Saturday 16 June 2012

Policing Violent Healthcare

It is with great pleasure that I can welcome back Inspector Michael Brown, highly revered police blogger of Mental Health Cop and award winning Tweeter @MentalHealthCop to guest blog on Trying My Patients. His work on mental health policing has won him acclaim across the country and is highly regarded as 'the go to guy' for all things mental health. Enjoy!

***WARNING: This post contains some graphic descriptions some may find distressing ***

"23 year old female, self harming"

The area where I worked as a sergeant had a hostel on it for women. The people who stayed there had various backgrounds, most of them troubled. It included domestic violence victims in need of temporary accommodation; those rehabilitating from substance use / abuse as well as being used as a 'step-down' facility for people with mental health problems. You can imagine the police service were there most days for a range of reasons.

I went there one New Year's Day with a probationary police constable I was working with - she'd won a "shift with the sarge" and it was my evening assessing how she was getting on now she was 'independent' of her tutor constable. It was a night shift, just after midnight that we were called to staff asking for help with a resident who was self-harming. The name of the woman was given to us over the air, because she was a "regular user of police services" owing to her propensity to get drunk and self-harm and she became foul and abusive when was she did. She was already 'banned' from one Accident & Emergency department in the city because of her relentless abuse of medical staff and she was flagged on the ambulance systems as someone who should always attract police support. 

We turned up quite quickly. I'd remarked to my inspector just before being despatched that the evening had been quite dull so far - as 01/01 night shifts often are - and flippantly stated we could do with a 'decent job' to keep us all awake. The inspector had stared at me the way I often now find myself staring at ignorant young sergeants!

We were ushered by a member of staff through the corridors of the hostel and into her room. We walked into what first looked like a blood bath: she'd cut her arms to shreds - she was incredibly drunk, bleeding heavily and muttering whilst banging her head off the wall. The cuts were not superficial. You could see the flesh cut centimetres down and the skin was widely split across the wound. Staff had attempted first-aid and to at least get dressings covering the injuries. She'd pushed them away and hit one of them, determined to hurt herself more. They sort of looked at us as if to say, "Over to you." We hadn't been told that ambulance were on their way, so just in case, I asked again.

She was scratching at her wounds, as if to pull them apart - I noticed a knife and a razor blade on the bed, red sheets soaked in blood. I did what all good sergeants do and patronisingly said, "Let's see how you handle this, then!" and let my probationary constable try talking to her. She did really well - the fact it had no effect whatsoever was nothing to do with any lack of empathy or effort to engage: it was almost certainly going to fail. I remember saying, "Let's just get the weapons away" and we each took hold of an arm whilst we passed the implements to staff.

We sat, holding her arms, getting covered in blood to the wrists waiting for ambulance. They turned up after about ten minutes. They tried what we'd already tried and failed and were also shouted at and abused for trying to get covering dressing on the wounds. It was explained again and again that she would need to go to hospital and it was me doing the telling after what seem like ages of trying to persude. This only seemed to make her more agitated. I found out later that the woman had a history of being sexually abused, had serious PTSD and personality disorder problems and she had real difficulty with men, especially male authority figures. Great! - nothing much I could immediately do about being a uniformed male police sergeant built for rugby with a special line in not messing about!

She was still bleeding, but the paramedics had said there wasn't a lot they could do. We tried to lift her to her feet, but she pulled away. Her arms were slippy because of the blood and she was frantic. She was going to have to be handcuffed otherwise we couldn't move her. Watching paramedics trying to just wrap something 'round her arms after we'd handcuffed her to the rear and she was starting to get violent wasn't happening ... she was just going to have to be shifted as is.

I remember looking at the paramedics and without speaking we were each thinking, "She's going in your vehicle, isn't she?!" Both of us looked horrified at the idea. "Come on, mate - she's drunk, injured, mentally ill and restrained by the police." No - they weren't having it. She was too violent to be conveyed in an ambulance and this wasn't for discussion apparently! Today, I'd have said, "One of you get in the police car then!" but as an ignorant young sergeant it didn't occur to me. So she went in a police vehicle without paramedics who resumed to something else - Costa Coffee, I'd imagine - wiping their hands of this healthcare situation and off we went to the nearest A&E.

Turns out, it's the one she was banned from. The receptionist looked at us and tried to start saying "No" but I said, "Come on, she's handcuffed and restrained by two police officers, she's bleeding and we can't move her miles to another A&E -somebody's got to see her, surely?!" It was like gatecrashing a party - you were in, but you knew you weren't really welcome. No coffee offered this time, as it often was in A&E. They cleared out a cubicle of its trolley and 'stuff' and placed a thin mattress on the floor. The woman had become more hysterical as she'd arrived in the bright lights of A&E and started head banging. Two other female officers from my shift had arrived and they took control of her whilst we got our breath back. She was finally able to be safely searched by two female officers, who'd had change to get "gloved up" and more razor blades were found.

After about an hour she was seen but she spent the whole of that hour trying to headbang and being restrained to stop her doing so. It was an hour of fighting police officers so who knows what kind of physiological strain she was subjecting herself to. I'd now be saying various other things to nursing staff, about NICE Guidelines and my fears and restraint related injury, but at the time I had no idea about these things. She spat towards the Doctor when he arrived and abused him severely so we were shortly afterwards ordered to leave the A&E department!! No healthcare at all. "Get her out!"

As the four of us, placed this poor soul back in a police vehicle - this time a caged police van for the safe transport of disturbed detainees, often mistaken for a 'dog van' - we had two choices. We try another A&E or go to police custody. I thought about asking the grumpy custody sergeant that night whether he'd like to detain a physical injured, mentally ill, untreated intoxicated detainee?

Another A&E it was: a four mile drive off our division to the area where I'd worked as PC. It felt like familiar territory as I'd almost lived in this A&E for four years. The woman was placed in a side room and actually became somewhat calmer, escorted by the two female officers who had come to help. My partner that evening and I started to think about getting ourselves cleaned up from blood and spit and I was asking this young officer whether she'd had her HepB jab from her GP - police officers don't get routine HepB, you have to ask your own doctor - she hadn't! "I strongly advise you ..." etc., etc.. Got to look after your cops.

The woman went on to get assessed under the Mental Health Act and was sectioned sometime late on the 02/01 after many hours being guarded by the cops and resented by the NHS.

But it was as we stood discussing HepB that the evening took a really interesting turn: A nurse tapped me on the shoulder and asked, "Officer, could you just speak to this woman, she's been shot!" I saw a young woman holding up her hand and you could clearly see a gun shot wound. it was Sophie Ellis, Charlene's sister. At that stage I had no idea who knew what about the incident so had to treat it as me being the first police officer to know ... well, I had asked for an interesting evening and my inspector said, "I told you to keep your mouth shut!"

To read the Mental Health Cop blog check out his website! Well worth a read! It's the one-stop-shop for all things mental health.


  1. I love the content of your blogs but I find the font incredibly difficult to read, it hurts my eyes. Any chance of changing to a more user-friendly font? It looks great in the headers but (in my opinion) very difficult to read in the content. Thank you :) x

    1. I'll try a few different ones and see. Thanks for reading

  2. That was an eye opener for me. I worked in a hosptl for 19 years mostly on switchboard at night and i have seen some sights but never quite that disturbing.

    1. Me to! I'm yet to see a situation like it. Would never refuse to convey a patient as long as the police are with me!

  3. Hey, sorry to be a pain, I love reading your blog too and I know you aren't aiming at those who may be mh service users but I know a few such people who do (including myself). I don't suppose you could put some kind of graphic/trigger warning on this one as it really is rather descriptive and could be difficult for some to read? Quite different from most of your mh/sh blogs.

    1. Hi there, sorry, I do aim it at everyone but will see if I can add something.

  4. Thanks. You're a star :)

  5. All I can think is how desperately sorry I feel for this woman... I'd put money on the fact that she isn't being properly supported/ treated for her problems. They may have token CPN to visit, various meds thrown in her direction, but no long-term psychotherapy to get to the root causes or admission to hospital when a crisis is looming. Out-of-hours crisis teams are often virtuatlly inaccessible or at best useless for people with long-term traumatic issues. (Time restraints = dismissive.)

    You mention she had PTSD and 'personality disorder problems'; there's actually quite an overlap between the two (I'm assuming from her behavoir it'd be Borderline PD) and a school of though that says they are essentially the same. Soldiers who have been to war get 'PTSD', women abused at home get 'BPD' (not trying to sound utlra-feminist, sorry!). The reason I think this is important is because it really affects how health professionals (on the whole) treat someone: PTSD = poor, truamatised person, wheras BPD = evil attention seeker deserving of no mercy.
    These people can be futher traumatised by distressing experiences with emergency services/mental health care; the person is in the uncomfortable gap between being considered 'mad' or 'ill' so as to be forced into 'treatment' or to get help, yet considered a waste of time by hospital staff and sent on their way without the long-term, consistent, compassionate care they need. I have often wanted to scream at them, "You can't have it both ways!"

    Sounds like you handled it well though, this comment wasn't a criticism, just my reaction :)


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