Psychiatric Unit Liaison Officer

Once upon a time in a police force an inspector got a new posting – no, this was not me.  He was put in charge a busy city suburb, with retail and residential areas, very demanding and diverse.

As all good inspectors do, he sought out his crime maps for the intelligence analyst and looked at his monthly, six-monthly and annual crime, broken down by crime type: robbery, burglary, vehicle crime, violent crime, anti-social behaviour, etc., etc..  Several things stood out but on the matter of violent crime, one thing stood out in particular.  A specialist psychiatric facility for women and children.  Very, very high levels of reported violent crime.

The new inspector asked the local neighbourhood sergeant to get a constable to look at this properly at roughly the same time as a certain HQ ‘mental health lead’ was looking at the issue of inpatient violence against NHS staff and other patients.  Several cups of coffee and a few hours of very informal ‘training’ later and that neighbourhood PC disappeared into the unit with offers of ongoing advice and support from her boss and from me.

Initially not allowed to enter in uniform or wearing handcuffs, baton, CS, etc., it was a matter of building trust.  The unit had a very high levels of sickness amongst staff, who often needed considerable periods off work with visible injuries and others who suffered from stress and depression at a relenting volley of crime that was effectively unaddressed.   Of course, there were the standard challenges discussed in two other blog posts – here and here:  why would you investigate / prosecute those detained in a secure unit for assaults, especially if those suspects were children from highly disturbed backgrounds, often involving considerable abuse of all types?  What information can you share in order to do so?

The officer formulated an approach:  no reported offence would receive no reaction at all; however ‘minor’ the matter, if made aware of an incident, the patient would at least be spoken to and advised or warned.  Reports would be delayed wherever possible, until she was next on duty and this would allow her to respond to ensure continuity of approach.  Only if there was ongoing, immediate risk that needed an emergency response would 999 be used.  Even then, her ‘response’ colleagues would simply ensure that safety was restored and refer the ongoing investigation to her.

Once the certainty of a response was understood, she was allowed to ‘patrol’ what became her favourite ‘tea-spot’ in uniform.  When on the ward investigating other matters, she would take time to talk to patients who had been flagged for low-level, verbal threats.  She told them what she could consider doing if anyone was assaulted.  She pre-empted problems.  Eventually, she was allowed to move around the hospital unaccompanied by NHS staff, with a set of keys and an NHS ID badge ‘police liaison officer’.  It was her ‘beat’.

She had a range of responses to crime – including for minor offences and for those cases that were highlighted by the staff as being inappropriate for formal prosecution.  It involved such informal police reactions as ensuring a written letter of apology to a nurse – welcome for many reasons if the offender was a child with literacy issues.  Adults were invited to repay the cost of minor damage as many people in wider society are so invited, as an alternative reparation.  Some offenders received fixed penalty notices for damage – fining them £80 and some received police cautions.

In a serious cases – which were thankfully few – and some persistent cases of repeated offending where informal approaches were tried first, matters escalated to formal prosecution and significant understanding from CPS colleagues when provided with good background information from the NHS.  All of this was a joint approach between the NHS and the police / CPS and as a result, a couple of s3 patients became s37/41 restricted patients because highlighted risks which had led to their original admission to hospital, were realised against staff within the unit.  It became clear that they represented a ‘serious risk of harm to the public’ and prosecution ensured public protection after release by ensuring the justice system managed risk.

Very little of this involves arrest and removal to the cells, she would arrange interviews of suspects, with appropriate adults, solicitors and doctors assessments of ‘fitness to be interviewed’ inside the unit.

Guess what happened?

Violent crime reduced massively; staff sickness levels reduced massively – to a point where the worst unit in the trust for sickness is nearly one of the best.  Better continuity of care for patients with regular staffing; a safer environment for all staff and patients.  How much work was this?  Initially, the officer said it was about 50% of her role, sometimes more.  But once trust and procedure was established, it was an occasional thing that took little time at all, just regular passing attention and frequent ground-floor liaison between the agencies’ staff.

This partnership working won a National Patient Safety Award.

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23 thoughts on “Psychiatric Unit Liaison Officer

  1. So glad to read this information as I have found this area of Police/Mental Health Trust liaison work sadly lacking.Does each Trust have a Mental Health Liaison Officer? Does each Trust supply details of relevant meetings to ‘their’ Mental Health Liaison Officer for his/her patch? How much does effective communication between MH services and Police affect liaison work?

  2. Arrangements in areas vary from place to place – some police forces send their response officers to each job as it comes in and response varies, some areas have an inpatient liaison officer as described here. Some units have regular formal meetings with the police, others don’t. it’s all very ad hoc. I believe that each neighbourhood policing team who covers an inpatient unit of any kind, should make it the responsibility of one constable on that team to be the liaison. We do this for so many other types of issues – school, retails areas, concentrations of licensed premises, etc., – that I think we should be doing it for psychiatric liaison units.

    Overall, I believe that we can show it reduces police time spent dealing: but improves confidence and outcomes for all.

  3. This is good, but equally I wish more was in place for service users assaulted by fellow service users or staff to have that addressed too.

    1. I may be wrong but I assumed that would alk be part of the same remit. That’s how I read it anyway. Any offence, whoever the perpetrator victim.

      Cheers,

      Stuart

      1. Yes, all part of the same thing – on reflection I could have emphasised that more and will look to add a sentence to the post. Parntership working is important but if allegations are made BY service-users AGAINST other patients or NHS staff, they should be professionally investigated also.

    1. Notwithstanding my response to Stuart’s point above, I understand why you’ve just posted that comment. It is harder to convince some police officers to take seriously allegations made by inpatients, but we need to overcome the stigma of mental illness but immediately assuming that allgeations or evidence offered by people with mental health problems is inherently unreliable. Far from it. Each case on merit.

  4. Out of interest, would this officer take reports of crimes committed against patients whilst out of the psychiatric unit? Or was it solely about criminal activity committed by patients?

    I’m also interested in how it affected the patients. Obviously increased levels of safety is a massive, massive bonus. But, I know a lot of people with paranoid delusions are very, very scared of the police. I got hit by a cupboard once when two officers arrived on the ward and a lady tried to hide behind said cupboard, but accidentally knocked it over. She wasn’t scared of the police because she had done something wrong, but because of her illness.For her, police presence made what should have been a place of safety and respite something very, threatening. Don’t get me wrong, I think the scheme you have written about sounds well run and very constructive, but I do feel that there are downsides to having a regular police presence on hospital wards.

    1. Of course and I’d hate to paint the picture that she’s in there every day. I also agree about the impact of policing on patients who are paranoid, but others have observed – including other service users on here – that when you see the person behind the uniform and realise they are human too, just wanting the best for everyone, it starts to normalise the experience. Also, police presence is about ensuring a place of safety, not disrupting it.

      I’ve heard psychiatrists say, “there are police in the real world, there are police in other hospitals, patients need to understand they could see police here.” and so on. I accept there need to be limits and sometimes you’d control it. I’ve had a lot of conversations – in uniform – with service-users. When they realise you a normal human and you take some time, it can significantly and positively impact upon impressions of the police. But that’s true of community policing with other groups, too.

    2. Forgot to answer your question about offences outside the unit – not ordinarily, no. But I’m sure if any of her colleagues asked her advice, she’d give it very freely. As do I to officers from all over the force (and sometimes the country!) Other reports would go through ‘normal’ police channels.

  5. If I may offer a different humorous perspective for a moment – bring those nice little spaniels with you because I love dogs, infact I made my psychiatrist laugh when I told him that sometimes I make a point of going to a certain station because I know the police dogs are sometimes there. As someone who loves dogs but can be very afraid of strangers I know it’s safe to approach an officer with his dog for a pat because he sees that as just good public relations. So I get some ‘dog therapy’ and know I don’t have to worry about the owner. I know I’m a sad git but I can’t own my own dog because there are times I cannot leave my home, and the dog has to go for walks.

    1. Joanna
      In at least one MH Trust I am aware of attempts to tackle illicit drug use in in-patient facilities led to the Trust seeking support from the local police dog section. Each organisation (and service user representatives ) had concerns about the proposed arrangements. The police didn’t want to be dealing with very small (for them) finds of usually cannabis among patients some of whom were compulsorarily detained. Staff and service user reps were concerned about the impact of police officers in uniform with dogs searching service users bedrooms and living areas. With support of a very understanding couple of police dog handlers who did attend in uniform a process was agreed which was trialled. After a number of searches, and finds of drugs, and no complaints what became apparent was that many service users who might not have been engaging with staff and may well never have had a positive interaction with a police officer in their life became engaged in talking about and making a fuss of the police search dogs and in some cases chatting openly with the dog handlers. Certainly not pets as therapy but undoubtedly for some,like you a brief period of “dog therapy”

      1. Aww that makes me smile!
        I’m not surprised people responded to the dogs & handlers, although I would have thought the amounts found would be fairly small for the police, would I be right in assuming that a joint or two wouldn’t have resulted in arrests?
        There is another side of that you know – people who experience EPS’s or dyskinesia from antipsychotics can find cannabis helpful despite all the ‘drugs = Schizophrenia risk’ line which I’m not entirely convinced of. I’ve also seen it help others with their differences in perception, and they took it AFTER the diagnosis not before. I actually think there is medicinal use albeit for small groups of people – MS sufferers for example, but I’ve definately seen it help some service users – I know I’d be shot down in flames by most people for saying this but I have to say it as I see it.
        Of those it has helped they wish it could be medically prescribed and preferably in a spray or liquid form to save their lungs.
        PS – I don’t use it myself but yes I have tried it

  6. Very good reading – I hope that the creation and support of the PULO becomes part of best practice for all forces and that the police and the mentally ill can be regarded as people too.

      1. I think dogs in A&E on a Friday night could be helpful – but maybe the nice big German Shepherds !

  7. On a more serious note – it’s not just about stigma and credibility – there are other consequences to filing a complaint within the health service. Patients are disbelieved by health professionals, look at the cases where it’s taken years before a nurse/doctor has been taken to court/struck off and that’s not only about the police, CPS and judiciary. People report it to health workers and are disbelieved, or their diagnosis gets changed overnight to PD either to discredit them or to suggest that their complaint is a part of their condition. They can find themselves ostracized. Sometimes staff know and they do nothing, but then look at how NHS whistleblowers are treated, it’s very difficult for anyone to complain within the NHS.

  8. Are you aware that some A&E departments threaten people with the police?

    I’m referring to their policy of psychiatric liaison assessment BEFORE being treated for self-harm [even if it needs surgery]. Years ago, you always received treatment before being offered or cajoled into a psychiatric assessment, so it was possible to leg it before they arrived. Now, many depts will insist at the point of Triage that you “agree” to seeing the duty psychiatrist irrespective of your wishes [and even offering named support with contact telephone number].
    “Talk to the psychiatrist or talk to the police” – that’s a misuse of the police by healthcare staff, and I would stress that these threats are made to people who are not under the influence of alcohol/drugs/and with no known history of violence or threatening behaviour.
    . It’s a bit of a grey area in A&E – being held without a section, having security posted to sit beside you in case you leave. I could be restrained by a small spaniel so it’s ridiculous to be threatened in that way

  9. Interestingly a security officer once told me how in his experience people waiting for the crisis team would happily chat away to him but became very distressed once the team arrived!
    I’ve read online about people being taken from bridges by the police, the crisis team won’t or can’t come out so the person has had to spend a night in a cell, and then still hasn’t been offered any support the following day, that’s wrong. Although its debatable as to where is a ‘place of safety’ but can’t say I’d want to spend a night in a cell for being distressed, I know people who have had to and have found it very distressing.

    1. I know I don’t speak with any great experience other than a handful of arrests for S136 however, I and I am sure that quite a few other officers fully recognise that a police station is the very last resort for someone who needs a place of safety – the custody block at times can be best described as a place of non-safety.

      If there is no crisis team option (for whatever reason, its only recently we have started to have a S136 suite) then I am not sure what else we can do, in the brief circumstances you describe I would need alot of convincing to return someone home (which can be a place of safety, obviously depends on the circumstances) and then the only other option is the police station. Place of safety is defined in S135(6) of the MHA.

      And I cant see it lawful that people in the custody block are not offered any support having been arrested for S136, the only reason that they are arrested is for the purpose of offering them help and I would be interested as to how they were released if they were not visited by a doc/AMHP.

      We do however have 72hrs for detention under S136, I can’t see any custody officer who wants a S136 arrest in their block for any period than is longer than absolutely needed, I would argue that the majority of the delay is arranging the AMHP/doc to visit (I have known it take approaching 18hrs, don’t even get started when their is an issue with the place of where the patient lives vs. the place of arrest) and there is very little the police can do about it.

      And Sir, an extremely good blog. Some fantastic information on here so thanks.

  10. My thoughts too, but this reflects a wider problem with crisis teams and cuts to services whereby crisis teams have overruled A&E consultants in terms of admissions. They are now the gatekeepers and are very picky. Danger to self no longer means you get a service and that danger will also be judged on diagnosis as well. Someone with a diagnosis of psychosis will be taken more seriously than someone with a diagnosis of PD. This bias is dangerous when it comes to danger to others. Think of the cases where the person has asked for help and clearly announced their fears of being a danger to others [Michael Stone] and then that’s promptly ignored because he had an ‘untreatable’ condition – PD.
    There are documented cases online of people who have been taken to police stations and released later with no support in place because the crisis service has said no, or they don’t have the capacity. There is nothing the police can do about this other than to speak of it.
    What is your s136 suite like? That sounds like a step in the right direction [have chocolate on offer]

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