Mental Health Screening in Custody

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.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


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9 thoughts on “Mental Health Screening in Custody

  1. Good idea and while potentially more difficult during office hours could see it easily working outside of office hours where the police could ring EDT who they normally have a good working relationship anyway and at least in my area have access to health IT systems, during the day it could be the crisis team or the access assessment service who have staff by the phone all day anyway.

    1. I’ve raised this as a suggestion recently for police dealing with people who haven’t reached or aren’t destined for police custody but who are displaying behaviour which is suspected to be due to mental ill health. If police had better information about a person’s health issues in real time officers would be in a better position to make considered decisions and people could be referred to appropriate agencies sooner.
      A positive side effect to this may be a reduction in the number of sect 136 MHA detentions.A problem to overcome is how you access information when you have four different mental health trusts in your area and a large number of Acute Trusts all with their own information systems.

  2. I think it’s a good idea. Although having nurses in police stations sounds apeeling it’s not cost effective but having a person on a phone is. Question is that crisis teams are not always at the office but you could phone a switchboard and they could notify them if needed!

    1. That IS the only problem, getting hold of the acute mental health team, in my experience. However, if a system such as that suggested could be established I think a lot more people would get help (in Scotland they have permanent drug workers in the courts, could they not do the same with a MH nurse) and I reckon it would impact massively on re-offending figures. Certainly something needs to be done.

  3. its a good idea, personally i think the answer may lie in just basing the NHS criminal justice teams (who deal with diversion) into the police station custody suite. that way, you have instant access to mental health workers who could triage / assess as required and follow this through with a brief written document that goes with the file and onto CPS / court….this would save a whole heap of work further along the chain and stop the use of detainees waving their mental health card…..

  4. I am an RMN employed by NHS and I work 8.00-16-00 in police custody, it,works, but it can always be improved. My team work six days a week and offer screening to anyone who has been arrested. Following an assessment we feedback outcome to the custody sergeant, complete electronic health database and create a risk assessment and letter which is made available to police, probation or Mags if remanded for court.
    We have developed referral pathways into community services and will refer clients if appropriate.

  5. Is this going to be updated?
    Psychiatric nurses in custody works and doesn’t cost the police a penny!
    Still would like the video from the mental health and policing conference…..

    1. How are you defining ‘works’? – NHS England Liaison and Diversion lead accepts that the way this has been judged is inadequate. Much more work to do.

      I have the video, will work to get it out ASAP, but it’s lower down the priority list, I’m afraid as there’s that much going on.

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