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.
Imagine you enter a private premises and realise you are answering a mental health crisis call. You make that initial assessment of the person, the location and grab on to any information which is available. Here's the quick checklist for what I will call you primary assessment … you go through theses issues, in this order, to see whether you can unilaterally ensure the safety and wellbeing of the person you've just met –
If so and you are responding to someone you think is over 16yrs old and who lacks capacity about a specific decision, then you may have a duty to ensure their welfare and you would be able on rely upon the MCA if challenged about what you did. Call an ambulance if you're a cop; call the police if you're a paramedic who is going to need help to restrain the person and remove them to hospital and whichever you are: have a think of this problem from the other 999 crew's perspective as to why they will want your support. Scratch each other's backs, as it were! #team999
Try to engage the patient in agreeing to attend hospital for assessment and care. If they decline and police or paramedics think the medical issues are already life-altering or life-threatening, you may consider removing them to hospital under the MCA. Your legal justification will be around section 5, 6 and 4B of the Act because even if your actions amount to depriving the person of the liberty, s4B outlines how this can be justified if you are provide a 'life-sustaining intervention' or doing a 'vital act to prevent a serious deterioration in someone's condition'.
So if you've quickly checked off that list and you find that you're still stood in a private premises with someone who you think is experiencing a mental health crisis. Next part … and this is the bit that's crucial, based on what I went through in the Coroner's Court two weeks ago.
"If a local social services authority have reason to think that an application for admission to hospital or a guardianship application may need to be made in respect of a patient within their area, they shall make arrangements for an approved mental health professional to consider the patient's case on their behalf."
So to sum that all up! –
At this stage, you need to be clear about what you're communicating:
"We've been called to a MH crisis incident where I'd be using s136 MHA if we met this person in public. I'm concerned for their immediate welfare and in the absence of legal powers of my own to remove the person and safeguard them, I'm seeking your support to consider the need for a Mental Health Act assessment."
Document everything, including names and their verbal reactions – formal or informal. If you should ever have to stand in Coroner's Court, you will want and you will need to be able to show your 'working out' for all of this, accepting you won't be an expert in these areas of law. I would encourage you to refer to the Sessay judgement in your statements and if you're really feeling confident, refer to paragraphs 33-38 to reinforce your understanding of MH issues in private premises is that the MCA cannot be relied upon (unless it's life-threatening / life-altering) and that the MHA is the route to take, via an AMHP and a DR.
And on behalf of AMHPs everywhere, who will probably feel somewhat stitched up by what I've written above, please be prepared to help them with this if they ask for help. The above has been known to lead to an AMHP turning out to premises with a doctor within 45mins (yes, really) and detaining someone under s4 MHA. They will face exceptional challenges however, if doctors are in short supply, if they need warrants from the court or if there are no beds. Help to the extent you can because any decision to walk away will also be questioned. And trust me – it will be questioned!
Finally: whoever may complain about this approach about resources or local policy, just keep coming back to this point: "Nothing I am asking for breaks the law and this approach reflects my assessment of the risks in these circumstances and I am legally entitled to draw to the local authority's attention that s13 MHA may apply to this situation. Your responsibility is to decide what your response going to be, bearing in mind it will be documented for the record and referenced in legal proceedings if necessary. This is the way Parliament have deliberately chosen to structure the law and I'm operating within it."
This is about partnerships: but that's not just the professional partnership between the police and other services, it's about balancing that against the partnership the police must maintain and develop between the police and the public, because they are who we serve here.
Winner of the President’s Medal from the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.