Give Me Two Days

Chuffed to bits that Nathan Constable has written another guest blog for me – I still remember the first time he rang me up to tell me what a difference a nugget of knowledge had made after he’d read one of my blogs.  It was obviously a subject he was passionate about and you’ll find out why when you read this.

You should check out his blog – he reaches far and wide on policing topics including his own stuff on mental health issues and the regard in which he is held as a blogger was shown when he recently decided to move away from doing it for a while, amidst a sense that it was making no difference to the world.  Various people persuaded him back – if and if it hadn’t worked, we’d have dragged him! – because he’s got a good eye and offers a great insight.  Here he is:

I dread some calls more than others. Strangely it is not the calls involving death or horror which cause me anxiety. A murder, though high-profile, is often a relatively simple investigation. Large-scale public disorder is unnerving but the police receive extensive training to deal with it and can usually rely on force of numbers to help out. If it’s a crime – we investigate. If it’s anti-social behaviour – we try to tackle it. If there is an upset victim or witness we try to comfort them. We are largely in our comfort zone when dealing with any of these circumstances.

The jobs which tax me most are those which involve any element of mental health.   There are a number of reasons for this:

  • Firstly, the boundaries of whether something is or is not a crime can become blurred. Does the person know what they have done is criminal or are they too unwell to be aware?
  • Secondly, it is highly unlikely that I am going to be able to resolve whatever is going on quickly.
  • Thirdly, I am not sure I can count on other agencies to support me whilst I try to resolve the situation.
  • Fourthly, and honestly, I don’t have the first damn clue about what I am dealing with nor do I really know how to resolve it.

Police officers are extensively trained. The initial training lasts months and you are then in a two-year probationary period where learning continues. You never stop learning as a police officer but training helps. Although there has been a reliance on “e-learning” over the last few years (something I loathe) officers are usually (eventually) brought up to speed on changes in legislation which will affect them. Training days are often built into the shift pattern and allow for dedicated learning time. Courses are available for any number of specialist knowledge or skills. It is a legal requirement to receive annual personal protection equipment (PPE) training (self-defence, baton, CS spray, handcuffs)  and this training concentrates on the legal aspects of the use of force as well as its practical application.

In the vast majority of cases it would be safe to assume that if a police officer turns up to deal with an incident then that officer or their supervisors will have received some form of training in dealing with it or something like it. Unless it involves mental health.

I have a passion for this subject.  This is the third guest blog I have written for Michael so let me be candid about why I am so passionate.

I am a police officer AND I am a mental health sufferer.

EXPERIENCE AND TRAINING

I have battled with serious depression for the best part of twenty years so I have some understanding of where it can take you. I can relate to the sense of utter despair, loneliness and hopelessness.  I can understand the way a depressed person might think. I can feel their pain. I can offer insight and talk about how things can get better but this does not make me an expert.

Put me in a room with a suicidal person and I can make a pretty good attempt at talking to them and talking them around but the only reason I can do this is because of personal experience. I have never received any training in how to do this. For all I know I could be saying all the wrong things but the point is – I don’t know.

Change this situation slightly and put me in a room with someone who is floridly psychotic and I am no more use than the next man. I have absolutely no understanding of what is going on and can only look at the threats this person presents to themselves, to me or to others.

The vast majority of police officers do not suffer with depression or any form of mental health illness. They therefore don’t even have personal experience or empathy to fall back on.  It is guess-work, pure and simple.  This wouldn’t matter if police officers didn’t have to deal with people suffering from mental illness but they do –  and frequently.

ONCE UPON A TIME

When I started as a fresh-faced probationer I got involved in one particular mental health sectioning. I went along with the social workers and doctors and with other officers to a Section 135(1) warrant. I had absolutely no idea what was going on. No-one explained to me what the process was and we sat waiting for something to happen. Nobody took the lead and we watched as the assessment team talked to the patient in their own home for the best part of an hour, wondering the whole time why we were there.  It seemed to be going nowhere. The doctors were telling the man he needed to go to hospital and the man was saying he wasn’t going. Suddenly, and without warning, my sergeant lost patience and pounced on the man. He told me to take an arm. There then followed an almighty bundle as we took the man to a waiting police van and drove him to a mental hospital. At the conclusion of this process I was still none the wiser as to what had just happened. This was many years ago but the event is lodged in my memory.

Since that day – almost two decades ago – I have received the sum total of zero training in mental health policing. In the same period of time, police involvement with mental health has increased from being relatively infrequent to occurring several times a day.

I work in an area where there is a mental hospital on patch. As an inspector who leads a team of 20 others I have had to make it my responsibility to learn about mental health policing fast. My officers have had the same amount of training I have had – none – and so someone needs to have a clue and, as the buck stops with me, it has to be me. I have been able to share my knowledge with my team and their confidence on the subject matter has grown along with mine.

Where did this knowledge come from?  From Michael’s blog. Nowhere else.

Michael and I have become friends as a result of my interest in this subject. Not only have I read and absorbed his blogs and guidance but we have spoken many times on the phone, we talk quite often, we have even met.  His blog is the single biggest resource for all matters relating to policing mental health in the United Kingdom. It is gold-dust. Yet he has written it in his own time! No-one asked him to do it and if he hadn’t done we would be much the poorer for it.

How can such an important topic as this have been missed off the training list?  Is it right that most of the service now looks towards a blog, written by an officer in his free time, for guidance on issue which could have fatal consequences if handled with incorrectly?

RISKS AND THREATS

Dealing with mental health issues is fraught with risk and danger.  When I see someone behaving in a way which appears to suggest that they have a mental health disturbance, there are any other number of medical emergencies which could be the cause.  Many of these are fatal – stroke, head injury, diabetes.  I had never come to even think about mental health as a potential medical emergency until I read Michael’s blog.

I knew nothing of the problems of restraining a detainee with a mental illness. Restraining violent prisoners is one thing and we are taught to look out for the risks of injury to them or the possibility of positional asphyxia but I knew nothing of the other issues regarding restraint of a mental health patient. This too is classified as a medical emergency. If the restraint happens in a clinical environment there would have to be defibrillators on hand and doctors present who can ultimately rely on the use of a chemical intervention to subdue the patient. In custody suites we have ready access to defibs but nothing else.

I had been led to believe that a police station was a suitable “place of safety” for a person detained by police under the Mental Health Act. It really isn’t! The Royal College of Psychiatrists says not and the Independent Police Complaints Commission would prefer it if police cells were never used. But they are used routinely and they shouldn’t be.

I have no idea what to do when I turn up and am faced with an individual who is experiencing a psychotic episode or who wants to throw themselves off a bridge and yet it is me (or most likely one of my team) who is going to be first to the scene of such an event.  I also have no understanding of the role of an Approved Mental Health Practitioner (AMHP) and it has become painfully apparent to me that they have no understanding of my role either.

This isn’t something we come across now and again – this is daily business. Sir Peter Fahy, Chief Constable of Greater Manchester Police, has said that “mental health is the single biggest issue facing policing today” and he is right. As other services contract due to financial and budget cuts it is the police who are increasingly likely to be the first point of contact in a crisis.

These are issues which require strategic intervention. The use of police cells needs to be addressed at a national and governmental level. The legislation relating to Section 136 of the Mental Health Act needs to be re-examined to include private places (or amendments made to Section 17 Police and Criminal Evidence Act to allow police to enter a property to protect life and to DETAIN to protect life.)

Work is underway on these subjects but progress remains very slow indeed. The correct changes at this level could greatly reduce the demands which mental health places on the police but, in the meantime, officers across the country are having to deal with things “as they stand” and without proper training.

So I am asking for two days. Two days’ initial mental health training for all police officers across the country. Followed by one day a year subsequent to that. For two days’ mental health training to be put into the initial curriculum for new officers in the future.

Two days probably isn’t enough but it is two days more than we get now and in that time you could cover a lot.

  • Inputs on the legislation relating to the Mental Health Act and Mental Capacity Act
  • Inputs on what to do when you DO detain someone under Section 136
  • Inputs from Approved Mental Health Practitioners and doctors on the mental health assessment process
  • Inputs on the various conditions and their presentation
  • “First aid” training for mental health – including rapid de-escalation techniques, what not to say to a suicidal person
  • Responding to allegations of crime committed by Mental Health Act patients
  • Dealing with AWOL or missing patients – who is responsible for what and when
  • Handling intelligence relating to persons who present a risk through mental illness

Separately I would ensure that the restraint techniques used in hospitals are taught as part of the annual PPE training for police. My understanding is that it involves a completely different set of tactical options and we need to know them.

I would encourage AMHPs to join in the training so that we could foster a better understanding of each other’s roles.   I would encourage joint training days with supervisors and managers from all the organisations involved so that the lines of communication can be “greased” at a tactical level.

WHAT WOULD THE BENEFITS BE?

It would give us a police service with a far better understanding of a massive and complicated issue which they are otherwise dealing with blind:

  • It would lead to better working relationships between the agencies who should be working together.
  • It would create a far more sympathetic police service which might be able to use options other than force to deal with a situation.
  • It would empower staff in their decision-making and to recognise when the right thing is not being done.
  • It would improve the way that risk is managed
  • It would improve knowledge, understanding and leadership
  • It would lead to better patient care
  • It would save lives and prevent injury
  • It would save money (albeit uncosted)

There is no way you can cover all this using “e-learning” no matter how good that computer package is. It is too important and the risks are too great.  Two days would not make us experts but it would give us a much better understanding and a fighting chance of dealing with events properly.  Given these potential outcomes is “two days” an unreasonable request?

And if there is any question as to who might prepare or create this training package – you wouldn’t have to look too far to find two Inspectors who would jump at the chance to help.

Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England.  It doesn’t substantially alter the post but certain reference numbers have changed.  My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here.  The Code of Practice (Wales) remains unchanged.


 

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 “Give Me Two Days

  1. This is excellent NC and you’re right, until you have been in that awful dark place you have no idea how it messes with the mind. As a nurse I had no idea what people were going through until IT happened to me and wish I could go back and deal with patients better than I did.

  2. What an excellent blog and which hits the nail fair and square on the head.

    Some 9 years ago, my mother developed dementia and died about four and a half years after its diagnosis. Coming to terms with it as a family, was difficult. None of us had had any experience of managing such a situation, or of watching someone you love deteriorate before you. Mum developed dementia just before I joined the police and this was something I kept to myself and did not take to work. However, that changed after I heard a report being given over the radio by a police officer that the person with whom the officer was dealing was apparently “not the full ticket”. That could have been my Mum about whom he was talking, and so it hurt to hear it as Mum was still with us then.

    I had already been to see the local Alzheimer’s Society on a number of occasions for help and advice on how to deal with, and manage, Mum’s condition. Based on what I had heard on the police radio, I went to see them again to see if they had any training packages they could deliver to police officers. They said they could provide one, but it may cost a nominal fee. With this in mind, I submitted a suggestion to the Force Suggestion Scheme for mental health training, recognising that it was a huge topic and Alzheimer’s was but a part. After scrutiny by whichever panel, I was told it was a good suggestion and that the reward payment would be donated to the Alzheimer’s Society as I had requested. After waiting some time with no contact on how it would be moved on, I kept hassling the relevant department but the matter seem to die slowly in the long grass of apathy. Still, there has been no formal training on mental health issues.

    The team on which I work was recently fortunate to have a very informative and enlightening input by Michael Brown. However, we are still not trained to deal with mental health sufferers but yet are expected to respond to calls and manage individuals. Now, the Home Secretary has jumped on the bandwagon and, it seems, police officers are not doing enough. There is one section of society who are trained in such matters – mental health professionals. What we really need is for the Home Office to work with the Health Department such that the trained professionals take full and active responsibility for their roles and assist police officers when requested. The police officer is seen as a ‘jack-of-all-trades’ and which therefore suggests that we are able to deal with a whole gamut of situations, but then rely on those agencies best able to conclude matters to take over and manage the situation. We definitely need training to recognise situations and how to deal with them until time as the professional turns up, but this training must be on a proper basis and NOT e-learning. As Michael found out with us, there were more questions than answers and an e-learning package does not have that interaction. The big question is “who will take the bull by the horns and ensure such training is delivered?”.

  3. Some very good points some form of joint training or AMHPs and others offering training sessions is required rather than the current situation which leads to frustration on all sides can only speak for my local area but sure that our trainers would be more than happy to offer sessions for the police which could give consistency rather than separate localities giving their views

    1. Sorry to oppose your view, but I really fear about localised joint training. Let me exemplify:

      If you have the infamous “135” conversation where I work, you’ll get AMHPs giving one version of events, mainly because of some influential, slightly more senior practioners. Have that same conversation in London and we know it will be different.

      And obviously, it is my standard reply to the thought of officers needing MH training, to point out that MH professionals need “police awareness training” or similar. Arguably, more so than the police need MH training. 🙂

  4. I am a mental health LO for met police. My self and my college learn as we go along. Like you say, no training. From our experiences and from reading everything we can, we have gained a lot of knowledge. We now give training to our fellow officers and the AMPS. We have a very good working relationship with our partners. We don’t have time at work to read . We do it in our spare time. We like you are passionate about what we do. These blogs are brilliant. I also have mental illness. I have suffered with depression for 12 years which gives me an understanding in some areas but not others. All I know is I love my job and would love some proper training.

  5. Effective mental health training is about keeping everyone safe – public, patients and police. I worked for many years in the Prison Service where the wider understanding of mental health was also very poor. I don’t recall ever having any specific mental health training though we now know that the incidence of mental illness in prisons is very high. Male prisoners are 14 times more likely than the general population to have two mental health disorders and female prisoners an astonishing 35 times more likely. Given that these prisoners will all have passed through custody suites, it gives some indication of the levels of mental illness that both police and prison officers deal with as a matter of routine.

    In this context, Nathan Constable is clearly right in suggesting that a minimum of two days’ training in mental health and learning disability should form part of a police officer’s initial training. It will, however, be some time before the College of Policing is convinced of this need and even longer before the training programme is amended accordingly. In the interim, I am interested in the level of support that exists for the NCALT e-learning Mental Ill Health and Learning Disability training package. Whilst I accept that e-learning is by no means ideal, compulsory completion of the online course would at least go some way towards raising awareness of key MH issues and concerns.

    When i read the IPCC report into the stabbing of Sally Hodkin by Nicola Edgington, I was particularly struck by paragraph 138 which reads: ” It is the responsibility of the Borough Commander…to ensure every police officer on the borough has completed the e-learning package for mental health and learning disability.” This appears to be part of Standard Operating Procedures rather than a recommendation.

    The sentence in question indicates to me that it is compulsory for officers – in the Metropolitan Police Service at least – to complete the NCALT package. However, I have spoken to a number of MPS officers who are unaware of the very existence of the NCALT package. This raises questions about how long the course has been compulsory, how the training requirement is cascaded into probationary or annual staff reports, how compliance and completions are measured and how borough commanders are held to account.

    Furthermore, the IPCC report gives no indication as to whether or not completion of the NCALT package is compulsory in other forces. I appreciate that the 43 forces operate on a quasi-independent basis but it would seem odd for something of such fundamental importance to public safety to be obligatory in one force area and not in the next.

    I would appreciate any clarification on these points!

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