Thursday 26 April 2012

Mexican Standoff

"Female u/k age, feeling suicidal, having bad reaction to cocaine"

In my last post Pass the Donkey the main point was responsibility. Who should take responsibility for a mental health patient suffering a crisis. Police, ambulance or hospital. The long and the short of it was the police should have sectioned but were unwilling and the hospital should have accepted the patient but didn't. Why? A simple but very pertinent question. Why were the police unwilling to go through correct procedure. Well I have found one answer to it. MentalHealthCop pointed me in the direction of this account by a front line police officer. This is their account, unedited and I think goes some way to showing what could be on an officers mind when considering a sectioning.

A Mexican Standoff is a situation where no one can emerge as a clear winner. I think that is very true with mental health care. Certainly the patient never seems to be the winner and as this account shows, finishing on time seems to be much more important to some, than the health and well being of a patient.  To set the scene, it's 5am at the end of yet another gruelling night shift. We all know the feeling, all we want is our bed, but invariably that will have to wait. There will always be one more job to do!

“Here is the full story of the MH debacle and the Mexican Standoff I had this morning with the NHS … Police called by Ambulance to assist them as a well-known self harmer has taken cocaine and has some unusually bad reaction to it. She feels dizzy and sick and it was enough to ask for medical help because it was weirder than her normal reaction to cocaine. I am a good 45 mins away from scene and so firearms vehicle attend. In our force it seems that once you have a gun you lose the ability to think for yourself and (god forbid) the ability to actually use your powers as a police officer … a bit like inspectors!

Helpful firearm officer asks over the airwaves “she says if we leave her she will kill herself. I don’t know what to do so can a local officer please come and help me”. Thanks for that. Try communicating with her for a start!

I get there. Firearms say “thanks, see ya” and leave me to get off and finish on time. Ambulance say – there is nothing wrong with her AND I QUOTE “apart from her her heart rate being a fast from the coke”. They know this frequent flyer and stand with their arms crossed saying can you get her out of the ambulance as we need it back on the road. Roughly translated as – I want to go home and I am tired of her again.

Girl says – if you leave I will kill myself. I now have no choice whatsoever. Oh, and I then remove the razor blades she has concealed in her hands which both firearms and ambulance failed to notice.

So I ’136′ her because I feel that if we leave, bearing in mind her mental health history, her substance abuse and her stated intent, she will make a serious self-harm / suicide attempt. Ambulance says – we are not taking her in, you take her in the police car. Out comes your blog for first time to highlight the first breach (of the Code of Practice).

FIRST standoff – I explain our/their policy of ambulance to 136. I explain this is not a criminal justice incident it is a HEALTH incident: me police; you NHS. Ambulance say we won’t take her unless you sit in ambulance with us. Fair enough – I agree in order to get this progressed.

Get to A&E for the SECOND standoff of the morning – they did not even let us in, we had to stand in the foyer of A&E. I explained the Red Flag (drugs) and why she needed medical assessment. They did not want to do this – roughly translated as I am tired and I want to finish thank you. Still in the foyer of A&E and not even over the bloody threshold I stand clutching my iPhone in one hand (with your legislation and blog) and my police Blackberry in the other with our policy on it re 136. Because the doctor asked our girl 2 questions (being name, DOB) and she did not answer, she declares this patient will not cooperate and asks, “Please take her away.” No monitoring, no communication apart from 2 questions repeated by a stroppy nurse. I say – are you happy she has the capacity? They say yes. I say – how do you know as you have only asked her name and DOB? They all shout at me.

I say “OK, if you are refusing treatment, please sign here and I will remove her, then if she dies in custody or at the MH unit due to cocaine intoxication and a lack of capacity that you haven’t assessed, I can evidence that I have tried to get her medical care and this has been refused.”

THIRD Mexican standoff – I am liking Mexican Standoff for the blog title – please sign here. “No” … we are AND I QUOTE “Not allowed to sign anything relating to treatment unless your Chief Constable asks for it in writing”. I write – refused to sign. They are not happy I have written their names down and shout at me.

My theory is that if you are convinced that you are right, and can back it up – why are you scared of giving your name? Or signing?! They knew they were wrong but they wanted to go home after working all night. Me too.

So, I ask can you please phone the MH Unit which is 50 yards away and ask if we can take this girl there or will they refuse us? Oh no, we cannot phone. Good will tank now running on empty. I am now aching through tiredness and frustration to the point where I may need admittance to the MH unit myself and I’m more than one hour off late already and I’m not done.

I take her to MH Unit who agree to accept her under 136 even though she has had a drink because I have to argue a FOURTH Mexican standoff of ” Custody and cells is not the right place for this lady, she is not a criminal, she is not well and the custody sergeant will not detain here there given the lack of medical assessment so far knowing she feels unwell after taking cocaine”.

All my NHS colleagues went home on time, only me off late. I felt so let down by them that I could have screamed. I nearly lost my cool in A&E and I did share a piece of my mind because they were being SO obstructive. They failed to see that if our girl died from the effects of the drugs – they assume she was telling the truth about what she’d taken – then it would be ME and not them losing their job, unless I did this properly.

So, that is the sorry saga of the shit service provided to MH patients by the NHS this morning. Good night.”

I'm always quick to jump to the defence of my colleagues in green. I am also more than happy to point the finger when it needs to be pointed. I can't for the life of me think what they were playing at. A patient is a patient, regardless of whether or not they are a frequent caller. A patient who by their own admission is having a bad reaction to cocaine is a concern. Threats of self harm aside, this still needs to be medically investigated before anything else is done. The ONLY suitable place is A & E. There are high risks of heart attacks from heavy cocaine use and that is heightened with high blood pressure. I imagine an MH patient feeling panicked and suicidal will probably have a higher than normal blood pressure. On top of that there is a significant risk of seizures and respiratory or cardiac arrest. Luckily this patient had a police officer who put their job role before their bed, to make sure the right thing was done. Why health professionals think that a police cell is the most appropriate place for these patients is beyond me.

There are so many similarities to this job and Pass the Donkey it's frightening. I'd never heard of an A & E department refusing entry to patient brought by ambulance or police. Let alone one who is suffering symptoms of drug toxicity, suffering a crisis and under section. I'm lost for words. Clearly this is more than an isolated incident. It's happening at more than one hospital and needs to be repeatedly reported and addressed. People simply cannot play God over patient care because they want to go home. I am not surprised the police don't want to get involved in a sectioning if this is how they will be treated. The only positive that can be taken from this particular job is that the police officer involved conducted themselves in a way that ensured the patient was put first. Sadly the same cannot be said for the services they came into contact with. I only wish those ambulance and hospital staff could read this and see what impact their actions and inaction are and will have on the health service.

What chance does the NHS have of surviving if it is going to continue to allow such bad practise to occur. Mental health needs addressing, these patients need the same care as any other patient regardless of drink, drugs, mental state or frequency of calling. Maybe the arms folded and 'not my problem' attitude from the ambulance crew and the 'you're not coming in here' attitude from the hospital are adding to the patients problems and inability to fit into society. Not such an open minded, accepting society as we like to advertise is it?!


This officers account can also be viewed on Mental Health Cop's website in the post entitled Mexican Standoff.


  1. Wow, just wow. Maybe this blog post needs to go up in all hospital staff rooms and at all ambulance stations. How disappointing to know that those who are supposed to be on the same side can't support each other. Thanks goodness it is only a minority!

  2. I would doubt that it is that much of a minority, sadly, but I agree it should be made more widely available, Have posted a reply on MHC. Mostly I want to say thank you for doing the right thing under very difficult circumstances.
    I hope we all (public services) support you better in the future and please keep holding us all to account.

    (Very Loud and Long Round of Applause)

  3. too shocked to comment! But our local hospital has had well-publicised patient abuses in Aand E . They recently called police and 'secirity' to a confused patient in ITU who was thrown out and then died.

  4. I too had a very difficult and frustrating experience recently which involved me trying to have my husband sectioned as he made repeated suicide threats, the police were unwilling to help and repeatedly ignored both myself and our GP's telephone calls, this ultimately resulted in my husband making a suicide attempt and being taken to A&E via ambulance. The police did attend and pick him up earlier but decided he wasn't risky and dropped him home, bearing in mind he had admitted to them that he had a very low mood and had made threats to his life to our GP! On arrival at A&E I found the most senior person on shift and spent a full hour begging for him to be assessed, fortunately my argument was not ignored and he was assessed within 3 hours and home treatment were involved there after, the police somehow must have felt that they should check what the outcome was as 10 days later I received a telephone call from them asking if we were ok, I explained what had happened and that I felt quite dismayed that they had not reacted and taken him to a place of safety and the officer very kindly apologised for what had happened and that was the end of that.
    It was an awful situation for anyone to be in and I agree that the services need to find a better way to deal with mh patients as it is an all too common and distressing ordeal for most concerned!

  5. Organized content is the best way to display or post an article, thank you for making it easy to digest your

    Small bits of content which are explained in details, helps me understand the topic, thank you!

  6. There really are a lots of investor within the financial industry offering you with a
    wide selection of short-run and long-term loans quick loans saint-tropez, the riviera
    resort that counts brigitte bardot among its 6,000
    inhabitants, took out a 20-year, 6.


I love comments! All bloggers do! If you have something to say, agree or disagree I would love to hear it! I will reply to all! (or try my very best!) If however, you're a troll, save your breath!

Due to an increase in spam I moderate comments but ALL genuine comments will be posted. See above exclusions!