Crisis? What Crisis?

A doctor calls The Crisis Team to explain that he thinks a patient in his A & E department needs a mental health assessment but unfortunately he has just walked out of the building – destination unknown. They know who he is and have an address for him. The doctor genuinely believes that this person needs help. They are making no sense and are displaying symptoms of paranoid psychosis.

The Crisis Team response is “you need to call the police.”

Not only “you need to call the police” but “they can go round and arrest him under Section 136 of the Mental Health Act.”

That’s it for the Crisis Team – involvement over.

We still have a person we can reasonably identify who appears to be having a mental health crisis but no – send the police.

The doctor calls the police where it is explained to him that we certainly cannot go around to an address and arrest anyone for Section 136. Firstly, we “detain” not arrest and secondly we have no power to do this in a private place and the Crisis Team should know this. The doctor is advised to recall the Crisis Team.

He does so in exasperation and is told that the Crisis Team don’t “look for people” it’s up to the police to find him and then present him to them. They aren’t coming out. Back to the police.

At this point I am notified of the situation by the control room. The poor doctor has tried to do the right thing and is getting passed from pillar to post.

I called him directly to offer help. He explained the circumstances and explained that he had been genuinely surprised when Crisis Team had referred him to the police. He described them as “resistant.”

I said that I wasn’t going to be resistant – I disagreed with the Crisis Team but someone had to do something so we would perform the address checks.

I did some intelligence work and then called two of my officers in and briefed them on what I wanted them to do.

This was classified as a concern for welfare rather than a missing person enquiry. The objective was to try and find the male – if we managed to do that we could decide what to do next.

He wasn’t at the given address and so began a few hours of other address checks and enquiries. He still hadn’t been found by the time I went off duty.

Me and my officers probably spent about 6 hours dealing with this. The Crisis Team didn’t.

The day before we had a similar message from the Emergency Duty Team who told us that they “don’t do welfare checks.”

They too had referred someone directly to the police.

This was the day we couldn’t get CAMs out to help with a 13 year old who had threatened his family with knives because they considered he was “having a tantrum.” Police officers had gone to the address and had to talk the knives out of his hand then restrain him to prevent him escaping. There were clear issues here – it was not a “tantrum.”

Three instances of mental health crisis – three instances where the mental health agencies have referred the matter to the police and done nothing with any of them. Phone down. End of.

Crisis? What Crisis?

UPDATE – @Mentalhealthcop has written a great response to this blog which you can view here please take a look.

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14 responses to “Crisis? What Crisis?”

  1. bananaman999 says :

    I have found in my area that the Crisis ‘team’ who turned up to my custody, were in fact 2 mental health nurses – with no power to section anybody. They came to assess someone in custody who had been seen by A&E threatening self harm – the casualty doctor declined to contact the crisis team and he was discharged. As he left the hospital doors he told officers he was going under the first vehicle he saw – and ended up in custody as a potential life saving arrest.
    The 2 nurses told me that they would talk to the detained person and ‘voluntarily persuade him’ to go to a mental health unit – they disclosed to me that as there were so few doctors that it would take up to 12 hours to get one if the detainee refused!
    The person did agree to go voluntarily, transported by my officers.
    I could give you example after example of this type of thing – there is absolutely no joined up approach by MH teams and A&E / Police.

  2. Emanuele says :

    The posts in this blog should be bound in a book and called “Case Studies for Emergency Services”. No more, no less.

  3. yorkymonkey says :

    I have had very similar issues with the very same Crisis Team you are talking about. It was either a Bank Holiday or a Sunday, I attended a house with a colleague where a male, a schizophrenic had not taken his meds, was allegedly walking around the house naked and had allegedly made threats to commit a serious sexual assault on his wife.

    Like a majority of jobs we attend it didn’t resemble the initial call. The male was dressed and lucid. There were issues, ones that the Crisis Team/MH experts could deal with, NOT POLICE OFFICERS.

    I contacted Crisis Team, who like in the blog, told me to arrest the male under Sect 136. They got upset when I told them, like you, we don’t arrest people under Sect 136, we detain. And only in a public place, not their house, which he was in.

    And it went down hill from there on in.

    I was told by them to arrest for the threats to commit rape. They got really uppity when I told them no such offence exist. They then tried to demand I arrest for a breach of the peace. Nope, sorry, he’s lucid, not aggressive therefore no breach of the peace.

    They then went back demanding I arrest for threats to commit rape and tried emotional blackmail. By now I had had enough of their pathetic behaviour. The blunt Yorkshireman reared his head and came out with some plain, blunt speaking. I told them I wasn’t going to risk my career, falsely imprison someone for a non existent offence because they couldn’t be bothered to come out and do their job. I told them them that as a police officer there was no offences being committed, that I was leaving, and that they were to get out of their office and come and deal with their patient.

    And a miracle occurred that day. The Crisis Team got of their arses and dealt with the patient.

  4. Claire says :

    I dealt with a job where a female with a history of mental illness-schizophrenia had phoned the crisis team for help as she felt mentally unwell. The crisis team put her in a ambulance and left. Within minutes of arriving at hospital the female left. The hospital called us to report concern for welfare. I attended females home address where I located her. It is clear she was extremly unwell mentally hearing voices etc bizzare behaviour. She was in her own home so I could not 136 her. I called the crisis team to ask why they had put her in an ambulance and just left her. Their response was they just went to put a sticky plaster on things it wasnt their job to section her. 6 hours later a warrant was obtained, a social worker, 2 doctors turned up and sectioned her within 5 minutes of speaking to her.

  5. gospatric says :

    As someone who has worked for a crisis team for years I’d say firstly that this one don’t seem to have tried to be helpful. They should have gone to the house you talk about. We did all the time in fact such referrals were bread and butter. But if someone skips from A&e what are nurses with no radios no arrest powers nothing much in fact supposed to do to find and offer “care and control” to a patient who has withdrawn consent to treatment?

  6. Sectioned Detection says :

    Likewise what are police supposed to do? If its a medical concern and they’ve withdrawn consent for treatment then they clearly have capacity and there’s no concern. If they don’t have capacity then the nurses and doctors CAN stop them leaving!

    If its a MH worry then why were they not assessed at A&E? Oh and being drunk or on drugs isn’t a bar to being assessed if there’s enough of a concern about them in the first place.

    I’ve NEVER seen a risk assesment made on a suicidal patient in A&E which should be a minimum course of action. Add to that they are usually left unattended so contact with police is sometimes hours after they’ve walked out.

    Unfortunately you just proved of useless and unknowledgable Crisis teams are!

    • Tony Walker says :

      Well, I don’t want to engage in name calling here. I personally have good relations with our local Police and have benefited from their support on countless occasions. My point is that if a patient leaves A&E then Crisis Teams do not have the ability or authority to go and recover them from the street or wherever they are. Usually the acute hospital will be a different Trust and the medical staff will need to refer to a mental health assessor who is mostly not co-located. There is a debate whether I (who work for a mental health trust) is actually allowed to lay hands on a patient of another Trust, and also I am not trained to restrain and it would be dodgy to do it on my own. But be that as it may, if a patient without capacity attempts to leave you are correct the doctors and nurses in the acute trust could lawfully stop them using the MCA. Though most medical staff don’t see this as their job and are unwilling to do it. In fact I’ve never seen it happen. However, if the patient has capacity they can’t stop them leaving as they cannot use a holding power in A&E. The only option is 136 outside. As for your comment about risk assessments – believe me I have done many hundreds (or even thousands) of risk assessments on suicidal patients. Crisis Teams do a hard job and are underesourced and under supported. Now I realise that the fact a Crisis team has one nurse on duty to cover a large geographical area isn’t your problem but it doesn’t make them useless or unknowledgeable.

  7. Sectioned Detection says :

    “Though most medical staff don’t see this as their job and are unwilling to do it.” Pretty much sums it up. Well it’s not my job either as its a medical issue and the Cheif of ACPO agrees.

    As for patients having capacity and leaving then 136 is the only option just shows the flawed logic that some MH workers have. If they’ve taken on overdose for example then they’re free to leave why call us? MH problems or not then can still refuse treatment on a 136 so they still die of an OD!

    My experience of MH staff carrying out risk assesments is they find a risk then make no efforts to negate it. Perhaps say constant obs on a suicidal patient?

    As for understaffing, if never heard of a MH worker being asked to turn out to a burglary and I wouldn’t expect them to.

    • Tony Walker says :

      Ok, I think I haven’t been clear enough on one point and I think you misunderstand the law on another. Let’s see if I can clarify this for you. I was distinguishing between mental health staff and medical staff. Medical staff (ie. not mental health staff) don’t see restraining patients as their business and are unwilling to do it. Now you can argue that under MCA s6 allows for restraint if proportionate and in their best interests but only if they lack capacity. If they have capacity and are in A&E, the doctors cannot use their MHA 5.2 holding power as they patients are not admitted. That is my point. So, 136 is the only option to hold a capacitious patient posing a risk to self or others arising from a mental disorder while in A&E. I hope this clears these points of law up for you. Or invest in a Jones.

      • Sectioned Detection says :

        I’m fully aware of the difference in legislation as I have to use it daily. However, I ask the question again if a patient is brought into A&E having taken an overdose and they have the capacity to refuse treatment. If they leave what is the point on calling police because Sectioning them under 136 doesn’t change the fact that they can still refuse treatment.

        The NHS trust still have a duty of care for patients even if they aren’t in patients (Pennines Trust v Rabone) so the “it’s not my business” doesn’t wash.

        As for MH staff I’m regularly called to physically remove elderly patients following 135 warrants as MH staff refuse to use force.

  8. Tony Walker says :

    On the issue of resources let me tell you a story. One night I was the only person qualified to do mental health assessments of any kind in an area which takes about 2 hours drive to cover north to south and about 1 hour east to west. I get a referral from a GP – a patient allegedly suicidal is at home with his girlfriend. Would I go and assess? (I had a support worker with me). Sure. Then just before I set out, I get a call from the Duty Sergeant saying officers are with a patient who (drunk) has attempted to hang himself but obviously failed and refusing medical attention but not seriously injured. Would I come out? Sure. But I have another suicidal man. The sergeant argues that his man is more suicidal than the GP’s man. GP doesn’t agree. His man is more suicidal. So I say that officers are with man 2, I will go to man 1 first as no professionals are with him. But as soon as I have finished with man 1 I will come to him. The duty sergeant being a reasonable guy appreciates our resource issue and I get to the police as soon as possible. 95% of all crisis assessments and about 60% of all AMHP assessments in experience do not required police presence and we don’t request it. You will notice that I am not slagging police off. They help me. I appreciate it. I have good relations with them. They sometimes make mistakes. We sometimes make mistakes. I am sorry if you have had bad experience with MH workers but my colleagues aren’t a bunch of slackers who deliberately set out to rile the Police. So can you try not to see things in such a black and white way?

  9. Sectioned Detection says :

    One night? That’s every night in my force. That’s not me being extremist either there really is only 1 MH social worker on call from 1700-0800.

    My bad experience is unfortunately EVER experience I have with MH workers. This may sound unfair but the more I learn about MH legislation the more I realise just how much MH staff either lie to police or have no idea of their own policies. When area managers and ward managers saying “we’ll nobody told me” when you point out that their own policy requires them to collect AWOL patients or your told they can’t assess drunk people it starts to become clear that for too long the police have been taking up the slack for MH services for way too long.

    I’m not alone in this view
    “Currently, the police play too great a role in what is, after all, a medical emergency. Far too many people detained by police under the Mental Health Act end up in police cells simply because there is nowhere else to take them. It is not a crime to be unwell and the chronic lack of provision for mental health assessment places (“places of safety”) needs to be addressed immediately”
    President of the Cheif Superintendents of England and Wales

  10. Tony Walker says :

    Ok, “One night” could have been “that night”. I’m not a social worker either. It’s sad you have never had a good experience. Why don’t you ask if you can get seconded to a crisis team for a week so that relationships can get better? We have had Police students on the wards and with Crisis for a while now and it works really well.

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