I first suspected that Muhaydin MIRE, the man arrested for attempted murder at Leytonstone Underground station on Saturday night, had mental health problem when I saw the videos of the seconds leading up to his arrest. I admit to thinking from his demeanour that mental health problems were evident. The second thing that made me suspect this case would end up of interest to me was media coverage of his Magistrates Court appearance. Having been formally charged with attempted murder and appeared in court on a Monday, no plea to the charge was reported and we learned he would be brought back before the Old Bailey, a Crown Court, as early as this Friday. This is a phenomenally short period of time. Let me explain why that is potentially relevant –

Magistrates Courts have no power under the Mental Health Act to remand someone to hospital under ss35/6 of the Mental Health Act until a person is found guilty or has pleaded guilty to an offence – a Crown Court, however, can do so prior to an accused person standing trial. Section 35 allows detention in hospital for treatment and assessment in the form of a written report to the court of anyone who is within the criminal justice system; and so it always catches my attention when I hear of defendants charged with serious or high-profile offences who have a short turn-around between the Magistrates and Crown Court. In my experience, it most usually means that mental health considerations are relevant to the ongoing criminal justice proceedings and the courts are attempting to expedite the second step in the process to allow for a remand to hospital for psychiatric reports under the Mental Health Act.

So let’s see what happens this Friday but the reason I felt able to raise this in a BLOG so soon after the event is because media reports are now directly quoting the Metropolitan Police in connection with mental health matters and Leytonstone. There was much speculation on social media over the weekend but I adopted my normal policy of staying out of it or challenging assumptions until something more certain became known. It is now reported that Mr MIRE’s family contacted the police three weeks ago in connection with their concerns for his mental health. The Metropolitan Police have responded that no mention was made of radicalisation, offending or anything else that wasn’t directly a concern for his mental health. They claim to have sign-posted his family to the appropriate, relevant health authorities and we are yet to learn what, if anything, the family or health system subsequently did.

ACCESSING MENTAL HEALTH SUPPORT

The media reports show us, yet again, the extent to which the police are seen and used as gatekeepers to the mental health system. Parity of esteem being the big issue that it now is, we also need to challenge this. You wouldn’t ring the police if someone had broken their leg or had chest pains without some additional factor making police involvement necessary – the need to force entry to a building, for example. So why do we see examples of the public ringing the police if they have mental health problems or concerns for their relatives? Naturally, the victims from the Leytonstone and the wider public will be interested in what was reported to the police and how they and other agencies reacted – that will all emerge at some point later, I’m sure.

But there are often, of course, answers to the question of why the police become a gatekeeper of mental health issues, even where there is no associated crime or immediate threat to safety – difficulty for individuals and families in accessing timely, responsive mental health services when there is a perceived need, being the main reason. See the 2015 CQC report “Right Here, Right Now” for more on that. In recent times, we’ve seen examples of mental health services telling people to call the police in response to health and wellbeing concerns that do not also involve those ‘core police functions’ around crime, disorder or immediate threats to safety – indeed one of my concerns about street triage is that I’ve seen its very existence encourage this reliance to an even greater degree than before.

So there is a debate to be had here about who the public should ring for unscheduled mental health care? Is it their out-of-hours GP? … if the person is not already known to secondary care (ie, specialist) mental health services, how else would they do it?! In fairness, there are few clues around: the NHS Choose Well campaign offers all manner of advice about which type of NHS support you should seek for all manner of health conditions and fails to mention mental health even once. Accident & Emergency is one route; the ambulance service is another but those two branches of our emergency system face similar difficulties to the police: how do they access specialist mental health nursing assessment and if necessary, statutory Mental Health Act assessment? In reality the police can often get you in to a statutory assessment of some kind faster than colleagues in the ambulance or A&E services: hence, they are a de facto route to support whether or not that’s right.

WIDER ISSUES

Criminal proceedings are now active around this particular case and we will have to wait to see what emerges. As always with these kinds of thing, there were some badly misinformed comments on social media, including from some mental health professionals, which reinforce the old myths about ‘mad’ versus ‘bad’ debate. So without reference to Leytonstone in particular, I wanted to signpost (again) to other BLOGs I’ve written on mental health and criminal justice, to counter some of the myths we have seen over the weekend.

In summary –

Just because you have a serious mental health problem, does not mean you cannot or should not be prosecuted following an allegation of a serious offence – to paraphrase the House of Lords, “Every man [sic] shall be presumed to be sane and able to be held responsible for his actions until the contrary is proved in court.”

Prosecution is the only route to the MHA orders that are exclusively available to the criminal courts under Part III of the Mental Health Act.

route to the MHA orders that are exclusively available to the criminal courts under Part III of the Mental Health Act. Part III balances an individual’s right to care, treatment and dignity; with the court’s right to fully understand the background issues relevant to an appropriate conclusion about criminal liability; and the public’s right to protection during and after the criminal process, as determined necessary by the court.

Diverting someone from justice – which usually means allowing hospital admission under Part II of the Act, would prevent full disclosure to the criminal justice system of the psychiatric background of the defendant, because of medical confidentiality.

You can read a summary of the different Mental Health Act ‘sections’, grouped into Part II and Part III, if you want to know more.

And as for #YouAintNoMuslimBruv, the hashtag that was trending on Twitter and which was endorsed by the Prime Minister earlier today?! … well, it’s always best to know enough before reaching a judgement, isn’t it? Perhaps #YouIsAPoorlyMuslimBruv would have been more appropriate – although this in no way seeks to provide any justification for what happened to the victims in this incident or the fear those brave police officers must have had in being required to arrest him. It is merely a caution against rushing to judge what exactly lies behind an incident that is seen partially, on poor quality social media recordings.

We now shouldn’t rush to further judgement about what happens next. We will learn more on Friday.

Winner of the President’s Medal fro

the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.