This year, I was privileged to be asked by Chief Superintendent Irene CURTIS, President of the Police Superintendents’ Association of England and Wales (PSAEW) to run a workshop at their annual conference in Warwickshire along with Supt Paul BARTOLOMEO from Hampshire Constabulary.
This blog is intended both for those who were able to attend and those who could not, by bringing together some resources we used and referred to on the day, which may assist our operational leaders in their work.
For those wider readers, Superintendents and Chief Superintendents are the service’s senior operational leaders: they run the local police areas on which we all live, providing 24/7 cover not only for leadership of critical incidents like homicides and serious public disorder, but also for command of firearms incidents as well as certain legal authorities for police custody and for the response to high risk missing persons investigations.
They are also in a significant position to influence local partnership arrangements on policing and mental health and it is around this area that the workshop was pitched.
Sir / Ma’am – here’s your test!
- Who is the offender health commissioner for your area?
- Who is the AMHP lead for your area?
- Who in your CCG is the senior commissioning manager for mental health services?
- Who is the lead GP, who probably chairs your CCG?
- Who is the Chief Executive of your local mental health trust?
- What protocols and arrangements do you need to have in place to stand a chance of succeeding?
I pose the questions, because we suggest that the names of these individuals are not always known to police officers and there’s a lack of clarity in our newly reorganised NHS as to what these roles now mean, two of them listed above being new. Some years ago, I wrote a one-side-of-A4 guide for senior officers to at least help with the last question: the basic requirements one might imagine are necessary to be able to understand mental health related demands and improve on partnerships, protocols and processes. It has previously been circulated by PSAEW and the ACPO lead on MH, Chief Constable Simon COLE, so it is heads a list of resources to understand this agenda in 2013.
- The Senior Officers’ Checklist
- The Adebowale Report
- 10th September Powerpoint from the workshop by Paul BARTOLOMEO and me.
- A blog which seeks to explain (or highlight?) the complexity of local NHS arrangements and how you may navigate through them when engaging in partnership work.
- The Code of Practice to the Mental Health Act for England; and for Wales.
PARTNERSHIPS – Getting the basics right
Having basic protocols in place for the operation of the Mental Health Act would be assumed a fairly basic requirement. After all, they are requirements of the MHA Code of Practice. You would be wrong to assume that every area has them in place; or that they have been updated and reviewed since the Mental Health Act 2007 and the latest Codes of Practice in 2008. You would also be wise to check that they have been legally approved by your own police force and / or the mental health trust they have been agreed with. Some of the major, more high-profile, untoward events have involved officers doing what their local procedures said they should have done. So assume nothing, believe no-one and check everything.
Invest in staff time and training – policing is at least 20% management of mental health-related demand, which is far more than the demand represented by burglary or robbery combined on each of which we normally have a detective sergeant with a team of specialist officers working in every BCU. Invest in analytics to understand the problem: we know that the police do not manage to identify all those coming through custody who have a mental health history, yet we still know that around 15% of those who come through are identified. How do we make our diversion decisions? My research showed we make them because of assumptions based on a supposed relationship between criminal responsibility and MHA admission criteria, without fully checking the history. See more on Liaison and Diversion.
LEADERSHIP – Going one step further
We have come to understand over the last fifteen years that mental health demands on the service are increasing – use of s136 is up; the number of missing people who are vulnerable is up; the amount of police time spent is up; we keep seeing the same tragedies over and over again with restraint related deaths and we have started to see human rights challenges in police custody. We know that the NHS is, because of rationalisations to serves, deliberately deflecting demand towards the police service which would previously have been CrisisTeam or Community Mental Health Team work.
As such, I submit we need to think differently about how we match this demand.
Legally and clinically, the police reaction to mental ill-health is always going to be complex: we need to recognise this in our deployments whilst shouting, “simplify, simplify, simplify!” We should consider programmes like “Street Triage” and comprehensive training to just enough of our 24/7 officers to ensure they are equipped to respond – this follows from the international development of Crisis Intervention Training in the US, Canada and Australia. My whole blog documents how much there is to know and it must be obvious that we’re not going to get 135,000 officers to understand and freely recall it. But we could develop a couple of thousand across our 24/7 response and neighbourhood teams who then develop experience on the back of knowledge. My idea for training in this way, has recently been requested by the College of Policing, in considering their response to the Adebowale Report.
We would do this for other areas of policing, why not for mental health? – did you know that basic mental health law is not tested anywhere in the OSPRE part 1 legal syllabus for promotion to sergeant or inspector? That’s why most officers don’t know the difference between a s135(1) warrant and a s135(2) warrant. Be honest: do you or did you ever?
All of this will require senior leadership and not just at force level. It is probably more important at BCU level where local senior officers, in proper partnership with the five individuals mentioned above, bring together their staff in a way which could be genuinely impactive not only upon the lives of vulnerable people but also upon the demands and costs that all organisations face.
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