Police actions against women attending the Clapham Common vigil for Sarah Everard were an unmitigated public health disaster.
The Metropolitan Police released statements defending arrests as necessary to ‘the overriding need to protect people’s safety,’ in reference to laws preventing public gatherings during the pandemic. These clashes, echoing the use of police force at Black Lives Matter protests last summer, provide a useful illustration of the problems that arise when the police are first responders in a healthcare crisis.
As a society we expect medical interventions to be subject to the greatest scrutiny before being deemed fit for public consumption. The process of scrutiny is complex and draws on a range of evidence to inform it, but is consistently present behind decisions all the way from large scale population-based interventions such as voluntary cancer screening programmes to the comparatively smaller dilemma a medical team might encounter about sedating a confused elderly patient trying to leave a hospital ward.
At each step clinicians consider the extent to which society is prepared to enforce a healthcare intervention, and there are a myriad of guidelines and pieces of legislation that act to prevent the public from falling victim to misconduct. But we are now in a profoundly different moment. The pandemic has brought with it some of the most restrictive healthcare policies the British public has ever experienced, and has also led us into uncharted waters regarding enforcement.
As a trainee psychiatrist I am closer than many medical colleagues to the uneasy intersection between police and medical authority which comes together in the Mental Health Act. Under its terms, individuals can be detained by the police for medical assessment, forcibly restrained and medicated, and in some cases decisions regarding discharge can be dictated by the Ministry of Justice rather than the patient’s mental health team.
This means you have to be attentive to the reality that medical authority is replete with opportunity for abuse – and the reality that healthcare can be weaponised to serve the interests of powerful institutions over patients. Under these systems, healthcare professionals can play a role in upholding social inequalities.
Historically, the involvement of law enforcement agencies in public health crises has led to disastrous results. Take the AIDS epidemic, for example. In that instance, inappropriate interventions ranged from police confiscating needles from drug users in 1980s leading to needle-sharing and subsequent outbreaks of HIV amongst adolescents, to police tasering a black man they suspected of having HIV in 2007.
State-sanctioned authority often has a dizzying influence on healthcare workers, causing them to dispense with ethical frameworks in their practice. In the past British doctors have forced vaginal examinations without consent on migrant women on instruction of the Home Office, provided conversion therapy to those with LGBTQ identities, and assisted in force-feeding Irish prisoners on hunger strike while ignoring torture conducted by the UK’s armed forces.
This leads us to a fundamental conclusion: police should not be in charge of responses to public health crises. It’s bad for medical professionals, who are placed under additional pressure; it’s bad for the public, who are liable to face the consequences of misplaced enforcement; and it’s bad for public health in general, undermining the legitimacy of medical interventions by combining them with the threat of force.
The response by police officers present at the Clapham vigil for Sarah Everard was a case in point. Protestors were kettled and pushed to the ground, with multiple officers restraining each individual. These strategies were devised to tackle criminal behaviour and disarm dangerous individuals. They have been extensively criticised for use even in those contexts, and more broadly in response to protests, but it was particularly alarming to see them implemented for the sake of public health.
No medical ethics committee would greenlight such tactics for use in a medical setting to force compliance with infectious diseases guidance. If a patient wanders out of a hospital room, posing an infectious risk to the rest of the ward, the response is not physical violence. And even in more extreme cases, where restraint is necessary, the police are not trained to conduct such risk-benefit calculations with regards to health outcomes. Our first responsibility is to the patient, and then to the health of others in our care – their first job is to protect the state and uphold its laws.
Beyond the particulars of forceful intervention, the inclusion of police in healthcare drags illness into the domain of criminality. This forces the patient into the role of potential offender to be observed. Clinicians are trained to navigate the messy and imperfect nature of the individuals under their care, to empathise with decisions they make that may not be in their best medical interests, or may not even be legal, but arise in response to challenges and needs that exist outside of the sphere of their health status. Patients have families, relationships, and fears, mistakes they regret, dreams for their future, they are not simply viral vectors shuttling between legality and criminality.
It is these distinctions – which can often manifest on the basis of race, gender or class – which the police are most clearly not qualified to discern. Rather than tending to understand and empathise with these particular positions of patients, policing in Britain tends to further the discrimination and alienation people from minority ethnic backgrounds, women and working-class people feel in their daily lives.
The inclusion of the police in the public health toolkit for the pandemic is a harmful incorporation of a system that builds and thrives on a discriminatory social order which criminalises segments of our society at large. By including the police in our public health response, we tie any healthcare goals to the social inequalities and racist violence perpetuated by that institution. And so police officers shoving women down to the ground becomes an anti-Covid health policy, mobilising patriarchal violence as an acceptable health strategy to curb viral transmission.
Under these conditions, the very groups public health structures have always struggled to reach become increasingly marginalised and distrustful of health authorities. The reluctance of minority communities to engage with vaccination programmes to combat Covid, for instance, will only be worsened by police violence mobilised in the name of public health. If permitted to proceed unchecked, this blurring of health justice with criminal justice will have ramifications for generations to come.
The police is an institution whose primary objective is upholding the law, not facilitating public health. They should not be given the discretion to determine how public health is protected – that decision must be made elsewhere, in a way that balances genuine healthcare expertise with established human rights, such as the right to protest.
Widely-disseminated, culturally-sensitive public health education programmes, properly-funded shielding programmes for the vulnerable, investment in community-based test and trace systems with local authority oversight, equity in vaccine distribution, lifting people out of poverty and penalising employers for exploiting workers – all of these measures can help us to get to the end of the lockdown. But we can’t police our way out of this pandemic.