I noticed a hashtag on Twitter last night that made me feel quite anxious but also intrigued – #CrisisTeamFail. Whether or not you’ve signed up to Twitter, you can still go on it and see the content. In short, various patients were tweeting their experiences of contacting mental health crisis teams and noting the replies that they received – it was revelatory in many respects, although I’m familiar with some of the responses people received because of what I’ve heard and seen as an operational police officer.
Before we get into this, I want to go out of my way to make one thing abundantly clear and please imagine me in a raised voice so there can be little or no doubt that I really mean this! —
- We all know mental health teams are under-funded – this is acknowledged right up to the level of HM Government ministers. We know that NHS England chooses to apply a differential funding arrangement to mental and physical healthcare, ensuring a recent 1.5% and 1.8% rise in funding allocations last year causing Department of Health Minister Norman LAMB MP to make his views very clear and he has continued to do so.
- We know that when demand exceeds supply of staff – this means they have to make decisions about what to prioritise. Like other public services with finite resources, this means that from time to time you will not deal with things that you would ideally like to deal with. Or, you will not deal with them as quickly or as well as you would like. The police do this too – as a duty inspector, I personally took certain decisions to that effect.
So, honestly – we do get it! The system is underfunded and ineffective and this is not the fault of frontline Crisis Team staff. We know this because we’ve seen the Crisis Care Concordat looking across the board from commissioning and commissioners to the detail of frontline provision across providers, to see what can be done better and a lot of that will be about joining up over-functionalised silos in which various kinds of healthcare provision sit. So really – we understand that ‘the system’ accounts for a lot.
Until it’s sorted out, we understand that decisions may be taken about what staff will or will not do and that this means some demand may end deflected to the 999 services, whether deliberately or not. As long as we’re not asked to do things that are illegal or asked to assume responsibility for decisions we cannot possible make, there’s a certain degree to which I don’t mind, however much I’d prefer it properly sorted by correctly constituted mental health teams.
But this hashtag went way beyond all of that for me.
In 1983, a fly-on-the-wall documentary was made in the Thames Valley Police area. It included an incident where a woman attended Reading police station to report a rape and the documentary makers were allowed to film the interview of that victim by a Detective Inspector and a Detective Sergeant. So these were supervisory CID officers. We then watched the most awful berating and disregard of that victim and it quite rightly generated public uproar, leading to disciplinary proceedings against both and to a total overhaul nationally of initial responses to rape. I’m afraid to say that the unfolding of this hashtag made me think of that.
Even now in relation to the investigation of rape as well as other offences, there are indications or perceptions in just some cases that victims question whether or not the police believed them. Of course, the operating presumption should be that people who walk into police stations tell the truth, unless and until something indicates otherwise. Prosecutions for wasting police time or perverting the course of justice for false reports of any kind of crime are comparatively very rare indeed, perhaps the most recently notorious of which was the prosecution being faced by Eleanor De FREITAS which led this young woman with bipolar disorder to take her own life. Validation for victims is achieved by the police taking reports serious and treating them as true allegations for the purposes of conducting a thorough investigation. In Ms De FREITAS’s, case her father stated that he understood that inconsistencies in her allegation rendered a prosecution very difficult and why the police did not seek to bring charges against her alleged attacker. That man then brought a private prosecution against her for allegedly making a false allegation against him and the CPS decided to continue the case, despite objections from her solicitor and family. Very, very difficult issues. Guidance to the Metropolitan Police would have made it clear however: upon first receipt of her allegation of rape, she is to be believed, validated and the investigators go wherever the evidence takes them.
This is what concerned me about the stated responses, which we all must acknowledge were made known entirely without context on a social media platform. I’m sure mental health professionals involved in those conversations would have their views about whether comments attributed to them were accurate, or whether context alters anything. But regardless of all that, it seemed clear to me that those patients tweeting their experience didn’t feel validated. They often felt patronised or dismissed. One example included a female service user who was asked whether she had considered going for a walk – whilst on her own, late at night and whilst feeling vulnerable. Oddly enough, she didn’t wish to consider this.
The suggestions about patients having a cup of tea, a hot bath or a long walk were frequently mentioned, by many. A doctor – who it must be said, was one of only a couple of professionals brave enough to become involved – pointed out that such things can be valid distraction techniques for people in crisis. It must be fair to observe, few people found this acceptable: many were beyond that stage themselves before ringing the CrisisTeam in the first place. Others had specific objections to the advice – like the woman who did not wish to go out late at night on her own for a walk. Or the person in crisis who didn’t want to have a bath and see a body they loathed as part of their principal mental health condition.
A few mental health professionals have then since made the point: there are far two few professionals in a crisis team to necessarily provide an effective response, that they are trying their best and that in some situations, all they can do is encourage forms of self-care or distraction that may get someone through the night or to the next day. But that moves us on to various tweets that made reference to the police. It was someone tweeting about being ‘threatened’ with the police that first drew my attention towards the #CrisisTeamFail hashtag. Now I’ve been the police officer sent to a home on many an occasion and I’ve taken advice calls from PCs and sergeants hundreds of times about such incidents. There is often a very stark difference between the 999 call made by the CrisisTeam and the response to officers from the patient. Of course, this could be for any number of reasons: might I be bold enough to suggest that occasionally, the risk to a patient is occasionally exaggerated to ensure the police do respond and become responsible? Might I also suggest that sometimes, patients are so surprised, intimidated or unwell that when cops with stab vests and tasers suddenly appear at the door, they quite naturally attempt to downplay their crisis for fear that they will be detained in custody to keep them safe?
Regardless of the explanation, I know this – the police can confirm whether someone is Alive, Breathing or Conscious and whether they are obviously Ill, Injured or Intoxicated. They can even inform the CrisisTeam of these observations – ABC/III. Whether this means that a person is ‘safe and well’ is a totally different assessment and not one for the police to make, ever. It does not ‘tick off’ a discharged duty of care that the Crisis Team called the police, except in the sense of mitigating an immediate threat to life. If the officers pitch up and find someone in similar circumstances to which the principles of the Seal, Sessay or Hicks cases apply, then the officers have no legal powers to act whatsoever unless there is also a criminal offence being committed or attempted. So the Crisis Team will still have to decide: “what are we now going to advise, if anything?” They are effectively back to where they were before they called the police because mental health care in this country is the responsibility of mental health trusts and general practitioners, not the police.
This hashtag – for me at least – showed how important it is to have good communication skills, to have a response that doesn’t sound like people are being dismissed or even disbelieved and to validate people’s experiences even if you are on the way to providing a response that may not be what they had hoped would happen. Some people reporting crimes as victims aren’t victims at all – no matter what their belief to the contrary; and some are actually telling lies. Only a professional investigation will properly determine into which category someone falls and you’ll never get that in an initial phone call. I can’t see how mental health care is any less complicated!
Maybe some patients aren’t in full-blown crisis when they think they are – some victims aren’t victims when they think they are – it sometimes takes more than a conversation on the phone, not only to make this clear but also to explain it and then further support someone. This will be no different in those seeking crisis care responses – your perception is your reality and if we’re talking about a group of patients experiencing suicidal ideation or delusional ideas, however short that falls from whatever the definition of ‘crisis’ is, it is effectively denying the significance of that experience by providing a response that doesn’t work for the person, and is therefore no response at all.
But I repeat my original point: if this is about the capacity of CrisisTeams, then commissioners and managers need to look at that. But this is also about how frontline staff communicate, which – of course – is an issue in the police too, especially when pressure is on professionals to deal with volumes. Managing sensitive, high-complexity demand sometimes takes time that appears not to be there. If this is about how vulnerable patients come to better understand how to support themselves in crisis, then who could object to that. But if it is also about how we communicate with people. The police are busy and being ‘rationalised’ too, but I was glad to read remarks in this hashtag that patients found that the police listened, cared and tried to help whenever they were involved.
So if all else fails we seem to ring the police – and I wonder if CrisisTeams do that more now many police forces have access to street triage?! Various pieces of anecodatal evidence made known to me suggests that we are – but that’s another post altogether!
Winner of the Mind Digital Media Award.