All AMHP’s will be
familiar with being asked to do assessments under the Mental Health Act when it
is not appropriate, but is motivated by the desire on the part of the caller to
pass the buck. They might, for example, receive a request to assess an elderly
person who actually just needs residential care, not a hospital admission, or to
assess someone who is in emotional distress, where the professional involved
with them is uneasy about leaving them over the weekend and just wants to relieve themselves of the responsibility.
Sometimes, it is
possible to avoid a formal assessment. But at other times, you soon realise
that, whatever the likely outcome, you’re going to have to go out and do a face
to face assessment.
Back in the days when
I did out of hours social work sessions, I was on duty one Saturday evening
when I received a rather agitated call from the police.
They had a
“situation”. They were asking for a MHA assessment to deal with it. They had
earlier taken a call from Mike, the partner of Bella, because Bella had
threatened to cut her wrists if he left the house. Mike was on police bail
having assaulted Bella, but had been to see their six week old baby. The
problem was that he would be in breach of his bail conditions if he did not
leave, and stayed overnight.
When the police
attended, they became embroiled in a domestic situation which did not seem to
have an immediate solution. Mike wanted to leave, but Bella wouldn’t let him.
The police could not
arrest Mike, as he had so far done nothing warranting arrest, and neither could
they arrest Bella.
Bella had a
considerable history of involvement with mental health services with
depression, having had a couple of inpatient spells following suicide attempts,
and had been receiving considerable support from mental health services, which
in the past had included periods of 24 hour domiciliary care. She currently had
regular visits from a domiciliary support worker in connection with the baby.
However, they could
not detain Bella under Sec.136, as she was not in a public place. So they
requested a formal assessment under the MHA.
It was further
complicated by the presence in the house of a three year old child as well as
the six week old baby. Removing the mother would raise considerable
difficulties about who was to care for the children, especially the baby. In
the circumstances, Mike was not an appropriate person to care for the baby, and
the three year old was not in any case his child.
It became apparent
that the only appropriate response as an on call social worker was to attend to
make my own assessment.
The police were
relieved to see me. So relieved, that they left almost immediately, despite me
asking them to stay while I attempted to find a solution to the problem.
I decided to try to
interview the two of them separately, but Bella was very reluctant to do this.
“He’ll leave the house
if I let him out of my sight,” she said. “And then I’ll kill myself.”
“But I’ve got to go,
or I’ll get arrested,” Mike pleaded.
“But you can’t leave
me. I can’t live without you.”
Bella threw herself at
Mike, who pushed her away and raised his fist. Bella seemed to be provoking him
to hit her, but to his credit, he turned away, obviously distressed.
“I have to make a
proper assessment,” I said. “I need to speak to both of you, but not together.
Otherwise, we’ll just go round and round in circles and get nowhere. I have to
be sure that both you and the children are going to be safe.”
“Leave the children
out of this!” she screamed. “You’ll take them over my dead body!”
“I’m not proposing to
take your children away, that’s the last thing I want to do, but I do need to
make a proper assessment.”
I did eventually get
them to agree to go into different rooms, and Mike promised he wouldn’t leave
until I had completed my assessment.
With Mike out of the
room, Bella slowly began to calmed down. She told me something of her mental
health history, and talked about her fears that she would lose Mike because she
had not been feeling like sex since her depression. I saw that she had cut her
forearm, although it was only superficial.
She spoke to me of her
feelings of inadequacy with looking after her new baby, feeling that she wasn’t
a good enough mother. It became clear that this was at the root of her
unwillingness to let Mike go, despite his violence towards her. I tried to
reassure her, and gradually she relaxed and became less anxious.
I then talked to Mike
on his own. He was in turmoil. He wanted to leave, but feared that Bella would
harm herself. She had cut herself in front of him, and he had never encountered
anyone deliberately self harming before. He couldn’t understand it, and that
made him afraid – both for Bella and for his baby.
“Look, Mike,” I said.
“Bella’s much calmer now, I suggest you leave now, while you’ve got the chance.
I’ll see to Bella.”
I saw him out of the
house, and heard him drive away.
Bella also heard him,
but by the time she came out of the room she was in, he had gone. I persuaded her
to make a cup of tea, and as we talked together, her anxiety subsided again. It
became clear that she had a good relationship with her baby and older child,
who were both blissfully asleep upstairs, and oblivious to the drama going on
downstairs.
As we talked, Bella
recovered some of her own confidence in herself, and began to make plans for
both the immediate and the longer term future. I encouraged her to do this, and
her mood began to brighten. She even managed a couple of smiles when talking
about her children.
I was feeling
increasingly confident that not only did Bella not require hospital admission,
but that she was capable of caring for her children. Additionally, I was aware
she was having a visit from a domiciliary care worker the following day, which
would provide monitoring until normal office hours on the Monday.
I began to inwardly
congratulate myself on having averted not only a detention to hospital under
the MHA, but also the prospect of having to find a foster placement for a three
year old toddler and a six week old baby late on a Saturday evening.
Then I heard a car
pull up outside. Was it the police, coming back to check how things were going?
I went outside to
investigate, and to my horror saw that Mike had returned. As he got out of the
car, I asked him incredulously, “Why have you come back?”
“I wanted to make sure
Bella and the kids were OK,” he said.
I found this hard to
believe. I could only think he was somehow trying to stir things up some more.
Perhaps he did not like feeling that Bella wasn’t, after all, entirely reliant
on him.
At this point, Bella
came out of the house. All her insecurities became reactivated.
“Don’t go, Mike, stay
with me. I need you,” she pleaded.
“No, I can’t stay,
I’ve got to go,” Mike replied, making a move to get back into the car.
Bella flung herself
onto the bonnet of the car as he revved the engine.
“Don’t go, don’t go,”
she repeated.
“I’ve got to go, I’ve
got to go,” he yelled out of his window.
This was rapidly
turning from pathos to bathos. I had to take control of the situation. Desperate
measures were required
“Right,” I said, “It’s
becoming apparent to me that you’re both clearly unable to look after your
children. I’m going to have to get the police back, and they can make a Police
Protection Order and take them to a place of safety.”
Bella was horror
struck. She removed herself from the car bonnet and came towards me, pleading
with me not to get the police. This gave Mike an opportunity to leave again,
which thankfully he did.
Neither Bella nor the
children came to any harm.
I've read this three times:
ReplyDeleteNotwithstanding the probability that the officers wouldn't actually appreciate the distinction between a mental health assessment, a Mental Health Act assessment and generic mental health support from a mental health social worker - I'm struggling to see how officers attending a non-criminal domestic incident like this, involving self-harm in private place by a person with a history of mental health problems, is "inappropriate" when they call for MH professional's support.
If there was a linguistic distinction about officers asking for what they thought was a MHA assessment when in fact what they needed was needed was a generic MH response to identify need, support or whatever - it is probably no more grave a failing than the error of thinking the officers might remove the children under s46 of the Children Act 1989 to a "place of safety". Section 46 makes no reference to a 'place of safety', but to suitable accommodation.
They don't know the full details of your job and vice versa; but one of the first things I'd expect an officer to do with the above scenario, is contact a MH worker connected to the woman's case to become in some way, shape or form, involved in it all. Even if just to advise or provide some information to better inform a decision.
I understand it's cheeky when they leave ... an AMHP did that to us in custody they other day, arguably whilst in breach of s13 MHA. We've all got these stories, including paramedics of AMHPs and of the police.
Does that make sense, as written?