The Metropolitan Police have set up an independent commission to examine issues around policing contact with people in mental health crisis. The only police representation on the group will be Chief Constable Simon Cole, the ACPO Lead of Mental Health and Chief of Leicestershire. Otherwise, there will be various mental health professionals. There has been some disquieted reaction by organisations such as Inquest and Black Mental Health UK and today the Deputy Commissioner, of the Metropolitan Police, Craig Mackay, appeared before the London Assembly with regard to this review.
This post focusses upon a remark by the Deputy Commissioner, the second most senior police officer in the Metropolitan Police:
“The standard operating procedure is over 100 pages long and individual officers don’t have much chance of being able to understand the complexity of it. This is why we wanted an independent commission to do a root and branch review.”
It got me thinking about this whole blog - now approaching 200 articles and 160,000 words, which is roughly two PhD theses. On just s136 Mental Health Act alone, there are 23 articles covering various issues. They were deliberately written as explanatory pieces, not operational guidelines to be accessed in a crisis. Such posts came later in the form of the Quick Guides, in order to simplify, simplify, simplify.
We can see from just overlooking s136 how complex a subject it can be. It is often said when I’ve done training or inputs on this stuff, that it is complex and this is right. We are talking about police responses to legally demanding situations, involving medical complexity, often in an emergency. Therefore we all know, that to give any operative a chance, we have to simplfy, simplify, simplify.
We should also bear in mind the frequency with which operational officers deal with different mental health jobs. In my force there are around 8,000 officers and we detain around 1,000 people a year under s136 MHA. Bearing in mind that the number of officers who are likely to come across a scenario where s136 would be exercised is approximately 4,000 is still means the hypothetical ‘average’ cop doing this stuff once every Olympics. How many MH assessments in a private dwelling – well my borough does about 1 MHA assessment a day and far fewer than half of those involve the police. So there are about 125 cops likely to attend and these jobs happen about once or twice a week – could you remember the legal complexities of such things – bearing in mind that AMHPs can’t always agree - if you’re doing it about once every two years?! Simplfy, simplify, simplify.
How easy is it to recall even simple operating models on MH jobs, if you’re doing it once in a comparative blue moon? … and let’s be frank: it is made more complex than it needs to be by the NHS -
- Some will deny officers access to a PoS for children – others won’t.
- Some operate a zero tolerance to drugs and alcohol – others don’t.
- Some will deny anyone who is resistant – others won’t.
- Some will demand officers stay after arrival, even if the patient is calm – others won’t.
- Some will say ‘excited delirium’ is a real, life-threatening medical emergency – others will say it’s been made up by the police to justify killing people through the excessive use of force!
These are just some of the things I could list … so how do we make it simple for cops?
This is where the Quick Guide series of posts comes in: written to make operational reference tools from the larger, substantive posts which tries to explain backgrounds, problems, solutions and provides links to case-law, guidance and other relevant news articles or material. The Quick Guides are more about “Consider this; bear these things in mind; take a good faith decision according to what you know and act in the person’s best interests. Now: crack on.”
But actually, s136 and Places of Safety is EASY. All of the above complexity and debates about exclusion criteria can be summarised into one brief model and this model can be applied to EVERY NHS AREA, whether or not they provide their Place of Safety services in accordance with guidelines.
This is crucial >> if they DO provide PoS services properly, it will work well and we’ll all be happy. If they do NOT, then application of the model will make the NHS part of the decision-making around where someone ends up and they will be professionally and legally obliged to account for this in the event of untoward events:
- Arrest – under s136 MHA
- Ambulance – called every time
- Assess – the clinical needs of the patient
- RED FLAGS to A&E
- No RED FLAGS to the psychiatric place of safety – it is for them to determine how much alcohol or resistance is too much, not the police.
- Police station as a last resort – if you can’t improvise around it. << Yes, improvising solutions is legal as long as it is assessed carefully.
It is therefore my view that police officers can and should apply this model, irrespective of their local arrangements because to do so would always be to act legally, against laws, codes of practice, guidelines and to act morally correctly.
Other debates about whether or not the police service could / should be involved in issues which are principally health and / or social care matters can be determined with reference to another, even simpler model – Are there any “RAVE Risks“?
Where there is “Resistance or Aggression”, we’re helping the NHS achieve their objectives to prevent crime and a breach of the peace, where there is “Violence and Escape” risks, we’re leading the operation with NHS support. This stuff isn’t actually hard.
These things can combine, for example if Mental Health Act assessments on private premises:
- Do we get involved in such assessments? >> Only if there are RAVE Risks or a s135(1) warrant.
- Having got involved to ensure safety against such risks, someone is detained under a s135(1) warrant for a place of safety? Ambulance – Assess for RED FLAGS and then one of three things … etc..
- Having got involved in MHA assessment without a warrant and someone is then ‘sectioned’ – do we convey? >> We’ll support the NHS in doing it if the RAVE Risks continue to be relevant.
Of course, senior officers need to accept that this is complex business and the breadth of incidents which fall under the “policing / mental health” banner is very wide. Professor Jill PEAY commented in her book “Mental Health and Crime” (2010) that work at the interface of mental health and criminal justice is the most complex that either set of professionals will ever undertake.
I would encourage everyone connected to this work or this debate to read Professor PEAY’s book if they get the opportunity.
I would respectfully suggest senior officers also need to reflect upon whether there force has a co-ordinated strategy around simplfying and improving policing responses in partnership, along the lines envisaged by the ACPO / NPIA Guidelines on Police Responses to Mental Ill-Health and Learning Disability (2010).
Of course, one of the reasons that police services find that mental health is made complicated, is that we deliver far less training on mental health issues in relation to the proportion of our work that this business represents, than in other areas of policing. That this remains the case is surprising for a few different reasons. If for no other reason, we know that many very high-profile tragedies in policing have involved issues around mental health matters: these have included the deaths of patients during police responses to mental health emergencies as well as the deaths of members of the public and of police officers from offenders who have mental health problems and relevant risk histories.
I remain convinced that our society’s response to the diversion of offenders (whatever that means) can unwittingly ‘stack the deck’ towards the building of hidden risks because we still have not defined what ‘diversion’ is and what we’re trying to achieve. We still see official reports talking about “appropriate diversion” without defining it. This is a problem.
It is also true, that forces which maintain partnership arrangements with several mental health trusts and local authorities often acquiesce to often to individual mental health trusts preferred arrangements which are overly localised. The law on s135(1) is the same in Bristol and Birmingham; the law on s136 is the same in Newcastle and London. So why the differences? I don’t mean differences in local arrangements, I mean why do trusts maintain differences which imply differences in law? It self-evidently obvious that the law is the same.
So we need models that take this business and simplify, simplify, simplify. This blog contains many … we can make more. The Quick Guide Series of posts turns most MH issues into a series of bullet points in under 300 words. If I can work out how to fund it, we need to develop a SmartPhone app with this material on it – meanwhile, why not save blog pages to your homepage? I’ve got stories now of cops waving iPhones at NHS staff to “oil the wheels of partnership!”
This stuff is there to be used / adapted / improved upon. Fill your boots.