, Sally was still turned away. She died by suicide at home and it amazed me to learn that at Sally’s first inquest (there were two, which is a whole other story), NHS staff suggested the police should have used s136 MHA if they were so concerned. Use s136 MHA on a patient who mental helath professionals have just decided needs to be sent home as is, by definition of that decision, not in immediate need of care or control otherwise they’d have given her what she was seeking without kicking her out?
Melanie Rabone was the patient in Greater Manchester whose experience now forms the basis of the UK interpretation of the phrase “immediate risk to life” following a Supreme Court ruling. She was also a voluntary patient who had been allowed a period of leave in circumstances where the psychiatrists involved in her care had written up her medical notes to say she should be held under s5 MHA if she attempted to leave. Despite this, based on a 5-20% suicide risk, it was allowed when she asked for it. After her life ended by suicide, Melanie’s parents brought an action against the NHS and won.
It’s thanks to them we now know Article 2 ECHR does apply to voluntary patients and how we should rationalise the so-called operational duty, the immediate risk to life.
If you look at the Chief Coroner’s website, you’ll find plenty more – google searching news media also reveals several. If we were to discuss how “risk averse” the police and its police officers can be, we probably need to remember, the accusation comes from a different perspective involving people with a different skill-set and organisational cultures. And it’s not correct to say those skill-sets and cultures lead to a record on suicide risk predication which is always spot on and something to be emulated.
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 