By working in a role that takes me around the country, I get to see the various differences that exist between police areas – and I don’t just mean the 43 police forces of England and Wales, but even more local than that.  I’m a West Midlands Police officer and my operational experience has mainly been in Birmingham but I’ve also spent three years working in the Black Country.  The Brummies and the Yam Yams will hate me for saying this: but those areas are not as different as they’d like to think they are – I hope I can get away with that, being neutral (a Geordie).  But there are differences in the way that services operate: different local authorities, different mental health trust albeit the same 999 services who often work across those boundaries.  Section 136 MHA works very differently on Shenstone Road, in west Birmingham depending on which side of the road you’re detained – one side of the road is in the Sandwell LA/MH area, the other is Birmingham’s.  Or maybe it depends which are the attending police officers have...

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Today, I was invited to do something because I’ve been identified as “an expert in emergency mental health care.” I did wonder whether this was one of those mistakes made by someone who wasn’t reading closely enough, as when a medical recruitment company recently invited me apply for “vacant consultant psychiatrists’ positions in Birmingham, Manchester or London”. Apparently my CV had impressed them – my LinkedIn page, actually. It was obviously somehow beyond-impressive as it managed to distract their attention away from my utter lack of a medical degree or any professional registration as a medical practitioner. In fairness, I do have a first-aid certificate … but actually, even that’s expired if I’m being completely honest because I’m not currently in an operational role. I’m an associate member of the College of Paramedics, if that helps, but in fairness they don’t let me anywhere near the drugs or the cannulas. So nothing makes me an expert in emergency mental health care … I’m a policeman.

I can probably...

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1. For the first time in my career, I gave so-called 'expert' evidence to a Coroner's Court around a mental health incident. It all centred on the response to a vulnerable man in his own home and I will blog more specifically on that once the court has published its documents. Suffice to say here, I become quite concerned by the difficulty 999 crews seemed to face justifying their actions and inactions; as well as the extent to which other organisations tried to focus on those difficulties.

So leaving those specifics for later, here is a checklist for how to approach these issues so that as a paramedics or police officers you can't be the one accused of doing too little or failing in your legal duties towards vulnerable people. This is what I want you to know, having read hundreds of pages of documents and given over 5hrs of evidence overall, just in case you end up there connected to an operational incident.

PRIMARY  ASSESSMENT

Imagine you enter a private premises and realise you are answering a mental health crisis call.  You...

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This morning’s headline in The Times is a complete stunner – NHS abuse of mental patients ‘endemic’ (£).  Already, early on the day of publication, we have various commentators running off down various routes, from Professor Louis Appleby bemoaning a ‘harmful media bandwagon’, to individual mental health professionals pointing out that the words ‘mental patients’ are outdated at best and stigmatising at worst. Then we’ve already seen objections to the implied journalistic conclusions whereby The Times is mistaking every serious untoward incident review for ‘abuse’, which conflates distinct issues, apparently.  I’m sure we’ll see more of this as the day goes on – for example, I’m waiting to hear the ‘bad apple’ theory which we often hear about when it comes to excesses and abuses of police powers. This is the idea the majority of officers are good people who get up every day to put themselves in harm’s way in order to protect the public and the stories we hear of abuse are isolated examples by individuals who...

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Today, the head of the Family Division has handed down a judgment containing some of the most extraordinary language I’ve ever known a senior judge to use, questioning whether the issues before him mean we can lay claim to being a civilised society and warning that we may soon “have blood on our hands.”

WOW! …. just WOW!!!

It concerns the case of a 17yr old young woman, currently detained under criminal law after being sentenced by a Youth Court and who is due to be released from that secure custody location 11 days from now – the 14^th August. It is agreed by prison staff, mental health and social care professionals that she requires admission to an inpatient mental health unit for further assessment and treatment, one estimate being that she may need to be there for as much as two years in the opinion of the Consultant Child and Adolescent Psychiatrist who wrote a report. It is further agreed that she poses and real and imminent risk of suicide if released, staff fearful that she wouldn’t be alive more than 24hrs or...

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The police have been rolling out body worn video (BWV) for many years now.  You will notice, if you look at 999 response officers on patrol, many of them have two devices hanging from the upper portion of their protective vests: one of them is usually their police radio, the other, slightly smaller device is usually one of several types of camera.  This gives a fish-eye view, with audio, of what is in front of that officer at that time and offers considerable insight in to the incidents they police.  I remember when I first joined, most police custody suites did not routinely have comprehensive CCTV throughout and that when this was first introduced there was an amount of disquiet about the surveillance and scrutiny officers would be subjected to both whilst attending to their duties and whilst in between.  However, once rolled out, most custody sergeants – and I was one of them! – took the view that it merely assisted in showing some of the outrageous things people do to the police, the support staff (including...

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You may have noticed the Care Quality Commission published a report this week on the State of Mental Health Care.  Or maybe you were getting on with your life or your job, but I’ve given it as much time as I have spare and was very interested in what I read.  The CQC run an ongoing programme of inspections across the mental health trusts of England (there is a separate inspectorate for Wales) and they are also the statutory regulator for the use of the Mental Health Act 1983. This week’s report seems, to me at least, to be a overview of the individual reports they produced in their last inspection round, peppered with a sprinkling of MHA insights. I hope I understood it correctly.

As ever these days, with so many reports to read and keep an eye on, I tend to sometimes use my iPad just to search for terms within the report that will be relevant to my work.  Things as obvious as ‘police’ often through up little nuggets and so it proved with the CQC report.

Page 38, worth quoting a block of the text, if you have a spare moment!...

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There is a commonly occurring scenario amongst our colleagues in green and blue where they end up conspiring together to cause a nightmare and it needs to stop before someone is disciplined or worse, hurt.  Wouldn’t BLOG on this unless it had happened a large number of times and I’ll prepare you: I’m banging on at length in this one to set it all out again(!) because it really grinds my gears how often I hear of this!  But if you just want the punchline, there is a Quick Guide on responding to mental health crisis in private premises.

It usually goes something like this –

Paramedics attend a 999 call reporting a mental health crisis on private premises. When they arrive they discover a non-compliant patient in distress and after talking to them, they form the view that the person has potentially serious mental health problems and appears to lack capacity around their immediate decision-making. They are concerned the person would be at risk if they were left at home. Paramedics call for police support and when the officers...

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Did I mention I’d been to France?! … see above! We arrived home late last night and now have a recovery day before the harsh reality of work, first thing in the morning! I had a very interesting experience  once I’d arrived at Calais until disembarkment because of a discussion on social media which I found too interesting to ignore and which arose from the lack of beds to allow for an urgent admission to hospital. An AMHP found themselves in an invidious, albeit increasingly common position over the weekend following a Mental Health Act assessment after the police use of section 136. The lead doctor in the assessment was unable to provide a PICU bed to allow the AMHP to complete their legal application to a psychiatric intensive care unit so, after various escalations to NHS managers and no doubt a considerable amount of frustration by all involved, the man was released, his 72hrs assessment period having expired. This happened notwithstanding the AMHP describing the man as a “high risk to others” … and that there were “concerns...

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I’m being absolutely inundated at the moment, via email, phone and social media, with questions about when those changes to the Mental Health Act 1983, contained within the Policing and Crime Act 2017, will be brought in to effect. The amendments will alter quite considerably the 1983 powers relating to the police and to the operation of Places of Safety.

Such is the relentless volume of enquiry, I decided to text the Home Office from holiday(!) and want to share an update with their permission: I begged them to do this to help spare me the pain of relentless enquiry and so that I may focus my efforts on fromage français et vin blanc, etcetera! –

“We can clarify that the changes to s135/136 Mental Health Act 1983 (ss 80-83 of the Policing and Crime Act 2017 and related reulgaitons) will come into force no sooner than September 2017.  When the exact commencement date is known (ie, at least three weeks in advance, when those regulations are laid in parliament) this will be communicated to national partners for dissemination to local agencies....

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