On more than one occasion I have been involved in the discussion that arises from the taken-for-granted proposition that the police must need “more mental health training”. From the record, at the outset, I want to say that I agree. We can hardly countenance the idea that officers are adequately trained if we are seeing independent commissions into policing high-profile events that went awry and if we are seeing the investment of millions into schemes like liaison and diversion and street triage. Even the narratives attached to these schemes imply the lack of training: I’ve noticed that mental health professionals are coming to “help” the police. Maybe.
So what would this training include. I’ve asked that many times of many people. I’ll tell you the one they don’t say and return to this theme at the end: no-one says, “legal training” on mental health law and human rights law. More of that later when I’ll also address the “help” narrative. Focus tends to be upon what I will call “recognition” issues – how can officers better identify those of us who are potentially living with a mental health disorder, in order to adjust their decision-making accordingly? How can officers better communicate and interact with us, so as to de-escalate situations that might otherwise necessitate the use of force; how can we avoid unintentional behaviours that cause anxiety and fear?
We also see suggestions that officers need to have a level of appreciation for the various kinds of conditions that are seen in psychiatry: schizophrenia, bipolar disorder, anxiety and depressive conditions and personality disorder, for example. But over the years we have seen particular representations made in the wake of events: following the Fiona PILKINGTON case in Leicestershire we hear about the importance of understand learning disabilities; the ZH ”swimming pool” case led to calls for autism training; every time we hear of force being used in situations that involve dementia patients we hear understandable representations that officers need to more about the condition.
THE MORE THE MERRIER
There’s nothing here that one could really object to, is there – why wouldn’t the police not want to know more? Well there are a couple of things worth saying on this:
We need the police to know enough about mental health to be able to police effectively, so it does involve a need to communicate in a way that minimises any anxiety or difficulty that an officer may unwittingly create; it involves a need to employ behaviours and language that de-escalate situations wherever a use of force may be required and it involves being able to work out which of us are “in” and which of us are “out” of pathways of referral or detention that officers may employ where they believe they need them.
But how much training is the required amount on any particular sub-category of mental disorder listed above. Organisations who specifically provide training will usually offer general awareness courses that last a couple of hours – for a fee, most usually. But if you list the different conditions where training could be given by a charitable group associated with it, I could easily list eight training sessions the police may need, without trying hard.
That’s a three-day training course before we have even begun to talk about mental health law, how the NHS works and how officers may apply particular laws, tactics or referrals to advantage.
I have to make a disclaimer ahead of the following paragraphs: I am not arguing here that any one kind of mental health condition is less worthy, less serious or less impactive upon people’s lives than any other condition. What follows is merely an argument about whether a particular condition is characteristically unique to mean that it requires particular consideration in police training.
To what extent would police reactions need to be distinct? Surely this must govern training. If officers are attempting to influence a suicidal person to climb back over a motorway bridge, does it matter whether they are there, suicidal, because of bipolar disorder or because of a personality disorder? Maybe it does. If the police have responded to a 999 call following a report that a member of the public is worried about someone who is acting in an agitated, distressed way in the High Street, does it matter whether that person is psychotic because of schizophrenia or because of post-natal depression? Maybe it does.
Where any vulnerable person has committed an offence whilst unwell, does it matter for the purposes of making the policing decisions whether the background is one kind of personality disorder or another, whether it is complicated by drugs and / or alcohol or whether the person is or is not known to mental health services already. Well, it probably matters that the police have enough training to make that early decision about whether someone will be detained under s136 of the Mental Health Act or whether they will be detained for the offence but once that decision is taken, it possibly doesn’t – all that stuff about the “nature or degree” of someone’s health will be unravelled in whichever location the person is taken to.
So my question about the extent to which it is necessary, strictly speaking, for the police to appreciate difference becomes important. When you sit with representatives from different organisations representing particular interests, there is a huge amount of overlap and similarity in what they say. Avoid jardon and acronyms, avoid metaphor and figures of speech, minimise surrounding confusion and distraction by turning radios and mobile phones down or off; listen non-judgementally, validate other people’s experience and given them time and space wherever that is consistent with safety. This list not intended to be exhaustive or prescriptive – if you ask how it differs to the advice officers would be expected to bear in mind for other sub-categories of mental disorder, it usually doesn’t.
The one exception I make for this point, as I have said before, is for autism. Having discussed this point many times, there are certain things you might add, as we saw in the “ZH” or swimming pool case, as it is often known. Autism is the only sub-category of mental disorder (if it is such a thing at all), that benefits from its own legislation, the Autism Act 2009. It is worth remembering that autism is a spectrum condition, affecting many of us in a wide variety of ways and those who live with autism can be affected by particular stimuli and can be especially affected by the bright lights of strange behaviours of policing. Worth looking into in more detail, for certain and there is a good guide for CJ professionals on the National Autistic Society website.
MENTAL HEALTH LAW
I mentioned the lack of legal training in the training ideas – this is probably the single most important point in the training debate, for me. As police officers, we should be very aware of how our actions fit into the law of the land – more precisely, we should be aware of how our actions are determined by the law. I’m not just referring to the Mental Health Act, the Mental Capacity Act and to those parts of the Police and Criminal Evidence Act 1984 that affect investigation and custody; I am also referring to a proper understanding of Health & Safety Act 1974, the Human Rights Act 1998 and other ad hoc pieces of legislation that affect this Venn diagram from time to time.
You can turn me into a mental health nurse if you want to, but if I don’t know whether or how the Mental Capacity Act 2005 is implemented when necessary, then it all amounts to very little. My ability to turn up to any operational incident and either assess whether someone is “within” the consideration of particular pathways and approaches because of mental disorder, but also that this possibility arises from a personality disorder is probably not as important as knowing how s136 of the Mental Health Act needs to work to ensure that people are kept safe and treated with dignity after its use. It is probably more important that an officer executing a warrant issued to an AMHP under s135(1) knows the law around how the warrant is executed, what can and cannot be done, how the conveyance must occur once someone is detained – given that the officer will be accompanied by a doctor and an AMHP, to what extent does it matter that the officer could not explain the difference between Alzheimer’s and dementia?
Of course, none of this means that officers should not be taught about autism or Alzheimer’s – far from it. It is merely a question of extent and determining what purpose that depth of training services, not least because there is a reality to be acknowledged here: training time is finite. Most officers have had about 4hrs of training as a national requirement (it has since gone up) that was supplemented along the way with an e-learning package and whatever local training was deemed necessary. Not all areas deem local joint training to be necessary so even if we were to obtain a mandate for new training, what form would this training take and how long would it last – a day, or two? … a week?!
TWENTY EIGHT DAYS
Whatever your answer to the potential timescale, remember that form follows function and we need to get back to what we actually expect our police to do as a result of their training. It is not their role to diagnose particular conditions and there is a very strong argument that they couldn’t do this even if we wanted them to – we know from decisions taken in police custody by mental health professionals that it is occasionally necessary to detain people in hospital for up to 28 days to get a full assessment of the particular condition someone may be experiencing and to understand fully the “nature or degree” of that condition. So what chance a police officer in an operational incident can work this out when the fifth most important thing on a list of important things may be whether someone or not someone is suffering form a mental health disorder and what that particular disorder may be?
The last time I dealt with an operational incident at work involving someone who was found to have a mental health problem, all of the key decisions required of me and of the police were done before it became important to understand his health history. All of them. The slower-time, detailed decisions around mental ill health were taken later in a controlled environment, involving medical professionals. By the time the next set of important police decisions was needed, officers’ ability to distinguish this condition from that condition was not relevant or important because it had all been handled during a full assessment under the Mental Health Act. Once this was completed, it was back to legal decisions about whether or not diversion into the health system should take priority or whether it would be necessary to prosecute the man. Officers allowed diversion whilst retaining the person on bail – the correct legal decision.
So here, I am putting an argument that some training on mental health conditions is needed – indeed, vital. We need an overview of functional and organic conditions, including affective, autistic spectrum and personality disorders – we need to know how risk and immediate care are affected by drugs and alcohol. Police officers need to know how this all relates to approaches and decisions that they may need to take focussing on difference, only where it is necessary to those conditions and the law. Beyond that, the need for training is about the legal framework that governs police operations as well as something on the underlying philosophy we expect officers to take when exercising those judgements: what, precisely, are we asking them to achieve and how?
I suspect this will have to fit into a training day – one seven hour day that contains coffee and lunch breaks, so we need to be prioritise the “need to know” from the “good to know” and this will involve tough decisions. My personal view for some whilst has been that we should be selecting a certain proportion of officers across 24/7 and neighbourhood policing functions and giving them substantially more training – perhaps 3-5 days. I can almost hear the reactions of some senior officers to that suggestion, but I’ll be frank: I’ve been doing the same three-day public order training course every year for the last ten years or so and yet in that time I’ve had no mental health training.
With mental health related demands comprising twenty percent of policing demand, is that sustainable given that we are where we are with this?
NB: What’s the next number in the sequence: 2, 4, 6 … ? If you thought “8″, you’re leaping to conclusions as it could equally be “10″ and you ultimately don’t have enough information to know.
The Mental Health Cop blog
– won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs
– was highlighted by the Independent Commission on Policing & Mental Health
– was highlighted in the UK Parliamentary debate on Policing & Mental Health