AIBU to think mental health crises should not be treated as antisocial behaviour

[Serencwtch]

TW: Some references to suicide.

In my local area Police have started a new initiative to reduce the demands & costs involved in attending to 'concern for welfare'/mental health crisis type calls.

They have issued a number of formal enforcement notices and warnings using Antisocial Behaviour legislation to people who have caused inconvenience through mental health crisis/suicide attempts in public places. These enforcements are community protection warning (CPW), Community Protection Notice (CPN) & Criminal Behaviour Orders (CBO).

I know one individual very well who has received one of these & they were very distressed by it & have now become very withdrawn & secretive. It's also difficult as a loved one as if I was concerned this person may be at risk I would be hesitant to involve emergency services as even a call to ambulance would likely result in police attendance & therefore have criminal implications for them. I also can see that it has increased their risk but in a more secretive & less public way. No doubt police consider this a success as they have not been called out to them.

I fully understand the pressures on police, I have friends & family that have served as officers & police staff. The funding cuts are every bit as bad as NHS or social care but with less public awareness.

This doesn't sit right with me at all. I think it's misuse of legislation designed to tackle antisocial behaviour & that a mental health crisis/someone attempting to take their life should not be labelled as antisocial behaviour.

Yeah. Some 78 year old fucker has been arrested for vandalising James Bulger’s grave. Claiming mental health. I actually don’t give a fuck any more. I hope they throw the book at him.

Yes obviously 'something should be done about it' - they should be receiving appropriate mental health care!

Perhaps the people attempting self harm in a public place are so desperate that they believe it's the only way to get any attention or help. It's very sad that suicide is expected to be performed in an acceptable manner and not inconvenience anyone. On one hand people are expected to manage their own mental illnesses with absolutely no help, yet they're also not allowed to become suicidal or become a nuisance for others to deal with either. A very sad and bleak situation.

Yes but that would be a S2 or S3 having been assessed by 2 qualified psychiatrists not S136 which is a police holding power. These are in no way the same thing. In case the user name doesn’t give it away I am a psychiatrist

You can’t just rid society of mentally ill people and hide them away. The naivety of people who think mental health crisis can be cured by a helpline, a&e or a fast track to a psychiatrist 😭 many of these people who will have life long mental illness. They’ll just plod along as best they can between crisis’

I used to volunteer for a MH telephone helpline.

there always have been people who make repeated self harming and/or go to places and think about throwing themselves off but do not do it on a very, very regular basis.

we usually had a list of “regulars” as it were, some of whom were so regular it was almost every week.

with the best will in the world this is not the role of the police. They need help - but the police are not the right people to give it and I think it is fair that after multiple call outs the police essentially refuse to come.

Yes of course, I didn’t mean to imply they were admitted under a 136. But it’s not exactly rare for a 136 to be followed up by a 2 or 3 is it?!

Absolutely shocked by the lack of compassion here. The police really aren’t qualified to judge on someone’s mental health and giving these kinds of orders could make things a million times worse.

On the plus side it’s finally given me the push to deregulate from MN. So much bile about people who are suffering.

Yes very sad and bleak.

If appropriate mental health care was given sooner, there would be fewer incidents for everyone - the person themselves, their families, the public, the NHS, the police - to respond to overall.

What of the people that find the body? My friends little brother found a person who had killed themsleves on our local beach when he was about 11 and it messed him up.

One of the reasons the police are not following up your car vandalism, burglary or the anti social little gits down the road is they spend so much time dealing with MH issues. Now that’s for the health service to sort surely, well that’s creaking at the seams. If someone is hanging themsleves or standing on a bridge threatening to jump as much as it is sad it is anti social.

Too many variables to have a single approach. Whereas often I would say Yanbu there are plenty of circumstances where it definitely is anti social behaviour, eg sitting on the motorway bridge stopping traffic flow, 20 mile detour (think of costs as well as inevitable congestion) now realise one individual has done this 5 times in a month, 17 hours of closures and yes that individual as an anti social behaviour order not allowing them within 200m of the bridge, their safety and for the rest of us a good thing. I’m thinking of single situation as are you op but as every situation is different this can’t be taken as a solution for everyone.

I agree

Those with drug and alcohol addiction cause lots of anti social behaviour but is it due to mental health or lifestyle choices or both.

In any event they dont trump people attempting to go about their lives in a law abiding way.

The excuses made when crimes are committed though, anything yo excuse behaviour. Perhaps part of the solution is more rehab and mental health support

But that doesn’t make any sense. How does a ASB order stop some kids finding a dead body?

these ideas might seem logical to people who are terrified of breaking the law but if you are about to kill yourself, a community order is hardly a deterrent is it?! So what’s the point?

So they did not meet the criteria for suffering from a mental disorder that required long term detention, were found to be at no risk of harm for their own or others safety and that detention is not necessary for treatment.

Then there is an issue with the behaviour. I know it doesn’t sound fair, but if this person is not meeting the threshold criteria for longer term detention then this would suggest that the repeated behaviour is anti-social, no? A repeated deliverate public display of distress? I’m not saying that’s not coming from nowhere or that they are not suffering but I am not sure what the alternative would be other than the repetition of this scenario over and over again. All the police have been able to do is respond and get them assessed under S136. That’s all they can do. So when this happens multiple times and diverts vital resources from emergencies they have to try something.

@Serencwtch

when it happens so frequently (few times a week here) you become desensitised, it’s not that you don’t care but it’s become just another alert from the local facebook group that you can’t get to where you need to be or my neighbour panicking because she’s stuck the other side (for 90 minutes) and school child care closes at 6. We do care a believe we need better mh care but please don’t sit on bridges and think of train drivers. Unintended consequences mean we lose compassion

Suicide in a public place isn’t an inconvenience, it’s hugely traumatic for those present. I know the train driver who could never work again after a man (my friend’s dad) jumped off a bridge in front of his train on Christmas Eve.

Not sure what the answer is and no idea about your friend’s circumstances but it does suggest more than one incident and it’s a cry for help so she needs to find better ways to do that. I hope she gets the help she needs but no one here can say whether the police are right or not based on half facts.

With the greatest respect to people who are suicidal (and I have been there), the kind of behaviour described in this thread is antisocial and it isn’t the police’s job to be community mental health experts. The police need to be able to do their jobs and support everyone in the community.

I used to do some work with TfL and saw drivers, good, compassionate people, have their lives ruined - at least for a period of time - because of suicides.

People who are in mental health crisis and suicidal naturally often have very little insight into how their behaviour affects others, and I think some element of ‘tough love’ may be helpful in some cases, helping people realise that the emergency services are not just there for them, and that no matter how deep their distress, other people have lives and problems too. If they are frequently behaving in ways that cause a lot of inconvenience, distress and cost to the wider community they need to know that that is a serious problem.

It sounds un compassionate but if the current system had enough capacity and could cope, I don’t think measures like this would be brought in.

I think that used to be the case but since SIM sprung up & was then abolished & these new schemes are being developed in its wake, the thresholds for action are much lower.

It used to be the case that police had to be sure that a person's intention was not suicide & the threshold for enforcement & punishment is now much lower.

It doesn't sit right with me at all.

I understand the demands & pressures on police time & not saying there shouldn't be interventions, it's just the use of the label 'antisocial' and the use of punishment that concerns me

The hit rate is pretty poor in my experience.

I think the OP has made a mistake by using an individual example, when what she really seems to be raising is a policy change

I used to live next door to an older teenager who was struggling with mental health issues. Every other day there would be ambulances and police outside my front door. She would often go out in public and harm herself to get attention, and she regularly threaten to take her own life before running off. She never followed through. She was also very nasty to people and had attacked community workers and police in the past.

Her mum would always call the police if she ran off and they always had to attend. If something had happened and no one responded, they would have gotten into trouble. It clearly put a huge strain on emergency services, and you could tell both the police and paramedics were exasperated by it.

Her mother seemed overwhelmed and wasn’t getting the support she needed. Meanwhile, neighbours (including myself) were being woken up at all hours of the night constantly, and people in the community who kept encountering her in distress were also becoming increasingly shaken and unsure how to respond.

It was just a very sad and difficult situation all around, and I honestly don’t know what the right answer is. There should be some sort of consequence for all the time and resources of the emergency services she took up but it’s clearly rooted in a much deeper issue that she wasn't getting the right support and care.

I moved house in the end. My DD was getting older and I didn't want her to witness all the constant drama.

I would imagine there’s more to this than you know about which is why the measures were taken. I’m sure it wasn’t just a one off incident.

You don’t imagine the police make these decisions lightly, after a one off incident or on their own do you? There are interagency forums where such cases are discussed.

I’m sorry you feel it is not compassionate but I really think there is a lack of nuanced understanding here. It is possible to feel compassion for someone in distress and still to think that them going to a bridge repeatedly is an unhelpful behaviour that merits a deterrent.

Some people who go to a bridge really intend to end their lives but there are others for whom it’s a repeated maladaptive behaviour and they need to be deterred from doing this for their own sake as much as anyone elses because it does not help the person concerned either and there is a risk of them coming to accidental harm that accumulates the more they engage in high risk behaviours.

I am not commenting on the specifics of your loved ones case. However, I can tell you from professional experience that there are people who significantly misuse emergency services and then blame a “mental health crisis” when it isn’t actually a mental health crisis at all. I think that is probably what these are aimed at trying to deter, I’m not familiar with these orders, so not sure on what basis they are issued and what criteria have to be met. That said, I would think this is aimed at repeat offenders, those refusing to engage with services appropriately, or those behaving recklessly where a mental health condition is not diagnosed, for instance.

In cases of misuse of emergency services, there is often something else behind it that is not a true “mental health disorder”, but the individual is not seeking help from the right sources (often despite being told to). For example: not uncommonly an underlying social problem; sometimes emotional distress but not an emergency; sometimes related to misuse of alcohol or drugs; not uncommonly personality disorder diagnosis. I do think the under-resourcing of social services, community resources, addiction services etc plays a part in this issue too.

By way of example of what I mean by misusing because of “crisis” which is not actually a crisis, at all- I know of one person who had action taken against them after a prolonged and protracted process (including warning that if behaviour continued there would be action taken against them) during which they misused gp, community mental health, hospital, police and ambulance services to such an extent that there was no choice.

This person had a personality disorder diagnosis, but from personal knowledge these “crises” were very actually true crises- somewhat distressed but not actually suicidal, often furious a request has been declined etc- if they did not a significant enough “reaction” from CMHT, would call GP, then escalate from there. On many occasions having two, three or even four of these services out in a single 24 hour period. On multiple occasions an ambulance out more than once a day. This individual would keep ambulances with them for long periods and in a quite rural area. There were multiple multi-disciplinary meetings including all services- taking up even more time and money. I can’t tell you the processes that were put in place- and money spent- on this individual for very little long-term progress.

At one case review, it was noted that tying up the service with this patient (threatening suicide if they left, refusing to be taken for mental health assessment as they wanted to go to hospital when there was no reason for an acute admission), meant that another ambulance had to be brought from out of area to another (actual) emergency and this patient had a delay in treatment which was catastrophic. It’s one thing if the service is stretched with actual emergencies- that’s a resource issue (and there is one within ambulance services across the country)- but when it is because of time-wasting, it’s an avoidable tragedy. I know this person was an extreme example, but the underlying narrative/behaviour is not uncommon. They just pushed it further than the vast majority, in this person’s case, threats of prosecution and then actually being charged did significantly lesson the abuse of services.