Like Buses

It's been an absolute age since I last went to someone in the process of being sectioned.

For those of you not well versed in English law as it pertains to mental illness a 'section' refers to a part of the Mental Health Act 1983. Most often it is used to describe admitting someone for mental health assessment against their will. The section that I most often come across is the police using Section 136 which enables them to remove to hospital the naked man running down the street screaming that he is off to kill the aliens who are putting thoughts in his head.

Don't laugh, it's happened.

But on this day we were sent to two 'Section Two' cases, people with a mental illness who are a danger to themselves or others. These are often a bit of a circus to be honest, you have a social worker (and probably their backup), two doctors (and sometimes their drivers) a stack of police (normally around six, it case it all 'kicks off') and an ambulance crew. There is a lot of hanging around on street corners waiting for these various people to arrive. You also have all the neighbourhood turning off their 'Jeremy Kyle Show' and instead putting chairs out in front of their houses to better watch the show.

Not good if the patient is distressed already. But then, that Bedlam spirit of gaining entertainment from the mentally ill has never really gone away.

I have no idea why you need an ambulance to take a physically well person to hospital. There are two ways that a Section two job goes – either the patient agrees to go to hospital (and can therefore travel in a car) or they refuse, in which case the safest place for them to be is in the back of a police van. I have no idea why it needs an ambulance to take this patient to hospital at the cost of £400+ in addition to removing an ambulance from frontline duties. While we are doing this we could have been dealing with the mental health patient who can't wait for an appointment. If the patient decides to get violent you find yourself struggling in the back of a van with loads of equipment that can be broken or used as weaponry.

But, at the end of the day, it's often an easy job – even if we are just being used as a very expensive taxi.

At both jobs the patients decided to come into hospital of their own accord, which is nicer for everyone. At the first job the Social Worker in control said, “Oh – I'm glad we didn't have to wait for you” to me and then wandered off – no-one thought that it would be helpful to tell the taxi driver anything about the patient.

At the second job we didn't even get that – the patient walked out, the Social Worker managed to string the words. “He he is – I'm driving back on my own” together and then vanished. Under a Section Two we aren't supposed to transport without an escort, so a police officer was pressed into service. Again the patient was fine the whole way, but it did seem that the receiving ward had forgotten that he was coming in that day.

I love to see that whole 'synergy between healthcare professionals in a multi-disciplinary, multi-pathway in an ethnically aware process' thing happening.

I'm not prejudiced, my dislike of social workers is based on experience – if I meet some who are good at their job and polite to me then I may amend my position.

I'm still waiting though…

17 thoughts on “Like Buses”

  1. I think there's an insurance problem or something with police transporting a patirnt.As part of training in a previous job I spent a day out in a police car. We got called to a mentally ill person who'd smashed a window in his flat. When we arrived he was calm and wanted to go to the local mental health respite hospital as he knew he was having an episode and it would be safer for him. The landlord didn't want to press charges so he was not to be arrested. He had no money for a taxi and couldn't get any money out. The police were not allowed to transport him as he was not arrested. They didn't want to call an ambulance as its not an emergency and they would probably have to take him to A&E not the place he needed to go.

    Eventailly the police officer managed to get authorisation to take him, but it had to go up to the highest officer on duty that night. All because they're not insured to carry him or something. Was a total waste of hanging around to get this permission. If he'd been left he knew we'd probably be out there again in a few hours..

  2. It does strike me as it being something 'silly' like that – as there is no 'real' reason why such a thing wouldn't be allowed.And the police will sometimes drive the victim of a crime around to see if they can find a suspect.

  3. Thanks for describing a section two – something very similar happened to the chap a few doors down from me recently, who had previously broken all his windows, and thrown crockery across the street.(I did wonder if it might be you in the lurking ambulance, but it looked like two lasses.)

    However, after the chap's departure, I think the landlord changed the locks… hopefully he's now getting the care he needs.

  4. Police Standard Operating Procedures have recently changed in London – These require all mentally unwell people who have been sectioned to be transported to a place of safety in an ambulance. Only the most violent people should be put in a caged police van. I think this is so that the patient is with healthcare professionals who can watch more closely for dangers like positional asphyxia. Of course the media and public interest with 'deaths in custody' have had a major impact on this policy change.You may just feel like a glorified taxi but your skills could come in very useful during this period.

  5. For my money, it's the uniform, the image as well as the actual skills and experience of ambulance staff, and the physical structure of an ambulance.The fact you're uniformed does, at a certain level, command respect – you're not just an individual, you're part of a large group. The associations for that group are that you are “nice people” – ambulance staff don't go and arrest people or give them fines or anything, you go and save lives and help people. No one shouts “shit! EMTs!” and runs away and no one goes on a rant about “fucking paramedics, they're all the same, why don't they show a little human decency…” like they do about the police.You (ambulance staff) are used to taking charge of stressful situations. You are also (in my experience) good at being friendly and talkative even with people who aren't being that responsive for a host of reasons. You have nothing to do with a person's long-term treatment and therefore on the whole you don't have to view your interactions with the patient on a long-term basis (eg, if I restrain him now, will that cause problems with trust and our working relationship in six months time?).As for the ambulance being an ambulance, well, it's big, outsiders can't see into it, so the patient isn't being forced to share personal space (like in a car), but also isn't being left alone or exposed.as always it is possible that I am talking from my arse

  6. Tom – the BMA & MDU have both added their concerns to 50 other organisations opposed to the draft mental health bill [presently going through parliament].Not least because it is said to threaten the civil liberties of the entire population, not to mention the professional boundaries of psychiatrists.

    I wonder who will get the job of transporting non-compliant patients being treated under the dreaded community supervision order ?

    Ah well, think of all the quality time you'll get to spend with your favourite ASW.

  7. No, Batsgirl, you're no talking out of your arse! To someone who is mentally distressed an ambulance feels a lot safer than a cab or similar.It's very difficult to know what to do when you are mentally ill or married to someone who is, (I'm both). When my husband was self-harming the police ALWAYS came with the ambulance although the impulse to harm is never directed at anyone else. Having the police there was always a shock and not really helpful except for the important thing of reassuring the ambulance crew. One crew in particular was very unhappy about taking us to A&E. There was a powerful implication that we were abusing the system. In the first place we didn't know what the protocol was for MH patients, in the second my husband was far too anxious and wound up to be able to manage any other form of transport. I was also extremely upset at what was happening and the continued stress of the months of his illness. What would have been the appropriate form of transport for us? I don't know, all I know is that the only manageable one was an ambulance but that became horrendous due to the exceptional attitude of the crew. Thank goodness it was a one off and I suspect that it's probable that they had recently had to deal with some traumatic physical illness/accident which coloured their reactions to us. As patients of course we had no knowledge about what their situation was and already had too much to deal with. On other occasions ambulance people were fine and helpul.

  8. Sad your probably well earned view of Social Workers. I was a Social Worker for 33 years and tried to always be cooperative with and friendly to other service types like police and EMT's. In South Carolina, USA we have a law similar to Section 2 but the police take the person to the Mental Health clinic. As long as someone would open the door, police handled the situation. Usually I called in information to the clinic and/or police after I or family went to the Court for the emergency commital papers. That way both knew what to expect. I have been known to ride with police to pick up a child, visit jail at 3 AM, take clients to Mental Health appointments and anything else I could do to help “the team”. On the other hand, when I asked a doctor to send either me or the client to the state hospital because the client was driving me nuts, he obliged and sent the client. The deal was for me to help another of his clients get on Social Security. Helping each other pays off for all of us.

  9. i think that (whether financially and whatever else it makes sense!) that it also has a lot to show about how a person who is mentally ill is percieved (i guess ethically and theoretically!). They are acutely ill, but are not 'bad' or been accused of any other arrestable etc offence.. therefore logically they have no reason to be transported in a police van, but rather an ambulance… it might be a bit of a moot point, and only really applicable in theory, but imagine if these oggling neighbours see a person getting dragged off by the police, as opposed to being ushered into a waiting ambulance. When they get home again, are they going to have to deal with the stigma of being perseived as dangerous, or a criminal…Does that make any sense at all, haha, i know what i mean in my head!!! xR

  10. because a person being sectioned has not broken the law, and is facing more than enough stigma without being seen to be taken away in a police van.They are just as unwell as a woman in labour, or someone with a broken leg.

    The only section 2 I have been present at was my own. I knew I was a desperate danger to myself, and I knew that in order to stay safe I needed to be in hospital, I needed to be kept safe. But, I was told by the crisis team, my CMHT and my GP that the only way I would manage to get a bed in the next few weeks was to get myself sectioned. So I did. And luckily I am still here to tell the tale.

    maybe if the mental health services in this country were even slightly better we wouldn't have this problem. Crisis housing is being closed left, right and centre, and if, like me, you have a diagnoses of a Personality Disorder, then the crisis teams won't deal with you.

    The new Mental Health bill, btw, isn't all bad. It does address the above concerns in part and will make it easier for people with a PD to get help in a crisis. This draft is also alot better than the previous draft when it comes to the ability to section. Combine this with the new advance directives, and we are seeing improvements.

    With you on the vast majority of ASW's. The best all seem to leave too quickly as the work is so tough…

  11. Re: social workers!As part of my university course every year, we have to work with different health professional students. This is a good thing, the aim being that we learn to work together, and learn about each others jobs and roles. Of course, the idea is that we end up with positive views about other professionals. Not so, to be honest! In my personal view (and apologies to anyone who takes offence!), most professionals have their own stereotype, that, unfortunately, they do live up to i.e:

    Social Workers – Beatnik types with long hair, and long skirts or sandals (thats just the men!)

    Podiatrists – up their own backsides with over-inflated egos

    Physiotherapists – bubbly, fluffy cloud type peoples, always full of enthusiasm

    Occupational therapists – quiet, contemplative individuals that like to draw and doodle

    Medics – arrogant on the surface, but actually very frightened people

    Child branch nurses – baby-ish, sickly sweet voices

    Mental health nurses – slightly crazy and over analytical

    Adult branch nurses (me!) – cynincal and jaded (already!), or have ideas that they are the perfect nurse (WRONG!)

    Midwives – assertive, loud and generally great (i should of been one!)

    anyway, i have met all of these professions, and although i have met one cool social worker, the others were useless, and they are not my favourite people!!

    I dont mean to offend people, its just my experiences and opinions!

  12. Makes sense to me, like all the similar points on here – it's about treating that person as ill, not criminal. Interesting stuff.

  13. My dad was a social worker for 28 years, and he was pretty good! He's left social services now, it made him go grey. 😉

  14. Too, too true!!! Why do so many people not see mental illness as illness and why do so many see mentally ill people as potentially dangerous. you actually never know when ANYONE may reach their breaking point. I am sure that we all have one. Behind the illness there is always a real human being who may be terrified and needs to feel safe more than anything else. Our local crisis centre has closed, beds have been drastically cut and we are mostly supposed to be able to cope with so called 'home treatment'. How can that work in reality when the ill person still has to struggle to do the day to day things for themselves, or neglect themselves with the consequent further loss in self-esteem, when they are still in the situation in which they became ill and are free to come and go, attempt to kill themselves and so on. It seems that the only thing that counts these days is money, NOT people.

  15. I think going grey is a fundamental part of working in health and social care. I wonder if I can make my employers buy my hair dye to cover mine up as its been caused by them??Interesting thought……………

  16. My family own adn run a private nursing home and my dislike and suspicion of social workers is legendary. You'd be astounded at the number of them who don't even question the hospital's decision to load an elderly patient with sedatives to keep them quiet and they then get sniffy when we try and wean back off the damn things. Most of the time they haven't got a clue what is going on with their cases. I remember a man called Chris who came, “Yes, he's fine to be left on his own in the office while you show me the room” the social worker says. By the time we got back downstairs the care assistants are cowering in the day room while a thoroughly excited Chris has despatched 2 windows, a fax, a computer and printer, a sink and a radiator cover to the great office in the sky. Social workers are more concerned with whether the paintwork in the home is fresh and sparkly and whether the wood floor has a cig burn in than the programme of outings and drug withdrawal schemes that we create. And god forbid you finally lose it and tell one of the do gooder idiots fresh from their college course that perhaps after 20 years of growing up in this environment you might have a better idea of what you're talking about than they do. If you do that then you won't get another referral until they move on and are replaced with another clone. They drive me mental.

  17. I don't know the policy with LAS, but within our service the Police are utilised on several types of calls. In relation to going to a house to see a patient with mental health issues, there are several routes to follow, a lot of the time it is down to the crew, but if a call taker hears raised voices in the background, or there is a flag on the address due to previous violent behavior (not necessarily physically) then the Police will be requested to attend, and the crews will not enter the property until the police have arrived. They are not their for anything other than the safety of the crew. I have been to several jobs where once they have walked into the house/room they will inform the people why they are there and then step back. Obviously there are occasions where this doesn't work to plan, but at the end of the day there is only one important person in the situation, and its number one. Many of us have partners and children to go home to at the end of a shift, there is no situation that would warrant injury to yourself (or worse).Now I appreciate that in your circumstances it is completely different, but unfortunately other cases in the past have proved that it is better to be safe than sorry (having been on the end of an unprovoked assault and having a knife pulled on me I am cautious on all jobs not just the ones that have warnings) It is unfortunate but no one is able to foresee what might happen, so its a case of taking precautions.

    A bit off topic now so sorry for that

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