Paul JENKINS, the outgoing CEO of Rethink Mental Illness, has been a keen supporter of this blog for a while. I vividly remember hearing a loud “Woop!” when Stephen FRY read out my name at the 2012 Mind Awards and was later informed that it was Paul somewhat leaping up from his chair. He was amongst the first to email me during a recent social media hiatus offering his support.
He is moving on to pastures new as Chief Executive of the Portman and Tavistock NHS Foundation Trust, he has commissioned a series of blogs on mental health issues from a wide variety of people under the banner of “What Would It Take?” – all being published on the Rethink website.
I was honoured to be asked to contribute this short piece as one of these essays to a question set by Paul himself. I know Rethink do wonderful work – I’ve seen some of it, and I know Paul is key to their success.
So I wish him the very best of luck for his new role and absolutely no luck at all with regard to our mutual love of rugby! Don’t forget, Paul: Twickenham on 09th March – unfinished business!
What would it take to make sure the police had the support they need to best support the people with mental health problems they come into contact with?
I want just two things to ensure that the police are able to support people with mental health problems —
An accessible NHS service, open to the provision of emergency mental health care — the NHS is complex, varies by geography and is difficult to penetrate. This is true for service users and emergency services alike. Police officers have just four options open to try and obtain support for someone who wants it or who the police think needs it –
- Urgent or out-of-hours contact with the person’s GP — if they have a GP; and if that GP has timely capacity to see them. Some GP services are excellent or have effective primary liaison services. Others put out-of-hours mental health at arms length and refer patients to Emergency Departments or the 999 services.
- Secondary care community or crisis teams — variation in service is huge as demand upon these services rises (16% in the last two years). We see deamnd deflected to Emergency Departments or the 999 services. Some Crisis Teams have started restricting operations so that they provide support by telephone or they see people in A&E or police custody only. Support required at home often leads to deflected demands.
- Emergency Departments — we all know well, the rising pressures. We know that many have liaison psychiatry services, but some do not operate 24/7. We know specialist support for people who have self-harmed is patchy, with 40% of people securing specialist psychological assessment. ED, for very valid reasons, has always had difficulty in providing effective responses to mental health issues.
- Legally detain them — the police do not have legal powers in all situations so by virtue of law, there can be difficulty ensuring an effective response. We know the difficulties Place of Safety provision and still hear that is not always staffed, available 24/7 and that exclusion criteria operate which have the effect sending up to one half of all detainees to custody. Street Triage schemes are making a difference to some of these kinds of problems, but it is still early days for them. We’ll see!
Training for police officers on their duties and opportunities around mental health law —
The heart of my interest in this area is my feeling that I started under-trained to cope with the operational realities. Much has been done to provide better guidance and training, including at a local level where we see joint training and agencies delivering inputs to each other. There are two dimensions to training problems —
- Mental health awareness — to what extent do officers need training on particular types of mental health disorder? How much of available training time is devoted to awareness raising? Schizophrenia and bipolar; conditions related to dementia and personality disorders; learning disabilities, autism and Asperger’s; conditions that may appear like a mental health disorder but are related to other conditions like acquired brain injuries, diabetes, Addison’s disease?
- Mental health law — at the end of raising awareness, officers need to know what they can and cannot do. Can they force entry to a premises, or redetain an AWOL patient? What powers do AMHPs or nurses have in various situations to which the police are called?
- Integration of law and awareness — and finally, how does this all weave together? Where police officers and others could legally fulfil a task, who should do it? Where is the threshold for police involvement and how do organisations work together, across their boundaries to protect vulnerable people?
If we could sort out that lot, I think we’d stand a chance. Until then, I suspect everything else is just a complex form of busking.
Winner of the Mind Digital Media Award.