Monday 28 January 2013

Have Yourself a Mental Little Christmas

After a recent spike in mental health calls I thought it would be good to do a blog on the police and ambulance service working hand in hand to get the best outcome for a patient. Mental health doesn't have to mean someone who looks like Freud, making chicken noises while head-butting a tile wall. (I'll post that shortly.) It encompasses a wide range of people & conditions, some permanent, some temporary. Some require intervention, some don't. The police service and the ambulance service generally work together trying to try and get the best, less restrictive and most appropriate outcome for the patient. I asked my friend and fellow blogger Mental Health Cop (@MentalHealthCop) if he had any suitable blog fodder for me! He sent me a tale of a job he had done at Christmas and said I could make something up to suit my needs! Having read it though, I thought it would be much better coming from the horses mouth, so asked him to guest blog for me. A few hours later it arrived in my inbox accompanied by the following:
"You can blah on your intro about what an honour it now is to have an award winner from the best emergency service!"
He would want you to see his badges ;-)
I can't really argue. He has won awards. And deservedly too! It didn't surprise me he has tried to use the titles to try and add weight to his ever failing argument that the Police are better than the ambulance service. Bless him! 

So. without any further ado and with as much pomp and circumstance as I can muster; to the sound of fanfare and drum rolls and a dose of pained sarcasm,  I welcome the one,  and the only, Inspector Michael 'The Guvnor' Brown, author of the award winning blog Mental Health Cop, winner of the Mind 'Media Award 2012' (presented by Stephen Fry) and holder of This Week in Mentalists 'Best Mental Health Not Otherwise Specified Blog' award. I wish that one day I can be as cool as he is! It really is an honour to have such a well respected member of the second-best emergency service come to my blog! 

*cue the cheerleaders*

Enjoy ;-) x

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"Male, u/k age, lying in road, ? intoxicated"

My last guest post for Ella was "Policing Violent Healthcare" - and against that backdrop I'd like to tell you a Christmas Story ...

I got to work the Christmas Eve night shift last year, finishing at 7am on Christmas Day. It was the busiest shift I've had for a very long while. By about 3am, all I wanted was some hot coffee and hot food and an easy descent to 7am so I could get home to watch Master MentalHealthCop ripping into presents with yet more coffee for me. Instead, I got to work hand in glove with some awesome paramedics at a difficult job.

Just prior to 3am, two uniformed officers in a plain car were driving down a street when they came across a man lying in the gutter. Initially presuming they'd found a Christmas Eve drunk, they got stopped and got out to check him. He was pretty motionless lying over the kerb, legs in the road. Upon closer inspection, they saw a massive, gaping wound to his neck. The split flesh was inches apart, underlying muscle exposed and bleeding profusely. The guy was in and out of consciousness and it was obvious he was under the influence of something, but no smell of alcohol.

There were members of the public nearby. The officers didn't know whether they were witnesses, suspects or just people watching the police. They shouted up for more resources and an ambulance, but there was a tone of anxiety in their voice on the radio. I got down there ASAP, the next police car to arrive - it always pleases me when I get there before the sergeants! By this time, one officer was focusing on the victim, the other on the other people present and the scene management. I confirmed to control that we needed at least four more officers (and the sergeants!) to manage everything. There wasn't a clear picture about what had occurred, but he'd obviously been slashed or stabbed in the neck by someone.

West Midlands Ambulance Service - officially the best in the country (sorry Ella!)  - were there quickly after we'd called them. Two paramedics were out of the truck and assessing this guy very quickly. They didn't do much before saying, "We've got to get him to hospital." A pressure bandage was applied to his neck area and officers and the other paramedic tried to help him to his feet. I asked an officer to accompany the man to hospital with standard instructions: seize clothing, pre-transfusion blood sample request; early updates on condition to indicate life-threatening or not; any account that the victim provides to medical staff and if / when authorised ask him what happened.

They then disappeared into the truck and I focused on getting the scene sorted and getting the people present properly questioned. The sergeants took charge of it once I'd briefed them and we started to really notice how cold it was - once of my officers told me off for not wearing a jacket, but I pointed out, as a Geordie, that until the temperature hit minus four, I wasn't allowed. Suddenly, the back doors of the ambulance flew open and out leapt the patient in some considerable stated of excitement. He was, by now attached to an IV line with dressing half applied and this was trailing in the wind as he attempted to speed away and the paramedics were out of the back just after the officer who was half-holding on to his trailing arm.

I really worried about this guy. He was still bleeding profusely, he was quite obviously under the influence of something and his communication indicated that he was struggling to process information. Yet he was a victim of crime, not a suspect. Were we going to let him run off from medical treatment into the Christmas night, or not? No - it took me about two seconds to decide that if we have to sit on him and handcuff him to ensure the paramedics can work and take him by force to hospital for proper assessment, that's what we were going to do.

Where is the law that supports this? The Mental Capacity Act 2005. I have written about this on my blog and in this case it was clear cut, although I had to explain it to the officer who restrained him with me. "Yes, you can handcuff him - get the cuffs on!" I understand why officers who are not obsessed by the Criminal Justice / Mental Health interface are nervous. There's is no obvious legal authority to restrain victims and no training on the Mental Capacity Act for the police. Yet legally, it's clear and it applies to paramedics too, if they had to take action when the police are not there.
  • We can safely say this man lacked capacity: he appeared to be suffering a disturbance of the mind (temporary) because of suspected drugs.
  • He was struggling to communicate, understand, retain or employ information.
  • This is a quick capacity test made known to me by a paramedic: "ID a CURE" 
And so he was restrained all the way to hospital. In A&E, the urgency of the need to treat him was reflected in the fact that he was quickly sedated and taken for emergency surgery. Had he not been taken, he would have died in the opinion of the doctors.

This shows how the Mental Capacity Act can be used. When we debriefed it, the officers there 'knew' the (morally) right thing to do, was restrain him and force him to A&E. They worried about the legalities, as do some paramedics, but it was perfectly legal and totally proportionate to the (life-alterting / life-threatening) risks involved of not acting.

Incidentally, Mrs MentalHealthCop bought me a funky new coffee machine for Christmas - she's a good girl and knows what flicks my switch after a night shift! ;-)


  1. Good post gaffer. Well done to you and your teams. Do you think there is a pressing need for inputs from MH experts like yourself for response teams and paramedics? (And not just in West Mids)

  2. I think all police officers should get a one week MH course and it should be 3/5 law awareness and 2/5 MH awareness. It is at lseast 17% of all policing and it includes some of the most controversial stuff, so yes, I do!


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