A little knowledge is dangerous
Mental health has been creeping up the agenda in policing for some while now. I will confess to mixed feelings about this progress and I imagine that might surprise you. On the one hand, I’ve spent years banging on about mental health in the hope of its importance being recognised and slowly but surely, it is. I really think we’re on the verge of getting somewhere with this. However, I’m also concerned about a trend over the last year or so, in particular – this trend arises partly from the fact that the police are having to manage remaining resources ever more closely as they become scarce; it also arises from that old adage that ‘a little knowledge is a dangerous thing’. The next part of that phrase is “A little want of knowledge is also a dangerous thing.” As more officers are told to undertake work on mental health, I see them struggling with the gaps in their legal knowledge just as I did when I began. I first piled into doing proper work on this topic over ten years ago, when a Chief Superintendent in Birmingham asked for volunteers to get involved in revising all the operating procedures with the newly merged Birmingham and Solihull Mental Health Trust. Ten years later – three years of which was spent working full-time on mental health – and I’ve learned just a thing or three. It is therefore with a wry smile that I notice some of those more recently involved police officers falling into the traps and pitfalls I was falling into in 2004. This blog was always intended, in part, to help police officers avoid those traps but only last week I heard a senior officer talking about ‘capacity‘ as if it meant anything at all in the context of criminal offending. He was bemoaning the lack of written statements of evidence by psychiatrists to confirm it is acceptable and possible to prosecute someone. He looked really confused when I asked why we were asking doctors legal questions given that we rarely take medication prescribed by lawyers. Whenever I do talks to groups of police officers about this interface with mental health, I often ask, “What is it that really annoys or frustrates you in how our mental health system or our NHS works?” and you always get a flood of answers. It will usually include something about section 136 facilities; having to wait around for hours; being asked to do things which are, properly considered, health responsibilities and lots more besides. I don’t ask the question because I particularly care about the answers – I ask it in order to set up another question: “What is that you think really annoys of frustrates our colleagues in mental health about police officers and the police service?” This question is ALWAYS greeted with total silence. Which means we either have no idea or it means the police must be perfect. I can tell you for free it’s not the latter, but I think you knew that already! We seem to have no insight into our own shortcomings and how they affect mental health services. So let me enlighten you, because I have repeatedly asked mental health professionals this question and they always have a long list of answers! Irritating health and social care This is not intended to be an exhaustive list, but there are usually a consistent range of complaints:
- Officers failing to take seriously assaults on health / social care staff: a lack of proper investigation and a lack of rigour behind decisions not to arrest or prosecute patients who have hurt NHS staff — I have never known NHS staff be unreasonable when you inform of a decision not to prosecute after an investigation which they know has been diligently conducted but where the outcome is not what they hoped for. It’s only where officers shrug shoulders and say, “Isn’t this part of te job?” or similar things that objections arise.
- To give just the most recent example drawn to my attention: one force had officers attend a mental health unit where a s3 patient had stamped on the ankle of a member of staff, breaking it, bitten someone else’s nose and attempted to gouge out someone’s eyes and the attending officers didn’t even record a crime — no investigation followed, all because the perception was that the patient wouldn’t be prosecuted so why bother. It all had to get looked at again.
- A lack of legal knowledge about the Mental Health and Capacity Acts leading to officers saying things which just sound silly to people who know what they’re talking about — examples include talking nonsense about ‘capacity’ as a proxy for various things; officers confusing the circumstances in which warrants are needed from those were they aren’t. In particular, the thought the AMHPs who have ‘sectioned’ patients need warrants to remove them from premises after a MHA assessment – which they don’t.
- Overuse, misuse and abuse of section 136 of the Mental Health Act — this is still happening on a large-scale, in particular where officers are detaining people MHA who should be arrested for drunkenness offences or more specific criminal offending.
- Difficulties in securing support for patients who become resistant to detention after being ‘sectioned’ — AMHPs calling 999 for support and being told that the police aren’t coming when there is no way the call handler or sergeant making that call can know it’s correct to decline to support.
- And a very modern trend I’ve only been hearing about over the last year or so – officers refusing to attend premises with AMHPs who have warrants from the courts to locate and remove patients — the two warrants contained within section 135 can only be executed by the police and telling staff to go to premises anyway and “ring us if you have any problems” is often not acceptable.
Proxy policies Some years ago the Metropolitan Police introduced a policy which in effect meant they would not support Mental Health Act assessments in private premises, unless the AMHP had obtained a warrant under s135(1) MHA. It was argued that the sorts of situations which required police support would always give rise to the grounds for a warrant being met. As such, because police officers are fairly powerless to manage risks without a warrant, they would ask for one in order to make sure that they did have an ability to intervene and keep people safe. I admit to thinking that warrants are sought less often than they should be and that the Met were trying to prevent frontline cops from difficult discussions by making it easy to process. Finally, the “no warrant = no police” debate reduced various fairly complex situations into overly simplistic scenarios where the warrant issue becomes a proxy for a more considered debate about whether it was right for the police to attend. It somewhat over-simplifies things. The are (at least) two problems with this “no warrant = no police” debate — It is quite possible to conceive MHA assessments where the grounds for a warrant would not be met and where the police would still be required to prevent crime or a breach of the peace. Where anticipated risks of crime or aggression arise not from the patient to be assessed but from third parties present at the scene, officers may still be required. Remember, it is a criminal offence to obstruct an AMHP in the course of their duty and AMHPs have legal rights to enter premises in conjunction with their warranted, legal responsibilities. It is not unreasonable as they are agents of the state, also, that they may need police support from time to time. Finally, if you read the new draft Code of Practice to the Mental Health Act, it shows a current intention to include a paragraph that outlines a requirement for the police to be told why their attendance at a MHA assessment is required if there is no warrant in force. Why would this requirement be there unless there are situations in which warrants are not possible, but police support is still required? But secondly, even where the grounds for a warrant are met, certain circumstances in which an MHA assessment might occur make it clear that no sooner will professionals have entered the premises, than a decision to apply for admission will occur This is the best example of why police officers and policy writers need to be careful about grabbing at a simplistic proxy position as a way of resisting demands that many be drifting their way. But for heaven’s sake! – if we’ve badgered away asking for warrants to obtained more frequently, let’s not mess about when AMHPs actually get them and then ask us to execute them. There is a growing trend of nonsense where officers have asked AMHPs to execute them (they legally can’t!) and where officers have suggested AMHPs should try to get through without police support and without executing the warrant. Pushing back I’m the first to think that there are too many demands connected to mental health that make it to the police and there are too many assumptions about what the police could or should do. I very firmly subscribe to the view that there is far too little early intervention and far too little Crisis Support that does not involve the criminal justice system and some kind of criminalisation contingency. But none of that means that police forces are perfect and that failings all sit with mental health services. Very far from it. Of course, one of the problems with police officers getting into legal debates with AMHPs about the Mental Health Act is that it’s like watching a David and Goliath contest: police officers with their four hours of mental health training debating law with professionals qualified to post-graduate level in mental health law. Let me just say it took many years before I started to feel confident I could hold my own. Many, many years of being interested and working on this stuff full-time … and it still took years! Why am I boring you with this post about police shortcomings and problems? Well, I write enough about everything that I think is wrong with our health and our mental health systems, so it’s only fair I balance it out! But there’s a far more important reason, too – if the police aren’t careful and if individual officers don’t ensure they’re well briefed or prepared, they will take this new-found enthusiasm and a just little bit of knowledge and get something horrendously wrong. I worried in the last post on this BLOG about policies that ask officers to walk out on their duty of care after a (quite arbitrary) two-hour period; I worry about officers not executing warrants issued by the courts and I worry that some junior PC will make a decision because he or she has picked up some fragment of knowledge or received wisdom. We all need to be aware that our lack of formal training and of the extent to which many things in policing in mental health are received wisdoms that may or may not be right. A little knowledge is a dangerous thing and a little want of knowledge is a dangerous thing. Courtesy of Insp Michael Brown at Mental Health Cop