The Bleedin’ Obvious

I’m sure you will be aware by now that I am in the early stages of a research degree. Though this may change or become more refined – the question I am seeking to answer is

“Are the police the right agency to be dealing with mental health incidents?”

I have spent the last few months reading. By which I mean reading a lot. I have read historical documents on the role of the police; books on mental health policy in the U.K.;studies in police interactions with people with mental illness from across the world; evaluations of Crisis Intervention Teams and Triage schemes; writings on a new concept called Law Enforcement and Public Health; reports on the implications of using Taser on people with mental illness; medical reports on the use and effects of restraint as well as papers on various elements of psychiatry and certain mental disorders.

Amongst other things.

The pile of paperwork is, as you’d expect, comprehensive and multi-disciplinary. I have tried to read up on law, ethics, policy, procedure, medicine and psychiatry. Reports and papers come from a wide variety of sources ranging from the British Medical Journal through to nursing magazines and local newspapers.

This process has been about studying what it already known about the various aspects of my subject of interest and then trying to draw it all together to form a literature review which would identify unanswered or unasked questions and gaps in the knowledge. An attempt to join up the dots.

It’s about as close to a strategic overview of mental health issues as I am ever likely to get and believe me, there are a lot of unanswered and unasked questions.

What strikes me is that there is a lot of research in some aspects of this field but a lot of it appears to have been done in isolation.

For example – plenty of research on borderline personality disorders and their manifestations but nothing which seems to draw a link between this condition, interaction with the police and subsequent non-treatment by mental health professionals.

Considering that two of the biggest manifestations of a person with borderline personality disorder in crisis are self harm and suicidal ideations or actions you can see that this behaviour is highly likely to warrant the attention of the police.

When you consider the two studies which show that psychiatrists do not like treating patients with borderline personality disorder and consider many people with the condition to be “untreatable” you realise they are not likely to be sectioned if the police should detain them and take them to a place of safety.

There appears to be almost nothing in terms of aftercare or follow up. Which leads to the next crisis – which leads to police involvement – which leads to the person being released from the place of safety without follow up…..

You see where this is heading?

Things get even more complicated and indeed dangerous when you examine the writings on restraint, excited delirium, acute behaviour disturbance – whatever it’s cause. Restraint is inherently dangerous – add psychosis to the mix and it becomes potentially deadly.

This week has seen the conclusion of the criminal trial of three members of police staff following the death of Thomas Orchard in police custody. This followed restraint. Thomas is likely to have been suffering from excited delirium. He died of hypoxia (starvation of oxygen to the brain.)

Thing is – you can read about this. The research is there. The exact sequence of likely biological events has already been spelled out.

Thomas’ death is a tragedy and I completely understand his family’s pain and anger. What makes it even more of a tragedy is that it is not the first in these circumstances and probably will not be the last.

We HAVE to learn from this – quickly – and work out the best way of dealing with these circumstances (which are very common) in the way which is least likely to cause injury, suffering or worse.

Restraint is a bad idea in these circumstances and yet it’s the only tool the police have in the box.

And what’s worse – no one seems to be rushing to help with a new tool box.

It is this I am finding frustrating. There have been numerous deaths in police custody where restraint has been a factor. In fact, the police restrain more people to death than they fatally shoot.

This simply shouldn’t be happening given what we now know both medically and from history.

We have reams of approved professional practice for firearms use and months of rigorous training. We have nothing on restraint.

The increased involvement of the police in managing mental health crisis is evident from the history. You can see it expanding as you read the papers. Further than that – it was even predicted. Several times. Particularly when de-institutionalisation started and the mental hospitals were closed and people were supposed to be treated in the community.

I won’t seek to answer my thesis question here – there is more work to do and the one thing missing in ALL the research to date is the patient’s voice.

Lots of professionals advocating the way forward being partnership work and an increased role and training for the police in handling mental health crises.

But no one seems to have asked those suffering if they actually WANT the police to be the service which turns up to help them.

I see this as a major problem.

There are several major problems and when you look down on it all – as I have done – you can see links and things which should be being discussed but aren’t.

If I were designing a mental health service from scratch – it certainly wouldn’t look like what we have now.

Incrementally, these subjects are being raised one by one but we are being distracted by the false promises of things like triage which barely touch what is really going on. It’s just another form of crisis management.

Police officers are still having to physically restrain people in mental health crisis and are then having to have a massive debate about where to take them.

Even the mental health laws and police powers don’t make sense when you consider what officers are actually being asked to do and compare it with what they CAN do.

So – what’s needed?

In my view – an honest conversation. We need to put down the gun that fires magic silver bullets and actually look at this holistically and then in macro-vision.

The problems go way way beyond anything that current suggested solutions can even begin to hope to address.

The system is entirely broken and mental health matters are now taking up an inordinate amount of the time of all emergency services.

This cannot continue but seems destined to continue. And get worse – because it IS getting worse.

We need to put down the politics, set aside simple quick fixes and call together the foremost experts in these various areas along with decision makers, legislators, PCC’s, clinicians, health commissioners, the IPCC, HMIC, Home Office, Department of Health, Department of Justice and SERVICE USERS.

The situation needs to be explained clearly and laid bare so that everyone understands exactly what we are up against and dealing with. So that everyone understands what everyone else is dealing with. And then the dots need to be joined up.

We need mutual workable solutions which do not involve everyone retreating into their own shrinking financial trenches. We need new solutions and new remedies. New  coping strategies and we have to – simply have to – recognise where the demand is coming from and stop pretending it’s someone else’s problem. At the moment it appears to be no-one’s problem which is making it everyone’s problem.

If the provision doesn’t exist – create it. It will be cheaper in the long run.

Perhaps it is time to ignore the politics and sensitivities, get everyone in one place at the same time and state The Bleedin’ Obvious.

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7 responses to “The Bleedin’ Obvious”

  1. korhomme says :

    Let me post a question; ultimately, what are the police for?

    As I understand it, the answer is ‘to keep the Queen’s Peace’.

    Which leads onto, ‘What is the Queen’s Peace’? And thus, ‘Are the police the appropriate people to deal with disturbances related to individuals, or even what you might call “domestics” ‘? If not, than who?

    I don’t have any clear answers; I do see it as important to try to find what the most appropriate, the base-line questions are.

    • nathanconstable says :

      If the police are wanted and expected to deal with a situation – then they need the right tools and laws to do it. This is currently not the case.

      • korhomme says :

        Nathan, I’ve read this and previous posts of yours. I used to be a Consultant in ‘administrative charge’ of an A&E dept, so my understanding is perhaps rather different from yours. And, while I don’t know the details, I would not be surprised if there are differences between the laws and regulations around the various police forces in England (and locally for me, the PSNI). I am very aware of the ‘place of safety’ which can be seen as a dumping ground for the unwanted, and also a place where the staff may not have the expertise to deal with them appropriately.

        Nonetheless, I have every sympathy for you and your colleagues, but also for those in A&E. Unfortunately, while I can agree that the present structures are inappropriate for those with significant, acute mental problems, I really don’t know what the solution is.

        Which is why I posed the original question: ‘what are the police for’, one that could be combined with ‘what are A&E depts for’. These issues do merit a serious debate; alas, while Brexit hangs in the air, I suspect that other things won’t get much of a look in.

      • nathanconstable says :

        Thanks for the reply. I think before we can work on what the solution is we need to work out what the problem is. Sounds obvious but we haven’t. We really haven’t. Consequently we end up jumping to “solutions” which are really just a complex and expensive way of not really dealing with the underlying causes.
        Was de-institutionalisation a good idea? I don’t know. Was it implemented properly? Absolutely not. Has that led us to where we are today? Quite possibly.
        We now have a situation where the emergency services are constantly chasing around looking for or looking out for people in various crises and for whom there is no safety net.
        We either carry on doing this or we look at who is calling us, why they are calling us and what we can do to reduce that or find a way of giving them some provision which may actually help.
        At the moment it is a bunch of ever decreasing vicious circles. Crisis – Police – Place of Safety – Release – Repeat.

      • korhomme says :

        While we come at the problem from different places, I think we can agree on one thing. And that is, as it so often is, is saying, “A Voice crying in the Wilderness….”

      • nathanconstable says :

        Amen to that 🙂

  2. judyb says :

    A great piece. As ‘just a relative’ the issue seems to me to be – how do we as a society want to look after people suffering with mental illnesses, including personality disorders At the moment mental health services seem to have reached a conclusion which results in people not getting enough help to allow them to live what most people would think of as a moderately normal life. There seems to be a depressing acceptance that people with depression kill themselves, people with schizophrenia live on the streets and people with personality disorders bounce between police and A and E. All in the cause of ‘least restrictive’ care. If you don’t recover with what is on offer then that is basically that. The focus on ‘crisis care’ is a distraction, few people who are being looked after by services should be reaching a point where the police need to get involved. I don’t know what the answers are, but the results of current policies/theories are devastating for many people

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