Tuesday, 26 February 2013

Does The End Justify The Means?

"36 year old make threatening to jump of balcony. HE IS VIOLENT"

Oh goody goody gum drops! Some mental health to end the shift! It'd been at least two hours since we had dealt with some! This time however, there was a little more gravity to the situation (excuse the pun). These 'jumping' jobs could literally be anything. I could be a Holby City'esque dramatic scene where we spend ages waiting while the patient is 'talked down'. It could be a cry for help where the patient has no intention for jumping and moves away from the balcony when asked. Or, it could be a major trauma waiting to happen and we don't know whether to leave our bags downstairs or go upstairs. The latter would be the least appealing and by far the most stressful but as always, it's a mystery until we arrive. These are things we think about on route to jobs like this. You need a plan for each outcome so you're not caught off guard!

We pulled up behind the police cars that were already there and looked up! Sure enough, about 4 stories up was a man leaning up against the railings of a balcony. About 20ft away were the police. Do we go up, do we stay down?! We went up and joined the police. The patient was shouting that he was going to jump and said he was fed with everything. The conversations between him and police went back and forth for a little while. Apparently this wasn't the block of flats he lived in so if he could be coaxed away from the railing s136 could be used to get him to a place of safety. Suddenly, without warning he ran! He ran down a stairwell, across a covered walkway and into the adjacent  block of flats! We all followed. By the time we caught up with the police, they were inside a flat. 

Inside was our patient sitting on his bed. His mood had changed from utter despair to one of anger and he would not be reasoned with. The police were explaining that he had to come to hospital to he indignantly replied:

"No I bloody don't!"

The 'yes you do', 'no I don't' playground argument went on for some time but at no point did he budge from his stance that he was going nowhere.

"You have no right to take me anywhere without a warrant. I'm in my own home, you need a court order to get me out of here."

He knew his stuff, the only power to remove him here and now was ours if we could prove that he lacked capacity under the Mental Capacity Act. His life wasn't in imminent danger now he was in his flat despite what had occurred previously. That was at least by the letter of the law. I went through the motions knowing full well that he would pass! And he did! He was able to rationalise his decision, he was able to retain information and he was able to explain in clear language that he didn't want to go to hospital and why! It is a frustrating part of mental health law. The only power available to the police was a s135 magistrates order that would need to be applied for by an AMHP to force someone to have a mental health assessment. We were stuck! Or were we......

We had a discussion with the police outside regarding what to do. No amount of pleading would make him come to hospital but the copper who seemed to be running the show said:

"We'll have to 136 him."

Alarm bells started ringing in my head! I'm no expert like @MentalHealthCop is but I know this can't be right!

"But he's in his own home so s136 is useless here."

"No, he was in a public place when we arrived so we can still remove him."

He said it with authority but I wasn't remotely convinced. Time to bring in reinforcements! Ah, the joys of social media and the professional connects Twitter gives us! Time to ask the expert! So, I texted @MentalHealthCop for some tactical advice!


Just what I thought! Needless to say I got bantered on Twitter for interrupting the rugby but I'll take that! It was what I thought but needed to be sure before I let me thought be heard. Before the times of Twitter there would be no immediate contact with people from other professions and I think it's great that it can be used in such a positive way. 

So, back into the flat I went. 

"Section 136 can't be used, he's exercised his liberty to remove that option. We'll need another plan. I know he's vulnerable and we've all heard him threatening suicide but I don't see there is much we can do now he's here."

"We are sectioning him, we are just waiting for the van to arrive."

Clearly I wasn't going to be listened to so we stood outside with our tails between our legs and watched the illegal kidnapping unfold. It wasn't a pleasant thing to watch, distressing to say the least. Seeing someone restrained in their own home, removed against their will and screaming for all and sundry to see was not in the patients best interest by any stretch of the imagination. He was already in a very fragile state, how will this impact on his future treatment? I don't know how the police involved documented and justified their actions but they certainly won't have said they sectioned him from inside his own dwelling. We watched as he was loaded into the van and my crew mate travelled with them while I followed. 

I know that the patient needed hospital, and as it was he was taken (albeit under an illegal section) to the mental health unit but it is NOT a case of the end justifies the means. Or is it? The mental healths laws and police powers that are there, are there for a reason. Breaking these rules only goes to put further barriers between patients the services available to them. This patient will never have trust in the police. I trust the police and I know this was one decision made my one policeman but a patient wouldn't see it like that. He knew his rights and he knows his rights have been illegally removed. Unfortunately, it will be his word against the police and who would believe a depressed, schizophrenic with a long history of crime and drug use. Rules are rules and laws are laws. He has been punished previously for breaking the law. What example does it set when the people who uphold the law are technically breaking it? The flip side is that in this instance the police were doing what they felt was right and were trying to act in the patients best interest. 

This job will also damage the image of the ambulance service in this patients eyes. We were party to it, guilty by association if you will. Sure, it's only one patient but that's not the point. Mental health is a challenging thing for all services to deal with. Like I have said many times before, working together and having an open dialogue with all services is essential but each service has its own responsibility to adhere to the rules, apply them within the framework that already exists and always act in the patient's best interest. The latter is where the grey area engulfs us all. Who really knows what is in a patients best interest? It will always be personal opinion and that will never change. You tell me, does the end justify the means?





41 comments:

  1. I was once detained under s136 inside my own home, forcefully removed and then taken to A&E. Once at A&E the medical staff questioned the s136, and said it was illegal. The Police response was that they could use s136now as I was no longer in my own home. This is what they chose to do.

    All it did was increase my distrust of the police and left me feeling like I didn't want to co-operate. I understand the problems that MH issues can throw up, yet I believe there are better ways of dealing with them. I am glad that there are people fighting for better response from services for MH patients, including yourself and @mentalhealthcop

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    1. Thank you! Sorry you had a bad experience!

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  2. Unfortunately it is still happening all over the place. The police are worried to leave them there even though they know the person has capacity and knows the law. Does make me wonder what this guy's agenda was if he was screaming and shouting threatening to jump one minute then changed his mind. Did he make a cry for help and realise he went a step to far and was in danger of being sectioned?

    I think we need clearer guidelines and more "what if's" to be answered. Being told "sorry there is nothing else you can do" makes professionals on all sides feel a bit useless. What if the person then does take their own life? When the post SUI investigation happens everyone waits for the finger of blame to be pointed at them.

    Fact is, you can't save everyone, if someone really wants to die they will do it, majority do it quietly, no screaming and shouting from balconies. They lie down quietly with their tablets, they go to the tall building and just jump straight off, they stand sedately on the platform before stepping in front of the intercity train.

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    1. There is the problem with the finger of blame. Or the fear if the finger of blame!

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  3. In scotland we arrest for Breach of the Peace. Great bit of legislation that is open to wide interpretation. Great way to get round sectioning problems & get people to a place of safety

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  4. Is/was it mental health or bi-polar ?

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    1. Bi polar is a one of many mental health conditions.

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  5. Horrendous abuse of power there by the officers in question. Did you write it up as above on your PRF?

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  6. There is no way of knowing if the end justifies the means in a case like this. It could well be that the next time this person feels suicidal they act in a private place hoping the police don't get called and succeed because of what happened this time.
    Not saying it's an easy decision but suffering from a mental disorder does not mean your human rights and right to autonomy can be discounted regardless of intention, the police should of called for a MHA assessment.

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    1. We'd all still be there now if the police had called for an MHA assessment ... I have done so many times in such situations and not ONCE in fifteen years has it ever led to one occurring.

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    2. Yep.......still sitting here waiting!

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  7. I suppose imagining a world where there was AMHP and magistrate cover 24/7 is total fantasy land - with enough staff cover so that a s135 could have been safely and swiftly achieved in the above situation and all those up and down the country just like it.

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  8. Fortunateness most mental health are frequent flyers & you are right it will have ruined the patient's trust in police/ambo. This means the problem will be even bigger next time he has a crisis.

    Mind you I once had a 'I know my rights' sort who had self harmed. After I exhausted all my powers of persuession to get him to accompany me to hospital I started to assess his capacity. He started giving obstrutive answers & pretending to not understand. I knew he had capacity really & was just trying to wind me up but hey-ho he failed capacity & I had the police drag him off to hospital!

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  9. Ahhh see I don't know the rules. Makes sense!

    My little suicidal bit was at home. I begged to be sectioned. I was crazy but still sane enough to explain my feelings.

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  10. If I were the guy detained by police, I'd be flipping through the Argos catalogue right around now, checking out which new flatscreen TV I was going to buy. Then getting on down to a solicitors to sue the police for unlawful detention. The going rate is around £600-1,000 I believe - plenty for a really nice new flatscreen TV.

    Whatever arguments people want to raise, the law is clear: police had no authority to act as they did and therefore they undertook an illegal arrest. We don't live in a police state. We don't live in a country where the police can make the law up as they go along and do what they want. Police officers owe a first duty to the law and can only exercise the powers which we, society give to them.

    Section 136 (or equivalent) has been around for hundreds of years. It recognises that, sometimes, when someone is found in a mental health crisis in a public place, they may need to be taken somewhere safer, whether they like it or not. So police officers who find someone in a public place who they believe is having a mental health crisis can arrest them under s136 in order to take them to a place of safety like a hospital or s136 assessment suite in a healthcare facility or (as a last resort) a police station. Ironically, in the context of this story, your home can be the place of safety to which you can be taken.

    The key words from s136 in relation to the story above are "find" and "public place". Taking someone from their own sitting room or bedroom is not - not - finding them in a public place. Trip to Argos for a flatscreen TV anyone?

    For the record, tricking someone outside their home so they’re then in a public place (as happened to me) does not - not - count as finding them in a public place. Trip to Argos for a flatscreen TV anyone?

    The mistake the police made in this case was falling into the trap of saying "something must be done", and believing that they, the police, were the people to do it. Police were first on scene so, surely, they are the ones to take charge? Wrong.

    When someone is feeling suicidal, that is a healthcare situation. In a healthcare situation, the role of police is to support the healthcare workers - the doctors, the nurses, the big yellow taxi van drivers (ambulance staff). Here, the ambulance staff had assessed that this man’s life wasn’t in imminent danger and that he had capacity under the Mental Capacity Act. Time to fill in the paperwork and jog on. Which is what the ambulance crew here were planning on doing.

    However, for whatever reason, the police decided to step in, take charge and turn the man's sitting room into a crime scene - the crime in question being an illegal arrest. Trip to Argos for a flatscreen TV anyone?

    What should the police have done here? Let the healthcare staff - the ambulance workers - take the lead and support them if – if - requested. Otherwise it's a trip to Argos for a new flatscreen TV.

    Will this guy be inclined to ask for help when experiencing mental distress in future? Will he welcome the ambulance service? Will he trust the police? I'd say he'd be less inclined to do so. I know I am, after my unlawful arrest - when the ambulance staff were complicit whilst the police took the lead. Perhaps that flatscreen TV from Argos will help me get over the experience or make the police think twice about acting unlawfully in future.

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  11. I once went to an incident, many moons ago, which I (briefly) covered on Twitter. Someone anonymously called police saying that they had just been to their friend's house and noticed evidence of said friend self-harming (I believe it was cuts to his arm but I'm not sure after all this time). Myself and a colleague were sent to do a welfare check on the address of this "frequent flyer" (of both police and ambo).

    On knocking there was no answer, although we could see lights were on and a key was in the lock from the inside, so someone was clearly inside. After much knocking, shouting and deliberating we decided to force our way in. My colleague, excitable as he was, quite enjoyed knocking doors in, and without any windows available that's what we did.

    Immediately inside was our man, fast asleep on the couch. He was easily woken with a light shake of the shoulder and it took quite a while to convince him that he'd managed to sleep through all the noise of us banging on his door with batons for 20 minutes and then finally destroying his door (the frame also came off along with part of the brick wall).

    Inside we found numerous bits of medication which we noted and asked him about. He explained that he'd been out for a pint (he wasn't drunk) and had just gone to bed, and didn't know what we were on about when we asked him about self-harming. There was no overdose, no cutting, nothing. He'd just been the pub and gone to sleep. Aside from evidently being completely deaf in his sleep there was nothing to be concerned about.

    Then, inexplicably, while I was in this bloke's kitchen putting his medication back where I found it, I hear in my earpiece my colleague asking our control room if they wanted him sectioning. "You can't do that if he's inside his home," came the reply. He persisted, though: "Do you want me to take him outside?"

    I interrupted, repeating the update I'd not long given, that he was quite safe and capable and just wanted to go back to bed.

    So with that we apologised about the door and left him waiting for the housing authority to come and secure it.

    I've no doubt that if I wasn't there something unlawful would have happened that night.

    Thankfully my colleague is no longer a police officer. He was mostly well-intentioned but despite his training seemed to have no idea what he was doing. Mental health training for police has also been improved since then and I'd expect at least a basic familiarity with the legislation as a minimum.

    I think this "something must be done" attitude stems from an acute awareness of the blame culture we seem to have these days and a perceived lack of support from supervision/management. If police get the blame when a husband murders his wife after we attended a domestic at their home 5 years ago, what's going to happen if you leave someone you're concerned about in their home and they commit suicide a few hours later?

    That said, the law is there for a reason and we need to stick to it even when we think doing so is inconvenient or a bad idea.

    Here's another one for you: Someone (with capacity) has been involved in an RTC. Unless they go to hospital their injuries will be fatal, but they're adamant that they're not going. If you force them to go to hospital you'll be acting unlawfully, but if you don't you're certain they'll die. Do you still do it by the book?

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    1. We all had a bit of a tweet chat about this a couple of days ago, so it's interesting to see the longer version.

      My view, for what it's worth, is that the police uniform is not a licence - nor a commandment - to wade in and try to fix everything. The question posed in the final paragraph above is about a healthcare situation. It's not up to police to save someone's life after a traffic accident.

      And the Mental Capacity Act was drafted to allow people to make stupid - even life-limiting - decisions if they choose to. So fill in the paperwork and jog on.

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    2. You are correct, of course. My last paragraph was a hypothetical example I read once of where the law might directly conflict with what a police officer (or a paramedic, in that example, as I remember it) thinks is the morally right thing to do. Of course detaining someone unlawfully is not really a grey area - if the law doesn't allow you to do it then you don't do it.

      The colleague I mentioned was a nice bloke in regular conversation, but it was a relief to see him resign in a huff as he was just a disaster waiting to happen.

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  12. Having been in this situation many times as the officer, if the rules weren't broken, and I've seen it many times, and a court order not obtained, he would've been left. He probably wouldn't have done anything to himself and this is the case in 99% of calls from the person threatening his own health, (my own statics on my own calls) but if he were the 1% that did, we would all be in the brown stuff. Give me a bollocking if it means the safety of the person is secured and we all keep our jobs.

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    1. I know, it's very frustrating.

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    2. So when you say "if the rules weren't broken" you really mean "if the police didn't make an unlawful arrest", right? And when you say "give me a bollocking" you really mean "sue my police force for unlawful arrest", right?

      We don't live in a police state. It is not acceptable for serving officers of the law to simply shrug and say they're going to break the law because there's a 1% chance they might be blamed. It's shocking to learn that a police officer is more worried about getting blamed for not acting than of breaking the law.

      Just because police are on scene does not mean that "something must be done" or that something must be done by the police in a healthcare situation. I hope you'll think twice about wading in with your size 10 boots into healthcare situations and carrying out unlawful arrests.

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  13. I agree with my colleague above. You must remember that us cops that go to 999 jobs are constantly second guessed by higher ranks in warm dry control rooms who will demand that we get them to an AMHP for an assessment because if we walk away and then they kill themselves we get blamed for not doing enough. As a fed rep I am representing 2 colleagues for just that in an incident before Xmas.
    Before people shout about human rights and plasma screens don't forget all the cops are trying to do is get them to a professional medical person. Not like we're fitting them up for murder and sending them to prison.

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    1. I understand that but the sectioning laws are very clear. Sometimes police and ambulance have to realise that not everyone can be helped.

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    2. "Before people shout about human rights and plasma screens ..."? As a fed rep, are you seriously condoning police making unlawful arrests to cover their own backsides?

      If you are, you are trivialising officers breaking the law and becoming criminals themselves. You are trivialising the unlawful arrest of someone who has committed no crime. You are trivialising subjecting someone who is in a vulnerable state to a highly stressful experience - instead of receiving health treatment, he got the opposite of what he needed to help with his mental distress.

      Maybe because you work with criminals and arrests all day you don't recognise the impact contact with police can have. Contact with police is not normal or usual for most of us. Restraint by police is not normal or usual for most of us. Arrest by police is nor normal or usual for most of us. Unlawful actions by the police are not normal or usual for most of us. Even at our best, most of us would find such experiences stressful. For someone experiencing mental distress, this is magnified. It was the wrong thing to do morally and, as Ella has pointed out, it was the wrong thing to do legally too.

      As a fed rep, it's understandable you're going to be defensive about the actions of officers you're representing. That's your job. But don't for one minute think that justifies police acting like criminals and traumatising a vulnerable person in his own home, denying him access to his own healthcare support.

      It's not a trivial matter, so please don't trivialise it.

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    3. What should we have done in todays case then? Officers didn't section and she walked out and killed someone. Now cops are slated for not detaining. Also she was diagnosed with a personality disorder so where I work she would not have been admitted anyway, 136 or not.
      I'm not sticking up for cops just because I'm a fed rep I have to do this stuff everyday myself. We are mainly doing the job of mental health practitioners in a very imperfect system and always trying our best. I get annoyed when people think we just stomp in with our jackboots and bang people up for jollies. We are damned whatever happens. If the NHS and community health teams did their bit they wouldn't have to rely on us to fill the gaps and we might actually get to fight some crime.

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  14. Ambulance Paramedic2 March 2013 at 07:36

    Well done the police, the person obviously lacks capacity as on a daily basis in our 'normal' rationale, we all threaten to jump from a tower block and then run home pretending it has never happened don't we?? Clearly this person is in need of a Mental Health Assessment and I would feel I had failed the patient if I had deemed them to have capacity and let them stay at home. The justification is that you are acting in the patients best interests as they appear not to be of sound mind.....

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    1. He did not lack capacity. Capacity looks at the ability to make a clear, informed decision with all the facts available and ability to a) understand the information given b) retain it and c) explain in clear words why they don't agree with your proposed treatment. Suicidal does not mean lack of capacity. Capacity is nothing to do with rationale. He had his reasons and with a full mental capacity was legally free to do as he chose within his own house. There were no legal powers to remove. If you are a paramedic you should know the rules regarding capacity. Kidnapping in someones best interest would not protect you in an HCPC hearing if the patient was to complain. Capacity insists that less restrictive options are sought.

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    2. Well said. Ambulance paramedic needs to go back to school and learn the basics of the Mental Capacity Act.

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  15. I have to say, if you don't want us coming round and scooping you up for a mental health assessment, don't go standing on bridges, high buildings or ringing up threatening to top yourselves. As a cop I would love that, I might even get time to deal with crime once in a while instead of spending endless shifts dealing with mental health jobs.

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    1. This comment shows an utter lack of understanding of what it means to experience mental distress. This isn't a game. These are things people do when they are distressed.

      And, if you don't think that what you call "mental health jobs" are core police business, you are wrong and should perhaps evaluate just what you joined the police service for.

      Apart from anything else, the police are a 24/7 response service, so they are going to be on the front line of responding to out of hours crisis demand. Where people's safety is at risk or a crime has been committed, this is core police business. As Inspector Michael Brown (Twitter: @MentalHealthCop) says:

      "Policing exists to handle society’s “failure demand” and therefore it would be discriminatory to assume that we should exclude patients, their families and mental health issues from that."

      And, if you still don't think "mental health jobs" are core police business, I suggest you educate yourself by reading this post on the topic:

      http://mentalhealthcop.wordpress.com/2012/10/16/999-whats-your-emergency/






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    2. Bless your sectioned socks. Police are only ones with 20% cuts, we are dealing with everything all the time. As a response cop I am literally a jack of all trades, master of none, sorry we aren't all mental health gurus but if you expect us to turn up at everything and be the expert then you need a check up from the neck up yourself.

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    3. So that's your excuse for breaking the law is it?

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  16. Entirely agree with comments from Sectioned_ - this was an abuse of power and illegal, and what is left if the police don't follow the law? They are not accountable. Which is really bloody frightening. The police can do what they like as long as they can justify it, by lying if necessary. Sadly no, no-one believes a 'mental patient' (from bitter experience of complaining about the 'care', or lack thereof, from the mental health system. Not a bad experience, mostly bad experiences in a rotten system). Seeing comments on here from police who would rather cover themselves than follow the law...who cares what the effect on the person being illegably forcibly detained? Which is really traumatic.
    People experiencing mental distress are still people. A few commenters on here seem to be forgetting that. Anonymous #1 (26 feb 11.08) and #2 (2 March 13.41) need to educate themselves about suicide, it is just not as simple as you either 'really' want to die or you don't. No-one *wants* to die - being a risk to yourself is *terrifying*, the tiny sane part of your brain wants to survive but the sick part tells you you don't deserve help.
    Ian Hutchings - how do you know this person was 'winding you up' and genuinely didn'ty know the answers?
    No-one, honestly, decides to make up being suicidal and phone 999, or do something in public that prompts others to call 999 for a laugh. They do this out of desperation and distress. It's not fun. By the time someone is in such a state, no they are not always nice or easy to deal with, but unless you've been there, don't judge. Been there, done that. Needed help, asked for it nicely, got turned away, tried again and again...left to deal with it...should never have got to the point where police and A&E got involved but it did. No wonder people feel ambivalent about 'help' if as I said earlier they feel that way anyway, and if that 'help' consists of forcing them to go somewhere they don't want to go, that is very intimidating and traumatic. The alternative to sectioning isn't leaving a person who may be vulnerable and a risk to themselves on their own - instead of the debate which as ella rightly says is playground level, 'You have to go' 'No, I don't want to' why not *ask why* he didn't wish to go to hospital and talk to him? Is he under the care of mental health services? If so, what has gone wrong (pretty clear something has, for him to be on a balcony saying he wants to jump). If someone can't be persuaded to go to hospital, and the police and paramedics don't feel they're an *immediate* risk but still feel concerned, they need to signpost to appropriate services (including Samaritans, local charities etc), refer to mental health services if necessary and make a plan with the person.
    I do sympathise with police and ambulance staff lacking training in mental health...which is disgraceful really that more training isn't given. 1 in 4 people will experience mental health issues, so it's an unavoidable part of their work - as MentalHealthCop points out. However a lot of cases crisis could have been avoided if mental health services had done their job properly, if someone is under their 'care' there is no excuse for them ending up needing to call or come to the attention of emergency services.

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    1. Well put.

      Police wading into a healthcare situation and illegally arresting someone is not helpful. It is not "doing the wrong thing for the right reasons". It is just making things worse.

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  17. I know this is a blog and no Patient Identifable information is disclosed but is this right I ask myself

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  18. If the officers hadn't taken any action, you'd have needed crowd barriers to control the slimeball solicitors if hedid hurt himself. Headlines in Daily Fail, "my son / boyfriend / brother would be alive now if the police had taken him to hospital "
    A no win situation

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