The TASER dilemma
Over the last few days the subject of the use of TASER on mentally ill people who are self harming had been fiercely debated following comments from Mr Paul Jenkins, Chief Executive of Rethink.
Mr Jenkins is quoted as saying that it is “completely inappropriate for police to use a TASER gun on someone who is threatening self harm.”
Both sides of this emotive and controversial issue have been covered exhaustively. The police angle has been best expressed by Inspector Michael Brown (aka @mentalhealthcop) in his superb blog on the subject:
Michael explains, better than I ever could, how the force continuum works and how sometimes TASER is, unfortunately, the “least worst option.”
This blog is a response to Michael’s. It is the view of another serving police inspector with a passion for improving response to mental health crises across the board. But it is a view which entirely supports Michael’s.
Mr Jenkins suggests that a number of things should be tried as alternatives to using TASER on a self harming person. Michael has commented on each of these but I would like to echo his points.
Mr Jenkins says that talking to the person is the most important step. I don’t think that there is a police officer in the land who would disagree with that.
The Force Continuum (illustrated on Michael’s blog) shows the range of options available to an officer when dealing with confrontation.
It starts with mere presence. Sometimes an officer in uniform is all that is required to reduce violence.
It ends with the use of lethal force. Sometimes a threat is so great or immediate that this is the only option.
Ideally you would start with “presence” and move up the scale until the confrontation, threat or violence ceased.
From my training I recall that “verbal communication” is step 2. Directly after “mere presence.”
In other words – if the problem isn’t solved by turning up in uniform – start talking.
Whilst it would be ideal to start at the bottom and work up there are occasions when it becomes immediately obvious that you either have to work up the scale very rapidly indeed or even skip steps. This is called a “dynamic risk assessment.”
In the worst case scenario of a sword wielding individual in a public place – arriving in a police car has failed to stop him, shouting “put the sword down” has failed to stop him – where do you go from here?
Do you work up the scale step by step trying unarmed defence tactics, cuffs, spray, baton, TASER and firearm until something works OR do you bypass the first few because they obviously won’t work or place everyone at risk?
This situation is slightly different from the one involving a person whose only threat is to themselves. However, there is a piece of legislation which applies to both scenarios.
Article 2 of the Human Rights Act places the police under a “positive obligation” to protect life. This means that, by law, the police HAVE to so SOMETHING to protect life – even the life of someone who doesn’t want it protected.
The question is – what should that “something” be?
The dilemma is – “How do I stop you from taking your own life in front of me because the law says I have an obligation to do so?”
Mr Jenkins goes on to say that a trained crisis negotiator should be brought in to resolve the issue and that an ambulance be called. This is all very well but, as Michael points out, the timescales involved in getting either of these to the scene make them inefficient.
That is not to say that where a situation is protracted and the self harmer is willing to engage that they are useless – far from it. They would be the preferred option in every case.
However, Mr Jenkins’ scenario takes no account of the rapidly escalating situation where intervention is required much sooner.
By way of an example – about a year ago I attended an incident where a lone female with long standing mental illness had become violently confrontational with people passing her house. She was throwing things from windows and shouting abuse. She had a knife in her hand.
Having attended she refused to answer the door or to engage. After a while she disappeared from sight and we had no idea what she was doing. She refused to answer the phone which cut off the first link for a negotiator.
As I was on the phone to our on-call negotiator a series of crashes and bangs from inside the house forced the issue. We had no idea what she was doing in there so forced entry.
We found her in the kitchen. She was stood holding three large kitchen knives to her wrist. She was threatening to harm herself if we came any closer.
At this point I had the negotiator on the way and an ambulance requested.
I tried all forms of communication with her but she was not responsive to any of them. I even tried bribing her with my cigarettes to see if she would put the knives down and come and talk to me.
I am not a trained negotiator but I would have stood there talking to her all day if it looked like it was going to make progress and as long as she was “just holding” the knives.
Having tried to talk her down calmly for a while she showed absolutely no signs of changing her position or stance.
Then she did something.
Even though I was a safe distance away she lunged in my direction with the knives then withdrew and made what appeared to be a concerted effort to cut her wrists with the knives. This action took a split second and she had gone from being unco-operative to being in a life threatening position in that instant.
The negotiator wasn’t there and nor was the ambulance. Behind me I had two trained TASER officers. Until that point the TASERS had remained entirely concealed.
The options available at this point were:
1. Withdraw and let her carry on.
2. Shout at her to stop
3. Rush her and try to overpower her
4. Use CS
5. Use Baton
6. Use TASER
Michael has also covered why some of these were inappropriate in his blog.
The only option which was most likely to cause an IMMEDIATE deescalation of the situation and cause her to drop the knife with minimal injury was:
This is what happened. It was immediately effective. The effects lasted seconds but it caused her to drop the knife, drop to the floor and allowed me and colleagues to step forward and restrain her in handcuffs.
No rolling round on the floor struggling. No prolonged restraint bringing the risks of positional asphyxia or cardiac arrest. No injury to her or us.
I took no enjoyment from that scenario but what other viable options existed?
What Mr Jenkins is suggesting is that when faced with a suicidal self harmer the only option is to keep talking to them. Even the most highly trained mental health practitioner runs out of talking after a while.
If you disbelieve me then ask why mental health staff are trained in control and restraint.
Normally this is a last resort but there are times when a patient can become so violent and volatile and even armed with a makeshift weapon that mental health staff call the police.
By that point – where are you on the Force Continuum?
Of course the officers will arrive and try and work up from the bottom all over again but what do you do when a patient is sat there, threatening to kill themselves, with the means to do so and showing a clear intent to so so.
In Michael’s blog he quotes Vicki Nash from MIND who talks about the need for rapid de-escalation measures. We are back to “talking and negotiating” again. This is fine if the person wants to.
Ms Nash goes on to say that there is “no substitute for comprehensive mental health training” and she is entirely right. However “comprehensive mental health training” does include the use of force to restrain a patient.
I agree that there is a massive need for wider MH training in the police. I am not negotiator trained and neither are my team but we could all do with training on how to initiate conversation with suicidal people. Rather than making it up as we go along as we do now – why is it not considered “first aid” training and give us the tools to try and hold a conversation until the negotiator comes along.
I would go one stage further and have a 24 hour Crisis Response capability. Two police officers, a negotiator and a MH paramedic who can respond to such calls as FIRST response rather than being “on call” and miles away.
If this is too expensive then there is a need to bring the training of all first responders up to a level where they can attempt to intervene with some knowledge of what they are doing or shouldn’t be doing.
Mr Jenkins criticism of police use of TASER would limit our options to:
1. Attempting to talk
2. Using some other form of force
3. Allowing the person to die
I agree that using TASER should never be the first and automatic response (though sometimes – it has to be) but there are occasions when “talking” simply isn’t enough.
Mr Jenkins alternatives are, currently, unworkable, impractical and rather idealistic though they do raise valid points for discussion and a moral dilemma.
No-one can prepare for a totally unexpected or unpredicted mental health crisis in a seemingly previously well person.
However, in almost all the cases I have been involved with there is a previous mental health history and the people are known to many agencies.
The question which has gone so far unasked in this debate is this.
Are risks currently being adequately managed.
Is it entirely fair to criticise the police for using TASER in extremis when they have been called to deal with a situation which has arguably gone “beyond critical”?
What has happened in the form of intervention and treatment up to the point of this crisis and has anything gone wrong or been overlooked which would have prevented it?
In summary – for what it is worth – I think both sides of this discussion have credible arguments. Mr Jenkins’ and Ms Nash’s thoughts should prompt debate on what else can be done to improve crisis response by ALL agencies.
But – as Michael rightly concludes – the use of TASER can never be ruled out entirely. There are occasions when it is necessary and, until someone invents something as effective and which causes no injury or discomfort, it remains a valid option.
Even if it is “the least worst.”
NB – please note that this blog is not an “endorsement” or “advert” for the product TASER. There may well be other such devices available but TASER is the one licensed and approved for UK police use by Her Majesty’s Government.
It is the application and use of the “device” that I am referring to. TASER being the product name and also a generic term.