Over the past few days, the Media has published news and discussed the impacts of the guidance letter sent by the National Police Board of Finland regarding the Police executive assistance under the Mental Health Act. The news have contained certain partly erroneous interpretations and views which the Police Board wishes to rectify and specify through this blog.
Executive assistance as per Article 31 of the Mental Health Act
Firstly, the Police continues to provide executive assistance as per Section 31 of the Mental Health Act (in Finnish) in transportations if a physician in service at a health centre or hospital district finds that the transportation of a person to a health centre, hospital or other medical care unit necessitates the escort, in addition to the healthcare professional, by another person due to the violent nature or similar reason of the transported person. The healthcare professionals are entitled to request and receive executive assistance if
- it is requested to assist in the transportation
- if the person in question is subject to a referral for observation or
- if they are transported to the healthcare unit for the issue of a referral to that effect.
Naturally, the recent guidance letter by the Police Board does not interfere with the statutory obligation per se but it is guides and outlines the operations of Police departments when executive assistance is provided. According to the information obtained by the Police Board, there have been differences in the executive assistance practices of various Police departments. Therefore, the Police Board found it necessary, in keeping with its mission, to direct the Police executive assistance operations though a guidance letter regarding the executive assistance as per the Mental Health Act, also as regards the use of Police powers potentially related to the executive assistance tasks. One of the purposes of the letter was to ensure that the Police operations are based on law and that the modes of operation are uniform across all Police departments.
The guidance letter contains an outline of the contents of the executive assistance and the nature of assistance measures the Police can resort to within the legislation when executive assistance under the Mental Health Act is provided. In accordance with Chapter 9 Section 1 Subsection 1 of the Police Act (in Finnish), the powers of Police in executive assistance are defined in the legislation regulating the operations of the requesting public authority, which in mental health issues is the Mental Health Act.
Section 31 of the Mental Health Act specifically defines the content of the powers of the Police in the provision of executive assistance. According to Subsection 1, the Police can be asked for executive assistance for transportation in cases where the transportation to a medical care unit of a person necessitates the escort of another person, in addition to a health care professional, because of the violent nature of the person to be transported or for another similar reason. The Police executive assistance and related measures are limited to the assistance in transportation and immediately related measures only. The Police cannot be requested to provide executive assistance for other purposes, such as fetching or searching the person in question.
As relates the potential measures to be taken during the executive assistance task, the legal position of the target person is pertinent, in other words whether the person is covered by a referral for observation or not. If no referral for observation has been drawn up, neither the healthcare professional nor the Police providing executive assistance have powers to unilaterally interfere with the person’s freedom or to take other action limiting the scope of the person’s freedoms. For example, the Police may not
- apprehend a person,
- assist the emergency care personnel to enter an apartment or other such place,
- perform searches to find the person or
- to exercise force to overcome their resistance.
For that matter, the measures listed above are not part of the assistance in transportation because the person has not been assigned for transportation and the transportation task of the healthcare professional has not yet started.
The Mental Health Act does not contain separate provisions on the powers of healthcare authorities to obligate a person, without a referral for observation, to go to a healthcare unit against their will. The lack of such powers significantly limits the content of the powers related to the executive assistance provided by the Police because they are always linked to the powers of the party requesting executive assistance. If the healthcare authority or professional cannot force the person to go to treatment, the Police providing executive assistance cannot do that, either. Under these circumstances, the task of the Police providing executive assistance is to see that the transportation can be made safely, and with their own presence ensure that appropriate Police services are available during the task, for example, if the person transported starts to act violently against the paramedics.
As early as 2008, the Parliamentary Ombudsman found that the provisions of the Mental Health Act do not allow for the patient to be fetched if not covered by a referral for observation. In the respective decision, the Parliamentary Ombudsman found that “the fetching of a patient to a health centre against their will constitutes strong interference with their self-determination and personal freedom.”
If a referral for observation has been drawn up for the person in question, the freedom of action of the patient has been limited through a decision by a physician in public service. And since the person’s freedom of action has been limited by a referral for observation, the Police can provide executive assistance in cases where the person refuses to go voluntarily to a healthcare unit. For example, the Police can provide executive assistance in getting the person into an ambulance, or in preventing them from getting out from the ambulance.
Obligation of the Police to take action
Under Section 30 of the Mental Health Act, the Police must inform the health centre or healthcare unit if they encounter a person who probably could be ordered to treatment against their will, or if they are informed about such a person. In extremely urgent cases, the Police is obligated to bring the person to a health centre for examination. Reporting and informing are primary.
The Police obligation to act relates to persons encountered during policing tasks. For example, the Police on a house call may get a justified impression that a person might be in need of mental health services. The obligation to act also refers to persons who are reported to the Police during policing operations.
In extremely urgent situations – in other words, in circumstances where a person needs to be brought to a healthcare unit without delay for the examination of treatment needs, for example for an immediate danger to the safety or health of the person – the Police must take action to bring the person to a healthcare unit. This obligation relates to persons signalled first to the Police if the Police has justified reason to find that they cannot wait for the healthcare authorities to take responsibility for the case. These persons and their actions would anyway be covered by the Police basic tasks.
In particular, the Police obligation to act relates to situations where the concrete threats and dangers caused or potentially caused by a person’s action call for Police intervention. In policing, the Police powers can always ensure the right of the Police to interfere with the actions of people who probably meet with the criteria of involuntary treatment.
However, the definition in Section 30 of the Mental Health Act, according to which the Police is obliged to immediately take the person to a health centre, does not mean that the Police would have the powers to apprehend the person or otherwise limit their rights or freedoms. Section 30 of the Mental Health Act is a provision defining the Police tasks and therefore the Police powers are determined under Chapter 2 of the Police Act.
The Police has the right to take a person to a healthcare unit against their will if they can be apprehended, for example, under Chapter 2 Section 2 of the Police Act to protect the individual in question. In this case, apprehending the person requires that the person’s life, bodily integrity, safety or health are jeopardised, the danger is immediate and serious, the person is not able to care for themselves and the danger cannot otherwise be removed or the person cannot be cared for through other means.
In policing, this situation could be constituted by the person trying or intending to commit suicide, threatening to do so or being otherwise suicidal. In case of a suicidal person, it is justified to think that they will probably be committed to involuntary care based on Section 8 Subsection 1 Para 2 of the Mental Health Act. In this case, the Police can apprehend the person for the time required to take them to a healthcare unit.
Apprehending a person in these cases may also be based on Chapter 2 Section 10 of the Police Act if the actions of the person are likely to cause threat or danger to others.
The Police have very limited powers to assess aspects of a person’s state of health, their mental health, in particular, without referring to the professional help of healthcare authorities, especially physicians. Particularly in cases where the physician has not drawn up a referral for observation, the Police on executive assistance assignments based on the Mental Health Act should be able to use the help of physicians, paramedics or other healthcare professionals as regards the state of health of the person in question, without confidentiality rules preventing such information being passed.
The Police can use the information obtained as decision-making basis when examining the requirements for the use of power under the Police Act. The decision must be based on overall assessment, taking the information obtained in the scene of the event into account and combining it with the information on the person’s state of health and mental health eventually obtained from the healthcare authorities. The decision on the use of Police powers is made by the Police officer directing the operation.
Should the Police not have the powers to apprehend a person under the Police Act, the Police can take the person to a health centre only on the basis of the individual’s voluntary will and consent.
The Police continues to provide executive assistance requested by a public sector physician for purposes justified by the Mental Health Act. However, the Police executive assistance does not solve the shortcomings in the powers of healthcare authorities because the Police executive assistance and use of powers are based on law.
The Police powers can still be used – under the current legislation – to ensure that the Police can intervene with the action of individuals whose life, safety or health are seriously and directly endangered in situations where there are probable conditions for committing them to involuntary care.
According to the opinion held by the National Police Board, the current mental health legislation contains shortcomings related to the operative powers of the competent authority and the contents of the executive assistance, and these problems should be rectified as soon as possible. An amendment would ensure that all those in need of acute help could be effectively assigned to the healthcare services they require.
Assistant Police Commissioner
National Police Board