The issue of how to better identify people with mental health problems in police custody keeps coming up. It was raised in the Bradley Review (summary) and there have been various suggestions over the years. Last year, an initiative started in Lambeth police custody and there have been recent calls to specifically improve screening for women’s mental health in police custody. There are various methods to do so:
- 24/7 psychiatric nursing in custody – expensive. Questionable whether it would be viable in less busy custody offices. Also, research from the 1990s (JAMES) showed that where psych nursing was available, something like 15% of people in custody got identified as having a mental health problem. This figure is only slightly higher than the 10-12% that the police would have spotted for themselves – it would still see some learning disabilities patients being missed.
- Screening Tools – of various kinds: IT based tools which can cost thousands and which take inordinate amounts of time to use per person detained. I’ve known some people keen to sell things which would take 30 minutes per arrest to screen. Not practical.
- Other problems around screening tools include the fact that they are often specific to particular issues like Learning Disabilities, rather than generic to a breadth of mental disorders. Obviously, it would be impractiable to have two or three different screening tools and use the lot to ensure that every base is covered because it would take too long per detainee.
- Better Police Training – never a bad idea. How well do you want us trained? Given that fully trained psychiatric nurses don’t spot that many more than police officers, would it really be the silver bullet?
So here’s a thought!? …
Why can’t all police custody areas and their local mental health trusts establish one or two phone numbers that the police ring EVERY SINGLE TIME someone arrested arrives in custody? In fairness, you could do this in many police encounters where arrests or detention were being considered and who knows what better ideas we could come up with, together? After the police provide the name, date of birth and address of the person arrested they give just one piece of information: whether or not the police have concerns that the person detained has a mental health problem – in the street, you’d only call if you had those concerns.
This view could arise for a range of reasons:
- Police or FME observations of the person’s demeanour / behaviour.
- Police information systems indicating prior knowledge of a mental health problem.
- Self-declaration by the person detained when asked by the custody officer
- Third-party information from someone involved in the incident being policed that the individual has a mental health problem.
Of course, the precise source of the information would not need to be disclosed, merely the existence of a suspicion. Meanwhile, in HealthLand those nominal details could be cross-referenced against NHS records. In order to preserve medical confidentiality, there would be no need to actually tell the police anything: the mental health trust would merely decide whether they are coming to custody to assess the person?
ONE OF THREE OUTCOMES
- If the police / FME have concerns and the patient is a known MH patient >> turn out the CrisisTeam and screen the person in custody.
- If the police / FME have concerns and the patient is NOT known as a MH patient >> turn them out and screen.
- If the police / FME have NO concerns and the patient is NOT known >> don’t turn out.
So what do we need to make this work? One or two phone numbers into the NHS which could be answered by someone who can access health records and notify the CrisisTeam, if that is required. Maybe one for office hours and one for out of hours … who knows.
How often would we be phoning? It obviously varies by area, but in my area’s custody office for example, we detain on average around 25 people per day. That’s one phone call per hour (average).
What would be the benefits? Well, in one initiative in the south of England, it was established that as many as 50% of people who are arrested are either currently known, previously known or need to be known by the mental health trust. If we therefore structure our response on indirectly accessing that data to influence the response of our health colleagues, in addition to those incidents where the police have concerns, I am suggesting the ‘capture rate’ would rise dramatically. Of course, if that were in addition to good risk assessment questions, so much the better.
Is it beyond possibilities that organisations as large as police forces and mental health trusts could not establish an arrangement whereby it is possible to make one phone call an hour to the NHS and say “Michael Brown has been arrested, [DOB / ADDRESS] and we’ve got concerns based on historical information of MH problems”. It would potentially capture a far, far clearer picture of the number of detainees in custody who have a history of mental health problems and better identify individuals who could be diverted (whatever that means).
Just a thought … and of course this principle could apply outside of custody, too! Officers at incidents with the ability to access mental health nurses and their advice or information. It’ll probably never catch on.
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