Portcullis

Inherent Contradictions

TrueFalseIn the police, we take deliberate decisions to ruin lives and we do it every day. In so doing, those decisions often bring officers into direct conflict with the aims of other organisations, including other public sector authorities. Although this feature of our work does not make us unique, we have that duty to act in a broader public interest, often at the expense of individuals.

So you sometimes see police officers prosecuting drink drivers knowing full well the consequences of doing it will be that some man loses his job (because he drives for a living) and that such problems may lead to other aspects of his life falling apart: an inability to pay his mortgage now he’s lost his job, consequential relationship difficulties and broader family breakdown. The decision to prosecute will affect third-parties, but we do it anyway, because of the imperative to reduce road deaths (still floating at more than triple the murder rate, incidentally) and to bring to justice those who would put us all at risk. We also see police officers taking decisions to put young people into the justice system in circumstances where we know that it will massively affect their educational attainment and broader life-chances as an adult. Perhaps not justified if they’ve shoplifted once or even twice, but if they’ve just robbed someone at knife point against a history of violence and acquisitive crime, it may well be necessary to do this in the broader public interest.

All of this appears to be done in the hope that subsequent services – whether they be health and social services, the criminal justice system or both, can reduce re-offending. But we must not lose sight of the “lock them up” dimension for people who have committed serious acts of violence, including sexual violence.

THE GATEWAY

PortcullisThe police are also in a somewhat unusual position of being gateways to both mental health and criminal justice provision and it is a weird position to be in, given considerable debates concerning those systems’ effectiveness. We know that many organisations and charities question the effectiveness of our prisons – “an expensive way of making bad people, worse”, etc.; – and we have seen movements over the last fifty years that question the long-term effectiveness and even the fundamental validity of psychiatry and wider mental health services.

We would anticipate an outcry of outrage if the police started making judgements of what to do based upon certain impressions of what mental health and criminal justice systems may do but I’m not clear that would necessarily be justified given the mission of the police:

To prevent crime: nothing more, nothing less — so all bets are off.

There it is, at the bottom of it all – an inherent contradiction between what we ask our police service to do for us and what may be in the long-term interests of individuals or our society.  We sometimes initiate proceedings that send people to prison for many years, causing their previous lives to fall apart and their mental health to be seriously affect – the criminal justice process itself is, for many, a pathway to poorer health and mental health.  Yet despite all of this, it may well be a pathway we still need to go down and in reality the police do make judgements about whether the criminal justice system will make things worse.

Is there a role to say we should do likewise with mental health?  Police officers are not clinicians, but we do know from published research that diverting people from justice is not always effective, either in terms of individual health or long-term health or crime outcomes. I think this is a debate that needs to start and about which research needs to be done: are we ever making things worse by diverting people from justice to health?

It’s about attempting to weigh the public interest amidst uncertainty about how effective outcomes will actually be.

LIAISON AND DIVERSION

WMPSo this is where I’m going with this? At 5am the other morning, I detained a man who had threatened another with a knife. It was obvious within seconds he was a man who was acutely distressed and by about ten-past five we knew that he was flagged up all over police systems for a history of mental illness as well as violent behaviour – I’m not necessarily saying these things are linked. I wrote in my notes that I queried that he was seriously mentally ill and when I went to work that following night, I learned that he had been detained in hospital under the Mental Health Act and retained on police bail so that a view may be taken at a later date, after his health has been prioritised, as to whether he should be prosecuted. A view may be taken that he posed a “serious risk of harm” to the public and that if continued detention under the Mental Health Act were necessary, maybe it should be dictated by Part III in the criminal courts? Who knows?!

But on two levels the consequences of police action could make this situation worse, in the long-term: if he is retained within the mental health system and not prosecuted at all or if he is prosecuted within the mental health system under Part III MHA, it could be that the action is the beginning or a part of a long-term relationship with that system that worsens the likelihood of his overall health outcome. Perceptions of dangerousness that lead to a long-term compulsory relationship with antipsychotic medication and all the side-effects we know this holds. If he is prosecuted and managed within the criminal justice system, we know that outcomes for re-offending are questionable and that this may also come at a greater cost to his mental health than would otherwise be the case.

WHAT ROLE FOR THE POLICE?

WMPSo what am I saying?

It is the role of the police to make judgements about when something has become serious enough for them to take a decision to intervene in situations where they risk making things it worse in the short-term, but in the hope of a positive long-term outcome. That said, I’ve argued for years, to my cost, that we need better research about the efficacy of outcomes and if we are to get anywhere close to an aspiration of “evidence-based policing”, we need to make sure that research is top quality. << That last sentence is a direct dig at the quality of the research we often see relied upon in mental health and criminal justice, for the interventions upon which we rely.

I often worry that I go to work and make things worse in the long-run, amidst the expectation that I will insert a crude, short-term intervention into a certain type of situation by referring things to rehabilitation experts in mental health and criminal justice, who are far from able to show that impact. I’m also conscious that as things currently stand, we have little other option but to keep doing so.

The criminal justice system exists to stigmatise just some people, selected from amongst us and at a cost to their health and our broader economy in just some cases. We cannot get away from that when we are making prosecution and diversion decisions which are inherently about far, far more than one individual’s wellbeing and we need to make sure that we understand these interventions far better in the future to evaluate liaison and diversion schemes.

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– won the Digital Media Award from the UK’s leading mental health charity, Mind
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4 thoughts on “Inherent Contradictions

  1. Excellent piece as always, thought proving indeed. I often wondered though during my time as a mental health nurse how many times criminals used the mental health route to avoid prosecution. I think that this is an issue that would have to be dealt with in the same research you suggest. It is also why I say that if MH nurses are going to work in custody suites they will need to be very experienced within the acute setting. I remain puzzled where all these nurse are going to come from!

    1. Yes, I agree. Pleased to say my previous blog on the new L&D schemes has reached the attention of the National Programme Director who is ringing me on Tuesday for a chat about it all. My main concern is the conflict that could arise when cops who look at MH staff as “the experts” forget that they are experts in MH, not CJ and that some decision-making will still need to result in sound, robust police decision-making to ensure that only the right people leave the CJ system after offending, never to return to it.

      It has to be a proper partnership predicated on respect and not, as we have seen, an assumption that expert professionals are coming to help the (thick?) police get it right. Different roles / responsibilities.

  2. Nice piece, thank you. I’m a child and adolescent psychiatrist and work especially with young people who get labelled as “complex” or “hard to reach”.

    You seem to address something that I am quite preoccupied with – what has been referred to as “Dis-integration” – i.e. the ways that (I would argue quite ordinarily, and inevitably) different parts of complicated systems (Police, Social care, Health, Housing…) can end up pulling in different directions, rather than doing what all the reports ask us to do – which is called “integrated working”. This doesn’t happen out of malign intent – I have never in 20 years encountered a worker who I really think gets up and goes into work with the intention of stuffing up the coordinated care planning around a vulnerable youngster (I am not saying that such people don’t exist – just that they are very rare!) With colleagues at the Anna Freud Centre charity, we have developed an approach for these kinds of young people and have run quite a lot of trainings with teams all over the UK, often including colleagues from Police, Social Services, along with mental health workers. All our material is freely available on the web here: http://ambit.tiddlyspace.com and if you search for the phrase “Dis-integration” you will find how we help workers to try to minimise this. Step one is probably for us to to become more forgiving of each other!

  3. I wish MH services were as reflective….of course they can’t be or the full horror of what they do would soon home into view….

    From Moncrieff

    “is that in ordinary practice, psychiatric diagnoses are applied to whoever presents themselves or is presented to psychiatric services, unless a good case can be made that they should be dealt with by another institution. Psychiatric services simply apply a diagnosis to whoever they are asked to deal with. The diagnosis signals that the situation can be re-interpreted according to a medical framework. This framework obliterates the memory that what psychiatric ‘treatment’ consists of is a particular social response to certain problematic behaviours. It conceals the fact that the response could be different. As Ingelby points out: ‘If it were accepted that the meaning of the label were simply to signal a certain organisational response, then questions would immediately arise about the propriety of those responses”

    http://www.palgrave-journals.com/sth/journal/v8/n4/full/sth200911a.html

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