Across a range of posts I have written, I have alluded to what we should try to call “suicide prevention”. The police have a crucial role to play for very obvious reasons, as we are often called to crisis situations where other options are limited, or where the nature of the crisis becomes an emergency. Section 136 of the Mental Health Act is often used in the arena of suicide prevention, because it allows officers to take a coercive decision to protect someone where the legal criteria of necessity are met. However, this power is limited to public places and officers often find themselves invited into private dwellings to protect vulnerable people.
The Government will today publish a new 10-year strategy for suicide prevention. This comes against a backdrop of economic and social factors which have given rise to suicide levels, including amongst younger male adults who are three times more likely than women of similar age, to take their own lives.
Some criticism of the use of s136 is that it is considered wherever someone threatens to kill themselves and I want to spend a paragraph on this. To use s136 officers must be satisfied of the need for emergency intervention in a public place, but on the grounds of mental disorder. Is it a mental disorder to threaten to kill yourself? Not inherently. There could be any number of issues ongoing, without the presence of mental disorder, which lead to such statements being made. There are two possible reactions to this, in my view: are police officers the appropriate professional people to be making those judgements of whether a particular threat is or is not an indicator? Secondly, on what grounds should they try given that the context of that judgement will range from situations involving long periods trying to “talk someone down” from a height, or acting in an instant to prevent an imminent or expected disaster? Practicalities dictate that the longer you have to explore the context and background, perhaps to involve specialist “Crisis Intervention” negotiators, the more likelihood that officers may reach a nuanced decision that threats are not indicative of a mental disorder. The less time you have, the more you may have to assume it is for the want of time and skill to tell.
I have recalled before a particular incident of my officers and I meeting a young man sitting in a communal grassed area hear his home, drinking alcohol but far from drunk and clearly very depressed. A local resident had called the ambulance service because he was sitting rubbing a bottle against his neck and the ambulance service requested police support. Officers got there first and established that he had lost both of his parents in the previous few weeks, both suddenly and separately, and he was struggling with his grief. The bottle had caused a minor mark to his neck – not even a cut – that required no formal treatment, perhaps just cleaning. The paramedic who arrived asked us to remove him to a place of safety but having spent 20 minutes talking to him, we weren’t convinced of a mental disorder. When directly challenged to confirm that the paramedic, as the lead healthcare professional, was stating that this man was “suffering from a mental disorder within the meaning of the Mental Health Act”, he declined to do so.
So these can be complex judgements to make in some situations. The more obvious point to make, is that we cannot and should not rely on s136 or other police interventions to sustainably lower suicide rates, because by the time it comes we already have “one foot off the bridge”.
We know that men are three times as likely to kill themselves as women and we know that patients and those with unmet health needs sometimes have to find themselves with “one foot off the bridge” before they can access mental health assessment or support. We also know that about 87% of patients with mental health problems are under the care of their GP, not their mental health trust. So when patients need to access out of hours assistance, they can often hit the problem of not being known to 24/7 Crisis Services run by mental health trusts, but being unable to access their out-of-hours GP for mental health support. This often leads people to emergency services, such as Accident & Emergency, the Ambulance Service and increasingly, the police service.
Of course, none of these emergency providers are equipped, commissioned or constituted to provide anything other than the most basic intervention. The ambulance service can choose to do nothing or take someone to A&E; the Emergency Departments themselves undertake basic triage and make referral to out-of-hours mental health trusts; the police can either do that – it is rarely popular – or utilise the “Section 136 pathway” to remove someone to a Place of Safety.
Police forces are actively looking at suicide prevention and I am sure we will see later, the role of the police noted within the new Suicide Prevention Strategy, launched today on September 10th. British Transport Police in particular, have well documented problems around the prevention of suicide, not least because of the tragedy this represents to individuals, but because of the absolutely enormous cost to the UK economy of shutting railway lines for investigations. As we know, suicide rates have been rising, which probably contributes to perceptions around increased use of s136.
I am very much looking forward to reading the new Strategy and I will link it at the foot of this post once it is published, but what we can already say is that it will need to re-address gaps which we have existed for years and which we know are spoken of, time and again. I also fear that it will be unable to address the underlying political, social and economic issues which we know contribute to suicide levels, alongside medical and psychological factors.