Erasing History

Do you know what I mean by a ‘vanilla’ tweet? – the phrase refers to something fairly inoffensive on Twitter, quite bland information that doesn’t tell us a huge amount but whilst purports to inform. Something like, “Great meeting with partners about mental health – loads of work going on to keep you safe” or similar. Well, I’m bumping into a fair few of them on the subject of the Crisis Care Concordat and I have a couple of concerns arising from it –

  • Vanilla tweets – of themselves – don’t tell us much and they never, ever have.  I can see, however, that they may be infrequently necessary.
  • Vanilla tweets on the subject of the CCC imply little difficulty in resolving the thirty to fifty year evolution of problems in policing and mental health.

It’s almost as if history has been somewhat erased and it makes me wonder why we ever had any problems in this arena because just one or two meetings and we seem to be sorting it all out without much difficulty! This also strikes me as highly unlikely. Take it from me, it took five years of my life (that I’ll never get back) just to sort out section 136 Mental Health Act Place of Safety provision in one area. That’s before the subject of Liaison and Diversion (whatever that means); patients who are absent without leave; and the multitude of other problems that all areas face to one degree or another.

Principle amongst the ‘other things’ should the creation of a system that avoids the need for as much crisis care as possible, because help is available before people have ‘one foot off the bridge’, to quote the Mind report on crisis care.

CRISIS CARE CONCORDAT

You can look at the Crisis Care Concordat website for yourself if you want to read more about it or see the local progress mapped out for us all by the mental health charity, Mind.  They will be chivvying people along for progress updates towards the end of the year.

One problem with the Concordat always was that it simply puts into one handy document with a checklist and a schedule of work, all the issues that we know have been problematic for decades, imperatives for which already exist. This, as Winnie the Pooh said, is “a good thing” – if you want it summarised and neatly presented and for those professionals in policing and health who are relatively new to this, it’s a great tool to help you start benchmarking where you are and working out how to plug the gaps. However, if you’re familiar with the field, it’s all very last century in some respects. Some commentators asked upon publication, this stuff is already written down in range of documents – why do it again?

So the Concordat asks us to address crisis care and in some areas this will mean that everyone works out there is overuse of section 136 by the police and, even allowing for the overuse, under-provision of health based places of safety by the NHS. The Concordat would say you get these things into the Action Plan that is submitted with your Crisis Care Declaration in November 2014 and look to improve this position over time. So you’d probably train your officers better on the use of the power, consider a phone or street triage approach so you reduce usage and look at expanding provision. Sounds easy doesn’t it?! Here’s the problem —

We’ve known that these things needed doing for at least twenty years and there are already various statutory imperatives to do so – what does the Concordat give us that laws and statutory regulations didn’t?! If we can ignore statutory guidance on the Mental Health Act, what is it about the Concordat and its implications that we won’t ignore?

Well, the idea is that this will be driven a lead in a way that wasn’t previously there – this is “a good thing”. And there is no doubt that areas are now talking whereas previously, they weren’t – this is “a good thing”. Arising from discussions, some areas have filed their local Crisis Care Declaration, implying that they now have a jointly agreed action plan to allow progress in 2015 and beyond – “a good thing”. However, there are many more areas that don’t seem to be fairing quite as well.

IT’S GOOD TO TALK

I’m assuming that in some areas, these joint CCC meetings have led to some of the discussions that I had when you have culturally diverse organisations coming together to discuss issues. You get doctors and NHS managers who know comparatively little about the law, getting together with police officers who know little better to discuss issues that are bedevilled by the received wisdom and inherited thinking of generations of professionals who’ve gone before them. And they are having to do it with fairly dreadful data sets about ‘stuff’, in many cases.

In some ares, no-one fully knows how many section 136 detentions take place, where they go or what the outcomes are. There are myths and personal opinion abounding about what percentage of those detentions is ‘appropriate – despite the fact that no-one seems to be offering a definition of what is appropriate. No-one looks at how many section 136 detentions are ‘repeat’ detainees or how many were already known to the MH, perhaps indicating a breakdown in the care plan. No-one knows the percentage of people arrested for offences who are known to the MH trust and no-one seems to be trying to define what ‘diversion’ means in terms of when the police push ahead with a prosecution decision for an offence when they know the offender is mentally unwell, as opposed to when they don’t.

Legal training in all the professions is parlous: I learned again this week having a child in an ‘adult’ place of safety is a safeguarding risk. What do we think is not a safeguarding risk about having a child in a police cell, not too far away from a masturbating drunk who is singing sex songs or threatening sexual violence to the custody officer? I can only imagine that in just some CCC discussions about certain issues, the myths and folklore are raging hard, with professionals of all kinds arguing they can’t do things they actually could do, that they shouldn’t be doing things that they’d prefer the other agency to do.

LET’S TALK ABOUT VULNERABLE PEOPLE

And nothing in this blog post so far is about vulnerable people is it? … their rights to effective police responses, accessible crisis care and dignity and respect for their human rights whilst in contact with the state? Those people who experience the indignity of being detained in the cells under s136 because they had the temerity to have a few drinks (or more) – to stop the voices in their head, or at least make them quieter. None of this includes references to the difficulties that some patients have in Accident & Emergency despite very obviously being there appropriately to access some kind of care that is otherwise unavailable and inaccessible. We’re not even talking about the ongoing extent to which our mental health care system is being increasingly criminalised by reliance upon the police and the justice system just to make extra sure that some face the extra stigma of having cops staring at them whilst the NHS do their thing with all that we know the feels like for some.

The Crisis Care Concordat will be examined next month for progress and as things stand just four areas out of 43 police forces and 57 mental health trusts have submitted a local declaration with an action plan. I’ve already heard that some areas feel they will be unable to submit anything by the November deadline. I’ve also heard that some relevant senior people have only not read the CCC, they hadn’t heard about it, as of a month or so ago. Quite remarkable, really. So we need to continue to raise awareness of its imperatives and remember, that most of them arise from existing laws and NHS guidelines anyway.

It’s what we should have been already doing – for some thirty years, actually!

If one or two CCC meetings is all it has taken to get complete agreement about what we need to do, then I’m thrilled. I’m also quite unconvinced.


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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9 thoughts on “Erasing History

  1. Mike,

    You brighten my life daily by your leadership in not shying from the true issues and saying it as it is; really interesting reading as always; you never cease to amaze me.
    Well done.
    Dave

  2. I share your cynicism/scepticism that this document will make a difference. I’m afraid that I can’t match your ability to write a great blog but here goes.

    I have read and reread the Crisis Care Concordat and think a better title would be ‘We Have a Dream’. Yes I would like a crisis service that works for me and anyone else who needs it and I’ve fed my experiences into the Mind report on crisis care and I’ve gone up to the Houses of Parliament as a Mind champion relating those experiences to MP’s. And still nothing changes.

    I attended my local CCC event last month. There were about 100 attendees, just the 2 of us service users. I sat there all morning listening to these wonderful professionals (police were good on statistics) and thought but is this actually going to change things? All these words but at the end of the day the gap is very wide especially so at the front end in preventing the crisis and at the back end in providing appropriate help. So I plucked up courage at the end of the morning and related my recent experiences as an ‘expert’. Hey folks this is what it is really like to be in a mental health crisis and not know where to turn, to be fobbed off and end up in the ‘buck stops here’ situation with the caring but put upon local police. There was silence.

    At lunch break my local crisis team manager told about the constant turnover of staff often due to stress and his inability to recruit replacements. With increasing demand for the service it is buckling under the strain.

    My concordat area is covered by one police force, part of a large ambulance service, 2 county councils and 6 unitary authorities with matching CCG’s, 3 NHS mental health trusts and several acute hospital trusts. A lot of people to be able to work jointly. One representative from a mental health trust just said that there was no way the trust would be able to sign up to a wider area agreement. I found out later that trying to get agreements locally was proving challenging enough they couldn’t contemplate anything involving more organisations.

    I am certainly preaching to the converted here but I’ll say it anyway. Increasingly I find myself being checked out by the police because they have been asked to do yet another welfare check or to locate this vulnerable misper by the crisis team instead of that team seeing me face to face like they used to. Unless the mental health trust gets more funding (instead of a 2% year on year budget cut) I can’t get the support I need to stop me ending up in a crisis or if I do end up in a crisis a service that has got enough staff of the right calibre to answer the phone or visit. Instead I go round in circles being 136’d by the police possibly ending up in the back of a police car because there is not ambulance available for a long time or worse still in a police cell. There is every chance that there will not be a bed available for me if I need one and if there is I will probably be discharged too early back to the community where the crisis team forget to ring or cancel their visit. Such is the reality of using mental health services. You can fix all you like the bits in the middle but it won’t work if mental health services can’t cope.

    While staying in hospital a couple of weeks ago the psychiatrist there who is also psych to the crisis team told me to accept the fact that the crisis team doesn’t and probably never be that helpful because they are not trained to help those of us with complex needs. I think I’ve worked that one out but that seems a bit of a cop out. Why should a sector of their service users not be covered, why not remedy this but I’m not sure there is a genuine determination to change and overcome all the obstacles or the funding to do it.

    Well I could say so much more and I really would like to hope that this CCC initiative will work but as pointed out if it was that easy …..

  3. Keep talking about dignity, it can be more important than anything else. I’ve experienced episodic intense mental health crises over recent years and it’s been the gradual loss of dignity that has contributed more to my despair than any other service related factor. In the last two weeks police have broken my door four times courtesy of mental health services, it’s in pieces. I sit in my flat and hear my neighbours and passers by comment on it, I cannot close it, somewhat ironically it’s now that the voices in my head are quieter, it’s the real voices of judgement, disapproval and frustration of society that drive the despair. I’m now frightened of the real lack of safety in my home rather than just that due to my own risk.

    A week ago I woke up in intensive care, instead of family, for the whole time I was unconscious I’d had two cops sitting by my bed, because before I’d been found the day before (nearly dead with a GCS of 3), I’d been reported missing by mental health services. I’ve had cops sit with me in A&E and hospital surgical wards again called by mental health services to police and control attendance for self harm. I’m an intensely private person, yet once you enter mental health services there’s never privacy, the whole waiting room, street, and eventually community gets to know. When services have reported me missing police statements were taken from my workplace and friends in the middle of the night. I’ve not been able to face any of them since.

    Isolation, indignity and lack of safety both from self and others is not a foundation for recovery. I’ve never committed a crime yet have lost count of the hours spent in cells and cages of police vans while services argued about where i should be detained for my ‘safety’. Ultimately for me it now seems that this view is a very short term view of safety and preserving life. Life without dignity and with the loss of identity and confusion that comes with the criminalisation of illness is not a life I want.

    1. Hello Em.
      I am a police officer and a friend of Michael’s. I wanted to say that I found your comments very moving and such a perfect example of why it is so inappropriate for police to be providing much of the service you describe. I don’t blame the individual mental health workers who have asked for police involvement. I am sure they have done it out of a genuine conern for your safety. Their hands are tied as they have very little in the way of resources or powers to be able to do anything about it. also many do not have a good understanding of what is out there or what powers police do or do not possess. I would love to be able to use your comments in forums where we discuss these problems. So I suppose I am writing to ask your permission to use your words?
      I hope you eventually find the right support for your difficulties.

      Michael – get your site sorted out becuase it is really difficult to type on it at the moment!!

      Jan

  4. Hi Jan
    Sorry for the slow reply, been in ICU again after more police/ambulance/intensive care resources being wasted. You’re welcome to use anything. If you’re a friend of Michael’s he’s welcome to furnish you with my email address if you wanted more context/specifics.
    I agree completely with not blaming individuals in the system, even those of whom get so burnt out/frustrated that they suggest I ‘just get on with it’ [suicide] I see as feeling pretty powerless in a system where than cannot help others, or themselves. System-level and cultural changes are tough, but they need to be taken off the ‘too difficult to do’ list and dealt with. Otherwise the preventable deaths will continue.

    1. Not a problem at all and I am sorry to hear you are suffering so much. Thank you for your offer. I will speak with Mike and get your email so that if i do use your comments I can let you know and show you the context I have used them in.

      Please look after yourself

      🙂

  5. Hi Em

    Mine is the 2nd comment above but also my life recently has been a little similar to yours. I have a note on my door that says ‘dear emergency services please do not break down my door again there is a key with my neighbour’! I agree with you completely about the loss of respect and dignity and the many other areas that it affects. I hope very much that you are going to get some real help right now. I don’t know where you live but locally my crisis team are all getting ‘burnt out’ but it is totally unhelpful to tell you to just get on with it. The reality is though they might not be able to get you an admission if you need it or extra support then you’re right they probably are frustrated to. I wish you well.

    Hi Jan

    You may have recognized my description above of the CCC event that you also attended. May I say that I have never been put in a police cell in your area and only infrequently been 136’d. Your officers will go out of their way to get me help in some other way but I know they get very frustrated when trying to get help from the mental health team. As a force in my personal experience you seem to get it a right as you can. Here’s hoping that the CCC does make a difference and that the police continue to take a lead role in making sure that people get the right help in the right place when in a mental health crisis. Can I ask in what forums do you discuss these sort of things. Are they multi agency or police only?

  6. Hi J. Yes I do recognise you 🙂
    There are a number of forums across Thames Valley and some have service user involvement. The more operational ones and the ones generated by police tend not to. However, if there was a case conference then the person being discussed would, where possible, be invited. We are trying to work with MIND more to make sure we are hearing the service user experience and adjust our ways of operation to “try and get it right”. Perhaps a new forum in partnership with MIND where we can talk directly with service users might be a good idea.

  7. There was a moment of embarrassment when I saw your post here!!
    Please to hear there is service user involvement. Getting involved with Mind sounds a good idea but in my area there is no Mind but there is a service user group via PALS which I think know of. Always the opportunity I suppose of contacting service users via the NHS trusts. I have found with other initiatives I’m involved in though that some SU’s are scared of compromising their care and maybe some are terrified of the police because of past treatment so they are hard to get at to seek opinions. Really important to get across the board interaction with SU’s. I may be fairly vocal but mine is just one person’s experience and I’m sure other people have a different one.

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