I’m hoping to get far more guest bloggers in during 2013 and couldn’t be more pleased that ‘The Boss’ for the police on mental health & disability has undertaken the first of these. There is loads of work going on at senior levels on policing and mental health, much of it unseen and as ACPO lead, Chief Constable Simon Cole is right in amongst it and I know he’s influencing current and future leaders of the service to think about the role of mental health in policing.
Can I start by thanking MentalHealthCop for letting me crash his blog? I must also acknowledge that he has personally done much towards getting debate and work going that helps to ensure that people suffering from mental ill-health get an appropriate service, from the most appropriate service, putting their individual needs first. Of course there is still a way to go.
In the early 1990s I was a response Sergeant working in Birmingham. I attended a call to a young woman sat with her legs over the edge of the top floor of a multi-storey car park who appeared to be distressed and self harming. With a female colleague (hello Erica) I got to the top floor and could see a very upset woman holding a shard of broken glass. I was not happy, I am not good with heights and felt very exposed indeed. Erica and I made it unseen to a concrete block within 10 feet of the woman and had a muttered conversation about what to do. We adopted 2 plans; plan A, our preferred option, was to make ourselves visible and to talk her down, plan B was that if we felt that she was about to jump or slash herself then we had to try to grab her before she went over the edge. With radios off we watched for a few seconds before the woman cut a huge looking gash in her wrist and shuffled nearer to the edge. Plan B was quickly enacted and we managed to keep hold of the woman as she tried to slash herself, dangling over the edge with only the streets of Northfield below. We then spent several hours restraining the woman in a cubicle at A+E before she was assessed as not sectionable under the Mental Health Act. She was released, to the best of my knowledge and recollection without any care plan, and within 24 hours had jumped from the same spot, sustaining serious injuries.
If we had failed in our efforts to catch her as she fell then what repercussions would there have been for Erica and I? Our decision to adopt Plan B, made for all the right reasons about a complete stranger in a split second with barely a word, would have been scrutinised, and dissected with the benefit of hindsight.
Would things be different now? The honest answer is that in some places I am not sure that they would be, in others then things would be different and the woman would not have been sat above the heads of onlookers contemplating her fate.
Much has happened in the intervening two decades. Most significantly there has been a huge shift in many, but not all, places towards the use of health-based Places of Safety rather than police cells. That can only be good. Police cells are not generally high on lists of the best places to deal with coughs, colds, or broken limbs. It seems to me to follow that they are not the right place to treat mental illness either.
So as we end one year and start 2013 there is a chance to think about what good service looks like. I believe passionately that good service can only be delivered in partnership. Really good service would stop the woman getting to a point where she is sat on the lip of the top storey of a car park in Birmingham.
What might good look like?
- As the recent MIND report ‘Mental Health Crisis Care; Commissioning excellence’ highlights there must be access to support within communities prior to the point of crisis being reached.
That might be crisis care-plans (as the Coroner pointed out were missing in the case of Sean Rigg), that might be crisis houses, that might be identified alternative Places of Safety (such as a family or friends house) as the recently initiated ‘Divert before Detain’ work in Lincolnshire describes.
- Strategic partnerships which feature evidence based joint commissioning that prioritises mental health services are key. I recommend to all partners MentalHealthCop’s ‘The Senior Officers Checklist‘ as a good guide as to what should happen.
- Police representation on Health and Wellbeing Boards, service user representation on boards and commissioning bodies, and ongoing monitoring of mental health issues through data are key. For instance take a look at the fascinating data on mental health, including spend and for your specific area;
- If detentions are made then, in line with the agreed national position, ambulances must be used to move people who are ill around. This has been achieved in the West Midlands, which begs the question as to why it is not the case everywhere else.
- Health based Places of Safety must be provided 24/7 that are adequately staffed so that officers can resume duties promptly, and so that patients can access immediate medical care.
- Assessments must be carried out in a timely way by approved and accredited mental health professionals. The Royal College of Psychiatrists is working on guidance at present on what is a reasonable time.
- Everyone involved, including police colleagues, must be trained and equipped to deal with those who are mentally ill. That includes knowledge of the agreed ‘rules of the game’ enshrined in the joint ACPO and Department of Health guidance ‘Responding to people with mental ill health or learning disabilities’
- It also includes a willingness to look for appropriate and effective diversion; that might be by identifying an alternative Place of Safety (as the law allows ‘any other suitable place the occupier of which is willing to temporarily to receive the patient’; note the word used is ‘patient’ not ‘detainee’) or by working with health colleagues to find long-term solutions that help us all deal more effectively with the kind of persistent issues that persist.
2013 will see some important moments in the policing of mental health. There is significant political interest at the highest levels of Government.
- The Criminal Justice Joint Inspection will report on their assessment of the use of Section 136.
- Lord Victor Adebowale’s Commission on mental health and policing in the Metropolitan Police will report in the Spring.
- Health and Wellbeing Boards will come into being from April.
- The National Health Strategic Commissioning Board will be created and can ensure mental health services are properly commissioned.
These will all help make a positive difference if, at a local and national level, partners work together with vigour and commitment to ensure that broken minds are treated with the same alacrity shown with broken limbs.
Simon Cole is Chief Constable of Leicestershire Police and the Association of Chief Police Officers lead on Mental Health and Disability.
The Mental Health Cop blog won the Mind 2012 Digital Media Award, in memory and in honour of Mark Hanson.
The Awards celebrate the “best portrayals of and reporting on mental health in the media.”