Living Within The Ripples – Part 1

To mark the end of Mental Health Awareness week I am going to publish Part 1 of a series of blogs from the very heart of a family in crisis.

These are not my experiences and they will not be my words. They are the experiences and words of someone whose family have been dealing with the trauma of mental health issues for many years.

I have not edited the words – I have just serialised the story in terms of breaking it into parts.

The author will remain anonymous and all the names within the blogs have been changed. I know that the author has been working on this for a long time and I hope that the exercise of writing it and having it shared is cathartic. I know it has been tough and emotional to do this and I admire the bravery shown in wishing to publicise this.

This is about as raw and emotional as it is possible to get. This is reality.

After my initials – all the words are those of the author.

NC

I,m not your usual blogger and to be honest I,m finding it difficult. That’s because my debut into blogging is about a hugely personal, enormously emotional subject! The reason I am writing it is really just to share a real life experience of how such an ordinarily “normal” family can have their lives turned upside down by a loved one’s Mental Health! “There but for the grace of God go I”

I have changed all the names for obvious reasons but everything you are about to read really did happen.
Here is our journey…………

LIVING WITHIN THE RIPPLES

An ordinary family’s story of how domestic abuse and mental health can destroy lives.

The day started the same as any other, nothing spectacular, a normal day at work. My mobile rang, it was my youngest daughter, Jessie. “mum, our Sarah is missing” she yelled! She was upset I could tell. “OK love, don’t worry, I’m sure she will be fine” I arranged to meet her at Sarah’s house a couple of miles away.

On my arrival it was chaos. Sarah’s husband, Dan, was in the living room with a can of special brew in his hand. The three boys, ages between 7 and just 2 were running around creating merry hell. They were filthy dirty, smeared with chocolate and sticky lollies they had been given to keep them quiet! The two smallest just had scruffy t-shirts and nappies on!

I tried to get some sense out of Dan while Jessie rounded the boys up and cleaned them as best she could. The house was a state. “Dan, please tell me where Sarah is” I asked. “She went out last night and I haven’t seen her since” he slurred!

Oh my god, I was panic stricken. There was something about the situation that gave me a nagging fear in my stomach! I asked Dan if he had reported her missing at all, he hadn’t!

I told him I was phoning them immediately! And I did! They were there very quickly, a missing young mum who may be in some distress was a priority to them thankfully!

Jessie and I told them what we knew, very little really! They then spoke with Dan and he beckoned one of them into the kitchen.

We waited, wondering what was going on. Next minute the radio crackled into life, the officer stood by me walked away listening intently. Dan staggered round the living room, he was wrecked and it was only 6pm!

Eventually the police officers returned to me, “we know where she is, Dan told us and we have had it confirmed. Sarah is in the local hospital, she has taken an overdose! Dan let her go off by herself”

I was mortified! Not only was my poor girl in hospital all alone, he, Dan, had known all along and he let us suffer and worry and report her missing knowing full well where she was!!!!

I was livid! I told the police officers I wanted to take the boys home with me because he was pissed and not fit to look after them! Dan argued and said I would take them over his dead body, the police officers said fine, lets do that! They would take them into protective custody unless he agreed to let me take them and then they would hand them over to my care anyway. Dan finally said “do whatever”!

Jessie and I rounded up the boys with a few belongings and took them away, they never went back!!!!

Jessie and I went to my home with the boys. We bathed them all and settled them into nice clean cosy beds with lots of cuddles.
The Police Officers had said they were going to the hospital to speak with Sarah and to firstly tell her the boys were safely removed and in my care and secondly to try to encourage and support her with any domestic abuse issues she may have.
They called later to say she had refused to see them but the nurses would tell her where her boys were and she could call them at anytime.

Days went by and there was no word from Dan, thankfully!

Sarah was admitted to the local mental health ward for assessment as she was “very low” in the words of the staff there!

I was desperate to see her but I think she was embarrassed and ashamed of what she had done! She had left her beloved boys with a drunken wife-beater!!!! (her words not mine)

And then the real battle began……..

Sarah was detained under section 2 of the Mental Health Act! This is the first stage, a 28 day assessment period. I had to return to work but I didn’t know how I was going to do that with three small boys!

Time for a family pow-wow!!!

I called Jessie and asked her and her husband to come that evening, I also called my eldest daughter, Nicola, and her partner, Katie. We all sat down and debated what we could do and how we could do it! Who can help??? Social Services??? Isn’t it their job????
Well, apparently not but more about that later!

Nicky & Katie said that they would look after the youngest two as they could blend and bond with the two they already had of their own! And, the eldest boy was a real out of control handfull!!!! Jessie and her husband worked full time so they would help at weekends to give us a break!
He was to stay with me, go to school and they would collect him and keep him till I got home, after all this was only a month, till their mum was well again?????

I guess we were very naïve! I truly believed that she would come out fixed and they would all be a happy family again, Sarah and her three beautiful boys!

Then the worst news possible. Dan wanted the boys!!!!!!!!…………. Oh my god please no!

I panicked……. what should I do? Could he just take them???? Time to seek advice.

Nicky and I went to a local solicitor, he was great, fitted us in straight away. He told us our rights, Dan’s rights and Sarah’s rights. He wanted to speak to Sarah immediately and arranged to do so that very day, he told us to return at 2pm.

We waited………… 2pm on the dot we were in that office, pacing…..waiting……checking the time…..pacing again……… at last, he was there!!!! “Right, quickly, we are in court at 3pm! OMG! Court? Why????

He literally ran us across the road to the local family court……. “go straight in he’s waiting for you” said the usher, a kindly lady in a twin set, it’s a very small local court, one room only!
In we went, Nicky and I were nervous as hell……. things were running away from us! The judge was a kindly man with white hair and a beard. Our solicitor stood up to speak and speak he did! Suddenly he knew everything that had been done to Sarah and the boys and why she had tried to take her own life that night, she had felt it was the only way she could escape from this cruel oppressive man she was married to!
He told the Judge that Dan had been found drunk in charge of a minor by the Police and how he had lied to Jessie and me and let us suffer that night he said she was missing! What cruel games he had played! He told how Dan had not been seen or heard from for several weeks, yet suddenly shown up demanding to the the boys away, only HIS two of course, not the oldest who Sarah had before she met him!

The judge didn’t need long to make his decision……………… he stamped a few papers and muttered something incoherent to the solicitor and then we were ushered out and back across the street, Nicky and I had not uttered a single word!

Back in his office I wrote a cheque for £1000……. alright for a days work eh!

The next day I visited Sarah……………..

Oh how my heart broke………..

She had stitches from ear to ear where she had cut her own throat…………. on the ward……………….. what can I say…..I wept!

Further parts of this serialisation will follow in the coming weeks

It’s all we have and it has to change

An interesting debate is ongoing at work. Officers are becoming increasingly aware of the fact that they actually have no powers to deal with mental health crises in private places and are beginning to openly ask the question

“So what should we do?”

The fact that this realisation is dawning after 30 years is also interesting.

The Mental Health Act is dated 1983 and the powers we have now are the same as they were then. Nothing has changed.

One has to ask whether the realisation is, in fact, due to the increasing number of occasions where we are being asked to deal with it or whether the message is finally getting through to officers and supervisors on the front line. Perhaps both.

This debate was kick started by an open question of “how can we reduce the number of 136 detainees we put in cells?”

I believe there are 2 responses to this:

1. We take a firm stance with the NHS commissioners and MH service providers and say that within, say 6 months, we will not be accepting 136 detainees in our cells. You have until then to get your house in order.

2. We train our officers so that they can consider options other than 136, recognise what they are dealing with and know what other agencies should be doing. Training is empowerment.

There is much to be done to improve the capability and responsiveness of Emergency Duty and Crisis Teams also. Having two people answering the phones (well – calling back after you have left a message) is not so much an Emergency service as it is a call fielding / delay it til the morning tactic.

I don’t blame the front line staff here – the system simply is not designed to deal with emergencies at all. It is mostly used to put things into a holding pattern rather than dealing with them there and then. Which often leaves the police holding the fort until such time as an “emergency” response can be mustered.

Someone has rightly recognised that police are powerless to deal with emergency MH crises in private places and has asked the same question I have been asking all this time.

What are we supposed to do?

I have attempted to answer that question and someone has then asked

“What about the Mental Capacity Act?”

I have then spent some time explaining that the MCA is not a silver bullet when it comes to dealing with MH crises in private.

More often than not, it is no more useful legislation in an MH crisis than the Badger Act 1973.

The “Sessey Judgement” spells this out for us in crystal clear terms.

Here was a case where police officers, no doubt acting in the best interests of the claimant, have entered private property with no warrant and relied on the Mental Capacity Act to restrain and remove the person to a hospital.

Upon legal challenge, the Honourable Judge has said “Oh no you don’t.”

The Judge’s ruling makes it quite clear that only Sections 135 and 136 confer powers on police officers to remove someone to a place of safety.

Section 5 and 6 of the MCA do not.

The Judge also says that the ONLY way to lawfully deal with an MH crisis in private is to get an AMHP and doctor to the scene to carry out a Section 4 assessment. If necessary with the 135(1) warrant.

Even if this is too slow and takes forever and a day it is the ONLY way it can be done as it is what parliament has given you to work with.

Some colleagues have said that we shouldn’t be trained and we don’t need extra legislation as this will create a responsibility for the police which doesn’t currently exist and will allow other agencies to expect us to deal with these situations.

Whilst I understand these points of view I disagree with them.

Whether we like it or not, the police WILL be called to deal with MH crises in public and in private. Irrespective of whether we are the best or right agency to be dealing – we can expect to be called, we can expect to be confronted with it and we have a duty to deal with it if we are.

Even if the Emergency Duty Teams were suddenly boosted to full 24/7 roaming capability and went to 90% of such calls, the police can still be expected to attend and deal with some.

At the moment we have no powers to deal with it at all.

Instead we have historically relied on The Ways and Means Act in order to discharge our moral duty (and responsibility under the Human Rights Act) to protect life.

We will arrest for Breach of the Peace or Affray knowing damn well that they will never be prosecuted but it means we can place them in custody and get someone help.

Using “offences” to deal with an MH crisis in a private place is like criminalising a heart attack.

The debate about the proper provision of Places of Safety is still needed. Ideally, nobody detained under the Mental Health Act should be setting foot inside a police station but let us leave that debate aside for now.

What is currently lacking is the ability for ANYBODY (not just the police) to take IMMEDIATE action to deal with a life threatening MH crisis in private.

If I can see someone cutting their wrists open and they appear to have mental capacity (the decision to take one’s own life is not an automatic sign of lack of capacity) then I have to get a warrant from a magistrate before I can do anything about it.

I can kick the door in and enter but to do anything else requires a warrant and the presence of an Approved Mental Health Practitioner and a Doctor.

How quickly do you think they can get to the scene of a situation like that – even after they have been diverted to swear out the warrant first?

At any time of day this is next to useless. At 2 am on a Sunday morning it is even worse.

The answer is very simple.

The judge in the Sessey case said that you have the provisions of the Mental Health Act to work with as that is all that the legislators have deemed necessary.

The legislators need to re-examine this urgently.

Either you amend Section 136 Mental Health Act to include private as well as public places (this has some ethical and libertarian concerns – understandably)

OR

Amend Section 17 of the Police and Criminal Evidence Act 1984 to allow officers to enter a premises to protect life (which they can currently do) and then DETAIN to protect life (which they currently can’t.)

The legislation could even be amended to include detail of where a person detained under such circumstances should be taken. Preferably a Place of Safety or a hospital.

Mental Health Law could then be amended to make sure that a detention under this power is treated the same as a 136 detention with the expectation that it is handed over to the NHS or MH services as the norm.

I would also point out that the kind of cases I am talking about here are the really urgent ones – the real “life or death” moment ones – someone who is about to cut themselves or hang themselves there and then.

In any other cases which are less time critical then it is only right to obtain warrants and take a slower and more considered route.

All the other issues I have previously mentioned regarding mental health provision still need to be addressed but this is perhaps the most pressing aspect.

We have struggled, making it up as we go along for nearly three decades.

Mental health crises are becoming more common, our involvement is more frequent and the situation is becoming acute.

The disparity between a situation occurring in public or private is nonsensical when the system in place for dealing with cases in private can take hours rather than minutes or seconds.

But that system? Its all we have and it has to change.

Losing My Patients

Last night I tweeted about a situation where a patient had absented themselves from A&E.

This person was awaiting the results of tests. The doctors were convinced that they should really be in hospital as they genuinely feared he may have a condition which required urgent treatment.

Having left of their own accord and apparently having made a conscious decision to leave – even against medical advice – A&E reported this fact to the police with the expectation that we would go to the persons address.

This request leads to a few questions.

1. Is this a missing person or a concern for welfare?
2. Why are the police being asked to go and speak to the person?
3. What exactly do you want officers to do when they get there and find him?

The answers are:

1. It depends. Is the person “missing”? Well – we don’t know where they are so technically. There is some serious concern for the person’s welfare, of that there is no doubt but they have managed to get out of hospital and there is no compulsion for them to remain there.

2. I am quite certain that the request to find this patient was made with their best interests at heart but is this a police function? What we are being asked to do is to locate someone with a medical problem who has left a clinical environment. Crucially, we have no powers to return them when we find them.

Police have been told their function is to reduce crime “no more – no less.”

Anyone who works in policing will tell you that this is nonsense and that police work involves a lot more than that. We have a duty of care to the vulnerable but the Home Secretary wants us to “single minded crime fighters.”

Does this situation fit that definition?

3. Is the $64,000 question.

At present there are only two pieces of legislation in existence which allow for someone to receive treatment against their apparent will. They are the Mental Health Act and the Mental Capacity Act. Both of these allow for “treatment by force” if necessary.

As I responded in one tweet last night – you might as well call the RAC for help in the circumstances as I have described above. They have as much power as the police to deal with it i.e. none at all.

Until the person is located it can be argued that the risk they present to themselves currently “makes” it a police matter in the absence of anyone else to deal with it.

Once they are located police are faced with one simple, clinical, decision.

“Does this person have the mental capacity to make an informed decision?”

In what other area of medicine (outside the Mental Health Act – and even then it is only a preliminary assessment aka – “guesswork”) is it acceptable or appropriate for police officers to be making clinical decisions?

The most that any police officer is medically qualified to say is “This person appears to be alive.” The extent of our training on the Mental Capacity Act can be counted in minutes.

(Let it be known that the law does not allow a police officer to claim someone is dead – even if they have been decapitated. This can often mean waiting hours at the scene of a “sudden death” for a doctor to arrive and state the obvious. Ambulance won’t come any more.)

The fact that they might very well be making entirely the wrong decision does not make them incapable.

You could argue by extension that anyone who smokes or drinks heavily is making a poor decision about their well being but this does not mean they lack the capacity to make that decision – no matter how obviously bad it is.

If the person seems rational and simply states that they got fed up of waiting (as happened in this specific case) police can do nothing.

It wouldn’t matter if the person had the most virulent, deadly, contagious disease known to mankind. Police still have no power to detain them preventatively or otherwise.

My response, once we located him at home, was to tell my officers to call an ambulance so that they could go and make a proper and educated clinical decision on his mental capacity.

Which raises the question – why didn’t they send an ambulance or doctor to his house in the first place then call police if he wasn’t there or was deemed to lack capacity and they needed help?

Ultimately, this was a bad decision by a patient which led to police involvement. The accepted response now seems to be – if they walk out of NHS premises – call the police.

The NHS staff involved have reported the facts to the police and then gone about whatever else it is they were doing. They played no part in the locating or recovery of this poorly individual.

I am concerned that the police are being overly relied upon by the NHS in a variety of situations.

Mental health matters have been covered in great detail on previous blogs and I have also opined on how we appear to be plugging gaps in ambulance provision and availability.

It is becoming increasingly common now for police to be asked to find and locate patients in circumstances as I have described them here.

These are all clinical matters and the problem is being passed to an agency whose staff have had little or no training and who have no power to deal with such situations – simply because there is no-one else to do it or no-one else is willing to do it.

Are the police actually being asked to ensure that NHS procedures are complied with (capability assessments / discharge / disclaimers) and is this really the role of the police?

Once again I stress that I am not specifically blaming front line staff (though there is an argument that “call the police” has become a cultural norm.)

The issue is strategic.

When NHS Commissioning Bodies look at what is required over the coming months it is high time that they looked beyond what can be simply achieved on clinical premises and looked at contingencies, using NHS staff, for when things take an unexpected turn. Occasions where, for example, a patient decides to up and walk out.

At present police are being called far too early in the process by both the ambulance service and in cases such as this.

There needs to be a capability for the NHS to be more self-sufficient in these matters – only calling the police when absolutely necessary, once initial enquiries and actions have stalled and when there is a power for them to actually do something.

To put it another way – rarely.

I believe that @DiagnosisLOB may have written a blog with an identical title. I haven’t checked but I think I remember. Apologies for my lack of originality. The title just fits the blog so well.

Could Do Better – MUCH Better

An interesting article in Police Oracletoday which says the police officers are spending, on average, an hour a day dealing with mental health issues. I think any serving cop in the country would tell you that this is a conservative (with a small ‘c’) estimate.

Of course, there are days when we don’t have to deal with any mental health issues but they are quite rare and when we do have calls you can measure the time taken to deal with it in hours rather than minutes.

The mental health calls police get called most to would be:

1. Missing people – often having left or absconded from a mental health hospital.
2. Concerns for welfare – often coming direct from mental health services, sometimes very late on a Friday afternoon, asking police to check the well being of someone they have concerns about (often these concerns have existed for some time.)
3. Calls from or about suicidal people – often in private premises – sometimes in public.
4. Calls from mental health hospitals asking police to “assist” with a “violent” patient.
5. Calls from mental health hospitals asking police to investigate a crime (usually assault) allegedly committed by a patient on a member of staff.
6. Calls from mental health hospitals asking police to investigate a crime (usually assault) allegedly committed by a member of staff on a patient.

Added to this demand is the issue regarding Section 136 detentions. I have covered this in many previous blogs so I won’t labour it here but police will either be sent to, or come across, someone in a public place who needs “immediate care and control” because of a perceived mental health disturbance.

Looking at that list I would hope that a couple of things strike you:

1. That’s a lot of work
2. What has most of it got to do with the police in the first place?
3. How have mental health services allowed some of these situations to happen and what are THEY doing about them?
4. How much of that demand comes DIRECT from mental health services.

Taking “Missing People” for example – it is a very frequent occurrence for a mental hospital to ring and report one of their patients “missing.”

There are usually two ways in which this has happened. There has either been a lapse in security which has allowed the patient to escape or – more frequently – the person has not returned from an agreed leave period.

Even Sectioned patients are allowed leave as part of their recovery. This can be escorted or unescorted and can range from hours to days.

Where it starts to rub is at about the third call.
“This patient has not returned from leave and we are reporting him missing.”
“But this is the third time in two weeks that this has happened – why are you still allowing him leave?”
“It’s part of his rehabilitation.”
“But you know he’s not likely to come back.”
“……………….”

The expectation is then that the police will go looking for this individual whilst the hospital staff carry on with their day. Often making no enquiries of their own and certainly not going out to look themselves.

After about the 12th call for the same individual (yes really) it has gone beyond a rub to a become a major bone of contention.

If someone goes on leave and fails to return on more than two consecutive occasions – why are they still being allowed leave when the outcome is quite predictable?

With Section 136 detentions the problem, as I have highlighted many times before, is the handover from police to mental health services.

Either they won’t accept because they say the patient is drunk or violent, they don’t have capacity or, in the case of juveniles in some places, they don’t have facility.

So it’s off to the cells in up to 50% of cases (something which really shouldn’t be happening) and so begins an indeterminable wait for an assessment team. This often takes hours – many hours – and during this time officers will be required to maintain constant observations on the patient.

Concern for welfare calls are another problem. It is extremely common for social services or mental health services to call the police directly and ask them to go and visit someone on their behalf.

About 4:45pm on a Friday is a usual time for a call such as this.

When police ask why they aren’t going themselves the answers are usually

“We don’t do welfare checks”
“There are only two of us”

Or there is some perceived threat which means they can’t do it themselves.

It is also common to find that they have been aware of an issue for several days so goodness only knows why they haven’t called earlier.

Suicide intervention is more common than you think. Either someone has gone missing with apparent suicidal intent or there is something going on in their house which suggests the same.

The call itself can tie up a call taker for a very long time as they try and engage with the person who is calling in desperation. They have no training for this I hasten to add.

In the absence of a threat to anyone else the police are actually powerless to deal with a situation like this. But we still get called by the person themselves, concerned family or mental health services.

Asked to go and deal with it – purely because we are “the police” when in fact we can do very little indeed.

I have discussed the need for legislative change here and elsewhere which will allow officers to take decisive action in these circumstances but it is slow to happen.

These calls happen every day in every station in every force in the country. It is not confined to one area – it is a national problem.

Not only is it a national problem but it is getting worse not better. We now have evidence of NHS managers deliberately deflecting demand towards the police as their budgets constrict.

As the Police Oracle article says – it has been a year since the Home Secretary announced that the police were spending too much time dealing with mental health issues and that something was going to be done.

Is there any evidence of this at the sharp end twelve months later?

(Insert sound effect for Family Fortunes ‘uh uhhh’ here )

Look at the language used by the Home Office in the article.

Last year Mrs May said she was going to liaise with her counterparts from Health and Justice.

Last week in direct response to a question from Inspector Michael Brown (@MentalHealthCop) at the Home Affairs Select Committee, Mrs May repeated that she was speaking with her counterparts at Health and Justice to sort this out.

This response was repeated again in the Home Office response to the Police Oracle article.

So given all this talking by ministerial heads – what EXACTLY is there to show for it after twelve months?

What was also obvious from their response is that, actually, they are expecting someone else to sort it out.

The Home Secretary has written to all PCC’s instructing them to make dealing with mental health a priority. Their response then talks about how some forces are “making improvements” in this area.

The issue is that it shouldn’t be the police making the improvements – it should be the NHS.

By simply writing to PCC’s and expecting them to deal with it is to completely miss the point that legislative change is required and it is arguable that provision of mental health services requires statutory regulation in terms of its quantity and capacity.

Only the government can amend the law with regards the Mental Health Act or Police and Criminal Evidence Act. These changes are as important as any local discussions about commissioning and provision.

How can the Royal College of Psychiatrists provide guidelines on Section 136 detention and yet the reality on the ground looks absolutely NOTHING like it?

In twelve months it seems that the Home Secretary has spent a considerable amount of time talking to her counterparts but having little or no impact. Her other action was to write to someone else and ask them to deal with it locally.

Locally, the issues are still not universally high enough up the agenda despite the Home Secretary’s letter.

We know that NHS budgets are getting tighter and we believe that mental health work is being deflected to the police on purpose.

The Police Oracle article was written by @hollieclemence who later tweeted the question:

“A year on from Home Secretary’s pledge to reduce police time spent on mental health incidents, has anything changed?”

The answer – quite simply – is “No.”

A big fat “No.”

There appears to have been a lot of talking and instructing and whilst I am quite certain that ACPO lead, Chief Constable Simon Cole of Leicestershire, is doing his level best to take this forward it appears to have all the urgency of continental drift.

I doubt very much that this is because of ACPO – I suspect that the resistance is elsewhere. It is this inertia which needs to be met head on. The police are going to have to take a very strong stance and force the issue.

HMIC have just announced a thematic inspection of police detention of the mentally ill. I could save them a fortune and write it for them.

If you ask me – which nobody has – I would urge HMIC to look beyond 136 and at the total impact of mental health on the police service.

What is needed is an official, probably scathing report from someone with clout which will document all this in great detail and ask the simple questions:

“Why are the police spending so much time dealing with a medical issue and what is going to be done to change that?”

If a report card on this particular subject were being written there would only be one comment

“Could do better – MUCH better.”

Boston – the double edged sword of social media

I will start by paying tribute to the people of Boston. It takes a lot to shock me these days but the events at the marathon really managed to do that.

This was an horrific and evil crime. Calculated to slaughter innocents and given that the youngest victim, Martin Richards, was only 8 years old it succeeded in doing just that.

There is a dreadful picture circulating which has now been picked up by the mainstream media. It shows Martin stood on the railings watching the race with his mother and sister. Behind him is one of the suspects and between them is the bomb in the backpack. This picture horrified me more than any of the graphic injury shots which were quickly posted after the event.

It shocked me more because I don’t think it should ever have seen the light of day. It was no doubt taken minutes before detonation and – knowing what happened next – I felt powerless and empty just looking at it.

It captures evil incarnate and I wasn’t prepared for that. It was circulated this morning on Twitter and has now made it onto the front cover of a UK national newspaper.

There are some things which are simply best not shared – this is one of those things.

Once again, in the case of the Boston bombings it was social media which broke the news to a horrified world. First there were pictures of smoke clouds and even the moment of explosion. Then came the graphic shots.

These really are not for the faint hearted. The most famous of them is the one of the man in the cowboy hat assisting the gravely injured man in the wheelchair.

I won’t describe the unedited version of that picture any further as it is horrific but that one image manages to capture the severity, the tragedy and the self-less heroism which emerged in the minutes after the bombs went off.

In some ways this is a picture that shouldn’t be shared because of its graphic nature but also should be shared because of the human spirit it demonstrates.

Back in January I blogged about the helicopter crash in Vauxhall, London.

To summarise it was a text book example of how to manage a major incident on social media.

Boston gave us an even more vivid example of what emergency services are up against when confronted with the Internet in the aftermath of disaster.

I have previously talked about how everyone is now a journalist. Everyone has a camera on their phone these days as well as the ability to publish pictures instantly around the world.

Inevitably, this happened in Boston. Uncontrolled, instant dissemination of images, rumours and accounts reaching a global audience within minutes.

There is no editing on Twitter. Many of the pictures circulated would never have been shown on main stream media (Carlos the Cowboy hero being one of them – iconic though it was.)

There was no consideration for the feelings of others. That picture of Carlos went around the world in moments and it probably reached other continents well before the family of the poor victim knew anything about the situation.

Boston illustrates how the professional agencies are fighting a losing battle with citizen journalism. Of course people have every right to post and pass information but there is no regulation and no self control.

Whatever the agencies in Boston came out with had to be good. I think they passed the test but it also demonstrates that whilst the primary role of those services is to deal with the scene and the injured – managing what is being said about that scene is right up there in the list of priorities.

Anyone can now spread panic and fear with a mobile phone.

Over the course of the next day or two speculation was rife across social media as to possible motives and suspects. This has to be monitored for clues and evidence as much as anything else. We now know that one of the main suspects was tweeting in the immediate aftermath of the explosions.

Whilst the authorities are passing on useful information on social media, the conspiracy theorists are busy proclaiming it to be another “false flag” incident. A positive message has to come from the professionals to counter this nonsense.

During this time a number of “suspects” were identified and outed on social media. None of these were right and it placed innocent people in great danger.

Events then took a massive turn when the suspects were cornered. An officer lost his life in the ensuing gun battle and Boston was placed on lockdown in the biggest show of police presence in history.

These scenes were incredible. Ten thousand officers conducting a house by house search whilst a major US city looked like a ghost town.

Throughout this, the Mayor, Colonel Albens and other agency representatives did a superb job of keeping the media in the loop. Their regular press briefings were informative and human.

Mainstream media, and particularly American networks, went into speculation mode. They didn’t exactly cover themselves in glory with some of the inane, time-filling, desperate commentary they were coming out with.

They may as well have said “we don’t have the first damn clue what’s going on so we’re just going to report every rumour as fact.”

Someone commented on Twitter that they almost longed for the days when you got your news in some semblance of factual order in the newspaper a day later.

And the rumour mill on social media? Wild and frenzied. People scanning the police radio channels and then tweeting what they heard – thereby compromising the tactics of the SWAT teams and potentially alerting the suspect of their activity.

This is a ridiculously stupid and irresponsible thing to do and it led to a desperate appeal from the authorities pleading with them to stop.

Anyone who has worked a major incident will know that individual radio transmissions are fragments. They are snippets of information, sometimes irrelevant and sometimes they aren’t even right. They are often a long way from the big picture.

Just about every transmission was broadcast as fact. This led to all sorts of inaccuracies. Suspect caught – suspect not caught. This vehicle – that vehicle. Connecticut, Niagra, New York.

The police on the ground had a massively important job to do and, at times, social media made it many times harder than it needed to be. Even President Obama referred to the Internet speculation in his news briefing after the second suspect had been caught.

The simplest thing to do in events like this is to shut social media off. That would be an affront to free speech and democracy. However, there is no way that you can rely on everybody to self- regulate and be sensible either. Doing so would also shut down a vital channel of communications.

Effectively, the only option is for the professional agencies to have a very active social media presence and to mobilise it immediately and comprehensively.

Not doing this is not an option and services need to develop their strategies quickly and in advance. Social media cannot be ignored and it has to be a strategic priority for disaster planning.

If anyone doubts how important social media is – if you can – review the footage from the last 24hrs and count the number of times the TV reporters refer to Twitter.

Boston has shown that it is impossible to stop or control what happens on the Internet after a major incident. The challenge is to manage it as swiftly and effectively as possible.

As well as passing my sincere condolences to the victims of this tragedy I would like to pay tribute to the first responders and public who ran towards danger on the day itself. I also congratulate the emergency services and all law enforcement agencies involved in the subsequent investigation and manhunt. You have done a magnificent job.

The Man in the Hole – a personal blog on Depression

Depression is a hideous illness. If I had a virus or a fever I could take medication, allow it to do its thing, and expect to get better in a few days time.

I would see the symptoms. I might be hot, cold, shivering – my body would be showing me it was not right. To the rest of the world it would also be pretty obvious that I was poorly. No doubt this would lead to sympathy from those closest to me – even platitudes from acquaintances but either way – someone would feel the need to express their concern for my well-being and hope I “get well soon.”

To the outside world Depression can be symptomless. Well – I say that – perhaps not symptomless but the symptoms can often be confused for something else. Someone can come across as miserable, anti-social, perhaps their work might suffer their relationships certainly will.

Depression often doesn’t attract a great deal of sympathy. For some people it’s as simple as suggesting that you “snap out of it” or “get a grip.”

The problem for the sufferer is that unless you get the right help there is no “snap” and there is nothing to “grip” on to.

I have suffered with depression for about twenty years. It isn’t a great deal of fun and hasn’t been for my family and loved ones either. They are the forgotten sufferers of depression.

At its worst – depression is like being in a pit. A pit with sheer walls. There is no hope, no sunshine and no-one in there with you.

You become like a passenger – watching life pass you by. You feel completely disassociated – life is something that happens to other people. You don’t want in. Let them get on it with.

You live by instinct – you eat when you absolutely have to (otherwise you can’t be bothered.) You sleep when you can’t stay awake any longer – sometimes you sleep in the hope that it passes time.

The simple things in life which should be fun like socialising or even a conversation become hard work. Too much effort. Consequently you dig deeper into your pit. Wishing everyone would just leave you alone.

It can leave you psychically breathless. Exhausted yes but also so bereft of hope that it takes your breath away. You could win the lottery and it still wouldn’t make a blind bit of difference.

It’s a spiral. The worse you feel the worse you get. The worse you get the more isolated you make yourself. You shut out the very people who offer the most in your life. Work becomes a burden.

When you are depressed it is amazing how empty a room full of people can be.

At its darkest comes the thought that there is no way out. That the pain needs to stop. That there is only one way out.

Four years ago my friend took this path. None of us saw it coming. He had seemed a bit down but we put that down to tiredness caused by the recent arrival of his new born child. We missed the clues as much as he kept them hidden.

The morning it happened was one of the worst days of my life. His partner hammered my door to tell me he was missing. Flipping into “work mode” I assessed this as a high risk situation and started asking questions about his life. The more I learned the more worried I got.

I started a search and called my local police for help. It was at this point that I learned they had found a body nearby. I knew what that meant but I had to absorb that and keep it to myself.

Hope needed to live for a little longer for the others.

I went to meet the officers and my worst fears were confirmed. There was my friend – his partner and child waiting at home for news. I knew what that news was going to be. I had known for a short while earlier but now it was staring me in the face.

I asked the officers to go and deliver the news and I would follow up behind them to try and pick up the pieces.

For the first time in my life I saw what happens when the police leave an incident like that. Until then, as an officer, I had done the leaving. Now I was sat in my friends house knowing he wasn’t coming home and knowing that the lives of his family were shattered.

I had no tools in the box for this. Although delivering a death message is about the worst job an officer can do I realised that once its done – its done. For those left behind, however, the problems have only just begun.

Bizarrely – even though I could see the devastation that this had caused everyone it sent me into a pit of my own that I didn’t emerge from for two years.

In that time I was unbearable to everyone. I was silent, miserable, literally hopeless. I was permanently ill and when I wasn’t ill I was imagining I was ill. A slight sore throat lasted 6 months and was investigated to the endth degree. Dizziness ended up with me having an MRI scan.

The cause of it all? Depression.

Unbelievable – horrible – depression.

Even though I had suffered with it for years it took a GP to ask me directly when he saw through my hypochondria. It was like a light coming on.

But recovery was a slow process. It took a year to find the right dose of the right medication. In that time I am surprised my relationships survived. I have a lot to be thankful for. I didn’t realise it at the time either.

I was furious with my friend – absolutely furious. Not so much for taking the path he took but for not telling anyone he felt that bad. If he had said something we could have helped. Then it dawned on me – I don’t talk about it either.

And that is the purpose of this blog. I don’t have a magical solution for dealing with depression. I have my own ups and downs where sometimes the medication needs adjusting or I need a little extra help.

Every depression sufferer has their own journey to make and I am realistic enough to know that not all of these journeys end happily.

For me there is one essential element to fighting depression and it is something that I am still bad at.

The essential element is – talking. Not counselling – talking.

Counselling is extremely useful and I would recommend it to anyone but before you can get access to it. You need to talk.

You need to recognise that you are in the pit and the only way put of it is by talking to someone. A friend, a doctor, a charity – anyone – this is the first step on the road to recovery.

The resultant journey can take months or years but you can’t begin it until you talk.

I will leave you with a parable which is used in The West Wing. There a scene where Josh Lyman is battling some personal demons brought on by PTSD. His boss, Leo McGarry stops him in the corridor and tells him this story.

I have used it twice to other people in real life. I am convinced it is a life saver.

A man is walking along the street and he falls in a hole. It’s deep, the sides are steep and he can’t get out. He calls for help and eventually he sees a doctor walk past.

“Hey Doc! I’m stuck in this hole – you think you could help me out?”

The doctor peers into the hole. Writes down a prescription, throws it into the hole and walks on.

The man is still stranded and starts calling out again. He sees a priest walk by.

“Hey Father. I’m stuck in this hole -is there any way you could help me out?”

The Priest looks into the hole, scribbles down a prayer and throws it into the hole. He walks on leaving the man stuck.

After a while he starts shouting out for help and sees his friend walk by

“Hey Jimmy, I’m stuck in this hole. You think you could give me a hand?”

Jimmy looks into the hole and then jumps in. His friend is astonished.

“Hey Jimmy – why did you do that?! Now we’re both stuck in this hole!”

“Yeah,” says Jimmy “but I’ve been in here before and I know the way out.”

This is why I love the West Wing.
This is why we need to talk about depression.
This is why talking is good.

And if you can’t find anyone to talk to about it – you can talk to me.

For more information on depression please take a look at the website of The Depression Alliance

You can always talk to the Samaritans – 24 hours a day – 365 days a year on
08457 90 90 90

Or visit their website for more information

An Irresistible Force meets An Immovable Object

Somewhere up above the skies of Britain a passenger plane experiences some problems. The pilot believes that the only course of action is to land the plane at the nearest runway.

If she does so – the plane can be successfully brought down and everyone on board will be saved.

The conversation goes something like this:

Pilot: Mayday Mayday – request emergency clearance to land at nearest runway from my position.

Air Traffic Control (ATC): What seems to be the problem?

Pilot: Not sure. Plane not responsive to controls. Can successfully land if allowed to do so now. Can see airfield ahead. Permission to land.

ATC: Sorry. That airport is full. Too many planes taking off and landing.

Pilot: What? Can you not clear a space for me I have 200 people on board?

ATC: No. Impossible. The schedule is full. We weren’t expecting you. No capacity. Sorry.

Pilot: Well what am I supposed to do?

ATC: You can circle around for a few hours until there is a space or land it somewhere else.

Pilot: I don’t have fuel for that. I need to get it down now! Where else do you suggest I land?

ATC: I don’t know. Try another airport, call back tomorrow or use a motorway. Sorry – we can’t help you.

Elsewhere, someone calls the fire service on a completely different matter.

Caller: Hello? Quickly! My house is on fire!

Fire: Is everyone out?

Caller: Yes but it’s well ablaze.

Fire: OK. That’s good. We have no-one to send to you right now so it’s a good thing that everyone is out. Our advice is to stay well back and let it burn.

Caller: Let it burn? That’s my home – I will lose everything!

Fire: Sorry about that. All of our engines are busy. Can you call back tomorrow?

Meanwhile an ambulance is hurtling towards a local hospital:

Paramedic: the patient has just arrested. No output. Can we have a CRASH team on our arrival please.

Hospital: Negative. We haven’t got a CRASH team available. They are all committed with other things.

Paramedic: But this patient has internal bleeding – he needs emergency surgery.

Hospital: There is no CRASH team and no space for them anyway. You’ll have to divert.

Paramedic: To where?

Hospital: I don’t know – why don’t you try the local police station.

These are fanciful and ridiculous situations I know. The calls would never be dealt with like that. Heaven and earth would be moved to find a landing spot, send a fire engine or meet the ambulance at hospital.

Now try this:

Caller: Hello, I need help quickly, my husband is very ill. He is having an episode. He is threatening to harm himself – he is very agitated and worked up. I need help!

Where do we go from here?

Would an ambulance go?
Would a Crisis Team respond?
Would it be the police who get called?

If it is the police – what powers or training to they have to deal with this situation?

If the police do go and call up for medical assistance how likely is it that someone at the other end of the phone might say

“I’m sorry there are only two of us here – we can’t come out.”
“There is no bed space available.”
“Can you not take him to the police station?”

In the first three scenarios the responses I gave would lead to the plane crashing, the house burning to the ground and the patient dying.

In all of those situations it simply would not happen that the response would be so negative. That the phone would be put down without assistance being given and without an alternative – a sensible alternative – being put in place.

The point is – that in the real world, in none of those circumstances, can the call taker ignore the problem and hope it will go away, dismiss it because they are busy or leave it up to the person at the other end to deal with it.

There is still a plane in the air with a problem; the house is still burning; the patient is still dying. Putting the phone down and letting someone else cope is not an option.

So why is it not like this for mental health crises?

This week I will be preparing for a meeting where police use of Section 136 of the Mental Health Act will be discussed. It is an internal meeting where the only people attending will be police.

My fear is that someone will suggest that we set a target to reduce the number of people detained under 136.

This will miss the point.

There are a few reasons why police use of 136 is a problem.

1. Officers don’t have sufficient training or knowledge to deal with it any other way.

2. That expert training and knowledge comes from another agency who do not have the capability to respond.

3. There is insufficient capacity to accept 136 detainees in proper places of safety (a mental hospital)

4. Some hospitals refuse to accept detainees because of a self created “exclusion criteria” (drink involved, under 18, possibly violent)

5. Once a detainee is accepted into custody they will be on constant supervision for most of their stay. This could be up to 72 hours. Sometimes this will involve the use of physical restraint.

6. The turnaround time from detention to assessment to hospital admission can be painfully slow.

Is it any less of an emergency?

Some people would argue it was. It doesn’t involve 200 people on a plane; it’s not likely that someone is going to die.

Unfortunately – people do die. It is no coincidence that a situation where someone who is having a mental health crisis where physical restraint is required is designated as a “medical emergency.”

Prolonged restraint carries massive risks of injury, cardiac arrest or positional asphyxia. There are very strict guidelines on how such an emergency should be dealt with in a clinical setting. When they happen in a police setting it is nigh on impossible to comply with those guidelines.

Slowly but surely, the debate about over-reliance on police in a mental health crisis is beginning to gain some traction. An increasing number of high-profile figures within the police are beginning to talk publicly about it.

This morning I have read that the Police and Crime Commissioner for Staffordshire has done some research into the subject which shows that between 15-25% of police time is spent dealing with mental health issues.

I fundamentally object to time and motion studies but if this one proves a point I will swallow that objection.

The PCC is now calling for 24/7 mental health response teams who can deal properly and fully with these situations. This is something I have advocated for some time.

It would be right that police have a place within those teams as there are times when police powers (limited though they are) and the use of force are required.

What needs to change is:

The provision of bed space for new assessments
The removal of “exclusion criteria” which would mean people going to hospital not a cell.
Increase in the resources and capability (in terms of resources) for Crisis Teams and Emergency Duty Teams.
Faster response times all around for assessment and admission.

The police are not trained or equipped to deal with mental health crises. This needs addressing as well. Not so police can continue to “fill the gaps” but so they can deal more effectively to instances where they ARE required.

I have talked about legislation changes previously – this blog is about the concept of 24/7 MH teams.

This HAS to happen. Heads have been buried in the sand for far too long on this issue.

The country has a need – an increasing need which has largely been artificially suppressed by “coping.”

“Coping” is no longer an option.

I suspect that Mountain Rescue and the Coastguard have better response capabilities than Mental Health teams and whilst they are essential I bet that the latter creates more demand.

When the Royal College of Psychiatrists publishes guidelines on how their members should deal with 136 detention – and you look at those guidelines and think “not even close to reality” then something needs to be done.

The situation where an Emergency Duty Team or hospital can say “we’re too busy” or “we can’t accept that person” does not make the crisis go away.

In my hypothetical scenarios the plane would crash, the house would burn, the patient would die. All would be unacceptable to even countenance. The crisis continues and someone has to deal with it. That person should be THE RIGHT person.

I wholeheartedly wish the Staffordshire PCC good luck with this. It could be the first real test of a PCC’s influence.

Here is a problem – here is the evidence – now to convince the NHS commissioning body of the same.

Will they see the same problem or is it NOT a problem to them because it isn’t having an adverse affect? It’s not having an adverse affect because they aren’t dealing with it – someone else is. Even if they shouldn’t be.

I will be watching this story closely – it could lead to effective change – or it could be a case of an irresistible force meeting an immovable object.