This is going to be a challenging post: in good faith and in a way that is measured, reasonable and welcome, it has been questioned whether or not this blog is reinforcing negative stereotypes of people with mental health problems. In particular, is the blog reinforcing that mental health patients are violent and dangerous?
Whilst I do not recognise my own instincts in any suggestion of reinforcing such stereotypes, it is important that think back over 90 posts with all of their mention of risk, crime, violence, resistance, aggression and so on. I have very frequently typed these words and more besides in various contexts during my posts, so it probably is right to reflect on my own assumptions and subliminal messages.
I welcome this cause to reflect and do not mind the question one bit.
Let me start by making one rather obvious point and by listing various thoughts and statistics I keep in my mind during the writing of this blog:
- I am a police officer <<< by definition this means that the perspective offered here is one arising mainly from criminal investigations and offences of all kinds; as well as requests to assist or lead in the management of risks, sometimes very serious, unpredictable risks. I cannot blog from any other point of view as I would have no other relevant experience on which to base it.
- It also means it is not written from the perspective of someone with considerable experience of mental health situations which do not involve risk, badness and criminality either by or against people suffering from mental health problems.
- I have got direct operational experience of being requested to undertake tasks which do not involve crime or any risk at all, but which are made because the police are a 24/7 body of people who can support other public agencies.
- Such requests carry risks of stigmatisation and criminalisation I’ve blogged about in an effort to raise awareness about how we reduce them. It was a stated intention of the blog to engage a wider debate about how we de-stigmatise and de-criminalise the experience of patients by ensuring that the police are used only of necessity and where used, it is done right.
- But either way, violence – its assessment, its mitigation, its management and its prevention – is a limited part of being any kind of professional involved in mental health issues and this reality cannot be avoided.
- So all of that having been said, I keep these things in mind whilst writing –
- Most mental health charities have a “1 in 3” or “1 in 6” type claim to make, about the number of adults who will suffer with mental disorder during their lives.
- No-one seems to be able to explain why some charities think twice as many people will suffer mental health problems than other charities.
- It is frequently said, that mental health patients are more likely to be victims of crime than perpetrators – I will admit I’ve never understood the point of comparing victimisation rates with commission rates. It’s not at all obvious at all that this tells us much, either about victimisation or commission which are fundamentally different things.
- Research on many important things in this debate is – as far as I can tell – under-developed, contested and uncertain. I make no claim to being an academic and whilst I research the blogs, I am not in a position to conduct a full literature review on everything.
- There are some very valid criticisms to offer about pieces of research upon which some rely to make their point about mental health. I regard the whole field as one loaded with agenda of various types: political, philosophical and ideological.
- Many of the “1in4” type studies are self-reporting studies and other likert scale assessments which are notoriously unreliable. Often these studies have not been peer-reviewed.
- The definition of mental disorder changes depending on who is using it and in what context it is being used.
- Definitions also vary across borders and one only has to look at the DSM-IV and ICD-10 to see this.
- If one did wish to have a discussion about violence and mental health, the statistical prevalence would vary by sub-group: those suffering depression or dementia or paranoid schizophrenia or anxiety disorders or autism – it’s very dangerous to generalise about ‘mental health and violence’; BUT –
- Violence by mental health patients is a legitimate point of public concern following various incidents which may have been blown out of proportion by the media, but the response to an investigation of such incidents are by necessity, police work.
- So I’m back to where I started about my perspective and it’s perfectly possible to put almost any point of view about mental health and / or violence, if one wished to do so. You’d find the ‘research’ to justify that position if you tried.
- But mentioning risk, aggression, violence or escape (from psychiatric detention) cannot, of itself, be a reinforcement of stereotypes when the intention is clearly to reduce stigmatisation and criminalisation to absolutely minimal levels and where is is predicated on the need to better manage or mitigate?
I would hope that I’ve made in plain in various posts that I think both the NHS and the police need to look at and improve their responses to mental health incidents; their capacity for effective joint working and their operational delivery of the legal frameworks of the UK. These issues undoubtedly have the potential to stigmatise and criminalise; from all sides. It has been a matter of massive personal regret that I have found myself compelled to act in certain ways at work, precisely because what we all know should be happening, can’t happen.
Here is my own (strictly personal) view: where the police are inappropriately used or relied upon to administer the Mental Health Act, it has the potential to stigmatise service-users and criminalise them. I take the view for example, that the NHS should always lead the recovery of AWOL patients whose whereabouts are known, because coercing passively resistant patients with the deployment of uniformed officers is inappropriate. That said, some (but not all) NHS managers disagree with me about that and do not, can not or will not do it.
It is also my (strictly personal) view, that the lack of proper research and evaluation of operational risks leads to inappropriate resource deployments: whether NHS, police or both. There are various systemic reasons why the management of risks which do exist, sits with the police: these include availability of NHS resources, legal knowledge of police and NHS professionals as well as failures to agree. Most cops have stories to tell about going to jobs and wondering, “Why on earth is this a police job?” Why not the ambulance, the CMHT or the Crisis Team?
- Are most mental health patients violent? No, self-evidently not.
- Is violence in the social, policing and health responses to mental illness an issue that requires heightened awareness? Yes.
- Why? For various reasons:
- 68% of assaults on all NHS staff are within the mental health sector (NHS SMS 2010).
- The professional risks of assault at work is far higher within the mental health professions than in other health professions, or in the police / fire services.
- Failure to identify, plan and information share around risks has cost lives in the past – not just service-users, but professionals and members of the public.
- Does this mean that most mental health patients are violent? No – not at all. Most mental health patients on wards do not assault nursing or medical staff.
- Does this mean that we cannot or should not discuss violence. No – it is vital that we do. Not only so we learn the lessons of history and prevent mistakes being repeated, but so that we also work on approaches to appropriate management.
I want a social or public sector structure that only uses the police to support the administeration of the mental health act when there are RAVE risks present in an incident which are legitimately beyond the skill or capacity of properly trained, deployed 24/7 mental health or healthcare professionals to manage. If we can achieve this, we will have arrived at a place whereby any stigmatisation or criminalisation by involvement of the police is defendable in light of the specifics of the situation. Obviously the police will always have a role when responding to or investigating crime.
That means I would love to see a health and social care system integrated and organised in way that means it can manage the community and inpatient care it exists to provide without unnecessary reliance upon the police to do tasks which the NHS or social care organisations could manage for themselves. Again, this means appropriate professionals undertaking appropriate interventions for vulnerable people without stigma. The delivery of this rests with NHS and Social Care managers, outside the sphere of control of the police.
So whether this blog in general or this post in particular is reinforcing negative stereotypes, is probably a subjective assessment by each of us: dependent upon the definitions we’re applying to the concepts here; our understanding of prevalance, of both mental disorder and violence. Difficult stuff to weigh, given what we currently know.