Does It Work In Theory?!

There are nearly five hundred seperate posts on this blog — many of them covering the legal stuff and arguing about the common myths and folklore that we still hear to this day. A remark on Twitter this evening from a senior police officer about the need for a debate caused me think that I’ve been trying to have one for over ten years and we’re only just about now getting to the interesting bits! Indeed it took over five years before I felt that anyone was listening – up until then, I seemed to be talking to myself a lot of the time, or anyone who would stand still for five minutes.

A lot of the stuff I’ve covered is just frontline tension — is A&E a place of safety? – yes, it is; can the police restrain someone in a mental health unit for the purposes of them being forcibly medicated – no, they can’t; can you get a warrant under s135(1) even if access is already assured – yes, you can! Etc., etc., etc., ad nauseum. The bigger, some may say more philosophical parts of this venn diagram are – for me at least – the most interesting ones.  And we’re finally starting to see them discussed, and at the right level.

Senior officers are talking mental health more and more on Twitter – exemplifying issues which they alone can take into appropriately senior partnership meetings. We’ve seen for years that Simon COLE, the Chief Constable of Leicestershire who has also led for ACPO on MH, highlighting examples within his own force area and beyond. Tonight, Lynne OWENS the Chief Constable of Surrey was doing likewise after going on patrol with frontline officers on New Year’s Eve. She quite rightly identifies that we need to ask more fundamental questions about the role of the police. It is the absence of the questions and answers that lead to much of my confusion about initiatives like ‘street triage’ and ‘liaison and diversion’.  It gives rise to ‘mission creep’ because we haven’t defined the boundaries; so we don’t know if or when we’re straying beyond them.

I’m reminded of a remark which I believe is a French proverb – “This is all very well in practice, but does it work in theory?” I know that one of my (not always helpful) character traits, is that I like theoretical or philosophical constructs around what we do – something that helps us to ask whether we’re on the right track.

PROBLEMS IN PRACTICE

So when we think of things like ‘street triage’ or ‘liaison and diversion’ we tend to hear about a lot of practical, ostensibly helpful outcomes – an X% reduction in the use of section 136 and a Y% reduction in the use of police cells. What’s not to like? Well it depends on whether you think that the access to the care pathways provided by street triage or liaison and diversion should have had to necessitate calls to the police and the deployment of resources multi-agency resources.  If all the patient needed was access to a nurse-led service, why not call the crisis team? If the crisis team don’t have resources, does this mean we should build a new team where a uniformed police officer hovers in the background or do we just alter how we design and deliver crisis team services?  Things may work in practice, but – for me at least – they often don’t work in theory.

Someone rings 999 threatening to kill themselves: which is the ‘correct’ emergency service? This call could well have a health origin, grounded in a severe and enduring mental health problem – so why not send the ambulance service assuming there are no obvious risks like weapons, previous histories of violence? Why do we (usually) think that this is a police role, most of the time when we know from Street Triage schemes that two-thirds of that crisis work is in private premises anyway, where police powers of coercion are not available, just as Parliament wants it?

Someone is alleged to have committed an offence and there seems to be sufficient evidence to prosecute them – to what extent should a background or suspicion of mental disorder affect the prosecution decision that would normally be taken? How are we making these decisions – WHO is making these decisions, ultimately?!

WORKING IN THEORY

For me, this needs to be grounded in some kind of principled approach – you can get into Kantian deontology, utilitarianism or virtue ethics if you want to do this philosophically, but eventually – by default or otherwise – you’re going to have to get into some kind of theoretical position. It is my view that an absence of this is the reason we often seem to stumble from one issue to the next, without an overarching framework about what we are, in fact, trying to achieve.

What is the ROLE of the police service in this interface – on what basis should we decide whether to become involved in something; how do we approach the most complex decision-making that the service will face and to what extent should our decisions be affected by the views of other agencies? Let’s not forget: health professionals and health organisations exist to achieve objectives that are, from time to time, diametrically opposed to those of the police service. On other occasions, they can be quite closely aligned. How do we tell each from the other – and how does this affect our judgement about whether to become involved, to what extent and how?

For years, I’ve kept coming back to these two points: call them a vision statement, a philosophy or a strategy as you prefer, but this sums me up perfectly and is the basis on which I have normally decided what the police may need to do —

  • I want the police as uninvolved in the operation of our mental health system as possible – where consistent with our legal responsibilities;
  • I want police officers to minimise victimisation and any risk posed by those who offend – within or without the criminal justice system.

The problem with this is: not everyone agrees!  Hence the need for a wider debate between senior leaders and other stakeholders that comes back to the creation of some kind of theoretical position.  Something which allows tactical leaders supervising calls for service to ask, “Whether or not works in practice, does it work in theory?!”

PROJECTING THE ROLE

So this is the debate that I would like to see happening: what is the role we want our police service to play, in theory.  (And a sub-theme of my aspiration is that the construction of the answer is influenced by sound legal understanding about human rights, health and safety as well as the day to day operation of the Mental Health and Capacity Acts.  I admit that when difficult incidents occur and the police are asked to fill gaps in mental health provision or do the less palatable aspects of mental health care (that some services have unilaterally opted out of because they would just prefer not to have it under their sphere of responsibility – or perhaps on their conscience) I cannot stand to hear justifications based on the expedience of the moment.  We know that some demand for health related matters is deliberately deflected by NHS systems into policing and I want to see our debate ask why this is the case and what we’re going to do about it.

It’s easy enough to chat all day about s136 usage and s136 reduction; it’s harder to talk about how our systems’ interface is increasingly criminalising vulnerable people and stigmatising them as (potentially) dangerous by unnecessary entanglement in the policing and criminal justice systems when it is, strictly speaking, totally unnecessary. Meanwhile, policing needs to remember what it is here for: preventing and detecting crime, protecting life and property and maintaining the Queen’s Peace.  Yes, this includes crime and disorder within the NHS system where staff and patients are assaulted or offended against – whether that be by staff or by other patients – but this is also a role for NHS managers in how services are commissioned and provided.

During 2015 we need to move beyond operational expedience and endless fiddling with our Rubik’s Cube – we must define what role we would like our police service to play and work out how we nail that down. Never mind what works in practice – expedience is the product of ditching and resisting responsibilities responsibilities – we first need to determine what works in theory then build it.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


Advertisements

3 thoughts on “Does It Work In Theory?!

  1. I agree in principle with your sentiments. However I would add two provisos. The first is that mental health services are not and never have been geared up as blue light services. Mental health services cannot respond to emergency domestic or potential s.136 situations without serious change to philosophy, structure and accompanying law. The second and in my view determining factor is funding. This is the reason why so many people go inappropriately under s.136 to a custody suite rather than a mental health suit. I work as an out of hours AMHP covering an area which includes a notorious suicide spot and receives between 0 to 8 requests for MHAs on any given shift. The local area has, at best, capacity for two s.136 detainees and to my understanding has never received funding to staff this! The two custody suites serving this area serve as the only available place of safety when either both the s.136 suites are occupied or when staff are already overstretched by and committed to running the ward and are unavailable to staff the s.136 suite. Certainly the local NHS Trust could increase capacity and availability of s.136 beds but only with an increase in funding or an adjustment in the deployment of current and vastly overstretched resources.

  2. “Why do we (usually) think that this [threatening self harm] is a police role, ”

    Is that the case? I don’t know the figures between the two services but I know the ambulance service attend many, many threatening suicide/self harmed/overdose calls without the police being involved at all – except occasionally to pass us the call or because the patient has called the police and both services have attended. We only request police where weapons are involved, the scene sounds disturbed or the caller is threatening to harm staff (or has a record of doing so). This a small minority of mental health ambulance calls however.

  3. It was noticeable that the NHS / police health service interface became much more effective after the DCC of Devon & Cornwall Police recently announced the issue on social media. Is this the forum in which such subjects should be broached in future in order to get effective co-operation?

    Some suggested police tweets could be:
    MH patient placed in police cells, reason;
    NHS have not staffed the hospital based place of safety.
    Hospital based place of safety refuse to allow access as they believe the patient has been drinking
    Hospital based place of safety refuse to allow access as NHS believe the patient is aggressive.
    The NHS state they have no facilities in which to accept patients with MH needs in this area.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s