It has often been said when discussing problems within the Criminal Justice System that in reality, it is not a ‘system’ at all. It is a collection of separate organisations – police, Crown Prosecutors, Courts, Prisons, Probation – who are ‘managed’ by different parts of Government (Home Office and Ministry of Justice) and who have very necessary links to other apparatus of society including education and health. It is not a single, controllable ‘system’.
These agencies have for a while been operating to different targets, standards and goals and are not and never have been a coordinated whole. The farce of targets and functionalisation, costing money and lives.
Much the same could be said for the ‘mental health’ system. Care is provided by different parts of the NHS – primary care (GPs) and secondary care (MH trusts) as well as specialist services, NHS Direct, A&E and so on. Again, this is not necessarily as coordinated as PCT three-year strategic mental health plans may imply.
Consider the links that mental health must have to other apparatus of society: this care continuum must be provided in contact with local authorities and a criminal justice system whose very raison d’être could be said to be diametrically opposed to that of mental health services (individual care / public safety). Remember: you can only enter certain parts of the mental health system, via the criminal justice system: thus creating another larger ‘system’. All clear so far?!
Information sharing is a problem when looking at the de facto system which has evolved. The police gather so much information about mental health (from arrests, s136, AWOLs, etc..) which NHS services could use to look at ‘their’ system and some of it could be key to proper long-term thinking.
If shutting down mental health beds to save £100,000 on inpatient care means that over the next five years two patients will end up prosecuted for serious offences and placed in secure services at £250,000 a pop, then you’ve saved nothing at all, but you have created victims and criminalised patients along the way. Brilliant. Manchester NHS looked at this the other way around a few years back and chose to invest £500,000 on a comprehensive approach to ‘diversion’, thereby reducing the number of people entering secure care. They’ve made the money back already and more besides, in avoided secure care costs.
I posted three questions on Twitter this morning, to provoke thought:
- How many people in your area who are arrested under s136 are current or previous mental health patients?
- How many AWOL patients in your area are repeat reports?
- How many people arrested in your area are current or previous mental health patients?
In some areas the answer to all three of these questions is fifty percent. These figures in your area, may not be exactly the same, but you need to understand what they are because understanding these numbers will be a signal (from noise) about what may be right or wrong with your system.
Now some of this information sits with the police and sometimes with mental health services: some can only be established by sharing information into a joint pool. The police need to tell mental health who got arrested, in order to allow them to establish if they are current or previous patients and therefore provide necessary follow-up to those who were not flagged in police custody as having a potential mental health problem. Let’s remember, that the police usually spot 10-15% but sharing this information can identify up to 50%. What does the figure for your area tell you, if anything, about mental health care or policing? Maybe nothing, but probably loads.
Why not do it?! It would not be prohibited by the Data Protection Act 1998.
What about s136 MHA (EW) / s297 MHA(S) / a130 MHO(NI)? In some areas, as many as fifty percent of people detained under emergency police provision are current or previous patients. In some cases, by studying the nature and variety of this demand and by treating it as a signal, you learn something about up-stream provision which may have prevented the s136 becoming necessary. How many of your detentions are repeats?
- One sample in one area of my force showed that just 1 person accounted for 3% of detentions; and had been arrested in other mental health trust areas of the force.
- Proper evaluation of this demand made it clear: she was usually arrested s136 whilst committing victimless, quite low-level offences but it always emerged that she did not have a mental health problem of a nature or degree that warranted admission to hospital.
- We found out later that MH professionals were busy asking, “Why don’t the police realise she’s not mentally ill and just prosecute her?!!!” but it emerged she’d never been arrested by the same officers twice.
- So a strategy was formulated – via the ‘system'(!) – that she would be arrested and prosecuted like anyone else.
- Result: reduction in s136-type demand, prosecution for offences, remand to prison (because of her previous history of absconding and offences on bail), conviction for the offence and a short-term period of imprisonment.
- Upon release from prison, there have been no more similar offences 12 months after release and no more s136-type detentions.
- Easy isn’t it?! … and not just about upstream interventions by mental health; this is an example where different police action is key.
By not identifying these signals an officer may end up arresting someone for a serious offence, rather than under mental health law and then it is quite possible that just some of those patients will end up in the criminal justice system and subsequently back in the mental health system via Part 3 of the MHA(EW) or Part 8 MHA(S). By the time you then find health authorities paying £250,000+ a year for secure care instead of a fraction of this for effective community or occasional inpatient care, you realise the error of failing to examine signals from noise.
We properly understand the nature of the demands we face because we don’t study them.