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Police

Are We Failing Police Officers?

TRIGGER WARNING:  this post discusses suicide and mental ill-health very specifically amongst police officers – those affected by these issues should carefully consider whether or not to read on.  There is support available via the links and phone numbers at the bottom of this page, if needed.

Two separate news articles from opposite sides of our planet caught my attention this week: each of them referring to suicide and mental distress amongst police officers.  In the state of Victoria in Australia, the Chief Commissioner has set up two separate, but clearly related, external inquiries into police deaths and depression.  These reviews emerged after seven police officers in the last two and a half years took their own lives.  Set against a workforce of over twelve and a half thousand, that number may not seem large but that department estimate that as many as thirty officers are currently at risk of suicide.

Meanwhile, a police sergeant in Toronto took his own life after leaving a suicide note specifically attributing his decision to work-related issues and his battle with PTSD.  His family is calling for the inquest to examine the officer’s claims against a background that includes other police suicides and a former police sergeant’s criticism of the support he received for PTSD.  And let’s face it: these two countries are not alone and this issue does not just affect police officers. There are more deaths of US police officers after suicide than after homicide each year.  Queries a year or two ago to Her Majesty’s Inspectorate of Constabulary revealed that police forces here do not collate data on suicides, but we know there have recently been several and that policing in the UK is considered one of the higher-risk professions.

So, are we failing police officers? … or emergency first responders?

POLICING AND MENTAL ILL-HEALTH

Mental ill-health in policing generally is a subject we don’t discuss very much: having asked these men and woman to go and do a pile of stuff the rest of us wouldn’t do, it should come as no surprise that the police, like paramedics, are four times as likely to suffer from stress, depression and anxiety when compared to the population as a whole.  When I do talks that touch on the broad subject of mental health and policing, you often find questions asked about mental health in policing.  You don’t have to look hard to find something to say, either – individual anecdotes of suicides by serving officers, perceptions of in-house support and more general comments about the extent to which we don’t seem to have fully understood this.  We know from research that acute levels of stress in policing are probably connected to non-negligible levels of mental illness.

If you spend even a short amount of time on social media, you will bump into numerous examples of current and former officers living with mental health issues and plenty of those will say that they felt unsupported at key times.  It must be said, that prevalence of distress and suicide risk has been linked in some instances with criminal or disciplinary procedures against officers so it is always going to be difficult in some cases to be both impartial prosecutor and supportive employer.  I’m aware of several legal actions ongoing by former officers under employment law for alleged failures in a duty of care or because they have alleged failures to support employees suffering from mental distress or give proper regard to mental ill-health when it comes to personnel processes.  Of course, mental health problems are classified for the purposes of the Equality Act as protected characteristics.  Officers who experience mental health problems at work are – in theory, at least – no different to officers who become physically disabled after an assault or accident.  And as with physical health problems, disability can arise for all manner of reasons, including work related reasons.

So where is the narrative that talks about police work as a line of work that can carry a cost in terms of mental health?

Asking this question is not to ignore that other professions – including other emergency first-responders – are also at raised risk of inflicting psychological distress upon their staff.  In particular, rates of PTSD in police officers (and in other first-responders) are concerning.  More concerning still, are the support mechanisms available in many cases.  We know that amidst public sector cuts, some police forces are having to reduce the counselling and other support that is able to be offered to staff and that NHS support for counselling and CBT can involve as much as an eighteen month wait.

POLICE SICKNESS

NSYThe demographics of recruitment and retention don’t help trends in police suicide and mental ill-health.  Reporting on suicide in the population as a whole puts young and early middle-aged men right in the danger zone, when it comes to predicting overall probabilities.  The Samaritans produced a very comprehensive report on suicide in the UK and Ireland this year and it provides detail on age and other demographic factors.

So in a profession that is still comprised mainly of men, the profession-level risks become amplified and obvious.  Every time I read initiatives about male mental health, I must admit I think about my predominantly male colleagues up against a culture that suggests you should be able to cope and a structure that may struggle to support you anyway.

You can see clues about police culture all around and much academic time has been given over to studying it.  Suffice to say here: none of the seven police officers in Victoria who took their own lives sought help from their employer.  So where suicide is the leading cause of death generally in men from certain age groups, we should be concerned about the risk of suicide in a profession that has higher than average rates of psychological distress and mental disorder and which is predominatly male.  Of course, female officers are affected too and whilst female suicide rates are much lower than those for men, female rates of self-harm are much higher.  It means we need think about how staff may be differently affected and think way beyond suicide.

The above report from the police in Victoria is not the first to make the claim that more days are lost to sickness in the police to mental health and other psychological problems than to physical health problems.  And sickness days lost to stress, depression and anxiety is on the rise.  Reports suggest that since 2010, sickness arising from mental health and psychological problems is up significantly.  In the North East of England, three police forces reported percentage rises of 260%, 122% and 37% compared to three years previously.  Even a 37% rise is significant and despite my efforts, I couldn’t find a news article suggesting that any UK police force had seen a decrease.  Let me know if you find one.

It’s worth noting the emphasis placed by forces upon the potential for personal circumstances to give rise to this trend.  In response to the story of north-east forces as well as elsewhere, senior officers have been keen to stress this and of course, that will be part of it.  But it must be said, there seems to be a lack of acknowledgement of the role that police work pays in causing distress and illness amongst officers.  In 2007, psychological problems were listed at the top of those reasons that cause long-term absence in a report by the Health and Safety Executive.  It would be really interesting to read an up to date version of this report.

IT’S TIME TO CHANGE

For some while now, I’ve felt that we need to see the development of a charitable organisation specifically aimed at supporting police officers (or 999 personnel as a whole) suffering from psychological distress and mental health problems.  I keep seeing the effort, the work and the impact of Combat Stress in drawing attention to and supporting our Armed Forces Veterans.  The issues in policing and emergency services work being different, with obvious overlaps, it strikes me that there is a gap that needs filling.  So it seems we could be doing a whole lot more and talking about this would be a good start – the Time To Change initiative has long since focussed its message on the importance of an open dialogue about mental health problems, but they also highlighted that policing is in the top two professional groups to be comparatively unaffected by its campaigns.  Yet how many times have we heard police officers who have found themselves living in distress say something similar to, “I would have thought I was the sort of person to affected by mental health problems.”

There is the knuckle of the problem – there is no type of person.  It’s about the broader human condition and the way we live our lives.  In my humble opinion.

Are we failing police officers? – let’s just say we have a long way to go.  Who’s protecting the protectors?

NB:  if you have been affected by the issues in this post, you can talk to the Samaritans for the price of a local phone call on 08457 909090.

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BadgeThe 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

 

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The Public Interest

I keep encountering stories of incidents where potentially very serious crimes may have been committed and the criminal justice system appears to take no action because we have ‘transferred the person into the care of mental health professionals’ or similar.  Responses to crime where we fully and completely divert people into the mental health system without necessarily knowing the nature of the relationship between a suspects mental disorder and the act they are alleged to have committed.  That is, if there was any relationship at all.  I first wondered about all this when I was a custody sergeant – it seemed to me that if someone came into custody for an offence with mental health problems, they were never prosecuted if they were thought so unwell on that day to need hospital admission.

It seems fair enough that we give priority in most circumstances to health issues, but surely that isn’t the end of it if the original offence is serious? … or where someone is offending a lot?!

It’s all about how police officers and prosecutors interpret Home Office Circular 66/1990.  This is the current – yes, the current! - government policy on diversion of mentally disordered offenders from the criminal justice system.  This document is now approaching its twenty-fourth birthday and has not been superseded or updated.  It’s really is worth clicking the link to see a facsimile copy of a typed document! … that is how old our current government policy is.

It’s all very twentieth century, along with our mental health laws.

IN THE PUBLIC INTEREST

I often wonder about crime incidents where no specific reference is made in the police press releases we see about what is going to happen next.  For example, a man in Essex recently discharged a high-powered air rifle towards police officers and mental health professionals who were there to conduct an assessment under the Mental Health Act.  Having shot at them nine times he was swiftly arrested but all we currently know is that he was sectioned.  What happens with the firearm side of things? … if you shoot at the police nine times you generally expect to face a judge at some point so I would always expect to hear why this isn’t happening or that the investigation is continuing pending more becoming known about the suspect’s mental ill-health.  It’s about the public understanding how they are protected from future armed threats without a prosecution that has the potential to imprison someone.

I use this merely as an example because of the wording of the media coverage: not being involved in this particular case it may well be that the investigation is ongoing and the man is on bail.  My point is that we don’t know because this sort of thing isn’t mentioned by press releases.  Some may be wondering what business it is of the public to know this information, given that someone being sectioned is a medical matter and attracts considerations of confidentiality?  We saw following the murder of Christina EDKINS in Birmingham (2013) a press release which announced the suspect had been sectioned and it made no reference to the investigation continuing – it inadvertently created the impression that him being sectioned was the end of the matter and there was a predictable public uproar, especially on social media.  Whether we like it or not, the investigation of and the police response to serious crime is something which attracts public interest and it is in the public interest to understand why some of us who offend seriously are not prosecuted.

You will notice in some other high-profile cases in recent days that we have been told suspects are retained on police bail after being sectioned under the Mental Health Act.  I would like to see this more often – it either reassures the public that matters are still looked into or ensures we explains why they’re not.  The recent examples include the 47-year-old man who was arrested for a bomb hoax on a Qatar Airlines flight into Manchester Airport; and also the 23-year-old woman who was arrested (by my response team) on Monday evening on suspicion of administering a noxious substance to numerous people in a residential care home.  In each case, the inquiry is still active despite the person being ‘sectioned’ and both police forces were content to say so.

This means that once psychiatrists have established the nature and degree of any mental disorder, they can then decide what support is required and whether or not a prolonged stay in hospital under s3 of the Act would be necessary.  In due course, investigating officers can determine whether the psychiatric issues and the broader circumstances of arrest still give rise to the need for a prosecution in the public interest.  If a prosecution does follow – which it usually should for indictable-only offences, those triable only in the Crown Court – then Part III of the Mental Health Act 1983 allows the courts all the options it needs to manage any risk to the public whilst still ensuring that people receive any necessary treatment or care.

OUTCOMES FROM DIVERSION

Let’s not forget this: diversion was never intended to mean that people responsible for serious offences do not face justice and in the main we do expect to see people charged where they have committed more serious matters.  Being charged and going to court does not presume guilt, but it does allow the courts to request full psychiatric reports and allows them to weigh the circumstances – criminal courts have a huge range of options available to them that are not available to the police and prosecutors or to doctors and AMHPs.  We should never forget that most people who are diverted from police custody under the MHA after arrest for an offence are under section 2 of the Act.  This simply means that mental health assessment is occurring against a certain. background and it may conclude that there is nothing to know. 

Examples exist of patients being sectioned only for the conclusion to be reached that they are not mentally disordered – at all!  So imagine if this conclusion was reached after someone had been arrested for a serious offence and then diverted? … what happens with that original allegation and the victim’s rights to justice?  Perhaps nothing, unless the suspect had been retained on police bail when sectioned or otherwise followed up by an investigating officer who didn’t close their mind to the possibility that someone’s mental health problem may be quite incidental and entirely unrelated to the original circumstances.  Perhaps more importantly, diverting people from justice and taking no formal action on criminal allegations assumes a relationship that often just isn’t there:  mental disorder does not usually cause criminal behaviour.  There are normally other contributory, far more important variables in play likes drugs and alcohol.  And even if you did have a case where someone’s mental disorder was a causative feature of a serious offence: Part III of the Mental Health Act may still have a role to play in balancing public protection and the right to treatment.

Hospital Orders are the main sentencing option in Part III – they authorise the inpatient admission of those who have committed acts of crime, irrespective of whether they were found guilty of an offence or whether they were thought to be insane or unfit to plead or stand trial.  The fact that hospital orders can be imposed both with and without conviction is what shows us that the law makes no assumption about the relationship between mental health and criminal offending.  Where a hospital order has been imposed – whether or not it was restricted under s41 – the person concerned will then be subject to MAPPA processes upon discharge from hospital.  MAPPA will ensure a risk management plan is drawn up after information sharing across relevant agencies and this will form the basis of ensuring as far as we can, that any risk of further offences is minimised.  But MAPPA only applies to mentally disordered offenders who have been made subject of a hospital order. 

If you don’t prosecute someone for something, you can’t get a hospital order which means they will never be subject to MAPPA and other risk management processes that the police service and probation services have.  All well and good if that offender was arrested for shoplifting in an isolated incident but not if they’ve shot at the police nine times causing the AMHP to be run for their life or if their offending behaviour is more serious and / or repetitive.

I’ve written specifically about my vision for liaison and diversion elsewhere on this blog and it addresses what I see as real shortcomings in the way we hear these new services currently framed.  We need to be thinking about potential sentencing outcomes and public protection frameworks when suspects are in police custody otherwise we will end up building hidden risks and that is not in the public interest.

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BadgeThe 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

 

CoPcrest

College of Policing

A few months ago, I was asked if I would write a short piece for the College of Policing newsletter to coincide with Mental Health Awareness week.  I never did get ’round to publishing it on the BLOG, so here it is, reproduced below.  Remembering to do this now nicely coincides with another development for me personally, which involves the College of Policing —

From the start of September, I will be seconded from West Midlands Police to work for the College full-time on mental health issues.  After more than three years of “mental health policing” not actually being my ‘job’ and my efforts to contribute to this being mainly via social media, I am about to start a full-time posting which involves me having the opportunity to focus upon nothing but this.  Exactly what this role involves will emerge over coming weeks as I’m sure the College will have in mind a list of things they’ve been asked to do and the new ACPO lead on mental health, Commander Christine JONES from the Metropolitan Police will no doubt make her views known on this matter, too!

I couldn’t be more chuffed about all of this – and before publishing the newsletter piece below, I want to finish on a slightly naughty point, concerning something I said in 2011 as my previous posting on mental health came to an end.  I had a strong conviction leading up to my return to operational policing that the profile of mental health issues within policing was still rising and that we were far from having sorted it all – very far from it.  More and more forces were appointing mental health leads to drive this agenda, more senior officers were becoming interested in it.  I had previously been seconded part-time to the College’s predecessor organisation, the National Policing Improvement Agency and saw for myself the efforts some police forces were beginning to put into this area of work and the extent to which a few were still sleep-walking.  I had a strong feeling that there was still a lot more we could and should do and those ideas instead became the material you’ve read in this BLOG over the last three years.  It was partly written so that when questions flew my way, I could point people to the BLOG rather than keep answering the same questions – a bit of self-preservation and demand management – but it was partly to outline how much further we all need to travel.

So in February 2011, with that sense of a job not yet done and with queries flying my way from around the country as new officers began the steep learning curve of being required to work on mental health without any training on the matter, I remarked to a former boss of mine that I thought I would keep being sucked back towards this work and that the phone would probably ring around August 2014 with an opportunity to get involved in this again because more needed to be done.  It turns out I was wrong: but only by the small matter of eight hours!

So a very exciting new opportunity beckons me – to be a part of developing and updating training and guidelines within the College of Policing that will be used around England and Wales by all police forces and to support those forces, if required, in taking forward the increased focus that is now being given on policing and mental health.  As this secondment was being negotiated, the College asked me to contribute to their newsletter and this is what I wrote

COLLEGE OF POLICING NEWSLETTER

There is much to be said about policing and mental health that could improve the world.  We could talk about fairness in health funding or how NHS services are commissioned and delivered. We could get extremely specific about place of safety services, ensuring a proper response to incidents in private premises or the difficulties encountered when managing vulnerable detainees who are also intoxicated by drugs or alcohol.

However important all of that is, absolutely none of it – ultimately – is within our control and I have long since thought that whatever our view of our mental health system or wider NHS, there is much that individual police officers, individual police forces and now the College of Policing could do to improve our ability to manage demands connected to mental distress in society.

Three years of using social media to raise awareness of all things policing, mental health and criminal justice has taught me that most officers want knowledge and training on this.

Most of the questions I receive – dozens of them each week – are legal in nature:

  • What powers do officers have, what are the responsibilities and powers of other professionals?
  • What is it we could do and what is it we should do to ensure the safety and wellbeing of others without trespassing on the responsibilities of others?

The more I learned about mental health law, the easier it has become to police operationally – including in those situations where partnerships are not operating in an ideal way, for whatever reason. Even if the system doesn’t work perfectly, I understand how I can do the best that is possible to survive scrutiny with criticism.

We need knowledge – predominantly of the legal kind.

I would love to see the College of Policing develop a set of training products and resources that reflect the needs of all officers – mental health touches every area of policing, at every rank. Build our knowledge and thus our confidence to impact on this expanding area of business. The queries I receive come from response officers, custody sergeants, neighbourhood policing teams, investigators of all kinds from uniformed volume crime teams, to detectives and SIOs. They also come from inspectors, superintendents and ACPO officers about how to better structure partnership arrangements.

Duty inspectors and Force Incident Managers have particular needs, I would argue and I remain convinced that the United Kingdom needs training programmes of depths that reflect the complexity and the risks inherent in this work.

We also need to utilise technology to deliver support to decision-makers: internet resources, smart-phone apps with clear legal materials and it would be ground-breaking if the College of Policing could work on that material jointly with other professional colleges, including paramedics, social work and the medical/nursing Royal Colleges.

If the solutions are inter-agency, then the leadership and training needs to be too.

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BadgeThe 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