Here’s my theory about why some police forces have historically scratched their foreheads a bit about how to properly own and develop policy and practice on policing and mental health. I would say at the start however, that the service have really ‘brigaded themselves’ properly on this over the last few years and made real progress.
There have been genuine and very necessary debates within each force about which part of a police service should ‘own’ mental health; where it should ‘live’ within force headquarters departments.
Explanatory note for non-police readers >>> police forces are run by the Chief Constable who has a Deputy (Chief Constable). They have varying numbers of Assistant Chief Constables dependent upon population size. Lead responsibility for the range of policy issues faced by all forces is divided across the Deputy and Assistant Chief Constables. Some larger forces may have an ACC ‘Criminal Justice’ and an ACC ‘Operations’; whereas a smaller force may have one ACC responsible for both. Portfolios for ACCs can include ‘Intelligence’, ‘Crime’, ‘Criminal Justice’, ‘Security’ and ‘Local Policing’. etc.. In addition, each force will have local areas for the delivery of 24/7 and neighbourhood policing known as ‘Divisions’ or ‘Local Policing Units’, etc.. These are run by Chief Superintendents whose local area often matches a mental health provider; sometimes a couple of local areas match a provider.
If you’re with me so far(!), you’ll have spotted that mental health cuts across all of these; and that there is also a potential tension to be managed between local ownership and corporate control. Most of the mental health issues which affect the police do not sit in any one of these portfolio areas:
- Section ss135/6 Mental Health Act and AWOL patients are probably a ‘local policing’ issues;
- Criminal investigation of mentally disordered offenders and public protection or safeguarding are probably ‘crime’ issues;
- Police custody, and criminal justice liaison and diversion services are probably ‘criminal justice’ issues. Etc., etc..
In addition, there are only a few police forces whose NHS services are commissioned and provided conterminously by one Primary Care and Mental Health Trust. So most forces have the challenge of striking that incredibly difficult balance between delegating the issue to local areas who can work closely with their partner agencies; and retaining sufficient control to achieve the consistency needed to deliver accountable policy and training to the HMIC and the IPCC. It is for these reasons that many forces have experienced moments of confusion about how to properly progress, especially because we know that there are several approaches amongst a force’s mental health providers to the same legal or medical issue. Which one is right?!
(Massively important that I point out – the police also present this problem back to the NHS and local authorities. Most ambulance services work across multiple police forces and can find it frustrating to get police consistency. AMHPs who have worked in more than one local authority have often said the same when discussing police forces’ responses to s135(1) warrants and assessments on private premises, we vary massively. NPIA Guidance should assist in addressing this.)
So all taken together, Chief Constables most usually have to delegate responsibilities to local police commanders to work with their mental health trusts and local authorities to ensure that proper policies and protocols are in place in their areas, whilst attempting to have consistent minimum standards in policy and training across their force which local commanders strive to ensure are replicated locally.
Many forces achieve this by deciding what best fits their internal and partnership structures and then choosing an Assistant Chief Constable to bring together all relevant local areas, HQ departments and partners into a working group on mental health. They balance off the tensions by controlling at HQ those issues for which the force must be certain of particular standards to comply with law, leaving the rest to local procedures.
It is therefore clear why achieving effective policy and procedure around policing and mental health is complex!
So whilst I remain unsure why so-called ‘Excited Delirium’ is a very real life-threatening medical condition in my local A&E, but not my local psychiatric unit, I am certain that forces should treat it as a very real phenomenon until the debate ends one way or the other – this approach should not be up for debate in local police areas, for the reasons I’ve previously given and it’s up to local commanders to ensure that this is realised.