My Reaction To Adebowale

I thought myself very privileged to have been on the list of people to receive an embargoed copy of the Adebowale Report on Friday morning, two hours before the world saw it.  Although I was due to be at work on an EARLY shift, I had made mental arrangements to prioritise reading it amidst my various duties, tweeting some headlines and expanding on a blog I had prepared in outline earlier in the week.

Best laid plans …. before 8am on Friday morning, I was out of my police car having driven on blue lights to an emergency and running through a local park to get to a footbridge over the M5.  My Central Motorway Police Group colleagues had brought the carriageways to an eerie standstill at rush hour because of an incident where someone was threatening to jump and I was the incident commander to try to prevent this.  No sooner had we talked them down after an hour of effort and taken them to hospital with mental health problems and possible hypothermia, we followed this up with no fewer than FOUR more resource-intensive incidents where people were threatening or attempting suicide.  Adebowale would have to wait and hence this reaction comes quite late!  But he was right, for all the reasons that delayed my digesting his report: mental health is core police business.

Eighty pages, twenty-eight recommendations.

A succession of headlines in national media about “police failings” and social media interest of all kinds.  Some officers feel that the report attacks them individually and their profession collectively: one officer on Twitter said, “I literally give up. I cannot take this constant drubbing. I don’t know why I bother.”  Others have looked at some of the inferences within the report about racism and the use of force and been concerned by the analysis and the sample sizes from which conclusions have been drawn.  It has prickled a few of my colleagues, to say the least.  To them I say this:

You can quibble over details of academic rigour or research methodology if you want to: but we all know that the broad thrust of this report is spot on – a lack of proper partnerships and infrastructure for mental health emergencies; a lack of parity across our society and especially within our NHS for physical and mental health care; and a police service which has been hoping that the need to deal with mental health incidents would go away, if only partners would sort their resources and their responses.  Well, it won’t – it’s core police business.

THE REPORT

Lord Adebowale makes 28 recommendations, falling in to three categories of business, which I will let you read for yourself in the full report:

  • Leadership
  • The Frontline
  • Partnerships

If you read it cover to cover – the full report – there is ample opportunity to see that criticisms of what contributed to 55 deaths in contact with the Metropolitan Police, go way beyond policing.  “The Met cannot do this alone”, says the report.  “The police are forced to mop up situations that mental health and social services should be dealing with” although colleagues in health and social care were quick to point out, that this sometimes works in reverse.  One officer asked when the reverse is true, almost incredulous at the thought.  I often find that police officers don’t realise where we cause chaos and confusion: the misuse and abuse of s136 MHA; the all-too-often poor response to allegations of violence or crime by people with mental health problems, including where they are detained patients in psychiatric units.  It’s easy to wear blue and see the failings of a chronically under-funded health and social care system – harder to see what’s right in front of us in our own organisations. << Therein lies vindication for the report.

But there it is in Adebowale – a lack of leadership which the report suggests needs to be rectified at the level of the Commissioner; a lack of training and effective joint protocols with health and social care organisations which leads to it being all “too common and too easy” for police officers, AMHPs and NHS staff to have on-the-ground disputes over tactics and responsibilities.  Finally, a lack of established partnership structures through which to brigade all of this across the Metropolitan Police.  Of course, the complexity added by the size of the Met should not be forgotten: my own force covers seven local authorities, four mental health trusts and eleven acute trusts – complex enough, thanks!

London is a confederation of 32 boroughs across which (I think!) 9 mental health trusts operate alongside ??!? acute trusts and 32 Clinical Commissioning Groups.  To have an effective relationship with “the NHS”, the Commissioner will need cat-herding skills on an unprecedented scale to brigade in excess of 100 organisations in the capital.

MENTAL HEALTH IS CORE BUSINESS

I was grateful for the chance to speak to the Commission: two hours of my time I was very happy to give and I’m delighted to find that my views and in particular my blog, have been represented in the report.  A journalist who attended the press conference for the launch of the report informed me that my work was directly praised by Lord Adebowale whilst stating that “the popularity of [the MentalHealthCop] blog highlights a lack of education within the system.”

Obviously, Lord Adebowale has stated that there must now be a comprehensive package of mandatory training, pitched at different levels for various roles within the organisation – I’m delighted to say that the Metropolitan Police have already asked me to assist with that.  Some were quick to point out that training is delivered across the service and that this is updated.  I’m reluctant to point out – this blog only exists at all because what training is there is not adequate for the duties modern officers must perform.  No training contains reference materials about the recall or revocation of conditionally discharged or community treatment order patients; no national training specifies an approach to mental illness that seeks to recognise what needs to be treated as a medical emergency, including restraint and certaily no training tries to affect attitude.

If senior officer training were provided, there would have been little need and no appetite for the Superintendents’ Association of England and Wales to circulate the Senior Officers’ Checklist to 1,400 members nationwide (twice!).

Putting our house in order has to come first – senior officers, themselves properly trained and focussed on key priorities will need to “go in to bat” against agencies who will shout “resources!” at many suggestions of what is needed.  We need people at ACPO level and superintendent level who can prevent the police being “had over” by mental health trusts who are inclined to want to ‘bounce’ half of all their s136 cases on the premise of various ridiculous exclusion criteria, pushing clinical risks into custody; we need senior officers to allow the expenditure of resources at sergeant and inspector level who can build day-to-day relationships with health and social care service managers to regularly resolve problems that are caused on either side; and if we think s136 has been the poster-problem, we need them to understand and work with partners on a problem that is potentially ten times as big – criminal suspects arrested for offences who are mentally ill.  We need Liaison and Diversion Services and it’s got to be something other that a psychiatric nurse working 8am-4pm who scans the cells first thing in the morning after the key legal decisions were taken last night and overnight and then refers people after the fact.

All of this is predicated upon one point I’ve made before on here: mental health is core police business.  It always has been and it always will be.  The only question is whether we want to plan and properly prepare for it as we do with many other areas of our work, or whether we can keep busking.  Adebowale contributes to the view held by many including me: the time for busking and hoping we get away with it is long since gone.  It’s obviously from the court cases, the coronial inquests and the coverage in our media – we’re not getting away with it any more and we need to put our house in order before tackling the partnership structures and this work will not be a project –

It will be ongoing, without limit of time.

REACTIONS TO THE REPORT

NB: the top picture of this blog is the mental image that sits in my head of policing the Olympics in London in 2012 as I was posted to duties at the ExCeL and the O2 arenas.  A brilliant, world class city in which millions of people suffer from mental ill health.


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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14 thoughts on “My Reaction To Adebowale

  1. Thank you for this amazing summary of the report and for this blog. I worked in policing for a few years, and I am a person with chronic depression. I watched from within as a colleague gave up and killed himself. He had reached a desperate end in his mind. Shot himself where his own police force had to deal with his suicide. But he felt he could not talk about how he was suffering because of the stigma within the organisation. Mental health issues abound everywhere, in and out of the law circles, and it is a global issue to learn how to integrate functional and dysfunctional behaviours into our working lives.

  2. Generally – good piece of work, confounding the critics. It was right to have an independent person hear the views of special interest groups, not have the special interest groups hearing and considering the evidence.

    I think they could have gone further on questioning the root cause of the issue – police, prisons, A&E, ambulance (homeless charities) increasingly caring for seriously mentally ill people. We need to move the pendulum back towards the mental health services. This is addressed, but I would have liked to see more.

    I would also have liked to see more on safe restraint/ transport. Interpersonal skills can definitely reduce the need for force, but I cannot believe that police will eliminate the use of force all together. Officers obviously need techniques and clear training to do this safely. I think they dodged the issue on this one.

  3. Hopefully other forces will take on board the recommendations and timeline. I know that the people who can make this happen with within my force (GMP) read this blog so for them…..WE NEED THESE CHANGES TOO! While I’ve your attention why not have a MH version of ‘Nightingale’ officers on RPT. Give them advance training in general MH, legislation, local policies and crisis intervention. It could be roled out in a month or 2 if you tried.

    1. Not sure what Nightingale officers are, but if that means a few per shift with extra training, awareness, then we’re doing this during June / July in WM and by mid-Summer, we’ll have 50 officers per shift 24/7 with this training who can get involved in the less frequent, more complex and difficult stuff. I’ve been pushing for such a model for years and it’s finally going to be trialled!

      1. This is exactly what I mean. Can you give your GMP contacts a nudge and get them to start planning? :o)

  4. The need for officer training is included in the report; obviously more than just mh/mc legislation. Empathy and customer/client care can be taught to an extent but much of this is in an individual’s personality and their rapport with colleagues and Jo(e) public. Initial “recruitment” wasn’t mentioned as far as I am aware but perhaps the selection process is where professionalism in policing begins?

  5. one of the things that kent police used was a one day awareness course based on the prison service ACCT, rolled out to custody sgts, fcc and recruits, went down well, sadly replaced by elearning, which whilst good in content, was too short, lacked depth and just cant replace the dynamic of being able to ask questions like why and what and best approach. more than happy to email the slides etc. mick

  6. Really good to read your Blog Michael. The issue of resources and partnerships is surely one that the PCCs are supposed to be focusing on. In Sussex we have a very capable DCC who sits on the board of the (thankfully one) mental health trust and their CEO understands the need to work closely with the Police. However that cannot stop the inevitable differences at a national level between the HO of and DOH feeding through and the fact that the resources are very limited. Along with the need for PCCs to support and extend partnerships that do exist they also need to articulate with the public the reason why this issue is more important than ensuring there are police officers on every corner (or in the case of our PCC, specials in every village!).

  7. As a “carer” and parent of a son with a relatively mild psychotic illness, as well as being a member of Hampshire Constabulary IAG, I can recommend having a person with my sort of background / experience present on training courses for police officers. I was a local government EHO for many years (“life of grime, enforcement, etc.) and have considerable experience in the voluntary sector.

    I agree with “Mick” (above) about the importance of being able to ask questions and perhaps include a 10 minute slot for the invited “carer” to talk freely about the traumas, joys and hopes of living with the ups and downs of people with psychotic and depressive illnesses – episodic nature, behaviour, awareness, attitudes to other people, police, medics, medication, etc.

    Eg – my “carer” experience; with some history from teens my son’s later family breakup when he was living with his partner away from our home and separation from his children led to a rapid downfall of his business / earnings, family courts, etc. eventually led via inept “missing person” action to s136 / sectioning. Intelligent (degree qualified) man in mid thirties who had never harmed or threatened anyone was told to come quietly by taser wielding officers (not in Hampshire!) and taken to a police cell “place of safety” overnight to await assessment. His mother also severely traumatised by whole episode and given medication.

    After hospital sojourn he returned home initially on depot injections that gave him nightmares – worse than the condition he was being treated for! Later taken off medication and apart from several less severe episodes life is returning to “reasonable in the circumstances” – we await the next episode on tenterhooks! Support from The Prince’s Trust (as carers) has been invaluable.

    Life on the edge of a cliff for patients and carers can be disastrously exacerbated by heavy handed inadequately trained officers and staff from all agencies in what should be a well-coordinated support team assisting mh/mc sufferers (and their carers) from being a danger to themselves or others. Many of us would, I feel sure, be happy to assist the police, social services and medical services in training. My personal recommendation would be to include mental health, incapacity, etc. as a fundamental part of “CUSTOMER CARE” training which would also address hate crime, victim support, etc. This should start with basic (police, social services, medical profession) training with later reinforcement in specialist MHA, etc. training.

    I hope my comments help and can be passed on to “the powers that be” if you think appropriate? Thanks to Inspector Michael Brown for your dedication to this important topic that affects 1 in 4 of the community (probably much greater amongst police clients!). Keep up the good work! 🙂

  8. A really good post Michael. It is clear from the Adebowale Review that the Met (and by implication other forces) need to do much to improve responses to mental health. However, it is vital that local authorities, health and housing agencies also do more to support the police in their work – to prevent them being used as the default mental health service of last resort, with potentially tragic consequences. Hopefully the Review will provide a focus for all parties (and not just those operating in London) to improve their joint working practice.

  9. In my experience of being detained under S136 and subsequently S2 the whole process is hit and miss on an individual level. You can structurally organise things in a multitude of different and apparently sensible ways with targets and measures to support, but you can never replace simple human to human empathy and compassion, I do not care who is providing this!!! In my recent experience I moved rapidly from feeling relatively safe to extreme fear and panic dependant very much upon who was dealing with me and in what venue. The more contained and with less human contact, the more panicky and scared I became (especially in a cell, where I could see no one!). I have mixed memories of the whole event, but with the evidence of reports can be very clear that, I had no history, was not known to police or services, my behaviour was completely out of character. My point being, that if you treat me as a problem fitting a category and have a one dimensional response, you will inevitably miss connecting with me and as a result will miss the potential opportunity to achieve a less painful and traumatic outcome all round.

  10. I was surprised to read in the report just how high a percentage of police time is taken up with mental health.Clearly it is as you say core police business but I sympathise with your colleagues who are “hoping that partners would sort their resources and responses”. It might have been good if Adebowale had recommended that as good policing of Mental Health begins with the general public’s and NHS’s response what is needed is education of the public as to what to do and a separate commission to Adebowale into NHS response to mental health.If crime prevention is the main police priority (as it is in the Tom Winsor analysis) then the earlier catching of mental health issues must bepart of the way to reduce the police being left holding the baby.
    My own experience is that 10 years ago when my relative ,A, was first becoming unwell the GP didn’t notice anything amiss. Neighbours and friends advised that nothing would happen until a crisis occurred.Inevitably when that crisis came it involved the police and only then the involvement of mental health teams.Over the years A has been sectioned 6 times. On 4 occasions A committed a crime before a mental assessment was requested, although on 3 occasions I had contacted the team about the worsening situation about 2 months before. If this experience is common it could be that the NHS is taking (or has taken until recently) a wait and see approach that inevitably leads to more police involvement than there needs to be.
    And IF it is true that there is not parity between mental and physical health issues in the NHS then why isn’t the Equality Act enforced ?
    .Reading a few of your posts such as “Mexican Standoff” and “Doing It For The Kids” its also clear that the inter-agency problems are huge.
    I’m not quite sure what Adebowale means by enhancing the role of SNTs in mental health issues. Yes it would be good if SNT officers were equipped with local mental health team phone numbers to immediately call if they see a need.( On one occasion I was contacted by a shopkeeper to say that SNT officers had asked him to contact me to contact A’s mental health care co-ordinator to say A was wandering in the road in traffic.) . But if the inference is that SNT officers should take the place of care co-ordinators in knocking on doors to ask how people are then I don’t agree. An officer who might wish on one level such a person wasn’t on their patch, might one day be doing a stop and search and issuing a caution for cannabis possession and on the next knocking to ask how the person feels.Am I old fashioned in thinking theres a conflict of interest there ?
    I have been pondering these type of things for a while. Thanks very much for providing a place to put them !

  11. Great site, lots of help to push local forces to change now, rather than wait for action from the centre. We engaged the charity ‘rethink’ to train front line local officers. It’s a start, but our NHS MH provision in Bristol is woeful.

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