I’ve had a quiet few weeks on here. As well as some time off over Easter when I took my son’s Under7 rugby team on a tour to Lancashire and had one of the BEST weekends for years, it has also been due to planning and work around our restructure at work and a massive amount of time being spent on that ahead of ‘D-Day’ in July.
I’ve been busy on the mental health front and thought a little update may be of interest – I’m going to start a regular ‘update’ blog instead of blogging on specific subjects all the time. Frankly, I’m running out of topics that I haven’t already covered but want to keep covering a bit of what I’m up to and a bit of stuff in the news. There may well be specific posts too, as news or events dictate or if I or you come up with some fresh ideas!! (There is one coming up entitled Mexican Standoff which is a very interesting true story!)
Last Friday I spoke at an event at York Racecourse where I had been invited by Dr Keith RIX to talk to an audience mainly comprised of mental health professionals – including a large number of psychiatrists. I spoke mainly about how we should consider the investigation and prosecution of inpatients on psychiatric wards where there are assaults on staff or other patients. It was delightful to meet Dr Simon WILSON from the Institute of Psychiatry because he and I co-authored a published article on inpatient violence without having actually met! Having worked on that it was clear we’d sing from the same page and this proved to be the case. A gentleman who shared my distaste for what he called the ‘inappropriately dichotomous’ nature of the debate on diversion.
I have blogged about inpatient violence several times and it remains an important issue for the NHS. 68% of ALL assaults on NHS staff occur in mental health trusts whereas some may have presumed it as the “A&E on a Friday night” thing. However, in some trusts anything from 15% to 25% of those assaults get reported to the police – some trusts report NO offences. There is much work to do on this area where the police recognise they are not consistently providing the best investigative response and the NHS need to recognise that they are not always as forthcoming as they could be with background about someone’s mental health history with (properly disclosable) information to inform the legal decision-making by police and CPS. Bad outcomes all round where those failures emerge and one way around this is to have an inpatient liaison officer who gets to know what they’re doing.
I’ve also been progressing details around an idea I had about six years ago which I’ve been trying to get off the ground since. My ACC has agreed that we should pilot this idea to see what value it adds:
Police officers lack training around mental health and also around laws / procedures on mental health law. This type of feedback is a regular feature of mental health professionals’ and service users’ feedback about their experience of policing. Because X or Y or Z didn’t work (to their satisfaction) or because attitudes may not have quite been where those individuals would have preferred to see them, “The police need more mental health awareness training”. Maybe … probably … more training on many things would be nice. However, if you are a regular reader of this blog or if you look at the INDEX of posts and the FAQ page, you’ll see that there is much to learn! (It’s has taken my a decade of getting obsessed after getting curious to develop any knowledge I’ve got.)
My standard response to this response about police mental health awareness training – EVERY SINGLE TIME – is that such claims may well be true, but mental health and social care professionals needs more “police awareness training” around procedures and law. Most AMHPs I’ve met, can’t explain s135(1) properly, for example – although many can. Most mental health nurses on wards who are asking for patients to be arrested following assaultative behaviour, don’t realise that we arrest people to commence and investigative and criminal justice process, not for the convenience of NHS staff. If there is no complaint of an offence or no evidence of liability, arrests don’t occur however desirable someone may think that would be. (You should see the list of people I’d arrest in a fantasy world where we do it because I think it would be a good idea.)
My idea for police training is this: rather than give thousands of officers 4-8hrs training in the hope they’ll learn the contents of this website and then recall it all effortlessly in the 2-5 jobs per year where such detailed knowledge is required. Let’s remember, a lot of ‘mental health jobs’ don’t necessarily involve specialist procedural or legal knowledge at all, such as jobs where criminal arrests need to be made of suspects with mental health problems.
So! – let’s give a certain percentage of cops 3 or 4 days of mental health training including:
- Mental health awareness: inc learning disabilities, autism, personality disorder as well as ‘functional’ mental health problems like schizophrenia, bipolar and depression.
- Law knowledge around s136, 136, AWOL, inpatient violence, supporting NHS agencies in enforced medication, conveyance etc.,
- Knowledge of where to secure resources, help; how to avoid or mitigate against critical untoward events;
- Resolution of incidents by de-escalation, moving away from the use of force.
Then, deploy those officers with that raised knowledge and WITHOUT branding them as experts of ANYTHING which approaches crisis services to jobs involving mental health issues. We will categorise all MH jobs into three categories.
- High risk – critical or complex incidents: inpatient psychiatric violence; s136 cases involving A&E and prolonged restraint, s135(1) or ‘Assessment on Premises’ jobs;
- Medium risk – non critical volume incidents, AWOLs; standards s136 jobs, criminal suspects in police custody.
- Low risk – Any other business.
The idea is, we ALWAYS deploy these officers to Category 1 jobs; we deploy them where possible to Category 2 and ensure their advice is sought if not possible; we let ‘normal’ officers deal with Category 3 but our specialists are there for advice, if felt needed.
This is not original! – the US, Canada and Australia have started off this concept after it was commenced in Memphis, US. Each nation seems to be adapting it, but this pilot would appear to be the first time the UK have considered it and after six years of trying to give it a go, I’m really excited by what it may achieve.
Finally, I was delighted to give a very informal talk about policing and mental health at the main mental health unit for my home county and very impressed at their biscuit collection. I was invited to do it after by a psychiatric nurse who used to be one of my PCs when I was a young ignorant sergeant. I spent two really very enjoyable hours giving a police perspective on supporting “psychiatric emergency” and “criminal suspects who are mentally ill”. (I usually divide general talks on this work into those two categories and cover: s136, s135, AWOLs and some other bits in the first section; prosecution, diversion and inpatient issues in the second. Loads of great questions and engagement and at the end a crisis team manager said, “My team love your blog.” Given it was originally written for police officers’ reference, those are warm words which make blogging in the evenings and in my own time very worthwhile indeed!
(Incidentally: the U7s rugby – 10 played, 7 won, 1 drawn and 2 lost. Given 1 draw and 1 loss was them playing U8s at Blackburn, we were proud as punch and I got to watch my son score his first competitive try and then go on the ‘make’ the winning try in one of his games … proud as punch.)