When I first starting writing this blog, I didn’t quite know where it would all go and I certainly didn’t have a plan for what to write about. There were some obvious topics like s136 MHA, Places of Safety, prosecution of offenders, etc.; but I certainly didn’t predict getting into certain territories like CRB checks and specific blogs to be posted as reference tools on s42 MHA, etc., etc..
What I did anticipate to a degree, were some strong disagreements about certain things – frankly, because I’d faced precisely these disagreements in practice and thought they’d re-emerge. You can tell from some posts that what I have really be trying to do, is nail down some common misperceptions from a police point of view – misperceptions held by police officers, but also by some mental health professionals. I also hope the blog informs service users and carers whose dignified treatment and care we’re ultimately trying to ensure.
This disagreement simply hasn’t emerged. I’ve often had the edges of my own understanding tempered when I ventured into territory that isn’t on policing, in my own bumbling effort to explain mental health to cops, but what we haven’t seen is the kind of disputes that I have often faced in practice. We haven’t had, for example, AMHPs commenting and emailing that my understanding about s135(1) is utterly incorrect, and that perhaps I should go and read the Richard Jones Mental Health Act Manual. Actually, I can’t read my copy, because it’s wedging a door open, but that’s another story.
My experience of dealing with MH within the police is basically this: discuss any issue properly in a meeting and we’ll all end up more or less agreeing about what should be done. Discuss things in the heat of an incident, where practical decisions and resources are involved and we get into the cauldron of turning theory into practice where resources, approaches or underlying philosophies dissolved amidst considerations of resources, expedience and sometimes, convenience.
Sometimes, I’ve found that the law of the land can count for little: recently, an online forum sought advice about whether a five-hour wait for a psychiatric intensive care bed was ‘reasonable’ amidst a situation where a service user was described as volatile, aggressive and in a police cell. It’s the beginning of MS v UK again, although five hours is at the faster end of my experience in terms of how long it takes to get a PICU bed. We know that MH services are reducing the number of inpatient beds – one county I recently read about is reducing its beds by one-third, having already previously reduced them by a quarter. This takes general inpatient acute and rehabilitation beds from 128 to 64: overall reduced by half. You can draw your own conclusions about service flexibility and demand management from those figures.
As public sector reform continues and we all adjust to new budgets, new ways of working against old legal frameworks, we need to refocus on the “must do, should do, could do” priorities. We know that reported s136 usage is going up. We know that people are spending shorter periods of time as inpatients and being managed more frequently than expected on Community Treatment Orders, many of which involve recalls and revocations.
If you assess the way in which the country is managing deficit reduction, the public sector reform that is associated with it and the way in which mental health and health services are reacting to it, we can see a gradual tipping of demand towards policing. And yet we KNOW, that this is where tragedies have occurred in the past: deaths in custody include 17% of cases where people had mental health problems along with substance abuse problems. We KNOW that 15% of policing demand is connected to incidents where people with mental health problems have come into contact with the police. We KNOW that we haven’t properly understood the size of the problem or what we mean by ‘diversion’. We KNOW that policing and mental ill-health issues lie at the heart of what we require from our Government: our health and our safety. We KNOW that many basic services at the juxtaposition of policing and the NHS don’t operate the way we have decided they should.
We KNOW what we MUST do, what we SHOULD do and what we COULD do: all that is left, is what we WANT to do about this, if anything at all.