Tag Archives: mental health

Pushing the Buttons

What does the image below mean to you?

men-women-on-off-switch

If it’s not entirely obvious….

It’s about the difference between turning on a man and turning on a woman. Blokes are apparently relatively straightforward. [one click]. The ladies on the other hand need a combination of a number of factors all in sync before the magic happens. Switch A on, knob B at position 2 but only if dial 4 is at 50% and so on….

Before I get into territory that will have people yelling at me.. hit the pause button. That’s not what this blog is about. It’s about obtaining a reaction.

It was once very easy to obtain a reaction from the police. You simply called us up and we came. In other words the police were like the ‘man switch’ on the image above. We might not have attended straight away but we would come.. eventually. Even when I joined 20+ years ago we didn’t always come straight away. Many times I found myself apologising to someone for how long it had taken us to get to them. Over the years things have changed.

House alarms. We always went. Just a quick check over to ensure all was secure, contact the key holder if we had one and sympathise with the neighbours facing the noise. These days we don’t go. We only attend if there are additional factors reported. e.g The alarm is ringing and the door is wide open, or a strange man is in the back garden. Unless of course you have lots of money and have a monitored alarm.. then we come. (The contradiction of the latter annoys me and may form another blog about equality of service.)

If your shed has been broken into, your lawnmower stolen and nothing seen we are unlikely to come. We may send the forensic team if we think an opportunity to recover evidence is there. Otherwise we may not come at all.  I won’t go into a long list of incidents that we will not ordinarily attend. Suffice to say that times have changed. It’s not totally black and white. A particularly vulnerable or upset victim may well get a visit over someone who just wants a crime number. It becomes clear that we have moved from the man switch to the multitudinous buttons, knobs and dials of the woman model.

So the police have changed how we react to incidents. You could say we have streamlined in order to maximise our resources. You could say we have made it more difficult for the public to get to see us? Either way and whichever take you agree with there is, as our numbers reduce,  a need to be more efficient with our resources.

homer-angry-phone

The public used to expect us to simply attend.. and we did. We have changed our reaction  but my experience is that in many cases the public haven’t really changed their expectation. The amount of calls we get where the public are insistent or demand to see an officer hasn’t changed.

I have been in the control room now since the end of January and I am thoroughly enjoying my new role. It has given me the opportunity to monitor an awful lot of incoming incidents. What has become apparent is that the public are adept at ‘twiddling our knobs and pushing our buttons’. This is not something new but as we have changed the public have adapted. Members of the public who want a police patrol to attend but know we won’t come have become savvy. For a house alarm they will say ‘there is a suspicious person on the corner’ or ‘I think I saw someone on the flat roof’ or ‘I know they are on holiday and I can hear banging’. To be fair sometimes this is perfectly genuine and we should respond. Other times though it can be a manufactured response. A report of youths being a nuisance at a play area in the park will engender a response but not immediately. If the caller also says ‘One of them is waving something around. I can’t be sure but it might be a knife’ then suddenly the risk increases and we pull out all the stops to get there.

The difficulty is how to sort the wheat from the chaff. How do we differentiate between the genuine call and the manufactured call? Local intelligence and repeat callers helps but in reality our buttons have been pushed and we are coming. The net result is that the demand on the resources is not reduced.

Yet there is another factor now coming into play that I hadn’t noticed before. We have become smarter about how we respond to incidents and when dealing with partners we often throw questions back at them such as ‘What have you done to resolve this?’ We now try to deal with it from a ‘how can we support you’ position rather than ‘what do you want us to do for you?’

Mental health is a good example. The demand on resources for mental health, concerns for welfare/safety and missing from homes is not reducing. We regularly challenge partners on what they plan to do. They cannot simply report it to us, sit back and wait for us to solve for them. They have ownership too. With the help of Insp Michael Brown (aka @mentalhealthcop) we have become much wiser on mental health law and protocols. Where we once would have simply just responded to a request to accompany an AMHP to see a patient for a possible section we now challenge it. Where we would simply have attended at a hospital to help the staff administer medication we now question the need. We consider our powers more carefully, demand cooperation and teamwork and challenge their approach (e.g. informal attendance at an address to section someone over a s135 warrant).

This has had some positive outcomes but in between the successes are some incidents where our partners are starting to demonstrate the same behaviour as some of the public. They are pushing our buttons and presenting the right ‘key’ words in order to engender a response. We recently refused to assist with a mental health case without a warrant. All the RAVE factors were present, the known risks were obvious and a warrant was the best option to ensure the safety of all and we acted within our powers. The MH team decided they did not like this, attended at the address on their own and then called us saying the patient was aggressive and they needed back up. Irresponsible? I would say so.

The traditional 5 o’clock call on Friday afternoon about a concern for welfare of a vulnerable person is proliferated with all the key words that mean we cannot simply ignore it. As those staff head for home we are left to find the vulnerable alcoholic person with suicidal thoughts, mental health problems, cannot be trusted anywhere near children, has not taken their meds and as such can lead to highly unpredictable behaviour. All the issues that person had at 8am that morning when the staff came on duty.

The police are adjusting how we respond to demand. In many cases this will work. The vast bulk of the public understand we are under pressure and accept, maybe begrudgingly, that times have changed. Others however are ready to manipulate the circumstances just enough to get the outcome they want. To exacerbate our problems I now see this filtering into the behaviour of some of our partners. This is not about avoiding jobs. It’s about working efficiently and cutting out waste.

Unless the expectation the public and our partners have of the police changes then the demand on our resources will not reduce. We can present them with a myriad of buttons, dials, switches and knobs to obtain a reaction and they will simply push every one until they get it.

 

Nora

This is a true story. It details my first ever encounter with Mental Health as a police officer in 1992. Names have been changed

I sat in the parade room quickly scanning through my outstanding paperwork. I had a big smile on my face. It was 9.15pm, parade was over, the night shift loomed large ahead of me and I had been doubled up on one of the vans all night. No walking for me. Racing around with blue lights to pub fights, domestics and chasing burglars over back fences. A HUGE grin.

Nigel was my partner. A bobby with about 5 years service. Confident, capable and a good chap who would use his experience to develop mine. He stuck his head around the door, smiled and asked “You coming then?”

I leapt out of my seat, grabbed my coat, hat and gloves and followed him out into the car park. Our vehicle was a short wheel base Ford Transit van. Primary purpose; prisoner transportation. It had no cages in the back, just a wooden bulkhead that separated the driver and passenger from the rear. A wooden bench seat down each side and a spare tyre and a jack were loose on the floor. Yes, I kid you not, these items were just left in the back of the van and not once do I ever recall a prisoner using one to assault an officer.

We set off on patrol. We drove down toward the first town area and had a quick scan of the pubs to see how busy they were. A good indicator for potential problems later. We then turned toward our beat area. We chatted and Nigel asked if there was anything I needed to do. Any jobs I had’nt dealt with that we could try and get to as a learning exercise.

As we approached the next town area we came up to a roundabout. Just before the roundabout was a bus stop and sat on the bench was a woman. I came to know her as Nora but for now she was simply sat on the bench. She was leaning forward and waving her arms toward us in quite a distressed manner. Nigel pulled over and I got out.

Nora wasn’t making any sense at all. She couldn’t sit still, kept rocking backwards and forwards and continually waved her arms about. Emanating from her mouth were moans, groans and attempts to speak that we’re unintelligible. The next problem was she was drunk. A bottle of White Lightning or similar was propped up by the feet of the bench. She was in her late 20’s to early 30’s, completely bedraggled and unkempt.

Nigel joined me. “Your job. What are you going to do?”

I tried to talk to Nora but got nowhere. I tried to find ID but couldn’t. I pondered. People were walking past, she was making a bit of a scene and I couldn’t leave her there. I chose to arrest for Drunk and Incapable. Nigel nodded approval so we lodged her in the van and headed off for custody.

As a custody sgt for nearly 7 years that last sentence makes me smile. The response I got from the custody sgt that night was the response I would give now. He refused detention completely.

“I’m not having her in here. Take her to hospital.”

Tail firmly between my legs I escorted (almost carried) Nora back to the van, poured her into the back before heading off to A&E. Nigel discussed what had happened in custody with me. After a little while I realised the Sgt was right. This lady showed all sorts of signs of mental health issues and that was the key word for me.. Health. Hospitals care for people with health problems and that was where I was taking her. Sorted. Drop her off at A&E and we could get back on patrol. It all made sense.

We arrived and grabbing an errant wheelchair I slid Nora from the van into the chair and pushed her into hospital. The calm and respectful silence of the waiting area was destroyed immediately by Nora. I pushed Nora alongside the seating and left her to her caterwauling whilst I put my best smile on and approached the charge nurse.

The look on his face did nothing to reassure me that this was the solution to Nora’s problems or mine. The details of the conversation I cannot recall other than my pleading for help and his reluctance to get involved. He finally acquiesced a little. I was instructed to sit and wait with Nora and to keep her quiet. Nora was having none of it. She continued bawling non-word sounds that did nothing to settle the minds of those waiting for treatment or kick start the nursing team into action. Nigel got called away to a job and deeming I was capable of looking after Nora by myself cleared off.

The joy of triage. Nora and I waited for around 3 hours to be seen. I watched many people arrive by ambulance who were clearly in need of medical care and knew this was pushing Nora further down the queue. Occasionally a nurse would wander past, glance over with a mixture of sympathy and disdain and then continue with their duties. We were finally seen by a very nice nurse. She tried, unsuccessfully, to communicate with Nora and after chatting with me about how and where I had found her came up with a solution.

I was thrilled. Light was at the end of the tunnel. We had been referred to the on duty Psychiatrist from the mental health unit and he would come and assess Nora.

Two hours later he arrived. He looked like he had just got out of bed and his face said it all. This was not going to go well. He asked questions. Nora groaned, moaned and waved her arms about. Within the space of two minutes he concluded she was showing no signs of mental illness and was just drunk.

I can do nothing for you. You will have to take her to custody or do something with her.

I knew custody would not have her back so was stuck. I called up Nigel and asked him to come back with the van. Nora had no ID. I didn’t know where she lived and she wasn’t showing up on our systems. Just before I left a staff nurse took me to one side and passed me a sheet of paper. On it was a local address. “I think it’s her address. If not, at least a family member”.

I thanked her, helped Nora back into the van and told Nigel what I had. He concluded that with nothing else the address was where we were going. At about 2.45 in the morning I began knocking on the door of the address. No reply. I kept knocking. Nigel finally told me he had seen an upstairs curtain twitch. I knocked some more, harder, and eventually a lady spoke to me from behind the closed door. I identified myself and she was happy we were the police but she wouldn’t open the door. Meanwhile Nora was bawling her unintelligible noises out of the vent at the back of the van for all the neighbours in this quiet residential street to hear. Curtains were twitching at more addresses than just where I had been knocking.

The lady admitted that Nora was her daughter. She didn’t live there and she didn’t know where Nora had been living. She confirmed that Nora had been seeing her GP and mental health people about a number of problems. She also adamantly refused to have her for the night. “She causes me too many problems and I’m too old and unwell to cope with her”. Despite my best attempts Nora stayed in the van and the front door remained firmly shut.

One little nugget Nora’s mum offered was a street name and a red front door. “About half way down on the left hand side” she said. She didn’t know if Nora lived there or not but she had been known to stay there. The street was a huge row of terraced houses that were mostly student digs and shared houses. Desperate for any solution I pulled every last bit of Nora’s bag out and searched. Nothing to ID her, an address or anything but I did find one solitary Yale key.

We drove to the street and I sat looking at about 50 houses. Which had a red door? It’s not the done thing really as a cop to wake up a home owner/occupant by rattling a key in their lock trying to find the home of a drunk with mental health problems. I could have cried. I had had enough.

We drove up and down and based on Nora’s mothers comments I took the plunge and tried the key in the door of the nastiest, dirtiest looking house in the middle if the block with a red door. It unlocked the door. We checked the house. Nobody was home but it was clearly a doss house for drunks and down and outs. The downstairs front room had a bed in it that was astonishingly made up and clean’ish looking.

Faced with no solution we took Nora from the van and into the house. She still wasn’t making any sense but she was suddenly smiling in between her now quieter vocals and in a shambling, shuffling kind of way, steered us into the front room. We led her to the bed and she lay out on it and the noises stopped instantly. She simply smiled a rotten toothed and gappy grin at us, rolled over and promptly fell asleep.

With no other option open to us we put her bag and key next to her bed, pulled the door to and left her.

We returned to the station and finished just on time. A whole 10hr shift… gone.

***********************

Please remember this was 1992. Policing was very different and what was deemed to be acceptable then would never happen today.

This story outlines the problems that I faced as a police officer dealing with my first mental health case. You’d like to think that in over 20 years this situation has changed? Ask a response cop today. They still get passed from pillar to post even now. There are improvements and some forces have made great progress but on a national scale mental health still causes a huge drain on police resources. Whilst Nora never made it to a cell, many do, either as s136 cases or as those arrested for offences but found to have mental health issues. Either way its still far too many and the infrastructure that allows mentally ill people to get help and in many cases it is found wanting.

I am delighted, as a custody sgt, to know that we have strong advocates in the the police who are pushing, debating and helping to shape how improvements can be made in @mentalhealthcop and @nathanconstable who organised the #mhpolchat after the recent Panorama programme.

Only by talking and working together can we make progress. Any change needs time and care in planning before implementation. Officers desperate to get on with policing need to know that a quick drop and run at Mental health units is a long way off. Time sat with people at hospitals will still, for the time being, be necessary. Hopefully as time progresses though a team ethic will be built between us where the best interests of the patient are at the heart of everything we do.

************************************

I didn’t sleep after that shift. I was worried about Nora. No phone calls at home though and when I paraded on the next night I wasn’t dragged off to the office because something awful had happened.

I didn’t deal directly with Nora again. I was aware of other officers dealing with similar situations though and going through the same process of rejection at every turn. Eventually I moved to traffic and didn’t see or hear of her again…..

until….

One day whilst out on enquiries I was passing a Benefits office when a job came in. A female causing a disturbance. I pulled up outside and was met immediately by a member of staff.

“There’s a lady in one of the interview rooms. She’s kicking off and we can’t get any sense out of her”. I asked for her name as I was led to the room. “Nora” she said. Time stood still. Not again… It was probably 6 or 7 years since I had seen her. I was trapped. No escape. I had to deal with it.

The door was opened and I stepped into the room almost wincing at what was to come. Nora turned toward me. She was clean and tidy. Her teeth were still a mess but her long hair was brushed through and she looked healthy. I was speechless. This wasn’t the Nora I knew.

“Oh my goodness” she said. “I haven’t seen you in years. You’re that really lovely man who looked after me all night and then took me home and put me in bed. You really took care of me and I will never forget that. I was in a bad place in those days.”

I was glued to the spot.. I just smiled a confused sort of smile and said “Hello Nora”. I had never, ever heard her speak.

Nora turned to the lady from the benefits office. “I’ll come back and sort this tomorrow. I’ve spoilt this cops day once before. I’m not doing it again”. With that she put her arm through mine and walked out onto the street. She wished me well, said I looked like I had a better job now with a fancy car and said thank you again before walking away.

I never saw her again. Wherever you are Nora, I hope you are well and happy.

I say, I say

“I say, I say. My wife’s gone to Northern Italy.”
“Genoa?”
“I should think so, We’ve been married for 20 years.”

Can you remember jokes like this? Harmless and mildly amusing now but if read out by Tommy Cooper they would have the house roaring in laughter?

Let me try one.

“I say. I say. When is a police officer a paramedic?”
“I don’t know. When is a police officer a paramedic?”
“They never are”

As you can see there is much work still needed in my stand up routine. “Don’t give up the day job” I hear you cry.

So what on earth am I on about? Well let’s steer away from the humour and focus on why a cop is never a paramedic.

We know that in recent years, as the orchestrator of the cuts to policing, that Theresa May has come for a bit of a rough ride from the delegates at the National Police Federation Conference. My Gran used to say to me that “manners maketh man and cost nothing”. She was right. Whilst I wholly understood why officers were angry last year, any behaviour that went beyond common decency was not acceptable. However, there were some, Blair Gibbs (Policy Exchange at the time) who tweeted how appalling it was. I sent an email to him about his statements but he never replied. Oddly demonstrating a lack of that which he was trying to advocate by criticising the delegates; manners.

Yesterday, Theresa May, the Home Secretary, addressed the Police Federation Conference. This year, with a change at the helm of the Federation HQ, there was a appeal for dignity and questions asked of her were vetted beforehand. Her reception this year was much better.

During her speech she focused on mental health issues and how police resources are affected. During this she said;

Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness – nor are you meant to be social workers or ambulance drivers.

She also said;

Fourth, police officers should not have to step in to act as ambulance drivers for mentally-ill people. The provision of ambulance services for these emergency cases will be reviewed by the NHS this year.

These statements have caused some considerable upset. My friend @mentalhealthcop has blogged about it here and @diagnosisLOB has also written about it here.

Both are well written20130516-184236.jpg blogs and I endorse the fact that “Paramedic” is a protected title and that referring to such consummate professionals as “ambulance drivers” is demeaning to the skill, expertise and dedication of this fantastic profession.

I do think though that they are both grabbing hold of the wrong end of the stick. Either this or they, are attacking the statements in a “straw that broke the camels back” fashion and feel insulted.

I’ve spent over 20 years in the service as a police officer. I have regularly challenged people and newspapers about using the term police officer when they mean PCSO’S and Police Chief when they mean PCC. They are entirely different. You would therefore expect me to support the two blogs when the professionalism of paramedics is being undervalued?

The Home Sec said that police officers should not be ambulance drivers. She went on to say that police are not Doctors and flagged up a concern officers, and especially custody Sgts, have had for many years. That is that too many mental health cases still end up in the care of the police and not the appropriate medical professionals. Police officers routinely detain s136 cases and convey to hospital. Some force areas are better than others but there are many cases where a responsibility argument ensues that often leads to a mental health case coming to custody. Thanks to @mentalhealthcop and the ACPO Lead Chief Con Simon Cole this situation is getting better. However the Home Sec also points out that there is still a deficiency in health based places of safety. The systems are getting better but we a far from being out of the woods.

Police officers do not have the skills, experience or equipment that paramedics do. We can no more do their job than they ours. The Home Secretary, to my mind, was referring to police officers who are regularly transporting mental health patients around because nobody else will accept responsibility. The only thing we have in common with our paramedic colleagues at this point is that we have a medical case onboard our vehicle and we are driving somewhere. For all intents and purposes, we, the police, on those occasions, are pseudo ambulance drivers. A pale reflection of our esteemed 999 colleagues.

I believe the Home Sec was attaching the phrase to police officers. Not to the professionals who do it daily. It was a criticism of the system that leads to police officers performing a role they shouldn’t be doing. The only function they have in common with paramedics in such cases. Driving people around with medical conditions.

IF the Home Sec had said that police officers are “not meant to be social workers or paramedics” then the argument would be better placed. The fact is she didn’t. She minimised the role and applied it to police officers. This is entirely different to calling police officers paramedics or paramedics ambulance drivers. As it is I suspect there are many social workers, who haven’t spoken up yet to my knowledge, who may be upset that police officers are referred to a such?

It seems to me that this reaction, in isolation, is being misrepresented. However, I suspect my paramedic colleagues are more upset at a term that has been bandied around before and this is the last straw. I can sympathise with this but in the end I do not believe her comment was attributed to them but to us.

I’m not a paramedic. On occasion our roles may overlap but only in an observational sense.