Wednesday, 8 July 2020

EVERYTHING THE POLICE SHOULD KNOW ABOUT MENTAL HEALTH




I realize that in aiming this post at a particular group of people, it might dissuade others from reading it as they may feel it’s not relevant to them, but I think that it’s important I produce content tailored to the various people who read I’m NOT Disordered. I mean, there are plenty posts aimed at other Service Users, so why not for another group of my readers?


I recently received a message from a friend telling me that she’d just had a bad experience with the Police during a mental health crisis and that she’d heard of someone else having one too and that became the inspiration for this post. Of course, I’ve had a fair share of my own experiences and interactions with the Police around mental health…


The first involvement I ever had with Northumbria Police was in 2009 when I ran away from the medical hospital that I was a patient of after having attempted suicide for the very first time. To be fair, as unexperienced as I was with the whole process and the Police’s powers where mental health was concerned, the Nurse in hospital did warn me that if I ran, they would call them. I guess I partly didn’t believe her, and also thought that even if she did ring them, I would be long gone by the time they responded. I remember not having a clue where I was going when I left the hospital and ended up walking into the nearest town centre where I spotted a Police car parked on the high street. 



There were no Officers in the car though, so I carried on walking until I was suddenly being pushed against a shop window by two Officers. They checked they had the right person and pulled me to their car to drive me back to hospital. Once we were there, one Officer sat in a tiny room with me in A&E and I heard the other talking to the Nurse, who was telling him that they didn’t have the staff to sit with me the entire time I was there. I remember the Officer telling her “we have a few laws we can detain her under. I’ll leave my colleague with her.” 


After a bit of awkward conversation, the Police Officer agreed I could go to the toilet while he stood outside but when I came out, he led the way back to the room and I took the opportunity to run in the opposite direction. Of course, he gave chase and eventually I ended up in a random corridor and at a complete dead-end! The Officer told me I was now “officially detained under section 136 of the 1983 Mental Health Act,” restrained me, and called a Nurse to help him take me back to A&E in a wheelchair.


The next thing I remember was the other Officer returning and handing my Officer a pile of papers. Section papers, apparently. Every so often the Officer would get on his radio and ask what he should put as the answer to a particular question before turning to me and telling me that “this is the first time I’ve done this, so I haven’t got a clue!” Part of me was terrified at the thought that the one person in the situation who really should know what was going on didn’t understand any of it. 

The other part of me, though, appreciated his honesty and felt slightly comforted by the realization that we were sort of both in the same boat because it was my first suicide attempt and I’d never been sectioned before! Which meant I also didn’t realize that under section 136 of the Act, you have to have a Mental Health Act assessment with two Psychiatrists and an Approved Mental Health Practitioner (AMHP – usually a Social Worker or similar). On my assessment, the professionals made the decision to detain me under section 2 of the same Act and told me this meant the Police Officer could go. I asked how on earth they thought I would stay in the hospital for the medical treatment for my suicide attempt without him being there to stop me leaving and they explained that the hospital staff now had the power to restrain me and keep me there themselves.


The second time I was sectioned was a whole lot more dramatic because all the Mental Health Act assessment professionals came to my home (when I lived at my Mum’s) and when I still refused to go to the medical hospital, six Police Officers marched into the home, put me in handcuffs and leg restraints and carried me to their van. The two Officers in the van drove me to our local psychiatric hospital to be told that I needed medical attention first and they got back in their van and asked me “if we take you to the other hospital are you going to go in and stop messing us around?!” I was so taken aback at their rudeness and was shocked after my first experience with the Police had been a fairly positive one (or as positive as it can be where the Mental Health Act is involved!).


In the medical hospital, one of the Psychiatrists who’d sectioned me told me that they were waiting for four mental health staff to come to make sure I stayed there and I asked why they needed so many; “because it took six Police to bring you here and there’s only eight in your entire town!” I was immediately filled with the worry that I’d been completely unworthy of so much care and attention and that I’d totally wasted everyone’s time. I was especially worried that having taken up the time of six of the eight Police in my town, it’d left only two to fight crime and protect the rest of the residents of the town! I thought that if something happened and someone died because there hadn’t been enough Officers, it’d be my fault.


After that second interaction with the Police, I spent the following three years in a bit of a love/hate relationship with them around my mental health crises. I slowly realized that I think a huge reason why they often weren’t too great was frustration (on their part) because there were so many times that they would section me under 136 and then at a Mental Health Act assessment, the professionals would choose not to properly detain me and would send me home. The Police would often be baffled that mental health professionals thought someone who was suicidal, and hallucinating didn’t need to be in a psychiatric hospital. To the Police, that was the best place for that person.


I als0 think that the Police couldn’t understand (I don’t blame them because I didn’t learn how to put this into words for a long time) why I would overdose, tell someone or present at A&E with the intention of wanting help and then runaway before anything could be done and knowing full well that the Police would then become involved. They didn’t know that I would overdose in response to the hallucinations and doing what they wanted would silence them. When they were silenced, I actually wanted to be alive so I would get help, but then the hallucinations would come back, angry that I’d asked for help. I think that their lack of understanding around this point was a huge reason for some of the Officers often labelling me an attention seeker. This label was really debilitating and actually really dangerous because it meant I was incredibly reluctant to have any interaction with them which meant three things… Firstly, it meant that I put a lot of effort into running away and ensuring I wouldn’t be found by them. Secondly, it meant that I wouldn’t ask them for help or feel confident that they would even help me if I were to ask them. And thirdly, it meant that when I did have any interaction with them, I was usually quite rude.


I honestly believe that the Police can have a huge influence on someone who is feeling suicidal. When I’ve helped deliver training sessions, I’ve usually used the example that if they were called to someone who was standing on a ledge about to jump, their response would have the power to either talk that person back from the ledge, or provide motivation f0r them to jump. For this reason, I think that it’s important the Police read posts like this and hear the things that Service Users want them to know so that they are better placed at supporting a person in a mental health crisis.


I fully agree that the Police aren’t the ‘right’ people to be involved in such a crisis, but I think it’s about time that we all recognize they are being relied on more and more in these situations. The sooner we accept this, the sooner the Police are given more training and education in mental health.


With all of this in mind, here’s a few things I think the Police should know:



If you’re talking about the belief that someone is wasting your time or being an ‘attention-seeker’, at least do so out of their earshot!


I honestly think that you’d be naïve if you think that the person in a mental health crisis doesn’t already feel that they’re wasting a professional’s time. When I was feeling suicidal, I thought that there was literally no point in professionals using their time on me when I was convinced, I was just going to end up killing myself. So, to hear those professionals – like the Police – validate this in saying that I was? Well, it just made me feel worse.


There’s another side to this too though, there’s something to said about making comments like this with colleagues but within earshot of the person you’re talking about. It’s rude and disrespectful. It’s like in medical hospitals when Doctors draw a curtain around your bed, but then proceed to talk about you with other staff and you feel like shouting “that curtain isn’t magically sound-proof!” Sometimes – and this might be controversial – I think it can be better to say it to the person’s face because at least then you can talk it through and the person might say something that helps you to understand the situation better and realize that what you’ve said about them, isn’t fair. I once had a Police Officer say: “why do you like the attention so much?!” and I told her that if it was all for attention that I wouldn’t have a psychiatric diagnosis! Her reply? “Oh! Sorry, I didn’t realise you have one!” Obviously it was upsetting to hear she thought that of me, but I actually appreciated her telling me because it meant I could ‘set her straight’ and improve her understanding of things so that she was a whole lot kinder to me!


Of course, there’s also something to be said about the use of the ‘attention-seeker’ label in general… I’m a firm believer that wanting attention when you’re in a mental health crisis shouldn’t be given a negative connotation. I mean, surely it’s a good thing if someone wants another person to pay attention to something like that because it allows that person the opportunity to get help. Comments around attention-seeking have often made me extremely reluctant to talk to someone if I’m feeling suicidal or are having thoughts to self-harm because I’ve been so scared, they would think that of me. I’ve had a Police Officer once say to me that if I really wanted to be dead I would just “get on and do it.” Yet, if I were to attempt suicide, I’d be asked why I hadn’t tried to get help!



Get creative with your response & validate

The Inspector I worked with to deliver the mental health training to new Officers always used to ask me to tell this one story… I was under a 136 with a female Officer and was having visual hallucinations of rabbits. The Officer noticed me staring at what appeared to her to be an empty space under a chair in the room we were in and asked what I could see. After I told her, she silently lifted the chair and stomped her big, black boot all over the area until I was laughing and smiling. And when I was sectioned in the Act assessment, and she was asked to transport me to the psychiatric hospital, I agreed to go with her peacefully. I had so much respect and appreciation for her after what she’d done for me that I thought the least I could do was fight everything in my head telling me to run or fight against the admission. That Officer stamping her boot on a particular space led to me completely cooperating! And this is a key example of the importance of both validating a person’s experiences and being creative in your response.


I mean, that Officer could’ve easily just sat there and tried to persuade me that the rabbits were hallucinations and that she couldn’t see them, so they weren’t really there. But, I think that it probably took a whole lot less time stomping on the ground than it would have took to persuade me that my vision was fake! And stomping on the rabbits meant so much more than if she’d spent half an hour convincing me I was hallucinating. What she did meant that she believed I could see them – and that’s so important to someone who is hallucinating. The staff in hospital actually had disagreements around this and on their approach to my hallucinations with some thinking they should spend hours telling me they weren’t real, and others believing it’d be more productive to trust that they’re happening for me, and to instead, teach me healthy and safe coping mechanisms for them.


I think that you don’t realize just how much you rely on your senses until you’re hallucinating through one of them! So, for someone to validate just how scary that must be and to believe that someone can see or hear something they genuinely can’t? Well that means a great deal. And to think outside of the box and do something that has clearly come from your own brain and not that of whoever you were trained by? That shows tremendous gift and a truly caring soul. One time, after I’d told this story to a set of new Officers, one of them got in touch with me a few weeks into starting their job and told me that she’d just chased ‘the devil’ around a kitchen to help someone who was hallucinating because she’d remembered my story about the rabbit! I felt so comforted to know that there was at least one Officer out there doing something like that and to think that my little story had potentially helped someone else meant a great deal to me.



Don’t arrest someone purely because sectioning will change the statistics or take up more of your time


There’s been maybe three or four occasions where I’ve had Officers say to may that they would arrest me under Breach of the Peace because sectioning me would both mean that their fantastic statistics as to how few people have been detained under the Mental Health Act would be affected; and that sectioning someone takes up more time. It was kind of awkward because I obviously didn’t want to be sectioned but I felt as though I almost had to ask to be because I’d obviously rather that than be arrested!


 The difficult thing with sectioning someone is that as soon as you’ve done so, the procedure is that once the person is deemed medical fit, they must be assessed under the Act by two Psychiatrists and an AMHP. Obviously, becoming medically fit can take time (especially where it’s a paracetamol overdose because the antidote treatment can take up to twenty-four hours!) and then arranging the assessment and gathering all of the relevant professionals can take some time too. I think that sometimes, the knowledge of just how much time sectioning could take up, can end up providing motivation for Police to arrest someone for Wasting Police Time. I’ve heard countless examples of people in a mental health crisis being arrested for this, but two stand out. One, was of when someone was standing on a bridge and once the Police Negotiator had successfully talked her down, she was arrested and ended up in court for it. Another time, a girl had called the Crisis Team but refused to tell them where she was, so they called the Police and when Officers found her, she was arrested for wasting their time.


I guess that there’s one argument to say that neither of these girls should have been arrested because neither had personally gotten the Police involved. Also, there’s the fact that a mental health crisis shouldn’t be deemed a ‘waste’ of anyone’s time! However, you could also argue that both girls had ‘put themselves’ in a situation where it is almost blatantly clear that the Police would become involved. Those with that school of thinking might also agree that someone threatening to jump from a bridge and requiring the Fire Service, Police, Paramedics and the Coastguard to attend, should then be prosecuted if they don’t jump. I mean, it’s like with trains and people who have jumped in front of one – you always get a least one passenger moaning about what an inconvenience it has been for them. I have two thoughts here; try considering what an ‘inconvenience’ their death has been to their family and friends. And, how ‘inconvenient’ it is to even feel suicidal!



Two people can have the same diagnosis but present in different ways


This has been a very interesting lesson I’ve personally learnt through my diagnosis of Borderline Personality Disorder (BPD or Emotionally Unstable Personality Disorder as it is now referred to as). When I was diagnosed in 2009, the diagnostic criteria were that a person have at least five of nine possible symptoms. I was deemed to have all nine. The criteria, though, meant that you could get so many people with BPD and they could be so different because they each might have a different combination of symptoms. Having all nine, I tried to find a positive lining in that it meant I could – to a certain extent – relate to anyone and everyone with BPD.


However, I also found out that two people could have one symptom in common but that wouldn’t mean they coped with it in the same way. One symptom a lot of people with BPD have in common is self-harm, yet it’s a very well-known fact that there are multiple methods to hurt yourself. There was one girl admitted to the specialist hospital I was in and she had no scars on her arms because she used to abuse her Diabetes medication as a means to self-harm.


I guess that being aware of the differences in people with the same diagnosis can make it hard to care for and support a number of people at once because it may feel that the care and help has to be tailored to each individual. Which is one huge reason why I needed to be admitted to a hospital specializing in Personality Disorders – because usual services weren’t knowledgeable or experienced in supporting someone who needed completely different care to a person with, say, Schizophrenia. 


I think it’s important the Police know that what has worked or helped one person in a mental health crisis might do the exact opposite for another. So, it’s important that in some instances you sort of ‘play by ear’ and take your time to really learn and figure out what the individual needs in that situation. It makes me think of this one time when an Officer spent about an hour attempting to convince me to go to hospital with him; and then another Officer turned up and absolutely laid into me! I mean, he really went to town! Within minutes he had me asking “can I at least put my shoes on before we go?!” I actually ended up feeling terrible for the first Officer and said that I didn’t want him to get in trouble just because the way he’d been doing things hadn’t been effective. The second Officer said “people either need a soft approach or tough love!” and I thought that this perfectly illustrated that everyone is different and that help should be individual to that person.



Have courage and speak up if a more senior Officer discriminates against someone with a mental health condition


This is something that worries me when I do the mental health training for the new recruits because I’m very aware that there’s a hierarchy in the Police (and in most organizations!) but perhaps the Police are a bit more strict and stringent with theirs. And that’s completely justified! However, where it stops being helpful is when Officers who are either more senior or who have been with the Force longer, have a different approach to that which newer Officers are being trained in.


I mean, it’s no secret that mental health training for Police used to be extremely rare or at least very limited for a number of reasons but it has meant that Officer’s attitudes and decisions aren’t always consistent as some have a different level of education and understanding in mental health. This can make getting help as a Service User very difficult because one bad experience with an uneducated, discriminatory Officer can shape your entire view of the Police and leave you reluctant to trust them. I always used to say that even if there are more supportive Officers than unsupportive, those bad experiences can be more debilitating and outweigh the positivity of any experience remotely resembling helpful!


I guess that there can be two motivations for Officers to speak up; the first is to think of how you’ll feel if you stay silent. Could you live with knowing that you hadn’t tried to correct a wrong? That hadn’t done what was best? The second – and hopefully the most significant – is to consider the impact the other Officer’s response could have on the person in crisis. Like I said earlier, a Police Officers response has the potential to motivate someone to jump off the ledge and if you stand back and let another Officer do that, what does that say about you?



Don’t assume the impact a person’s actions (e.g. suicide or self-harm) may have


I think that a common response to someone expressing suicidal thoughts and feelings is telling them to think of their family and how they would feel if the person were to take their own life. This thought process makes sense and is usually well-intentioned, but it isn’t always helpful. A lot of the time, a person who is feeling suicidal is consumed by the belief that their death would either have very little impact on the life of anyone, or that it would be a blessing for their loved ones.


With my Mum and I having such a close, amazing relationship; a lot of people over the years have assumed that reminding me of that, and telling me how devastated she’d be if I committed suicide, would be helpful to me in a crisis. And it wasn’t that I didn’t think she’d be in pieces… I just thought that she would realize it was what was best for me. That being dead meant I was out of the emotional pain I’d been going through. Believing that life was painful meant that I also, sometimes had the attitude ‘is staying alive for the sake of someone else really fair on me?’ 


But, do you know what? Even if an Officer was right, and even if my death would have the exact impact they were assuming, it can actually be interpreted as condescending and patronizing for them to have this response. I mean, it’s reasonable – if you’re inexperienced – to assume that someone who is suicidal hasn’t considered everything that could keep them alive because why would they still be suicidal if they had? As someone who’s attempted suicide, I’ve never been told to consider an impact my death could have that I hadn’t already thought of. 


Of course, in some situations, it may be apparent that a person hasn’t thought things through in which case, reminding someone of the impact of their suicide could be helpful. I just think that it’s worth bearing in mind that it should be a response where you consider its relevance to the situation instead of it being generic and automatic.



Don’t judge someone for their coping strategies


It’s often incredibly easy to pass judgement on how someone is coping with something and compare it with how you would cope if you were in that situation. Easy, but not a great idea! I know it’s different, but it’s kind of like when you watch an action or a horror or a thriller and you’re sat screaming at the TV and the Actors, telling them what they should be doing. This is usually because from the outside looking in, things seem a whole lot calmer and easier to process which enables you to think clearly and logically – something that you may be less able to do if you were actually in the situation.


I think that doing this – screaming at the TV – is completely normal and understandable, it’s ok to imagine how you’d cope in another person’s situation. What’s not ok, is judging that person for how they cope in THEIR situation. I once had an Officer tell me that they’d been abused before and hadn’t ended up self-harming or attempting suicide. As though telling me that, would help me in some way?! I mean, maybe she had good intentions… But judging my coping skills by saying she wouldn’t do the same thing felt completely demeaning, as though I were in someway weak or useless for coping the way I was. 


On a really hard day, someone judging my coping skills also made me feel so alone in thinking that they must have absolutely no idea what I’d been through otherwise they’d be understanding and empathetic. And I guess that’s the point; what gives anyone the right to judge someone for something you really know nothing about? I mean, even if I met someone who’d been abused by someone in the same profession as my abuser, I wouldn’t assume what we’d been through was in any way, remotely similar.



Acknowledge the person’s courage if they communicate with you


I don’t think this is something I need to tell you, but a person in a mental health crisis can, quite often, not speak to those trying to help or support them. For me, sometimes I elected not to communicate because I worried that I’d say all the things that would end in me being sectioned and – at the time – I just wanted to be dead. I knew that as soon as I started talking, people would be passing judgement on what I would say and that wasn’t anything against those people, just that their profession entailed they make judgements in terms of ‘should we section her?’ or ‘is she poorly enough to be hospitalized?’ or ‘do we need to ring someone else?’


My reluctance to talk never got me anywhere, and often it was met with the response ‘if you don’t talk, we’ll assume you don’t have capacity and section you anyway!’ Which was another motivation to keep quiet; I worried that if I poured my heart out and told these professionals all of my deepest, darkest thoughts and feelings and then they didn’t help… well what would have been the point?! If I finally told them how suicidal I was and then they turned around and accused me of being an attention seeker or of wasting their time… And being met with those responses just provides further motivation not to confide in professionals because – rightly or wrongly – one professional’s attitude and behaviour reflects on the entire organization and shapes our view of everyone else in that profession.


The wrong thing was, my refusal to speak was always acknowledged but then my bravery in talking and pouring my heart out, was literally never recognized! And this isn’t me looking for a pat on the back but in a mental health crisis, sometimes the simplest of recognitions can make all the difference. It illustrates that you’re taking notice of the person’s struggle and that you appreciate when they do something to overcome it. You appreciate how much effort that would have taken and are grateful that they have done it.



And, here’s a few final basics that I wanted to add:

Be mindful of triggering sexual abuse survivors when restraining
Don't ask relatives or friends to take responsibility for the person

Don’t interrupt the person when they are talking

If you’re going to signpost to other organizations, at least have some knowledge of them

Resist making false promises or using blackmail out of desperation



I really hope that this post has been somewhat educational and that the knowledge it hopefully imparts on you, can influence the way you treat someone and that your response might improve the help and support you can provide to them.



For more on my journey with Northumbria Police: