The police are far from perfect in their handling of mental health issues: and even if we could skill up and widely train officers to the right standard, it would still be fair to question how we define the role we want the police to play. The distinction between ‘health jobs’ and ‘crime jobs’ is a false one: many are both, some are neither. How you decide to afford priority to either in making initial decisions is frequently complex and best done case by case.
This is why we see disagreement about police involvement and police decision-making. From issue to issue and from incident to incident, this debate can occur for a range of reasons:
- their (comparative) lack of training and knowledge – compared to mental health professionals and compared to other areas of policing, the amount of MH training is still small.
- their inability to access NHS or other services – knowledge of what 24/7 or emergency services are available is sometimes limited and to be fair to officers, consistency of mental health services varies enormously so there is no ‘mental map’ in an officer’s head of what exists behind the emergency they are dealing with, to enable them to identify the correct pathway into healthcare or assessment of need.
- we should also acknowledge that stigma or even fear of the unknown around mental health issues can play a part – our officers are drawn from society and we know that some individuals and our society as a whole structurally and individually discriminate against individuals suffering from mental ill-health. We would be naive to think that all police officers approach incidents involving mental health matters with the correct attitude. That reinforces why training is required – on awareness and law as well as on the ‘map’ of local services which can response, assist and support.
I also from time to time come across the “we shouldn’t have to do this” argument. It is this issue I want to discuss here in more detail. We know from this week’s Parliamentary debate on mental health - the first major debate in years – that the nature and the appropriateness of the police role was being questioned by Nicky Morgan MP. The Loughborough MP, who should be congratulated for securing the debate in the House of Commons, and ACPO lead on Mental Health & Disability, Chief Constable Simon Cole from Leicestershire Police, were interviewed on the Radio Four Today programme (approx 2hrs40mins) about the nature of mental health provision and the way in which the police become used. Many good points were very well made by both.
So against this backdrop, demand drifts to the police and the question can often arise “should the police be dealing with this?”. There are two answers to this question.
HERE AND NOW
Imagine a scenario whereby a service user had stopped answering their door to their CPN and had stopped taking medication because of a genuine belief that they had recovered and no longer needed it. Let us further imagine that the follow-up of that patient’s disengagement with mental health services was poor or non-existent and as a result of a deterioration in their condition the police needed to exercise their authority to remove the patient to a place of safety, we could have a debate about how or why it became necessary at all? Why didn’t the CPN follow it up, etc., etc.?
You could add more scenarios to this list: hospitals who fail to stop patients leaving when it would be reasonable, possible and legal to do so … not all AWOL patients are preventable, but some are. You could ask about requests for the police to convey compliant or only very slightly resistant patients and wonder why community based assessment teams don’t deploy sufficient staff, or appropriately trained staff, to manage levels of resistance that are entirely consistent with the responsibilities of mental health professionals without them being placed to risk.
I have three responses to these situations:
- A lot of policing is about officers intervening where a variety of other social controls or institutions have – for whatever reason – not worked. Some parents do not take responsibility for their children and bringing them up in a way which prevents them shoplifting or abusing neighbours; sometimes lapses of security by the Prison Service mean there is an escaped prisoner that the police have to find; individuals go out on many evenings and fail to exercise the personal responsibility needed to prevent alcohol related crime and disorder. I can’t help but wonder why any potential disgruntlement with mental health issues, may be different in nature?
- Right here, right now is potentially not the place for this conversation: if a mental health patient has absconded from hospital, all the arguing in the world about why someone did not keep the door shut, or exercise a nurse’s holding power under s5(4) MHA is doing nothing at all to find the patient. Let’s get them found and safely returned, let’s put that argument towards managers who control our partnership interface and let them sort it out.
- These frustrations tend to build in officers who cannot see police shortcomings: we know that police responses to reports of assault by patients against NHS staff is inconsistent and sometimes way short of what is required; and we know that sometimes a correct police instinct to resist involvement in something is taken too far and sometimes NHS staff or patients end up being exposed to risks. Let’s do the right thing and argue later if it remains an issue.
Whatever the rights and wrongs of the ‘Here and Now’ observations, the solutions are in proper partnership structures at all levels. Some areas of the UK do not have effective partnership structures and I know from my own experience that unless managers in health, social care and policing are meeting and discussing regularly the issues their staff face, then problems can gradually build. I’m at a loss to understand for example, why police and NHS services are changing so much about how they operate, without in some instances reviewing their joint operating policies for how stuff gets done against this changing background.
For example, we know from the Home Secretary’s speech at the Police Federation conference that she is looking at the role of the police in supporting mental health process: frankly, to reduce the amount of police time it consumes. We know that Chief Constables are doing likewise following public statements by Sir Peter FAHY, the Chief Constable of Greater Manchester Police. Sir Peter described the police service as being ‘overwhelmed’ by mental health demand.
Frontline staff need to know that managers are in rooms trying to square these circles, including by improving their own understanding of laws, guidelines and procedures. Debating the role of the police with healthcare professionals who are not sighted upon, in some cases not aware of Royal College of Psychiatry Standards on s136, the content of the Code of Practice to the MHA or NICE guidelines on Short-term management of disturbed behaviour or on Suicide and Self-Harm inevitably means we’re not being effective. I am aware that some Health and Wellbeing Boards are not including the police in their membership and yet I will have a small wager they will be considering strategic health issues that have a direct bearing on police services.
That’s why I firmly believe that frontline staff need to keep firing their operational reality into their managers; why managers at tactical, operational and strategic levels need structures to guide us through this changing landscape of public service reform and why if they don’t, we will be discussing police restraint of dementia patients in ten years time. But for whatever period we’re busy making things ‘right’, let’s keep everyone safe and do the right thing.