Whose Line Is It Anyway?

I had a fascinating comment added to my blog The Other Way Aroundwhich has prompted me to blog on a question which has been bothering me for months.

In this blog I suggested that Crisis Teams need to be more flexible and responsive and I recounted the story of the suicide intervention from last week which involved about 30 emergency services personnel.

The comment I received was this:

Is this a joke? So a drunk person threatening self harm is an “ill” person requiring medical attention? Not sure which med school you went to.In reality it’s a difficult pers on you don’t know what to do with.Your answer: send a nurse to the house to do what precisely?Apart from putting themselves and the person at more risk. Have a nice chat? Put the kettle on? Remember vast majority are not ill. Precisely what the antipsychiatry movement predicted many years ago. Call it “illness” and medicalise it. Funny thing is though,it’s always people outside frontline psychiatry who do that. Emergency situation=Emergency Service.

To which I replied:

Interesting argument. So if I say it’s not a crime either and the police have no powers to deal with it – where does that leave us?

It a variation of this which has been playing on my mind for a while.

What is a suicide attempt and whose responsibility is it to deal with it?

The author of the comment was perhaps a little harsh. I have never been to Med School and they know it. I am not a clinician, nor a psychologist nor am I a psychiatrist. I have no medical training other than basic first aid.

I am a police officer, with many years of experience, whose “Boss”, the Home Secretary, has told me that my job is to “reduce crime – no more, no less.”

Suicide was decriminalised in the UK in 1961.

Even the term to “commit suicide” is a throw back to the days when it was a crime – in the same way as you commit any offence. It has not been a criminal act for over 50 years but the terminology hasn’t changed.

So if the author is right then it is not a medical problem. If I am right then it isn’t really a police problem – the police certainly have no powers to deal with it.

So whose problem is it – and is it, in fact, a problem?

It is not an offence but what would society think of any organisation which turned around and said “it’s nothing to do with us”?

The law places an obligation on the police to protect life under Article 2 of the Human Rights Act. It is a positive obligation unlike any of the the other articles. This means that if the police are presented with a life threatening situation they MUST do something about it.

A responsibility without powers to back it up.

I am not even going to pretend to understand the complexities surrounding mental health and suicide but to my untrained mind it boils down to one simple thing. Capacity.

Does the person making the threats to kill themselves have the capacity to make that decision?

How can you determine this unless there are professionals present who can use their training, experience and knowledge to make that judgement?

Remember – I am not a psychiatrist and I haven’t been to Med school.

Returning to the lack of powers to intervene – if someone is threatening to harm themselves in their own home then there are absolutely no powers to deal with it. Why would we resort to using archaic Breach of the Peace legislation and arrest the person when the Government of five decades ago decided that what they were doing wasn’t actually a criminal offence?

The government have not seen it necessary to amend that or add to the Police and Criminal Evidence Act or Mental Health Act in all those years.

We end up arresting someone for NOT committing an offence by calling it something else simply to get them help and stop them doing it.

If someone is threatening to commit suicide this does not automatically make them mentally ill. I know that. But it MIGHT mean that they are mentally ill.
Shouldn’t all agencies be involved until we know one way or the other?

The author says “emergency situation – emergency services”. This scares me more than anything else he said.

Why? Because it has reached the point of becoming an “emergency situation.”

There will always be times when, completely out of the blue, someone decides to take this final course of action but in most cases there are signs and signals.

Depression, previous attempts, involvement with a GP, even earlier involvement with mental health workers.

If it reaches the point where someone is stood on a bridge threatening to jump then has this earlier intervention failed?

Why has it reached an “emergency situation?”

What does this person really need right now and is there anyone around who can provide it?

If the person then jumps whose actions usually gets examined most closely? I would put money on it being the police via the IPCC.

If suicide, self harm or attempting suicide are not criminal offences – and they are not medical issues – then who should be dealing with them?

In the meantime – I will continue to do my bit as people would expect me to. I will continue to advocate for increased training and awareness across all the agencies. I will keep campaigning for someone to straighten out the legislation on this and clarify who should be doing what.

I have an obligation – both moral and legal.

Washing my hands of it – “your situation – your problem” – simply isn’t an option.

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7 responses to “Whose Line Is It Anyway?”

  1. AdemanDeloya says :

    Unusual to see the “service of last resort” mentality expressed as succinctly as it was by your commenter. Everyone else gets to say “not my job, not my remit”, apart from the police. Which is of course exactly why we so routinely find police officers dealing with things for which they have neither the training or the knowhow, and just muddling through.

    “I grew tired of coming up with last minute, desperate solutions to impossible problems created by other f***ing people,” as a character in a great movie once said.

  2. youarewho says :

    Gone past the point of being a police matter – call the emergency mental illness team- oh there isn’t one ! As most people realise shit rplls downwards and the only people you can get hold of who 1. Cant refuse to answer the phone and 2 are available 24/7 are the emergency services. ….simples ! Should be doing a lot more ” thats nothing to do with us im afraid !”

  3. JL says :

    ‘The law places an obligation on the police to protect life under Article 2 of the Human Rights Act. It is a positive obligation unlike any of the the other articles. This means that if the police are presented with a life threatening situation they MUST do something about it. ‘

    Interesting conundrum because the mental health services if aware of this potential suicide should have a duty of care and shouldn’t they also have to use Article 2. There was a recent case where legal action under Article 2 was taken following the death of a sectioned patient. Yet time and time again they choose not to exercise this right – maybe because the crisis team cannot respond or there aren’t any beds or for whatever reason. Or they choose to take a positive risk with the patient and it seems like they cross their fingers and hope to God that the patient changes their mind or fails.

    ‘Why has it reached an “emergency situation?”

    What does this person really need right now and is there anyone around who can provide it?’

    Until such time as more funding is sent in the direction of mental health services and they work a bit smarter then this is going to be an ongoing debate. Someone needs to wake up to the fact that supporting someone with m h problems a little better will in the long run be more cost effective and allow other services to do what they are really meant to do. The answer to the above question is that the person needs psychiatric help or at least an assessment not police officers doing their best but probably frightening an already distressed person.There is no one immediately around to provide it with a shortage of mental health resources.

    Here’s a real life example of what can happen to get to an emergency situation involving the police. My own mental health trust now prefer to provide ‘short episodes of treatment’ due, I would guess, to funding restrictions. This meant that I recently lost my support. Since then in the last 6 months I have had 11 A&E admissions (mostly by ambulance) and several times I have been reported as a missing person – sorry local police force. I have been distressed and unwell but probably with capacity to decide whether I wished to end my life or not. At first I would ask for help but now it seems a pointless exercise as a 3 day response from the crisis team is not much good. My psychiatrist’s response is ‘you know I would change the system if I could’..

  4. Sectioned Detection says :

    Rabone and another v Pennine Care NHS Foundation Trust (2012)

    In this case is was deemed that an operational obligation under Article 2 can in principle be owed to a hospital patient who is:

    a) Mentally ill, but who is not detained under the MHA.
    b) There was a ‘real and immediate’ risk to the patient’s life of which the Trust knew or ought to have known and which it failed to take reasonable steps to avoid.

    In summing up Lord Dyson said

    “if there was a real and immediate risk of suicide at that time of which the trust was aware or ought to have been aware, then in my view the trust was under a duty to take reasonable steps to protect Melanie from it. She had been admitted to hospital because she was a real suicide risk. By reason of her mental state, she was extremely vulnerable. The trust assumed responsibility for her. She was under its control.

  5. Polly M says :

    Fascinating blog. I am the sister of someone who took their own life nearly four years ago and had been involved with both mental health crisis teams and in a crisis situation, the police.
    The fact is the responsibilty should lie with mental health services but ends up falling to the police because you provide a 24/7 emergency service, working nights, bank holidays and weekends while all the MH professionals are tucked up in bed/spending time with their families. Perhaps they don’t take ‘suicidal’ threats as seriously because they are so common place in the arena in which they work?
    It’s certainly an important debate which needs to be had.

  6. Peter Kirkham says :

    The only thing it can be is a mental health issue. As you say its often (usually) not a crime, especially in private. Its not usually a breach of peace (as now defined by clear case law). It can only be a mental health issue. So Mental Capacity Act comes into play – in theory that requires everyone to watch someone try to kill themselves if they’re considered to have capacity…& then when they lapse into unconsciousness dive in to try to save them! I would suggest that would be utterly unacceptable to anyone. That leaves s136 (I can’t see a Court deciding an attempt to kill yourself didn’t amount to need for immediate care & control!) in public places. So in private places its the equivalent…which means the NHS MH services getting their fingers out & having an emergency response able to attend & use their compulsory care & control powers to get person properly assessed.

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