acarerseyes

Through the eyes of a carer for someone with a mental illness

‘If you leave, we will call the Police’

32 Comments

One of my biggest problems regarding Chris’ care is the Acute Trust practically ignoring his mental health and the Mental Health trust refusing to see to him until he’s declared medically fit, the latter I can understand. So what does this mean for Chris? Well after attending A&E for an overdose, for example, he has to been looked after medically first and foremost, and in the case of an overdose it normally requires so many hours under observation at the very least. Now you try telling Chris, who has attempted to take his own life, would rather people just left him alone and doesn’t really want the help to stay put and allow them to do their jobs, it’s not easy. Most of the time there comes a point when agitation and thoughts are too much and Chris starts to get his things and leave. More often than not when I myself approach staff and explain that Chris is leaving and I’m concerned for his safety and wellbeing the reply is ‘if he leaves, we will phone the police’. Now in my eyes, this isn’t good enough, for a start what is to stop him walking out the hospital to the main road and under a car? He could have done that before they have so much as dialled the number for the Police! Also every time A&E/the ward/hospital have carried out their action and called the cops, Chris is always home, there for, what exactly are the Police meant to do? They can only ask him to go back.

There has been two exceptions to this, once when he was in Coronary Care and he was going to leave I spoke to the Dr looking after him and he said if he tries to leave we will section him and security would be asked to sit with him and follow him everywhere. The other was a lovely doctor in A&E who had security around to make sure he didn’t leave. Apart from those two occasions it’s always them mentioning and then involving the Police. Now if they deem him unwell enough to need to be dragged back by Police officers it’s their job and a duty of care to Chris to stop him leaving in the first place with the power they have to do that!

As part of yesterday’s meeting I bought this up with the Mental Health trust and asked them what the Acute Trusts policy is around Mental health, and was rather worried they didn’t know themselves and wouldn’t be surprised if the Acute Trust didn’t even have one. However, I have now asked to see what the Acute trusts policy is around Mental health to see what, if anything is meant to happen, and then I am hoping to make my feelings known to the Acute trust that I think what happens at the moment is unacceptable and dangerous. I had a consultant Psychiatrist agreeing that it would be completely inappropriate to let someone who had overdosed leave the hospital alone on the basis ‘we will call the police to bring them back’ he said they shouldn’t be allowed to leave until their mental health had been assessed by the appropriate person.

This is something I am currently looking into and hope to have some answers soon. I will keep you updated on how this goes, what I manage to find out and if they are willing to listen and perhaps encourage a change on how it currently appears to stand.

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Author: acarerseyes

I am a mum to four gorgeous girls, and a carer to my former partner of eight years, Chris who has a mental illness, BPD. I blog my experiences.. life is tough! We live in Greater Manchester, UK.

32 thoughts on “‘If you leave, we will call the Police’

  1. If a pt decides to leave under medical care and they are medically fit enough, the nhs cannt sit on them and make him stay. That goes against human rights and the mental capacity act.

    I, as a nurse,would do everything to persuade the person to stay but ultimately would nt put myself at risk and cannot physically get the patient to stay.

    How would you expect the staff to stop him exactly? The police have way more power than nhs staff. We cannot hold a person hostage who wants to go home.

    • you can’t always hold a person ‘hostage’ as you phrase it, but you can sometimes detain them and it’s vital A&E staff understand the differences, ahead of allegations of neglect or violations of Article 2 HRA.

  2. Police do not have the power to detain people who are not a danger to the public or family members. Their hands are tied as much as hospital staff and if security were to ‘sit on him’ they could be done for assault!

    • Yes we do have such powers; and no our hands are not tied. If security sit on people it might or might not be an assault.

      All of this is precisely why I say “NHS staff need more legal training” everytime I hear people saying that the police need more mental health training. We do; but it’s often not as important than improved legal knowledge by NHS staff.

  3. Chris did not of take enough to render him unconscious therefore if he was fit enough to get his things and leave he didn’t take an awful lot of drugs so what did you want the hospital staff to do? You have to see it from their side too. There is only so much they can do.

  4. I’m so sorry. This inadequate understanding of the situation must be extremely frightening for you. Good luck with your campaign.

  5. What a relief to have sound legal sense from MHC re the physical/mental health situation.
    Fact is IMO we are mind,body and soul….it makes us whole. Physical healthcare is clearly a huge issue on MH wards and I expect mental healthcare is just as dire on acute wards…..its parity that is needed!
    Well done Sarah and Chris for challenging this…..you are both stars!

  6. This is incredibly frustrating for you and others in a similar situation. The challenge for professionals is how then can act lawfully. There must be lawful grounds to restrain and/or detain someone. On what lawful grounds are the security guards stopping Chris from leaving? Is the MHA the answer? Or lawful restraint under ss.5&6 of the MCA using best interest principles? These are questions the Trust must answer, but do they know how to?
    We all know what seems to be the right thing to do and what makes sense, but this is not good enough in certain situation, acting lawfully is what stands up in Court, not just good faith and doing the right thing.

    • I fully understand the need to adhere to law and believe this is right but those that make laws sadly also break them by not adhering to National guidance and strategy Trust dont always implement policy policy and clearly identified care pathways.
      Too many “get outta jail free” cards used and when Duty of care is ignored then “dive for cover” seems to be the mindset!
      I also agree “to err is human but to dive for cover is unforgivable”
      How can lessons ever be learnt if NHS call system failures “service delivery issues”?
      Act lawfully…YES! But its not just about court,….how much money does it cost to prove system failure? OK for NHS as they just access public money! Humane professional competent care is ethically and morally in all aspects!

  7. You say: “As part of yesterday’s meeting I bought this up with the Mental Health trust and asked them what the Acute Trusts policy is around Mental health, and was rather worried they didn’t know themselves and wouldn’t be surprised if the Acute Trust didn’t even have one.”
    Seems there was s a recent meeting at CQC to discuss ‘admission procedure” and the CQC MH commissioner needed to be informed of legal content of MHA……OUTRAGEOUS!!!

  8. I think your blog is telling of the discrimination that exists in acute trusts towards those with mental health needs but also within mental health services towards those who they know need a degree of intervention.

    The idea of having nothing to do with those with known or potential mental health needs whilst medically unfit is common everywhere I reckon. There’d be shouts of discrimination against the acute trusts if medical specialists demanded physically unwell mental health patient on mh wards had to be mentally fit before they attend to assess. The MHA doesn’t state the need for medical fitness before a statutory assessment takes place so why the need for it for an assessment of anyone’s mental health?!

    Who’s discriminating against whom? Reckon mental health teams/trust a guilty of this all over the country.

    If you leave, we will call the police. Well if they were that concerned why didn’t they do something?! Acute trust staff repeatedly fail in their duty of care with those with mental health problems on their wards and refuse to accept they have a duty to safeguard those with mental health problems and will happily see them walk out of a ward and then call a&e liaison or crisis team to tell them! Very very few general nurses in the acute hospital I work within accept they can use the Mental Capacity Act or even proportionate common law to prevent some one at risk causing potential harm to themselves or others. I think this highlights the value the employers put on safeguarding as a whole and their ‘not on our wards’ attitude towards those with mental health needs.

    • Not saying it’s right but I think mental health services refuse to assess a patient’s mental health if they are not first deemed medically fit as they want all medical causes ruled out first. For example is a person acting in a confused or aggitated manner due to dementia, brain injury, intoxication, etc rather than because they are experiencing auditory hallucinations. A patient with one of the above medical conditions may admit to hearing voices when in fact they aren’t. Mental health services want a clear CT scan or an alcometer reading level below the drink drive limit so when they assess them they know what that person is saying is as a result of their mental health rather than a medical condition. Thats my understanding of the situation anyway.

      • What on EARTH has an alcometer reading got to do with someone’s mental health and ability to be interviewed under the MHA – notwithstanding the valid points you make about injury or organic condtions. Some people with mental health problems drink ten or more pints of alcohol a day and plenty of people are perfectly lucid and able to take decisions, articulate and resonate themselves clearly despite being over the drink drive limit. Other people are quite serious affected by alcohol without getting over the drink drive limit, especially if drugs, fatigue, etc., creep into the mix.

        And if we’re using the breathalysers, why the drink drive limit … and which one?! The one we prosecute at, or the actual limit?! Just saying.

  9. I’m going to do a blog in response to this because there is enough to say no it. Suffice for now, that Matt is right: professionals have to have grounds to act.

    That said, where you should act there is a duty to do so, or try or do so or do the next best thing, which might be ring police.

    My blog will give examples of where complaints of neglect were made following a failure to do anything to stop a suicidal patient walking out of healthcare environments. This included not calling the police. By time police were in the AandE taking one of those reports, the patient was dead and the Coroner was appalled. Rule 43 letters all round.

    Often, AandE will be powerless and but occasionally they will be obligated. Not even vaguely sure they (or MH trusts or the police) know how to tell the difference.

    Will try and blog response tonight.

    • Thank you very much. Once its been done, I will link it here as well for others who may want to read it.

    • Thank you….its now looking fairly obvious where system failure often starts. MJany MH Trusts seem to save £ by not employing adequate staff, yet rely on police to do their job!
      There shuld be enforceable legislation and clear national guidance on what is expected of Trusts and Boards. If Inquest hearings are the “get outta jail free cards” then there needs to be intervention here too. Should Coroners be part of (and accountable to) CPS or remain under LA?
      Thank you for your time.

  10. The issues you raise are ones that occur daily in Acute Hospitals up and down the country. Where they are in place ( and many Trusts don’t employ them) Healthcare Security Officers are frequently called to persuade, encourage and cajole individuals to remain who wish to leave against medical advice or wishes. Often this is because test results post overdose aren’t back or MH assessments have yet to be completed and Security Officers should be clear on what grounds clinical staff want the individual to remain and what legal authority may exist to forcibly retain the person within the hospital if persuasion is not enough. If no legal power of detention exists and persuasion fails then the only option that remains will be to allow the person to leave and report that fact to the clinician in charge of the persons care. If they are sufficiently concerned about the persons mental or physical health in practical terms the only option they may have left is to request police assistance, unsatisfactory though this is for all the reasons Mentalhealthcop explains in his blog. Staff shouldn’t be using calling the police as a threat, they should invest time and their interpersonal skills to persuade the patient but if you are determined to leave somewhere you don’t want to be how successful would a complete stranger be in persuading you to stay? There are big issues around liaision between acute and MH services will GP commissioning change that? Personally I doubt it! I hope you get answers from the Trusts involved and all the best to you and Chris

    • Yes you are right, I would feel a whole lot better them trying to talk to Chris at least to see what they could say that might help him, but they dont. This is why I am so interested to find out what kind of policy exists around it. I really wish the two would work closely together, it would be of benefit to both of them.

  11. Hi Sarah,
    I do sympathise with your & Chris. But I agree with the other NHS workers, they cannot keep Chris against his will. They don’t have the resources to provide ‘security’ for every patient! Also, Chris would have risk assessments in his medical notes. His attempts at ‘suicide’ are considered ‘self harm’. Realistically, he will never ‘end up under a car’, as it seems clear his intention is not to really kill himself, but to self harm. This seems harsh, but if you think about it, has he ever taken a overdose, without knowing somebody will find him, call an ambulance or admit him to hospital? I wonder have you ever explored the idea of being an enabler yourself? I don’t mean it’s your fault, but you make it possible for Chris ‘safely’ self harm, it is very common. Has Chrus ever tried any therapy such as CBT or DBT? Maybe it’s time Chris took a step towards responsibility for himself and actions? The mh & crisis team have clearly already assessed him & after years of psychiatric experience of Chris and others with similar Mh problems, that he is not a serious risk to himself or others. This should be a relief for you in one sense! Has he tried groups for people with the the same Mh problems as himself? It is impossible to help somebody that doesn’t want to help themselves. The police are not the answer in this situation. Being honest, if Chris really wanted to kill himself, he most definitely would not be with you tonight. Please remember people commit suicide in psychiatric units and prison cells all the time. The only person they can change the situation is Chris himself, after all, if Chris REALLY does want to do this, no dr, cpn

    • He has had more than one serious suicide attempt. It is in his notes that he’s high risk. He wasnt a risk to me holding me up by my neck with a screwdriver? He does want to help himself, hence attending a psychotherapy assessment, taking medication and begging them to help him.
      I am also lucky he is with me tonight, he nearly died a year ago, after a serious overdose of over 50 tablets, he ended up in rhesus with an abnormal heart rhythm, dangerously low blood pressure and spent 3days in coronary care, more than one doctor has told me how lucky he is to still be alive.
      He is extremely impulsive, his Care Co-ordinator knows how high risk he is so when he is unwell now its acted on pretty swiftly, however for most of the period of time i am talking about he didnt have her!

      • I did not mean to upset or offend you in any way. I am glad he is thinking about psychotherapy, as although difficult, can address root problems from childhood. In glad you have a goud care co ordinatir now, but they don’t work 7 days a week & my personal experience of the ‘crisis’ team aren’t very good. Having a good care co ordinator & CPA is key, especially if Chris can build trust & a relationship with this person, they can then at least have recommendation in place for when Chris maybe in an acute phase. I know with some diagnosis e.g. BPD the impulsivity is the problem & worry.. I think as a partner you are very brave. I don’t think Carers of people with mental health issues are recognised enough. I hope things improve for you both.

      • No its fine, I rather you asked so I could help you understand more about what I mean, if that makes sense. Thank you for your comments, I hope so too.

    • Hi Claire,

      Like your response to Sarah, which is full of compassion and attempts to help, I offer this reply to your post in a similar vein. I have spent my whole police career supporting NHS staff doing some of the most amazing things in challenging times / areas and when I was a PC I felt like I lived in A&Es and Mental Health units, so I’m not without insight to the challenges,

      There are just few lines in your reply which betray an attitude or approach that not only COULD but HAS got NHS professionals and their organisations into legal difficulties and notwithstanding that in some examples they have emerged OK legally, it has not been without stresses and strains of being criminally investigated and / or castigated in a public court during an Inquest. In future, such handling of these very difficult cases can only be placed under closer scrutiny by the 2005 Corporate Manslaughter Act.

      My punchline here is “The law of the land is the law, whether NHS professioanls recognise this or not; whether their managers recognise this (many don’t) or not; and whether or not training has been given.”

      As I say, I’m trying to be helpful. I’m aware of an investigation down south by Public Protection Detectives into NHS staff for manslaughter by gross neglience, arising from not taking action it was alleged was necessary; I know in my own area there have been investigations of neglect against A&E staff and MH professionals who took no action, or took inappropriately ineffective action. THIS DOES NOT MEAN it is always possible to take action! … it usually won’t be possible. But(!) when I’ve done a straw sample of A&E understanding of the Mental Capacity Act 2005, (look at sections 2, 3, 4, 5 and 6 – there’s a post on my blog about it), they know little about using it in practice.

      Imagine an A&E dept with a vulnerable, highly disoriented, confused and frail 82yr old dementia patient taken by by ambo in her night clothes: she was found wandering and cold in the street and before much was done or before we knew who she was she said she wanted to leave A&E, it is fair to say that a couple of nurses or maybe a security officer would put a couple of arms around her and guide her back in from the cold. We know this happens; I’ve seen it and probably so have you. Replace the individual with an adult man and not a lot changes, unless the particular presentation of the individual makes intervention risky. Imagine the adult man isn’t a dementia patient, but somebody with a long standing history of clinical depression and / or BPD who is stating an intention to kill himself after taking an overdose … bingo, duty of care. Even if you don’t believe his intentions to kill himself. (Incidentally, many MH professionals tell me that the most assaulted they’ve ever been is when ‘sectioning’ Older Adults, so it’s not automatically true to say it’s ‘safe’ with frail, old people and ‘not safe’ with adult men. These things should be judged case by case, not en masse.

      To say this “they cannot keep Chris against his will” is just wrong, both in law and in fact. Whether you (the NHS) meant 1) ‘legally able to keep him’, or 2) ‘physical able to keep him’ are two things. 1. You’ll probably will not be able to do so, but you might and the NHS need to know which is which. 2. If you are physically able to keep him there (when you legally should keep him there), then you must. If you are not physically able to do so, (when you would hope to do so) you should take the next most appropriate action and this may well be ‘stand back keep yourself safe and let him go’ whilst getting a colleague to ring the police and / or your security. No-one is saying put yourself at risk.

      Final point is one other thing you said, “Realistically, he will never ‘end up under a car’, as it seems clear his intention is not to really kill himself, but to self harm”. This is probably the most dangerous kind of thinking you could get into around this, in my view (said to help). How do you know that the person who thinks they’ve tried, but who hasn’t succeeded just ‘isn’t very good at doing it’ but will work it out after a few tries? When a Coroner (as in a case in my area) finds that not much was done because the perception of the patient’s risk history was a long the lines you outline, he despatched a Rule 43 letter to the NHS Trust demanding tightened approaches by senior managers. Words like ‘complacency’ were used.

      Sorry so long, but this is all to help you and your colleagues keep yourself legally safe, because (in just my personal view) there is a perception that certain obligations don’t apply to NHS staff in A&E.

  12. Pingback: “If you leave, we’ll call the police” | MentalHealthCop

  13. This is an extremely complex and emotive subject, and one that the individual, the carer and the professionals will all see differently. This is about changing the culture of how we deal with mental health, and importantly the support, training and tools that everyone needs to deal with the many types of situations that arise. I have sympathy with A & E staff, there role is difficult, in addition though they are right at the coal face with this, and there needs to be recognition of the different types of mental health; similar to all the different physical conditions that present, they all need assessed and treated accordingly. You cannot address each mental health case the same wayntheir needs will be inherently different. What is required though is a consistent approach to assessment, wellbeing and care. Carers needs also need to be considered in this regard and they should not be left in despair because “someone can’t be kept against their will”. I think a full review is needed, too often we are dealing with hindsight due to self harm or harming others. Those suffering mental health problems actually could assistnhere as could carers talk to them. Mehta health op also makes some good points, and actually is impressively knowledgable and understanding; this should be harnessed and utilised!

    • I completely agree with you. For example if they are going to allow said person to leave anyway then what is to stop them calling someone from Mental health to see them first, so although they dont want their physical needs dealing with, their mental ones can be addressed. This is all just thoughts. It just goes to show how far apart the two problems are when they can commonly present together.

      • From my experience’s I have found that mental health services will not come and assess a patient’s mental health until they are deemed medically fit. Any medical cause for their behaviour/health has to be ruled out first.

  14. All I can say is well done Sarah and MHC for bringing this blog subject up for debate
    On the issue of self-harm, it appears too many seem to see this as an attempt to be noticed and therfore treat it more lightly (harsh I know) but why is self harm know within services as “Screaming in Silence” …..could the opportunity to talk (with competent staff who can communicate!) be an answer.
    Isnt it looking for clues that count?

  15. For health workers it’s important to think outside the box and not to stick to rules that can result in increased danger for mentally ill people. Do what’s needed to protect them. If they need to stay until they r seen by a crisisteam, be creative and make them stay or get people who can make them stay.
    People who say they don’t want help are often not capable of accepting help. Try to help them to accept .

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