Should We Have To Do This?

The police are far from perfect in their handling of mental health issues: and even if we could skill up and widely train officers to the right standard, it would still be fair to question how we define the role we want the police to play.  The distinction between ‘health jobs’ and ‘crime jobs’ is a false one: many are both, some are neither.  How you decide to afford priority to either in making initial decisions is frequently complex and best done case by case.

This is why we see disagreement about police involvement and police decision-making.  From issue to issue and from incident to incident, this debate can occur for a range of reasons:

  • their (comparative) lack of training and knowledge – compared to mental health professionals and compared to other areas of policing, the amount of MH training is still small.
  • their inability to access NHS or other services – knowledge of what 24/7 or emergency services are available is sometimes limited and to be fair to officers, consistency of mental health services varies enormously so there is no ‘mental map’ in an officer’s head of what exists behind the emergency they are dealing with, to enable them to identify the correct pathway into healthcare or assessment of need.
  • we should also acknowledge that stigma or even fear of the unknown around mental health issues can play a part – our officers are drawn from society and we know that some individuals and our society as a whole structurally and individually discriminate against individuals suffering from mental ill-health.  We would be naive to think that all police officers approach incidents involving mental health matters with the correct attitude.  That reinforces why training is required – on awareness and law as well as on the ‘map’ of local services which can response, assist and support.

I also from time to time come across the “we shouldn’t have to do this” argument.  It is this issue I want to discuss here in more detail.  We know from this week’s Parliamentary debate on mental health – the first major debate in years – that the nature and the appropriateness of the police role was being questioned by Nicky Morgan MP.  The Loughborough MP, who should be congratulated for securing the debate in the House of Commons, and ACPO lead on Mental Health & Disability, Chief Constable Simon Cole from Leicestershire Police, were interviewed on the Radio Four Today programme (approx 2hrs40mins) about the nature of mental health provision and the way in which the police become used.  Many good points were very well made by both.

So against this backdrop, demand drifts to the police and the question can often arise “should the police be dealing with this?”.  There are two answers to this question.

HERE AND NOW

Imagine a scenario whereby a service user had stopped answering their door to their CPN and had stopped taking medication because of a genuine belief that they had recovered and no longer needed it.  Let us further imagine that the follow-up of that patient’s disengagement with mental health services was poor or non-existent and as a result of a deterioration in their condition the police needed to exercise their authority to remove the patient to a place of safety, we could have a debate about how or why it became necessary at all?  Why didn’t the CPN follow it up, etc., etc.?

You could add more scenarios to this list: hospitals who fail to stop patients leaving when it would be reasonable, possible and legal to do so … not all AWOL patients are preventable, but some are.  You could ask about requests for the police to convey compliant or only very slightly resistant patients and wonder why community based assessment teams don’t deploy sufficient staff, or appropriately trained staff, to manage levels of resistance that are entirely consistent with the responsibilities of mental health professionals without them being placed to risk.

I have three responses to these situations:

  1. A lot of policing is about officers intervening where a variety of other social controls or institutions have – for whatever reason – not worked.  Some parents do not take responsibility for their children and bringing them up in a way which prevents them shoplifting or abusing neighbours; sometimes lapses of security by the Prison Service mean there is an escaped prisoner that the police have to find; individuals go out on many evenings and fail to exercise the personal responsibility needed to prevent alcohol related crime and disorder.  I can’t help but wonder why any potential disgruntlement with mental health issues, may be different in nature?
  2. Right here, right now is potentially not the place for this conversation:  if a mental health patient has absconded from hospital, all the arguing in the world about why someone did not keep the door shut, or exercise a nurse’s holding power under s5(4) MHA is doing nothing at all to find the patient.  Let’s get them found and safely returned, let’s put that argument towards managers who control our partnership interface and let them sort it out.
  3. These frustrations tend to build in officers who cannot see police shortcomings: we know that police responses to reports of assault by patients against NHS staff is inconsistent and sometimes way short of what is required; and we know that sometimes a correct police instinct to resist involvement in something is taken too far and sometimes NHS staff or patients end up being exposed to risks.  Let’s do the right thing and argue later if it remains an issue.

PARTNERSHIP WORKING

Whatever the rights and wrongs of the ‘Here and Now’ observations, the solutions are in proper partnership structures at all levels.  Some areas of the UK do not have effective partnership structures and I know from my own experience that unless managers in health, social care and policing are meeting and discussing regularly the issues their staff face, then problems can gradually build.  I’m at a loss to understand for example, why police and NHS services are changing so much about how they operate, without in some instances reviewing their joint operating policies for how stuff gets done against this changing background.

For example, we know from the Home Secretary’s speech at the Police Federation conference that she is looking at the role of the police in supporting mental health process: frankly, to reduce the amount of police time it consumes.  We know that Chief Constables are doing likewise following public statements by Sir Peter FAHY, the Chief Constable of Greater Manchester Police.  Sir Peter described the police service as being ‘overwhelmed’ by mental health demand.

Frontline staff need to know that managers are in rooms trying to square these circles, including by improving their own understanding of laws, guidelines and procedures.  Debating the role of the police with healthcare professionals who are not sighted upon, in some cases not aware of Royal College of Psychiatry Standards on s136, the content of the Code of Practice to the MHA or NICE guidelines on Short-term management of disturbed behaviour or on Suicide and Self-Harm inevitably means we’re not being effective.  I am aware that some Health and Wellbeing Boards are not including the police in their membership and yet I will have a small wager they will be considering strategic health issues that have a direct bearing on police services.

That’s why I firmly believe that frontline staff need to keep firing their operational reality into their managers; why managers at tactical, operational and strategic levels need structures to guide us through this changing landscape of public service reform and why if they don’t, we will be discussing police restraint of dementia patients in ten years time.  But for whatever period we’re busy making things ‘right’, let’s keep everyone safe and do the right thing.

____________________________________________________________________
The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

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7 thoughts on “Should We Have To Do This?

  1. Of course police should only be used for criminal cases and NOT when people are seriously ill. But there are times when illness and criminality cross over and lines become blurred.Places of Safety (& PICUs?) are clearly needed urgently in mental health services and this can avoid police cells being used to restrain people who may need an urgent psychiatric assessment. If not a criminal, the stress of being locked up in a police cell must be very confusing!

    I too congratulate Nicky Morgan MP for securing the excellent Mental Health Debate and with only 28 MPs in attendance clearly the 1 in 4 who will suffer mental illness at some stage in their lives were not in attendance. maybe “other Parliamentary business” meant watching PM at Leveson? Congratulations too to the MPs who spoke out re their mental health conditions, Parliament certainly showed itself in a more honest ligh,t which has helped so many others suffering from being left unheard. Link to written debate where annotations can be left! http://www.theyworkforyou.com/debates/?id=2012-06-14a.504.1

    Its like Government promising to publish National Suicide Prevention Strategy…Link to Suicide and Self Harm in a Recession debate Oct 2010: http://news.bbc.co.uk/democracylive/hi/house_of_commons/newsid_9127000/9127737.stm
    If reading up on things look at suicides in Bridgend Local Lab MP, Madeline Moon was in Labour Government at time and now is APPG Chair on Suicide Prevention. When in power we must question why these deaths were not investigated as a “Suicide cluster indicative of significant system failure” according to Health service Guidelines HSG(94)27 specifically http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4113575….The debate is where health minister Paul Bustow announced new National Suicide prevention Policy going to be published (still not!) and all current suicide data has “historical prevalence” aka OLD!

    Bridgend suicides: http://www.telegraph.co.uk/news/features/3635396/Bridgend-suicides-It-just-seems-normal-fashionable-almost…-.html (over 20 deaths I believe and at that time when Labour were in power I tried finding out how many in a suicide cluster (nobody knew) I asked Parliament if the “suicide cluster” in Bridgend indicated “significant system failure” and Madeline Moon replied that it did as services were often inaccessible for that age group.
    Having now found out about Health Service Guidelines (HSG), have a look at HSG(94)27and I wonder why those suicides were never investigated(access criteria #3) as per guidance (cant get answer but now asking how we now access HSG if all suicide indicators have been withdrawn and current data has “historical prevalence”

    I agree “lets keep everyone safe and do the right thing”….which includes honesty from Governments and reliance on national guidance and policy plus robust procedures…. NOT just goodwill of police and healthcare professionals.

  2. Thank you for trying to ‘do the right thing’… I think also, outside agencies such as the police need to be putting pressure on mental health services from the top down – maybe even wider eg. politicians – in order to point out the massive failings of services and how it would be better/cheaper (!) in the long run to give people appropriate treatment. It would be interesting to know how many suicides and/or ‘crisis’ situations that require emergency services involve people already known to mental health services. I strongly suspect it is quite a lot, and that questions need to be asked about treatment plans and why someone deteriorates into crisis without suitable support they can access before things get that bad. I think it was in the MIND crisis care report, someone saying they felt they had to “have one foot off the bridge” before they’d get any help.
    When I first went to the GP for help, I thought it would be a case of taking prozac and being referred to a counsellor. Little did I know that I would be treated with utter contempt by services, not told what was going on or why nothing was happening, ignored, bullied, threatened (with police when I refused to leave abuilding until I got some help), lied about (so now I have an entirely fabricated record for ‘violence’), and generally treated in the most despicable way. Nothing has set me back and caused traumatic memories as much as my involvement with mental health services, and subsequent involvement with police – they seem to use them all the time for ‘welfare checks’ which is ludicrous, why not help the person themselves if they’re concerned?!f Being 136’d and manhandled into police cars/stuck in cells for hours/stuck in A&E with contemptful staff for hours is definitely not good for mental health, and especially frustrating to someone who went for help long before things got that bad.
    Sorry for the ramble; my point is that mental health services often seem absolutely counter-productive, actually escalating situations, and someone/and agency with more clout than service users needs to kick up a fuss about this. (Incidentally I’d highly recommend Dorothy Rowe’s ‘Users and Abusers of Psychiatry’).

    I’d also be interested to know what the procedure/guidelines are for prosecuting MH staff for neglect, and how often charges for neglect actually get to court. As I’m writing it here, I will be vague, but I know of a case where a very unwell person was dismissed when asking for help and nearly died from subsequent self-neglect. Charges were brought by those who eventually found the person, these were people held in high regard/reliable witnesses etc. And CPS decided it wasn’t in the publc interest to prosecute.

  3. I’m really enjoying your blog. I’ve had personal experience, of mental health problems, with depression, anxiety, an eating disorder and Post Partum Depression, and my best friend who has BPD lived with us for 18mths after her marriage collapsed due to her illness. At one point, when she was with us, she stopped taking her meds, and became borderline psychotic, and delusional. She was threatening to harm herself, and others. I spent hours on the phone, to her CPN, her doc and the local mental health services, who all were, frankly useless. She wasn’t actually going to get the emergency help she needed unless she actually did hurt someone! I called our local police, we have a number for them, and they were actually the most helpful. He came over, spoke with me, spoke with her, and helped me get her to our local A&E, (I was 7mths pregnant with a toddler, in tow) where she was assessed, and admitted to the local psych ward. He was brilliant, and even rang me the following week to see if we were ok, and how she was. I was most impressed. I actually raised a complaint with St.Georges and West London Mental Health trust, because of the poor handling of the whole thing. The local police should not have had to basically help me, deal with a very mentally unwell woman, who was a danger to herself. The system is shocking, and badly needs changing!

  4. Excellent article and many valid points raised. In this age of databases, smartphones and apps, surely a simple list can be made of all a police districts various mental health contact points. I’m sure the NHS would be able to provide ‘points of contact’ for this purpose. It is important to get the right person at the right place at the right time to efficiently and effectively bring a problem to a good outcome. A little training backed up by an up to date contact list of ‘expertise’ could be a good point to start.

  5. I am a frontline police officer who regularly sent emails regarding the problems I was facing up the management chain. Only for them to disappear into the SLT ether. The problem is senior officers don’t have the courage needed to resolve the problems brought about by the poor cover provided by MH trusts. It’s a waste of time and effort frontline officers raising issues because it would take an ACC or even a CC to resolve the matter and that’s never going to happen. The matter gets devolved to a lower rank and the impotuse is lost.

    I agree that the argument about who’s to blame should not take place whilst a patient is missing but the problem is it nevers happens after they are found. It’s difficult to be heard when frontline cops are thought of as the lowest of the policing ranks. Ever heard of a response PC getting to chat to the force lead on MH to bash out a few ideas? No. Because it assumed we’re not able to see the bigger picture. The fact that I can see that a very basic risk assesment could have stopped a seriously ill MH patient from walking out of A&E is clearly too simple a solution to the saving of thousands of man hours wased picking up the pieces from a broken MH treatment programme.

    Allow me to put it another way. If a suicidal prisoner is brought into custody then an officer sits with them until either they calm down or the risk passes (ie alcohol wears off). In my A&E if a suicidal patient comes in they’re left alone till a MH team can assess them (6-8 hours) or are left alone till the sober up (4-6 hours) but before either happens they usually walk out and the police are called. Am I really the only person to see the glaring discrepancies between the two methods?I agree that the police need better training (and I’m fully aware of our shortcomings) but MH staff need training in better risk assesments.

    Just like social services in Rochdale have been criticised for saying 15 year old girls are promiscuous rather than being abused it wont be long till a similar scandle befalls the MH world. When it does frontline staff still won’t be listened to and I know because I’ve tried to speak to my forces MH lead and was told to send my concerns through my Inspector. The problem is that it has to pass through several ranks before it reaches those who can make a difference and the message is diluted en route.

    What’s ironic is I know my very senior ranks read this blog as does my forces MH lead. Its a shame none of them are there with me at 4am when the problems arise so they can be as shocked as I am at the state of affairs as it stands. So MH cop if I may steal your podium for just a moment, if you are reading this and you have ANY input in how MH issues are dealt with in your force then please talk to frontline staff. I know some of us moan and are not very constructive about how we complain but if just one officers can can see the ‘bigger picture’ and provide real time evidence supporting your forces position then isn’t it worth it?

    So try it. Set up a working group of frontline staff who have an interest in MH issues who can feed back info to the SLT but who are also willing to take on extra training and can act as a MH champion within response groups when MH incidents arise. I could help in the following ways:

    1) Your force is less likely to be compromised when there is conflict over who takes responsibility over issues (ie transporting patients) as there will be somebody there who can say “No” and feel confident about saying so as they’ve the knowledge to support the decision.
    2) People suffering from MH problems are more likely to dealt with by the most appropriate service (jointly if needed)
    3) The number of hours spent dealing with MH incidents will reduce dramatically which in theses austere times can only be a good thing.

    There are plenty more reasons but I’m sure they’ll come out as the matters are discussed.

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