Imagine you’re a police officer (if you’re reading this and you’re not) you are called to an incident, a disturbance, a report of a drunk male having seriously assaulted someone. As you make your way, you are told CCTV operatives are following the suspect. Another mobile unit arrives and is with the victim. It’s a multiple stabbing. The victim is unconscious and an ambulance is en route.
You’re single crewed. You ask for back up. You’re the first person at the scene with the suspect, who is now casually sitting on a park bench. He appears dazed, and his behaviour is irregular. Mumbling to himself and appearing to talk to an imaginary person by his side. You talk to him but can’t smell alcohol. Could it be drugs? Back up arrives. You see a knife on the ground near the suspect.
By overpowering him you and a colleague detain the suspect and handcuff him. You have the knife now. He begins to struggle violently. You pin him to the ground and keep him there. Meanwhile over the radio you are told that the assault was unprovoked and the suspect had just stabbed an unknown passer by several times before walking off. This is life threatening and attempted murder.
Your worst suspicion is that the suspect is potentially seriously mentally ill. He continues talking to himself and his imaginary friend. Initially the suspect cooperates but while you are conveying him in to the car he headbutts the car window several times before you can stop him causing further injury to himself. Now it takes 5 officers to overpower him. It’s clear he’s trying to hurt himself.
The head butting was with such force that he now has very severe swelling to his face and eyes. A combination of a serious crime and a suspect that may be mentally ill, so where do you take him? Custody? He is likely to injure himself. But you need to preserve evidence. Hospital? He’s violent and dangerous and they may only accept him temporarily and not be able to treat him quickly. He may also injure staff and the public. Will he be fit to be detained and interviewed?
Further enquiries reveal the suspect has a history of psychosis and of mental depression. He’d warned his care team in the last few weeks he would kill someone. This has been logged and your Intel reflects this. Yesterday I wrote a tweet about the ‘system’. If the system is broken I suggested we redesign it. In this case the suspect requires care, protection from himself; treatment measures and an investigation must continue.
Who takes responsibility in extreme cases of mental health is the contentious issue. I foresee a secure mental health area in a hospital with a dedicated custody officer on call who can attend and open up. Manned by one gaoler and one mental health nurse for each detained person; only serious cases can take this route.
I see an on call mental health duty doctor with attendance times of 40 minutes from the time requested. I see a joint unit with the power to detain, treat, and investigate. I foresee greater powers and changes to PACE detention rules for serious extreme cases.
But most importantly I see joint police/NHS ownership through to conclusion; and conclusion means disposal from detention. Would this type of facility make any difference? Maybe it would take pressure off already busy custody offices, allowing them to focus on day to day stuff without this serious care specialism. Maybe it would stop the question of who owns this person’s care? The NHS or Police.
Primarily this piece is about a place of safety at critical times when there are conflicts of ownership. And isn’t that a change we want to see, enough with the blame culture. Who is important in the process? The public. What is important in this process? Care and protection of vulnerable people. Not budgets.
I see no reason why some that are mentally ill cannot still be processed via current procedures. But I just see that a joint unit, housed at a secure location, could be a way forward for the police and health service in very extreme cases. An independent qualified lawyer who is not answerable to either organisations would deal with legal matters upto disposal only.
I still view custody officers as responsible for the detention of a detained person under this model, but the health of the detained person must be a joint responsibility. I write this piece at a time when yet another Mental Health case hits the news headlines leaving officers injured.
With cuts in the NHS only the desperately ill get a service and let’s hope they have family and friends because if they don’t then the unbefriended person is out there on their own, unknown or detached from services and invisible until something very bad happens.
Is the system for dealing with extreme mental health persons broken? Society often leaves policing to pick up the pieces. This is no longer good enough. Change the system. If we want to protect better it is clear that society must also not put extreme cases into community care.
Care, health, custody, judiciary. It’s time to revise mental health dealings.
That was a guest blog by the Tweeter @SirIanBlair
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