News last week that there were 17 deaths in or following police custody in 2014/15 in England and Wales has rekindled outrage at the scandal and led to the usual political wails. Theresa May, announcing an inquiry into the deaths, said they ‘represented failure’. Well, that’s one way of putting it. Others rallied round ‘one death is a death too many’. Had Stilton been asked for comments, he would have said the deaths ‘absolutely represented failure,’ and that ‘one death absolutely is a death too many’. Sotto voce, he may have added, ‘we absolutely have been here before,’ because of course the GMC has had a hand in the death of similar annual numbers of doctors under FTP investigation, but from a far smaller population at risk. We should also note Stilton does not count year-and-a-day deaths, ie those occurring after FTP investigation. As a killing machine, or if you prefer a negligent machine that allows deaths, the GMC is far more lethal than the police. For once Stilton would be in error to say the GMC absolutely is more lethal, were he ever to admit such a thing, because in absolute published numbers the police are equal to, or slightly ahead of the GMC, but in relative, pro rata, terms, the GMC’s FTP processes are more lethal than police custody processes. If the police’s grim reaper is a scythe on open land, the GMC’s grim reaper drives a combine harvester down narrow streets.
As Stilton did before her, Theresa May has ordered an inquiry. The GMC’s inquiry, which focused on suicides, which accounted for a quarter (28/114) of the deaths in ‘GMC custody’, found there absolutely was a lot to do, but so far the highest profile suggestion from the GMC has been to propose some sort of ‘crack at the Afghan’ military style training for doctors, on the basis this would absolutely toughen them up, ready for when the shit absolutely hit the fan. In the meantime, it’s the doctors under investigation who are fed into and continue to hit the fan: more brown shirts and red trousers than the other way round. Time will reveal whether Theresa May’s enquiry comes up with similar bright ideas for society’s crack-heads and minor villains. If it does, it won’t be the first time a government enquiry has come up with crack-pot ideas for crack-heads.
Talk of resilience training is to look at the problem from the wrong end of the telescope, and furthermore gets precious close to victim blaming: ‘you weren’t tough enough, that’s why you got harmed’. Such talk misses the point. The common river of blood that runs through these killing fields is mental illness including, for the sake here of brevity, addictions. Almost half, eight, of the seventeen who died in or following police custody had ‘mental health concerns’, while in almost all, sixteen of the seventeen, drugs and/or alcohol was involved. The GMC inquiry, which focused on suicides, also found high rates of addiction and mental illness among those who killed themselves while in ‘GMC custody’. Though specific figures are not given, those that are (page 20 of the report) suggest roughly half of those who killed themselves had a mental illness and/or addiction. Even more worrying, almost a third were known to be at risk of suicide.
None of these deaths are necessary, in the vile sense suggested by some that they are the inevitable collateral damage caused by the police and GMC – the representatives of the state – as they carry out their enforcement activities. Some might be unavoidable – the person might have died anyway – which is why making these deaths ‘never events’ is a hive into nothing, a setup to fail. Instead, these deaths are tragedies, certainly in the modern colloquial sense, but also, in a way, in the Ancient Greek sense. Many, if not all, of those who die carry a flaw (Dr No uses the word descriptively, not judgmentally) that contributes to their death. The tragic element becomes even stronger if we recall that Greek tragedy has it’s roots in the dance of the satyrs – the ‘goat-song’; and where there are goats, sooner or later there will be scapegoats.
These diversions into the Classical world help to remind us that at the centre of many of these deaths is a damaged individual, caught in a tragic dance to the strings of fate, free-will and flaw. They may or may not have done wrong, that is for investigation to find out, but many are already damaged, and common decency requires us, and our representatives in the state enforcement authorities, to treat these individuals decently. The surest way to reduce these deaths – and death remember is here a one way ticket handed out to the innocent as well as the guilty – is to ensure that all bar none of those involved in police custody and GMC investigation procedures never forget that they are as often as not dealing with delicate flowers and thin-shelled eggs. Hot-housing them and knocking them about a bit has no place, because that’s what causes delicate flowers to wilt and die, and thin-shelled eggs to crack and be broken.