The men in white coats!

It is a saying from my youth that I remember well. It epitomised the taking away of someone by force, a disappearing of the person from view, a locking up and throwing away the key. but more often than not it was used to joke about being different,

 watch out or the men in white will come and take you away

 It seems a very poor joke now considering the number of years in which my being sectioned felt a very real prospect however it has stayed with me. Today it feels very much like an outdated stereotype since the people who come and persuade you to give up you current cause of action, are extremely unlikely to be of the medical profession at all. In fact the coat is more likely to be florescent yellow with a blue splash across it saying POLICE and publicising to the world that there is something very seriously wrong.

The coats may have changed colour but I fear very much that the stereotype, the otherness, the whisking you away from view, is still very much there if not even worse. I saw this article ‘Police need training to section vulnerable people’ http://www.guardian.co.uk/commentisfree/2012/may/14/police-training-section-mental-health about the use of force and feel that in fact the stereotype has been added to that now instead of that whisking you away from sight, we have a more sinister criminal undertone to contend with. That actually mental illness has now fallen rather haphazardly into the realm of being associated with criminal activity.

Wouldn’t it be better if it were trained health care professionals coming to persuade you to desist?

I have to say that honestly I’m not sure. Theoretically I would expect people who have been trained for jobs within mental health services to be more understanding, sympathetic/ empathetic and more persuasive than those without training (see earlier post on safety in mental health wards), however I am undecided about which facets of the training are most important. In many ways I feel that caring for the sick, helping them to get the right treatment for them is a different skill set to persuading a person to desist on a current behaviour path.

The article forcibly reminded me of a presentation I went to by a police negotiator. He talked very candidly about his job, his training and about some of the situations he’d been a part of. To say the least it was enlightening and realistically he is the kind of person I would want talking to me at that time. I could see this man and those similarly trained really making a difference to the course of my actions and that is what is needed.

Sadly there are few trained negotiators and therefore I feel for many of the situations it will be the local officers that arrive first and the negotiators may not even be called and thus I am uncertain whether I feel that are adequately trained.

There are of course some other practical reasons why I feel the police are used.

For a start understaffing within mental health. If you look at this article in the guardian Mental health services in crisis over staff shortages http://www.guardian.co.uk/society/2011/jun/20/mental-health-services-in-crisis-over-staff-shortages you can see that it is highly unlikely that they would be able to spare the staff for this purpose. In fact the earlier article the woman says

I was taken to the local acute ward by two officers who then had to wait with me until the ward took over my 'care' again. This took hours.

That the officers were not keen on this I can completely understand, reasonably I can see that they do not have the skills to care for the woman.

Secondly the closeness to the people. It seems with facilities and services spread so thinly that actually the police are far more likely to be physically closer to the people than most of the medical professionals and also in a position to arrive quickly to the scene.

Thirdly the increasing number of 136 removals. (see here for an explanation of this http://www.direct.gov.uk/en/disabledpeople/rightsandobligations/police/DG_4018603)The In-patients formally detained in hospitals under the Mental Health Act, 1983 – and patients subject to supervised community treatment, Annual figures, England 2010/11 http://www.ic.nhs.uk/webfiles/publications/005_Mental_Health/Inpatients%20Mental%20Health%20201011/Inpatients_MHA_report_201011.pdf page 10 table1 All detentions under the Mental Health Act, all facilities, by year

	2006-07	2007-08	2008-09	2009-10	2010-11
Total detentions	46,539	47,610	47,725	49,417	49,365
all formal admissions	27,716	28,085	28,673	30,774	30,092
detentions subsequent to admission	17,242	17,505	17,299	16,721	16,897
detentions following use of Section 136	1,581	2,020	1,753	1,922	2,376

Some caution show be added as these figures pertain to those people who are admitted to hospital and it might not cover the full number of calls to people in distress, Many of these will have friends, relative and themselves call for assistance via a crisis team, CPN (county psychiatric nurse), drop in at a hospital, or via any other source.

If you add to this the statistics from this article ‘Mental health services in crisis over staff shortages’ they quote the report of

Average bed occupancy rates in English inpatient units are much higher than the 85% standard, with some wards running at 120% occupancy...

The report reveals that more than half of all adult general wards run at more than 100% occupancy...

Which sounds particularly bad to me. What isn’t clear from the article is whether they are quoting %bed occupancy, ie in other words over 100% means there are more beds on the wards and filled than the ward is designated as having or  that there is more than the 85% number of beds on the wards are full, either way this is bad.

The fact is they just don’t have the staff to go and pick people up, however I am struck with the number of articles that end in the same way with the feeling about whatever it is that actually this isn’t good enough but they have no idea what to do. Except that I feel that it isn’t that people don’t have suggestions about what to do but that they don’t feel that they will make a difference.

So ideally I would like to see the police better trained in an awareness of mental health issues and more sympathetic restraint techniques, more user friendly facilities for detainment/transportation to and from hospital and availble staff to take over the care once they have arrived at the facilities.

As for the other problems of understaffing there is so much to be said that really I don’t have the space here.(see other post on far reaching taboos, the changing face of stigma, safety within mental health wards)