Designing Training

So here’s a knotty one – on the subject of police training.  We know that the police need (more) mental health awareness training because Lord ADEBOWALE told us so in a report with receommendations that were accepted after publication.

So it gives rise to a list of questions –

  • How long should the course be?
  • Who attends it?
  • What should the course contain?
  • How will it be delivered?
  • Who would deliver it?

In reality there are multiple audiences amongst the police – if an inspector with no previous background in mental health policing and partnerships were to be promoted to Chief Inspector and be told to lead on the issue for their area, what would they need to know to be effective?  Whatever the answer to that question, it would probably be different if we tried to address the needs of a frontline operational sergeant running a response team.  It would be different again if you were an officer with some interest and experience who was newly posted to a street triage team or a custody sergeant working where a liaison and diversion scheme was just being set up.

So can we agree: the police service needs a suite of options – perhaps modular and adaptable – capable of being delivered in a range of ways and that at least some of this needs to involve classroom inputs and partner organisations?

But what problem are we trying to solve – what is it that police officers don’t know that we need them to know, which we would hope effective training would address? What is it that we want them actually do differently?

PLAN A and PLAN B

One of the most difficult things of all will be to determine the specific legal training in circumstances where we currently know that the requirements of law and the codes of practice are not necessarily adhered to in all areas.  It’s all very well running an input on AWOL patients and pointing out to officers that para 22.13 states that where a patient’s location is known it is for NHS services to re-detain and return them to hospital. What are the implications of training that to police officers, if some of them work in areas where the NHS argue they don’t have resources or capacity to recover missing patients? You may think that it will empower police control room staff to ask the correct questions to allow them to say, “No – that’s a matter for you to undertake” where necessary. But many officers know that there can be other reactions from staff on wards who are physically not in a position to leave a ward or call upon colleagues in other mental health teams to undertake those jobs on their behalf.

So we have to think this through!

It’s all very well lining up the lessons learned from IPCC investigations and Coroner’s inquiries before drawing conclusions about what the police need to do differently but some change may involve the need to adapt partnership approaches.  How do you provide training to protect officers and vulnerable people that takes account of all of this, if certain aspects of partnership working is yet to change or is struggling to do so?  The question is not abstract:  training around the proper response to a mental health emergency involving acutely disturbed behaviour – possible excited delirium: amidst restraint by several officers I can of some areas of the UK where little resistance would be met some NHS areas and it would be hotly contested in others.  How do you train for that, bearing in mind that it is possible to highlight several force areas that cover multiple MH trust and acute areas where the NHS approach is not consistent?  I must stress: I’m not trying to particularly knock the NHS  by saying this! You could say – and I have said! – similar things of the police on various issues in this interface. These are the difficulties of partnerships and of trying to get national consistency on important issues amidst highly devolved local services.

Is training and an improved, raised awareness of legal and clinical risks something which should be trained for it’s own sake in the hope of improved awareness driving change; or is it irresponsible to suggest a course of action that may set in train a conflict between operational officers and colleagues in the NHS?  The reality is it would do both, because partnership arrangements, structures and the role played in different areas by ambulance and A&E services varies – or at least the capacity and involvement of them does.

PARTNERSHIP TRAINING

So what about multi-agency training?  Getting police officers into rooms with mental health nurses, AMHPs and psychiatrists – not to mention getting into rooms with paramedics with whom the police work so closely at a lot of mental health affected incidents.  What is best delivered to police officers alone and what should be delivered in a partnership setting?  All four of the above bullet point questions above apply thereafter and you would have to be careful to make sure all of this didn’t involve significant duplication.

Of course there is also a practical reality to be observed:  even if you answer the above questions and conclude that just SOME officers are going to need as comprehensive a set of training opportunities as we can possibly offer – force mental health leads, street triage officers, etc. – it still doesn’t address whether or not there is an appetite to allow the time for it to happen. Indeed one thing that has been discussed for years is whether Britain would benefit from the adoption of a ‘Crisis Intervention Training’ model that we have seen in the United States, Canada and Australia? So many reported benefits to this approach to policing and mental health but nowhere in Britain has trialled it. Do we need to design what that would look like, in outline, to help convince one senior officer that it would be worth seeing whether it improves things in a British setting.

So the major question is – do we train for the world we are actually policing or does training have a role in setting standards that could or should be delivered?

This is what we now have to wrestle with to determine what good training for the police will look like.  If you have a view – please leave a comment below as this post really is a part of my attempt to gathering different views and ideas to build a balanced perspective.


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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43 thoughts on “Designing Training

  1. My view is that Crisis Intervention Training would be a good thing, especially if it included service-user input. I have a diagnosis of paranoid schizophrenia and have had a few encounters with the police during the course of my illness. I am currently well and participating in training programmes for two UK police forces, talking to officers about the lived experience of psychosis. Thank you for raising this important subject.

    1. I agree, I have a history of depression and have had multiple run ins with the police all during crisis. Crisis training might help with how to approach and handle a person in distress perhaps?

  2. Learning should enable what you aspire to. Suggest must not be lecture but involve delegates working with the information……that is information re the legislative / procedural aspects….coupled with opportunities to apply the learning to realistic scenario…perhaps based on real issues. This should incorporate NDM. Important to address attitudes affecting behaviour as unfortunately stigma still needs exploring…..as you say one size doesn’t fit all and there is need for some multi agency training….still embracing multi agency NDM…..which the college has people working on……also from a learning perspective variety of styles and clarity what u want them to be able to do differently. Your work should highlight where policy needed I.e. If NHS in an area can not fulfil their responsibilities….however even then must be measured against doing the right thing! A fascinating area….good luck

  3. I think we have the same issue in the NHS, sometimes a little knowledge can be a dangerous thing and at others the lack of knowledge creates a whacking gap in provision. I saw your posts about the rcp wish list and the ‘isn’t a lot of this law anyway’ question, which for me is the fundamental issue, yes it is and yet organisations, commissioners and practitioners are either unaware, not doing it, or not provided with the resources, training or whatever else to actually deliver a lawful response. The cop review is part of the same issue for me, it’s all very well updating guidance but people don’t know what they don’t know, or worse think they know and are either woefully out of date or just plain wrong. I think this debate is something that needs to happen in all groups, we often can’t manage partnership training between the s12s and AMHPs let alone the wider professional group and this needs some attention across the board. Great blog Mike as always

  4. I don’t think the point is being missed slightly. The main problem is the Mental Health Act legislation itself. The government must grant more powers to police (for e.g. Section 136 to include detaining mentally disordered persons within private dwellings). There should also be a nationalised model of actions which must be followed by police and mental health services once a mentally disordered person is found by police. There are times police locate who they believe is a mentally disordered person due to the behaviour they are displaying but having spoken to a mental health professional, they often have a different opinion.

    Once additional legislation is brought into place to assist a multi agency approach to mentally disordered persons, training should be rolled out. The course should be rolled out to training departments by means of presentation and videos by the National College of Policing. These should go directly to police forces.

      1. There’s no harm in training the police service but they will be trained based on outdated legislation. National protocols and processes must be put it place in my opinion before any training is administered. Also, I would suggest before any training package is put together, frontline officers are consulted about the issues they face.

        I am not saying we should “do nothing” but the issues the police service and partner agencies face are due to the outdated Mental Health Act legislation. It would be beneficial for consultation with the government about the issues before any training is implemented.

        At this time, all police forces operate differently in terms of how they react to mental health situations. Everyone needs to be singing from the same hymn sheet before anything is put into place.

    1. So in an age where civilliberties are being gradually eroded and in some cases savagely attacked, you’d further reduce them by allowing officers easy entry into someone’s house? I agree the law is outdated, but I think there are better changes that could be made.

      1. Police can already enter your house what they can’t do is take you somewhere to get the help you may need. This includes life saving medical treatment if you don’t want it. So should a close family member ever take an overdose and refuse to go to hospital the police will have the legal power to enter their address but unless they are thought to lack the metal capacity to refuse treatment then the police are stuck with just asking nicely.

        Or do you think we shouldn’t even have the power to enter either and we should just ask through the letter box?

  5. its a big issue, i deliver training across the criminal justic system but particulary to police of all different flavours. i would suggest it may have these features

    1. joint delivery between service users and trainers

    2. trainer should have a broad up to date knowledge of mental health particulary acute and know there stuff. the staff i train see me on the wards when they attend the unit

    3. it should be grounded in reality and delivered in way that police will understand.

    4. it should be practical rather than academic and to bring in practioners from various fields

    5. modular and flexible

    6. be sensistive to officers own mental health needs

    7. should cover, common mental health problems, presentation and approach, forensic, children, dementia, autism, stigma reducing with a onus on joint working

    8. police to prioritise training and release staff

    9. the trainer should have the skill to change the level of training to fit the group

    10. explain how the mh system works (good luck with that one) and roles of various staff ie amhps

    i have a good range of materials more than willing to share

    i think 2-3 days should do.
    mick

  6. Mike, as for training surely this should be jointly given? In fact I would go further and suggest that our PPIU’s or vulnerable person protection units should be collocated with the council metal health teams.

    Co-location works for neighbourhood teams (take this as an invitation to visit the Runnymede Civic Centre and see for yourself).

    This would allow fellow professionals from health, social service and police to share data and form care [recover] plans for individuals and make them work.

    Where would they be co-located? Wherever they could do the most good. In Runnymede I’d suggest close to the Abraham Cowley Unit at St Peters Hospital – though this would exacerbate the current car parking problem.

    But meanwhile training – this should be given to all officers and partners concerned. It should be jointly given and received and we should always look to break down barriers and understand the partners problems so we can work for the benefit of the vulnerable in our society.

  7. Here in the US, the most popular CIT training (Memphis Tennessee Police model) has shortcomings. It is delivered to cops by heavy majority of localized advocacy groups and clinicians. This helps with awareness, understanding of illnesses, resources, relationships (cops and the local providers), and communication. However, the missing pieces are in: law, case law, emergency medical services, and generalized police incident strategy/tactics/force options. I see a disconnect between clinicians/advocates and street cops, which leads me to believe we need more integration of trainers who can explain how all the aspects of awareness, communication, law, force, etc fit together as a whole and into a whole system of policing in general.
    I have been pushing for The Illinois Model to be accepted as the framework for CIT programs in the USA – with resistance from advocates/clinicians who haven’t been exposed to the applicable Constitutional case law (specifically Search & Seizure issues). CIT is a decent start; it needs to mature into something more universal. Lou, CIT copper in Chicagoland

  8. Positive change will happen best if awareness of a mental Health Law and clinical risks is increased irrespective of possible conflicts with local NHS Trusts and Agencies.

    Training should of course be for the world as it is, but it also has an important role, if carefully crafted and delivered well, in raising standards.As much multi-agency training as possible and practical will help. From the outside, one of the strengths of street triage seems to be the level of mutual understanding that occurs. It seems to me that where relationships between police and NHS are poor locally, it is often about poor local leadership on one or both sides, and that can be mitigated by people learning and then working together.

    You will not be surprised to hear me say that de-escalation techniques and awareness of the potentially deadly nature of restraint to some people should be part of mental health awareness training, even if it already trained as part of personal safety or safe use of limb restraints.

    The fact that you are going to have this responsibility is very encouraging. I hope that you get all the support you deserve in your new job and that the people who have shown good judgement in hiring you allow you to do the things that will change things so much for the better.

  9. As a lay person, but a parent/career of someone with acute mental health issues and Asperger’s I would really like us parents/careers/service users to have a voice somewhere along the training path. We can add valuable insight and experience cos we live 24/7 with the issues.

  10. In my highly biased opinion, social workers should provide the training :). In all seriousness it should include a primer on a mental status exam and various disorders. Beyond this it should include scenario’s to reenact and dialogue about (much like you do on this blog). In responding to mental health issues there is no way to punch the info into a computer and have it neatly spit out. Officers need a foundation of a way to assess, respond swiftly, be compassionate, and ensure safety. After this continued support through interdisciplinary efforts described many of the above comments would be great.

  11. Mark Kilbey, Canterbury and District MH Forum is working with Kent police around training. A mine of information, with very relevant experience!

  12. I would echo those who have said about the importance of service user and carer involvement. I deliver training locally on mental health and my real loves are self harm and suicide. I have been asked by the AMPH lead to develop training for the Police particularly around self harm and suicide. I use my lived experience as part of the delivery.

      1. Real loves is an odd way of describing self harm and suicide!!! no a phrase I would use having seen the pain and horror.

  13. The police couldn’t give a toss about self harm, suicide or mental health problems. But don’t take my word for it, read the statement.

  14. I designed training for courts and jails in Ohio and Kentucky in 2001 and 2002 based on CIT training of the era, and have kept up with the CIT model since. My approach was to create understanding and empathy for what people in crisis are experiencing, and deliver deescalation approaches that minimized violence and maximized mutual safety. Some of this is counterintuitive. The key issues are appropriate situation assessment, creating a safe environment, and taking the time needed to accomplish whatever is needed safely. I can’t begin to train on local police or facility protocols, so our process matched a mental health trainer with a facility training director. We built in plenty of practical situations and role play.

    In my mind it is not the amount of training but the opportunities to use the training that matter. The techniques work when officers are allowed to use them, but in the US people with mental health issues die or get hurt when untrained police units come on scene and take charge. Officers who respond to crisis need safe options that work, based on an understanding of who they are dealing with. What I find shocking here in the US is that after more than a decade of success with CIT, most police organizations still resist it, even though the approach keeps everyone safer.

  15. I fully agree that officers need training. What they do not need is another half hearted attempt by way of an NCALT package. This has now become the easy option and does not work for the vast majority of people. I hope that they make an effort with this subject as it is close to all of our hearts, but i am not holding my breath.

    1. Speaking as someone who was heavily involved in the design of the NCALT package, I need to correct an assumption you’ve made. That package was never, ever intended to be the only training that people got. Chief Constables were told that they should consider this just one part of various mixed methods of training and provided with other stuff by which to design locally relevent, potentially multi-agency training.

      If they didn’t: you’ll have to take that up with them or their PCC! 🙂

  16. Read statements because many people have an agenda (including police themselves) against persons identified as mentally ill.
    For example people who don’t like their neighbours behaviour may make a malicious allegation. This has the potential to cause the mentally unwell person enormous stress, leading to a substantial increase in risk to self.
    If the police treatment of an allegation appears to place too much emphasis on these statements and none on the victim of the complaint, it will seem as if the police, acting in a position of authority, have taken a stance that speaks for the whole of society. The message is: you aren’t valued by society. Society is better off without you. This could, and probably does, happen quite often.

  17. Stuck on Social Work, a little offended by your comment re. training, so MH/LD nurses should have no role in the training at all? Highly trained clinicians in their own right? Social workers are fantastic but the key here is multi-disciplinary approaches, something your suggestion is virtually negating.

    1. Dan,
      Sorry if you misunderstood, I led in with the smiley face for sarcasm. I am a vocal advocate for multi-disciplinary approaches. I feel I am a better social worker because of spending time with mental health nurses in a crisis unit. Our team did multi-disciplinary meetings / debriefings and they were very powerful.

  18. Officers to do differently:
    I would call into question the nature of partnership working with the NHS. I think this relationship, between public sector employees, has the potential to lead to things being perpetrated in writing without the blink of an eye, when they should be causing concern.
    The Police should uphold the law without favour, but instead are too easily influenced by NHS employees, or Social Services, who have an agenda to influence, some might say pervert, the course of Justice.
    It is much easier to try and convict someone of crime and blame them, than admit to making serious mistakes or malpractice that has caused an acute crisis in a mentally unwell patient.

  19. I co-designed training here in Heddlu Dyfed-Powys Police pre 2005. it jointly involved the NHS Trust and service users, it involved several elements including placements to a unit. It was also mentioned in MIND Mental Health & Policing Guide as good practice. The training evolved to include Mental Health First Aid; all new to role police officers get this programme currently.

    I would like to see all PCSOs get it as well as they may well be firts to communicate with people with mental ill health; NCALT should only be part of a blended programme. Learning & Development is vital and needs to be jointly designed and jointly delivered, huge topic area and I still believe that learning and development can get officers and staff geared up for the operational arena but it has to be relevant and meet their needs.

    Currently doing a Masters in Education and mental health training evaluation at local level is my dissertation.

    KInd regards.

    David

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