No Man’s Land!

I’m delighted to host a blog post from Ben Hembry, a police control room sergeant who therefore has a good overview of all the kinds of demands that come in via 999 and 101 requesting responses and support. Call Handlers are key to getting resourcing requests right and preventing unnecessary or inappropriate police responses.  Control room supervisors in particular are very well placed to influence how we respond to and resource requests received, if at all, supporting colleagues who are often not operational police officers.

I particularly like the “No Man’s Land” analogy:  Well, read it for yourself! —

I am a police officer of fourteen years service, mostly in uniformed PC and Sergeants’ roles.  Most recently, I have been posted to work as a joint West Mercia / Warwickshire force control room Sgt at our police HQ.  I have had a keen interest in mental health for some time … developed after repeatedly struggling to deal with various incidents and finding how the police and health services often fall so short of really helping people in crisis.

Whilst it is important to say my comments within this blog are my own and not representations from my employers, it is from my operational policing experiences and the wider view I now have over two policing areas that I make my observations.

MIND THE GAP!

One of the main challenges I have always found consistent in policing MH crisis is the gap that appears between those who may live with and manage MH illness most of the time without a need for crisis intervention and those who either suffer extreme MH illness or their MH deteriorates into such.  Whilst there appears to be at least some provision of professional services for those at both ends of this spectrum  – there is this gap in the middle where there is little support for those with ‘non-sectionable’ MH illness, other than police officers responding in earnest to a cry for help.

Much is being discussed, written about and reviewed in relation to police dealing with extreme MH crisis at the moment and whilst I applaud the rise in profile of these critical issues, I feel that it is equally important to highlight that many, if not all of those who reach the point of extreme breakdown or regression in their MH, come from somewhere before they reach absolute crisis.

“No man’s land is land that is unoccupied or is under dispute between parties that leave it unoccupied due to fear or uncertainty!”

This phrase is most commonly understood or related to WW1 and the area of land between the trenches where so many sacrificed their lives for the freedoms we take for granted today.  For me growing up as a junior tennis player – it was used by my WW2 veteran tennis coach (and grandfather) to be the space between the base line and service line – where you really don’t want to be standing to play!

Yet, now this phrase seems very apt when referring to the place where a significant number of persons who suffer MH illness seem to exist. By this I refer to those who clearly suffer MH illness of some kind, but due to the ambiguity or complexities of the illness, they have limited treatment options or help.  A very recognisable example of this might be those defined as suffering ‘personality disorders’ – a diagnosis I understand is a very real MH condition, but also one that frequently does not pass any threshold for immediate crisis care or intervention.  Clearly ‘personality disorders’ are just one of many conditions we regularly see and it is all too common place to find those suffering various stages of depression, grief, alcohol and drug related MH issues, age related mental illness, learning difficulties and others in some form of significant crisis.

Whether this list corresponds to an increase in mental ill health in our communities over the years or is more representative of us being more willing to recognise and accept there are a large number of people who suffer daily with MH issues – it does lead us to identify that it is from this large number of people we get regular cries for help, often so desperate that it involves self-harm and threats to take their own life!  It is here that police officers so often get stuck responding to crisis, but lacking  any real ability to do anything to resolve it.

Now I am not suggesting that police officers should not be involved in trying to help in such matters.  Clearly, we have powers that are sometimes absolutely vital in given situations – including the power to enter a persons home with force, if necessary to safe life – (section 17 PACE).  However, police officers often find themselves attending such crisis without the support or availability of any MH professionals to assist or take over.  While I know the mere presence of an officer to listen to a problem can and has helped many…with no real training or resources to manage the issue we are confronted with – at best we can only offer some amateur counselling and an empathetic ear.

Even though we often get a fantastic response from our paramedic and first responder colleagues who regularly attend and give the necessary medical triage and / or mental capacity assessment at such incidents – they do not remain responsible for the individual or the crisis they are suffering.  The Ambo role ends when the medical health assessment has been completed.

THERE MUST BE SOMEONE ELSE TO HELP?

It is fair to say that there are ‘some’ options for police officers attending in these circumstances, but let us look at them —

  • There is the crisis team —  however, in my experience they are a phone support service at best and whilst there are some areas where 24/7 staff will physically respond to assist, this is not common place.  The more usual service, especially during hours of darkness, is phone advise which excludes a health professional coming to the location to help, or suggestion of an appropriate place where that help can be given.
  • There are community mental health teams  —  these work in our communities supporting those with on going MH needs and although I have personally experienced them coming out to an address I was at with a suicidal male, they were unable to offer any practical advise or help in the immediate circumstances of the males despair.  Also relevant here is most CPT’s only work Mon – Fri, 9 x 5 hours.
  • There is A&E  —  yes, you might think the issue involves health – let’s take it to the experts who are also 24/7.  However, A&E provide medical emergency treatment.  Whilst they can be a place of safety (another debate) and there are provisions in some hospitals for emergency MH assessment, this is not common place as a designated MH place of safety is the proper place for this. They certainly do not welcome nor accept responsibility for a person who has no physical health issues and is not in need of emergency clinical care!
  • What about the MH place of safety?  —  these can only be used for persons detained after being identified as suffering extreme MH breakdown and in need of emergency assessment.  We can only take a person to a MHPoS under S136 powers if found in a public place.  This is another debate in itself, but the fact is we cannot take a person voluntarily and the police have been often criticised for using the 136 powers for persons who do not require immediate assessment and treatment.

There are opportunities to be practical at times and enlist the help of family members or friends to support the individual in crisis and police officers regularly explore this option early on.  However, the reality is often that there is no one near, or willing to help at that time.  Therefore, other than the 24/7 paramedics mentioned earlier – there is very rarely any other professional to help or place we can take a person in these circumstances.  In short, we enter into ‘No man’s land’ to help and then get stuck in it with them – often for hours before we can find some form of resolution.

DO NOTHING?

Is there an option to do nothing?  Apologise politely and leave?  This may well be the option that is required with some individuals and perhaps if police did not attend it would force the hand of some of our partners to step up.  However, police officers have a duty of care to help people:  it is part of our core values to protect the public from harm – even if this is to protect a person from themselves!

Whilst tragically no person can realistically stop another from taking their own life if they are absolutely intent on doing so, I think it is fair to say that no one I know wants to be the officer who allowed the person to do it by leaving them on their own and walking away.  I have heard the phrase ‘attention seeking’ used by some, about individuals persistent calls to emergency services that they are going to kill themselves and it a phrase that does not sit well with me.  Even if a person is trying to use the threat of self-harm or suicide (even when they have no intention of following through) to gain a specific response from health services, they clearly have issues in the first place to behave in this way?  Furthermore, would you like to be the police officer that makes the call to ignore them?

Is this a new problem?

No, this is not a new problem at all.  This ‘gap’ has existed for many years, if not always.  However, I believe that this ‘gap’ has been previously masked by a practice, that until recent times use to be common place – locking them up!  This opinion was reinforced very recently when a colleague I have advised on a few occasions in relation to use of powers when dealing with MH crisis, jokingly accused me of leaving him with less options than he had before!

By this, he referred to a previously accepted practise of using 136 powers to most situations relating to MH and taking persons to custody or the 136 suite without much further thought.  By the fact that he now is considering when the use of 136 powers is appropriate and using Ambo support for mental capacity assessments where they are in attendance means less people are being taken unnecessarily to the 136 suite or custody.

That’s good, isn’t it?!

Well yes.  I initially took his feedback as a somewhat back handed compliment as clearly the messages and information I have been gradually feeding out is clearly getting through – and this was also evident from recent stats given me at a joint 136 meeting I attend at the Worcester 136 suite, which show a reduction in the use of 136 and increase in the use of Ambo triage and conveyance in the latest quarterly figures!

However, whilst my colleague joked with his comment and fully understands that what he now does is the right thing to do, I had to note he was not far wrong in his assessment and this got me thinking further about the whole subject.  In situations where he and others would have routinely used 136 powers, they now find themselves asking for other options and as I have covered – they often struggle to find them!

So therefore, the success we might already be achieving in respects to a reduction in the use of custody for S136 or the a reduction in using S136 powers at all, means that either the number of people who we use to bring into the place of safety are getting much better, or they are now existing in the ‘No man’s land’ I refer.    I believe it will be the latter and clearly this ultimately creates a bigger problem for police officers, having to respond to and manage a greater number of individuals they are basically powerless to help!

WHAT IS THE SOLUTION?

For me, any solution will still need police officers to be a first response to help people in MH crisis.  This is both unavoidable and necessary.  However, it can’t remain that they are only ones who do so or the ones left to manage the situation.

I know that ‘street triage’ is being piloted as a potential part solution to this issue and it may well be a really good initiative that does offer more support and an ability to successfully divert individuals caught in this void.  However, how will they realistically be able to help more during ‘out of hours’ times? What resources will they find, we obviously can’t? Will they support an option of doing nothing and take responsibility for an adverse outcome?

This I wait to see, but I also hope that even if it is more successful than I imagine, it is not set as the panacea to all issues we currently encounter, because the problems are far wider than even their proposed support will reach.

If the focus is not on the whole subject, including better prevention, education and referral, extended outreach health provision to take over from police on a 24/7 basis, as well as emergency crisis care in equal measure I fear there will be no real improvement at all and risk the potential for greater problems in ‘no man’s land’ – especially for police officers!

Ben.


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

Winner of the Mind Digital Media Award.


Advertisements

7 thoughts on “No Man’s Land!

  1. A sensible and thoughtful blog.

    As a mental health service user classed as complex needs (not personality disorder) I increasingly find myself in this ‘no man’s land’. Crises can come upon me rapidly and sometimes I can recognize when I need help but I find my hand hovering over the phone questioning whether there is any point in making that call. Indeed I have just had a conversation about what can be done to help me today. I am unlikely to be able to get a hospital bed if feeling unsafe (not many out there) and it would only be for a few days even if I agreed. The crisis team are not a ‘blue light service’ – lucky to get a home visit within several days and wel,l as for after 5pm, just don’t bother. So several times recently the police have been asked to do a welfare check. What do they do when it is obvious that I need help, paramedics are called and try to speak to the crisis helpline. Not a lot of joy there and I get persuaded to go to A&E where I get a brief assessment and am shown the door ending up walking home in the middle of the night (highly vulnerable situation) or in one case balancing on the edge of the multi storey car park nearby. The police do their best but what else can they do? At the end of the day I am left alone to deal with continual thoughts of self destruction and I have to accept the reality that there is little anyone can do to help. Just imagine what this is doing to my family. My partner is away on business a lot at the moment which means I’m alone a lot.

    I was asked to comment on a new method of risk assessment last week and being not in the best of moods pointed out that what was the point in getting better at assessing risk if they don’t improve the service to those at high risk. Where do we go to get help?

    Last week (and sorry local police force for this) I caused a whole lot of bother and a lot of searching in the dead of night. But what the police officer on the ground didn’t know was that I had made 5 calls that day to mental health services to ask for help. The final one being to the night crisis helpline who told me to call the day service in the morning and then left me hanging on while answering another call. Where did I go now? Desperate to escape my feelings – I just went down the self destruction path – found hours later unconscious. Ok the helpline had called the police but perhaps a home visit would have helped – they are supposed to offer it – but then they are not a true crisis service anyhow. I spoke to one of the officers out looking for me that night a few days later – when I was back from hospital and back to square one, alone and at risk – he must have wondered why he and all the others had bothered looking for me.

    PS Thanks to my local 101/999 call centre staff who are lovely compassionate and caring people and sometimes much much more helpful than the mental health helpline.

  2. Recently did some MH training where we covered Behavioural Personality Disorder. The official stats say it is rare and affects less than one in a hundred people.
    I made the comment that it is the most commonly heard diagnosis I hear.
    Particularly interesting is the comment “this person isn’t mentally ill – they have a personality disorder.”
    Is BPD a mental illness or not?
    It is this diagnosis which I find tends to allow people to fall through the cracks.
    One of the highest demands on policing but one which fails to illicit any positive response from crisis teams.

    1. “It is widely recognised that people given a diagnosis of personality disorder have often not been given the support they need and had difficult experiences of mental health services. In 2003, the Government wrote ‘No longer a Diagnosis of Exclusion’, a strategy for improving access to support and treatment for people given a diagnosis of PD. The strategy made it clear that people given a diagnosis of PD should not be turned away from mental health services.” from http://www.emergenceplus.org.uk a bonafide website. Or http://www.personalitydisorder.org.uk/ if you would like to find out more about BPD.

      Yet still even within the mental health service people find themselves judged or dismissed if have this label attached. Even A&E staff has the same sort of attitude.

      Mental health services must treat people with this disorder now. There is no excuse for them falling within the gap but their diagnosis can be used as an excuse that they can’t be treated on an acute ward and so not sectionable.

  3. Great post, matches my experiences – some other alternatives are desperately needed, although I have no idea what. I think it’s difficult when mnetal health services seem to see being picked up by police on a s136 as an acceptable part of a crisis plan, rather than it being a result of other support having failed.

  4. The charity Self Help Services in Manchester have recently opened a service that’s open overnight every night of the year to provide support to adults with mental ill health. Currently it is accessible to people in one area of the Force area but I hope we see a day when this kind of service is available everywhere. This gap in service provision has long needed to be filled.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s