Mark Winstanley, Chief Executive of Rethink, a major national mental illness charity, has written to the Home Secretary and the Health Secretary, asking them to order a pause in the roll out of the Right Care, Right Person (RCRP) programme. This follows charities like Rethink and Mind receiving feedback from those of us affected by our mental health stating people are being placed at risk. “The police must keep answering mental health calls” is the Guardian’s headline for this.
Although the article is light on detail, it cites “a series of tragic deaths” as the basis for calling for a pause, along with a reference to inquests and a letter from the ambulance service which states patients and paramedics have been placed at risk, including where the police have not responded to incidents where the so-called “threshold” for RCRP is satisfied.
“A mental health crisis is an emergency, and plans drawn up on paper have to work effectively in someone’s hour of need. Every second counts in a mental health crisis, and so it’s vital that the process works smoothly and that the most appropriate, trained professional can be quickly on the scene to reduce any risk to life.
We’re all in agreement that in most cases, the police are not the best agency to support people in severe mental distress. And we believe the Right Care, Right Person scheme has a future, provided it is rolled out carefully.
But monitoring the initial impact, we’re growing increasingly concerned that forces have stepped back too quickly, without the proper checks and balances in place alongside the resources needed to plug the gap.”
A LOT TO UNPICK
Those who’ve followed this blog over the last year in particular will know I have one or two thousand questions about RCRP, but that I’ve been arguing for over a decade for something which does address the over-reliance upon the police as a de facto, crisis-care provider. I’m under no doubt at all people have died because of this over-reliance and all too often, deploying police just because there is no-one else to deploy can be without utility, at best and quite futile, at worst. But that said, the debate which surrounds how this is being unfolded and rolled out fascinates me because there are risks in any approach to this as well.
When Humberside Police first did this, after 2020, they had 18-months to 2-years of partnership work where they sat down with their NHS and other partners to outline why they felt the had to do this, what the legal and ethical basis of it was and how it would be phased in its introduction. RCRP is about changing the police’s approach to four things: a) welfare checks; b) hospital walkouts, including AWOL patients; c) conveyance; and d) guarding s136-detentions. The Metropolitan Police caused some consternation when Commissioner Sir Mark Rowley QPM informed London’s partners in May 2023 that RCRP would hit the capital in September of that same year – 5-months’ notice.
In the end, because of pushback at how rapid this was, RCRP began in late October 2023 – so 6-months’ notice.
This business about “directing” the police to still attend is also in need of unpacking and we need to remember how ambiguous the real world is. Those officers making decisions about whether to deploy police officers tend to be the staff in control rooms or those supervisors, usually sergeants and inspectors who oversee police 999 response teams. You cannot, realistic say “you must keep answering all mental health calls”, not least because “mental health calls” doesn’t mean anything specific. Are we saying, for example – and it’s a real example – that if someone rang up the police and said, “I can’t get my son’s GP to come and see him about his mental health and he needs help” the police should respond to that?
THRESHOLD
This is why the law has always imposed a threshold on what we want the police to do – whether people knew that threshold was there and whether people acted accordingly are separate matters entirely. In our last example, it would be essential to know why he needed help and what was happening whilst the family were trying to get support. If the young man was harming himself (or anyone else) with an implement or putting himself at risk on high buildings or bridges, then this starts to look like something the police should be involved in, no doubt at all. But what if it’s all less acute, a much more generalised concern? … should the police really “keep answering mental health calls”?!
In that real example, from a time way before the RCRP-era, the police service contacted declined to attend, stating the family need to keep trying the NHS and take advice about how to get support. If the GP is non-responsive, for whatever reason, perhaps a complaint is justified and the NHS operates a 111-telephone service which could advise further, including in some areas an “Option 2” for mental health support. The NHS also operates an ambulance service and a network of emergency departments, if that were relevant. Nothing about a more generalised concern for a patient’s welfare screams “police”.
Of course, the concern being voiced now – by both the Association of Ambulance Chief Executives and by Rethink – is the police are non-responsive even where the threshold is met. I’ve been contacted by a number of mental health professionals in recent months, offering their summaries of incidents which have led to someone declining to deploy police officers and taken at face value, plenty of the stories are concerning.
NORFOLK
It was highlighted by the Guardian that Norfolk Police had “suspended” its introduction of RCRP after four bodies were discovered in a house in the county in January. We know from early February that Norfolk had decided to pause the introduction and I haven’t read anything from them since then – so I’m unclear whether the Guardian is referring to the ‘pause’ from February and is just confused or whether Norfolk Police has more recently said more to suggest further or longer delay. Either way, investigations are ongoing in to a 999 call made by a man who was advised to contact the NHS and around 70-minutes later police were forcing entry to a property where it looks like one person has killed three others, before then killing themselves.
Now, Norfolk Police had not formally introduced RCRP at this point but it was so close to introduction that one has to imagine staff had completed their training in preparation for introduction in the immediate weeks which followed the incident. This hints at something else flagged by Mind when its Chief Executive Dr Sarah Hughes gave evidence at the London Assembly session on RCRP. She pointed out her charity is receiving feedback to suggest some forces are “doing” RCRP in practice, even if it has not been formally introduced in partnership. It fits with other information the ambulance service seem to be offering up: they are seeing a rise certain types of demand as police forces decline to attend certain calls including in areas which are not yet “doing” RCRP.
But whose job is it to attend a property to check on someone’s welfare? I had to see my GP recently for my fat-man-almost-fifty MOT and I asked him if he’d heard about RCRP – he hadn’t. I mentioned some police forces might decline to help, for example, if a patient hadn’t turned up for an appointment and the surgery were worried the person needed to be checked. He seemed stunned, quite honestly so much so he must have misunderstood me to start with because he asked “But they’d still do a safe and well check, wouldn’t they?” … well, not unless there was an immediate risk to life or some other wider justification. “Oh … really?!”
AMBULANCE DEMAND
The ambulance service’s letter to the chair of the Health and Social Care Committee says a lot about all of this –
They seem to be seeing a rise in demand because of RCRP and we all know how the ambulance service was already struggling over recent years. But there are things we need to say about this. You could say it’s entirely unfair for the police service to off-load that demand to ambulance, knowing it’s barely more appropriate for paramedics than it is for police officers. On the other hand, when the Chief of London Ambulance Service gave evidence at the London Assembly evidence session on RCRP in the capital, he did acknowledge those now being signposted to the ambulance service were people in need of healthcare services – just not necessarily an ambulance.
So you can take your pick from all that as to how things are going – my sense of things is it’s just a little out of control now and I’m not sure how easy it would be to pause and reset. The legal reality has always been: nothing prevented any call-handler or police officer from making the kinds of decisions which RCRP is now attempting to formalise in to a systemic approach. In a very real sense, no-one can just say “keep doing the welfare checks”, because the whole point behind that was police can’t really do welfare checks anyway and are only under a qualified obligation to do so in the first place – I’ve written about this before. They can tell you whether someone is at a location and whether or not they have significant illness or injury requiring first-aid or an ambulance but beyond that?! … no police officers can do mini-mental state examinations or rely upon the answers patients give about things like intention to self-injure. Patients themselves have explained many times how they may be less-than-truthful about disclosing private, sensitive health information to police officers who may decide to detain or arrest them as a direct consequence of those disclosures.
So how do we move forward? –
In 2014, the Government, NHS bodies both national and local as well as local authorities all committed in the Crisis Care Concordat to putting in place the infrastructure which would reduce ongoing over-reliance upon the police service (and the wider emergency system) as a crisis care provider. Many years later when it hadn’t happened despite such a high-profile initiative backed by the (then) Home Secretary Theresa May, how long do the police keep doing the wrong thing on the repeated promise of changes to come which never materialise? But then this is more complicated than RCRP sets out to suggest: some of the things which do not legally sit with the police do not legally sit with anyone – therein all you have is unresolved dispute about what the “Right Care” and who the “Right Person” actually is.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 