I’ve never known what the “frontline” of policing really is, but I was asked last year to give a presentation on policing and mental health from that perspective. Given that my main role in the police is that of a 999 response inspector, it is actually the viewpoint I take from my work and so working on the theory that “frontline” means uniformed policing and police custody, I try to summarise that view in this blog.
I start by highlighting one thing that pervades my view now that I’ve done a lot of work on the police side of the interface between policing and mental health. Worry. I worry each and every day about this stuff, because I am confident in the knowledge that during a tour of duty, I could well be asked to become legally responsible for individuals with clinical needs that no junior doctor would manage without seeking support from more senior medical colleagues. And I worry precisely because I could be asked to manage such needs in a vacuum, without necessarily being able to engage the health service of this country. I start each day worrying whether I’ll actually be able to see quickly as some of the more complex challenges present themselves and whether I will have the time and capacity as well as the strength and professionalism to consistently do what is required of me.
I worry about that, every single day I put on a uniform.
THE DILEMMA THAT IS NOT A DILEMMA AT ALL
It is my view from the frontline of policing that in order get through any working day that involves responding to mental health emergency incidents, I will be repeatedly required to choose between adhering to local policies and procedures; OR adhering to the law. I cannot always do both because the services that exist where I have worked are not set-up to deliver outcomes that are always consistent with the law. This is true of much of our country in many different aspects of the interface.
There is a constantly implicit expectation – it is very often made an explicit expectation – that I will put aside considerations made clear in law in order to deliver outcomes that suit the set-up of local services and procedures that are legally inadequate. It’s important I provide examples: we know that the humiliating and degrading condition into which the claimant from the MS v UK case deteriorated was a clear violation of his human rights, because the courts have ruled on it. And yet, where people are detained under mental health law by the police, there is often an expectation that vulnerable people in such a condition may be detained ad infinitum where beds don’t exist for them or where services exercise exclusion criteria on their “Place of Safety.” I have seen this and heard of it multiple times in 2013 and once had to threaten to take legal advice about the position in which the frontline police officers I was supervising were left.
I know that I have seen countless examples in both practice and policy of mental health professionals preferring that paragraphs 10.22 and 22.13 of the Code of Practice to the Mental Health Act didn’t exist – but they do exist and the Munjaz case heard in the House of Lords (now the Supreme Court) reinforces how important it is that we adhere to these frameworks. The Lords ruled that the Code of Practice is not binding instruction, but it is statutory guidance with which we should comply unless there are “cogent reasons for departure.” We know from other European case-law that not delivering upon someone’s Convention rights cannot be defended by arguing “no money” or “not enough money.”
If I do what the a local protocol says – if it exists at all, because joint protocols on required business have not been agreed everywhere that should have them – I may find myself in legal difficulty if untoward events occur; but if I try to give practical reality to the law as I’ve understood it, I may find myself in direct conflict with frontline professionals in other organisations whose managers have in effect assured them that the police will disregard the law for their convenience and their benefit.
So what will I do?!
Actually, this dilemma is not very hard at all because I’ve got a family to provide for and more importantly, I took an oath of office to uphold the law. So I would take on inter-agency conflict to the extent that it is necessary to show that I’ve done everything in my power to access healthcare for people who I think may be ill and in a sincere effort to deliver a lawful outcome. Whether or not I succeed, I then refer it to the appropriate managers to debate, resolve or ignore as they prefer.
It is my view from the frontline that mental health related demands placed upon both our mental health and broader health systems inappropriately deflect some of that demand to the police. This occurs even though the police would be quite unable to ensure such demand is adequately managed from either a clinical or legal point of view.
Too often assumptions are made about what police officers are capable of doing, both clinically and legally. I can’t possibly tell you whether suicidal ideation by a mental health patient represents a high risk vulnerable person who needs safeguarding immediately, or whether the risks arising from certain behaviours or utterances are less serious than that. I can’t do a mental state examination or a mini-mental state examination and even if I could do those things, mental health services sending me to such an event in a private home means I’m legally powerless to do anything anyway.
Parliament do not want me there, as things currently stand – they want AMHPs and doctors there and this is the reality of our mid-twentieth century law. The fact that we’ve revolutionised our mental health provision in the sixty or so years since it was written doesn’t alter the fact that someone in a private home experiencing a sub-criminal or non-criminal mental health crisis is not someone they envisaged the police would deal with.
It is my view from the frontline, that the playing field of partnership working is not equal. And I say this, notwithstanding that there are many known short-comings in policing where officers and organisations fail to identify the policing and risk issues inherent within certain mental health incidents and take the necessary interventions, as required. For example, I know that some officers don’t know how to approach the decision-making that is required when an incident involves a vulnerable person who could be arrested for a crime OR detained under the Mental Health Act. Which should they do? I’ve seen it many times that the police get this wrong and that means the view from the frontline is insufficiently influenced by proper training on mental health and associated legal issues.
My view from the frontline is entirely unclear about whether managers in all of the relevant organisations are spending enough time in rooms together. I know that in some areas of England, some or all of the four basic protocols required by the Code of Practice to the Mental Health Act don’t exist and some that do exist are quite hilarious in their bias and their illegality. I reviewed this week on behalf of a front-line police officer in the north of England who reads this blog and was simply stunned that a formal governance process in a mental health trust AND a police force approved it for signature, bearing in mind that trust and force solicitors will have been asked to approve it. So I have to conclude, from the frontline, that the people who have to put our partnership structures together don’t always fully understand what they’re doing.
ARE WE MAKING THINGS WORSE?
My final view-point from the frontline, is that I worry we’re just making things worse. It is not always clear to me that creating a situation where we call the police to psychiatric wards to restrain patients for medication makes things better. How does having place of safety arrangements in place that send very distressed people to custodial environments make things better? I’m still to be convinced that the models of liaison and diversion for suspects in police custody are thought through sufficiently to represent a sound model that appropriately balances wellbeing and public interest.
We are seeing the start of many initiatives and improvements in this area: I just hope that they are properly evaluated by people who know what they’re doing so we don’t throw good money after bad. The amount of project money spent on liaison and diversion services that just fall flat on their face despite warnings that we do exactly that is depressing beyond words. And meanwhile, we know that some people end up unnecessarily criminalised because of it or diverted into a contact with a mental health system where there are good grounds to raise concerns about whether, at the population level at least, it is actually doing more harm than good.
The view from the frontline: there is LOADS of work to be done and when we do it we need to be wary of the “Do something” instinct that convinces us “this is something, so let’s do this!”
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