Police officers – not the most likely custodians of society’s mental health. However, they are frequently called out to mental health emergencies and they play an uneasy role alongside the mental health profession in enforcing mental health law.
In commemoration of National Crime Reading Month, I’m going to explore the often-complex relationship between the police, mental health professionals and people suffering from mental health problems.
Please note, I am neither a lawyer nor a police officer. These examples are mostly drawn from my own experience and attempt to offer insight for writers who wish to write about these topics.
Why involve the police?
Several situations may require a police presence in the context of a mental health problem. A few examples include:
> A disturbed man in the street, running into traffic.
> A desperate woman on a bridge, threatening to jump
> A 999 call from a concerned mother whose son with schizophrenia has gone missing
> A woman accused of assault says the demons made her do it
> A Mental Health Act Assessment at the home of man experiencing severe depression
In short, police officers attend emergencies. Therefore, they are often the first people on the scene when someone is experiencing a deterioration in their mental health.
However, although they receive training, they are not mental health professionals. Their ability to accurately determine whether someone has a mental health problem is limited. In the UK, they act under suspicion of a mental health problem to remove someone to place of safety for further assessment – Section 136 of The Mental Health Act.
To address this problem, some police forces are employing mental health nurses to work alongside police in identifying people in need of treatment.
Black and ethnic minority groups are over-represented in police sections, as they are in all Mental Health Act sections. The reasons for this remain unclear, as Section 136 data is difficult to gather centrally, but it’s an important area of research if the inequality is to be addressed.
Section 136: what happens
If a person is behaving in a way that makes police suspect a mental health health problem in a public place, they can be placed on Section 136. This allows police to remove them to a place of safety.
This could be in a hospital A&E, a police station and a specially-designed Section 136 suite. The example I am going to discuss in detail is what happens in a Section 136 suite attached to a mental health unit.
The suite is ideally located next to the Psychiatric Intensive Care Unit (PICU), where the most distressed and unwell patients are treated. This is because patients who come in on Section 136 who need to be admitted may need urgent transfer to this ward.
The person is brought through a dedicated door directly into the suite. Their personal belongings are removed, usually including their shoes and belts (anything that could be used to harm themselves or others). Inside the room, there is a mattress and chair, with an adjoining bathroom. Everything is securely bolted to the floor – again, to prevent throwing/damage.
At this point, the police sign over the person to the care of mental health services. They also hand over any information they have about how the person was find and if their demographic details are known.
The person is offered something to eat and drink – sandwiches and tea, with plastic plates and cups. Their basic vital signs are taken by the nurses, if it is safe to do so, and a doctor is called for a physical examination. The first examination is to determine if the person is fit to have a full assessment. Reasons for not assessing immediately are usually related to intoxication – an assessment while drunk can go very differently to one when sober.
It’s also to check out if there are any overriding physical health problems that need attention. Because police are not trained doctors or nurses, they may mistake a delirium, an epileptic fit or diseases such as diabetes or liver failure for a primary mental health problem like psychosis.
When the person is fit for assessment, a Mental Health Act assessment is arranged – as detailed in my post on The Mental Health Act.
Here are the facts:
> There is a slight increase in risk of violence in psychosis, but this is often in the context of delusions. Because if you thought people were going to experiment on you, you’d probably fight back too.
> People with severe mental health problems are three times more likely to be victims of crime than the general population.
> When reporting crime, a mental health problem can often lead to testimony being dismissed or disbelieved.
When a person with a mental health problem is deemed to be a vulnerable adult, he cannot be interviewed without an appropriate adult present. This is a legal provision to ensure that the person’s rights are safeguarded during interviews, intimate searches, etc.
Forensic psychiatrists are those concerned with mental health in the criminal justice systems – mainly prisons, police cells and court rooms. They also have their own forensic units, where they treat convicted criminals with mental health problems. The most famous example is Broadmoor Hospital in London.
Writing about mental health and crime
At CrimeFest this year, I asked the psychology and psychiatry panel about mental health and stigma related to crime fiction. We are pedlars of fiction, but if we drown the market in psychotic serial killers, do we contribute to stigma? We are fascinated by the psychology behind murder, but at the risk of perpetuating negative and damaging stereotypes.
I would like to see more recognition of how people with mental health problems are often victims of crime, particularly in crime fiction. There are fascinating avenues to explore in reflecting the real world in our inventions, and doing justice to the reality of living with a mental health problem.
If you have any questions about mental health or would like help with research, please feel free to contact me – I’m always happy to help!