The Crisis Care Concordat is ensuring that a lot of discussions occur about the interface between the police and our mental health system, amongst other things. We are quite predictably hearing a lot of the standard lines about “joint working”, “partnerships”, and cutting across silos and so on and so on. It’s the lingua franca of these things that we have to work together, which I am unable to hear without recalling the Birmingham accent from that appalling Prudential advert “We wanna be together!”
I’ve thought hard these last few months about what kind of policing and mental health interface I think we should be trying to build – not least because I’m involved again in trying to build it! What are we actually trying to achieve here? We could use the police in any number of different ways and I’m sure that views vary about the extent of the role the police should play in administering our mental health care system.
This post is about my vision for this, in the context of hearing cries by various people who argue for a blurring of boundaries – and I will warn you now that it’s slightly longer than my average post, so pause and pop the kettle on before you continue!
THE ROLE OF THE POLICE
I keep coming back to this —
- I want the police to be as uninvolved as possible in our mental health care system;
- I want the police to be as involved as possible in the response to mentally disordered offenders.
I put these two things forward against the backdrop that we already know from my favourite criminological quip that “policing is what happens when something’s happening that ought not to be happening about which somebody ought to do something now” and that “there is nothing that could not become the legitimate business of the police.” Of course it does not following that everything is the legitimate business of the police, who are something of a crude safety net and checking system – the police service (and the broader criminal justice system) is a secondary, not a principal lever of social justice.
There are ideas in both of my aspirations that need explanation —
MENTAL HEALTH CARE
Parity of esteem has to start with this, for me: we don’t routinely involve the police in the care and treatment of people with hip replacements or cancer. Only in fairly weird and exceptional circumstances do the police pitch in with things connected to oncology or orthopaedics and that’s usually around preservation of life issues, which falls under their remit anyway. So why would we want the police involved in our mental health care system any more than is absolutely necessary? Notwithstanding my passionate interest in this issue, I am not and never will be a mental health professional: I am a police officer and I, like many of my colleagues, joined the service for certain reasons. I have my views about the health system, I have my views about the mental health system – and believe it or not, many of them go unexpressed on this BLOG because they’re not relevant to the professional points I’m trying to make here. That being the case, it’s fair enough for the police to remind everyone that we are here, constitutued for a certain set of purposes:
- Prevent crime
- Bring offenders to justice
- Protect life and property
- Maintain the Queen’s Peace.
But as Sir Robert PEEL made clear almost two hundreds years ago: it is not just the responsibility of the police to do these things. The police are merely individuals paid to do on a full-time basis that which is every citizen’s responsibility – the police are the public and the public are the police. This is why consent is so fundamental to British policing and over-involvement in the mental health care system means that for some of the most vulnerable, already marginalised members of our society, their involvement with the police service is not about consent, but about coercion: officers being called in by the mental health system in circumstances which are all too often connected with coercing them into systems which may or may not actually be effective. We know for example, that Community Treatment Orders don’t work. We also know that when those kinds of legal orders are imposed on those of us with mental health disorders and are then ‘recalled’ under the Mental Health Act, this coercive revolving door is making little different to anyone and it could even be making things worse. Why should the police be involved in this, when there is absolutely no legal obligation to do so, in the majority of circumstances? Mental health services can plan and prepare for the implications of their statutory activities if they want to – indeed the Health & Safety At Work Act 1974 rather expects them to!
But more importantly, what does the routine involvement of the police do for patient experience? You want or are perceived to need a form of healthcare and a professional who pops along has a police officer metaphorically in their medical kit. For what purpose? What is it that the police do? Well, they usually talk to people, enforce laws and apply lawful force to compel – but they are not the only ones who can do this. So what is the message here?! >> “You’re having this, whether you want it or not – and I have come armed with the coercive apparatus of the state just in case the answer is ‘not’. Can you see the taser, the handcuffs and the leg restraints? – now let’s talk about whether you think re-starting medication would be something you would like to consider.” Remember, there are well over a million people in contact with secondary care mental health services in any given year, but only a small percentage of those are brought under the auspices of the Mental Health Act. We know that most of the contacts that mental health services have with patients do not and never will involve the application of the Act, so why involve the police in those that won’t?
For all the times I’ve heard the argument about the presence of the police ‘promoting cooperation’, I’ve got examples where the presence of the police stigmatised and unnecessarily escalted the distress in a situation. For all the patients who have told me that the police are often a welcome, reassuring safeguard there are others who feel involvement of the police further stigmatises and criminalises them – so police involvement in non-criminal aspects of our mental health system is something to be done very, very sparingly indeed and without presumption about what involvement of the police will achieve. Patients are individuals with complex situations – one size doesn’t fit all. This is (yet!) another reason why I have concerns about street triage: we already know that most interactions occur in places where legal ‘enforcement’ wasn’t going to happen anyway – so what the officer is achieving by being there is a subjective thing that hangs on any given point of view or background presumption. But it does re-introduce the NHS mental health crisis system to some of its patients, which may be an end in itself.
Regardless of the reason for an offence being alleged, the police clearly have a role to play when incidents occur which involve offending behaviours or vulnerable victims. I want the police to be better at this. By better I mean, I want victims believed and supported where they are vulnerable – let’s just STOP assuming that someone with a mental health problem is inherently unreliable as a witness in court. The CPS did this a few years ago in the cas of B v DPP  and were successfully challenged under human rights legislation by a victim with schizophrenia who was probably far more reliable than some bankers, police officers or politicians! Many things may render someone unreliable as a witness, but whether it does so will vary from witness to witness. Anyway, does it really matter than a very unwell, victim who was attacked gave a statement to the police that seems unreliably inconsistent if the attack was also witness by two other people and captured on CCTV? Let’s look to cooberate allegations with other evidence and deal with actual problems when they arise – not assume there will be problems before we’ve tried to secure justice for people.
I’ve written elsewhere on this blog: I want a more sophisticated approach to decision-making about mentally disordered offenders. Liaison and diversion sounds great to me, but only if we start talking about things and addressing issues that I’ve heard little about as new schemes have started to be piloted. I keep hearing about health interventions and health outcomes for mentally disordered suspects in police custody and at court: I keep hearing little about re-offending rates and crime prevention. The Centre for Mental Health admits that there is little evidence that liaison and diversion works, so let’s gather proper evidence as we go and see what we learn in the future. The evidence may emerge: but concluding that we’ve made offenders healthier is only one side of the coin. We also need to know what happens to offending and re-offending rates.
And we need to make sure that whatever approach we take in Liaison and Diversion, we don’t just build risks into a system that we thought was mitigating them. We know from the report into the treatment and care of Philip SIMELANE (who killed Christina EDKINS on a Birmingham bus in March 2013) that failing to take a longitudinal view of repeated arrests for a pattern of allegations that is increasing – in frequency, in seriousness or both – can lead to risks not being managed. But where individual offenders are arrested and on that day reach the threshold for the criteria of compulsory detention under the Mental Health Act to be applied to them, how do police and prosecutors take sound decisions about whether or not this should bring a permanent or temporary halt to an investigation? I’ve written about that elsewhere, but I submit that no-one is putting forward a comprehensive view of when acutely unwell offenders should be prosecuted notwithstanding how unwell they may be. And yet we know, occasionally – from time to time – it will be necessasry and proper. But we also know that NHS contributions to investigations through information sharing and professional opinion are not where they need to be, either – so we all need to get better at this, for the sake of ensuring humane, non-criminalising outcomes wherep possible and public protection where necessary.
WE WANNA BE TOGETHER
So back to what this means for partnership working – we know that the police exists for a certain set of purposes; that this includes a broader public safety remit rather than a narrow focus on crime and that we will see officers involved in supporting the administration of the Mental Health Act and our mental health system, from time to time. But we know that there have to be limits to this – we don’t want cops routinely standing on psychiatric wards and restraining people who are having medication forced upon them by medical and nursing staff. When the issue of ‘safe and well’ checks was being discussed on Twitter recently, there were some responses that indicated the police should just endlessly absorb requests for these things, partly because they always previously have. Apart from the unsustainability of this, it has to be remarked that some of these welfare checks are perfectly legitimately directed to the police and others are just not their responsbility. Agencies have a variety of means of checking up on the welfare and wellbeing of people who are not at immediate risk, who are not missing and who may benefit from checking. The resources that police forces are now pouring into checks for which there is no (broadly defined) policing purpose and which could be done equally well by others needs addressing.
“But we haven’t got enough resources – we’re too stretched as it is!” came the reply. If this means that things others are too busy to do because of high demand, under-resourcing or whatever other reason become police responsibilities, then we’ll also have start work on fixing potholes in roads, cleaning streets after the nighttime economy binge we see each weekend and doing various other things, too. We know that the police don’t fix road surface problems, but where they come across potholes that suggest dangerousness, they block roads, cone things off and call the Highways Agency. That they do this at all, doesn’t mean they fix potholes – they just mitigate risks around those that may render people unsafe. But all of this begs a far more important question about ‘partnership working’ and ‘working together across agency boudaries and silos’ –
IS THIS A ONE WAY STREET?
For example, if the police are rammend busy on a Thursday night with a serious incident and high demand of 999 calls, could they ask the Crisis Team to visit addresses for late notice court warnings? Obviously, each evening, the Courts Service sometimes have to re-jig Magistrates and Crown Court trials for various reasons. This often leads to a request being made to the police that homes be visited to tell witnesses they are required at short-notice. Maybe community mental health teams could do these things for us, if we’re too busy to attend? After all, that’s within the skill base of almost any sentient, responsible adult isn’t it? – ‘safe and well checks’ on those of us with mental health problems, is actually not within the skill base and competence of a police officer!
Because remember: this is all about breaking down organisational boundaries isn’t it? Let’s stop working in silos, not erect exclusive criteria about whose job is what – just get yourself down to Mrs MIGGINS and let her know she’s needed up the Crown Court tomorrow morning without worrying about how you’ll manage your patient caseload and your mental health assessments. The point I’m making here is not subtle one! – if the police were to say about ‘police work’ the sorts of things that some health professionals are saying about ‘health work’, it wouldn’t move an inch in a partnership debate. It would be (rightly) dismissed as ridiculous!
Your police force has finite resources, folks! – we can only one thing at a time for each of the officers we have and for all the reasons made above about mental health care, deflecting demand to the police and telling them not to worry about the resource this is costing or the fact that prevents them doing something else, is actually about the opposite of partnership working which should be built on mutual respect for the differences between organisations, as well as the overlaps between them.
Some jobs are ours; some jobs are yours and some could or should involve us all – the fact that on some issues there are overlaps does NOT mean that in all issues there are overlaps and that we all can or should be doing everything.
Winner of the Mind Digital Media Award.