One part of the debate that is going on in policing, is the extent to which the service picks up ‘failure demand’ from other organisations. You have to expect this debate, because policing is being cut to a far greater degree than many other organisations and the idea that as health and other services rationalise their own provision the police can pick up even more demand than they were before is highly counter-intuitive, to phrase it politely. In addition, certain public sector service developments that would be sought even if we were not contracting are being done in such a way as to mean the police are having to invest more resources than ever before to make things ‘better’.
So this is a plea for compliance with the Royal College of Psychiatry Standards on Section 136 of the Mental Health Act, amongst other things.
Let me exemplify this and please be ready to do the maths in your head –
Take the fictional area of Wessex Police which serves a population of 2 million people with almost 5,000 officers. They have historically been detaining around 800 people a year under section 136 of the Mental Health Act but one problem in the local area for the last thirty years has always been that the NHS did not have any Place of Safety provision whereby people detained under this power could be assessed in a health-setting. Following a death in police custody some years ago, arrangements have now eventually been agreed for a “section 136 suite” to open in the near future. As part of considering the planning of this new facilty, it has been established that an average detainee in police custody is held for 10hrs before the necessary treatment and care arrangements have been made and for most of those, the person is subject to an enhanced level of observations with an officer either sitting at the open cell door (20%) or observing the person in a camera cell (80%). In half of those camera-cell observations, the officer was observing two detainees on a multiplex screen because someone else was in custody being observed anyway and cell visits occured every 15 minutes.
Then they opened the new s136 suite and everyone was agreed that this was much better all ’round – once it had settled down they found that the ‘average’ detainee was held in the Place of Safety for 5hrs, only half the previous period of detention and it was in an undoubtedly superior environment.
What’s not to like?! – the NHS had resourced the captial investment for the building but not the resource investment for the staffing because it wasn’t commissioned effectively to what we might call the Royal College of Psychiatrists’ standard – we are not quite where we should be. In fact, the RCPsych standards outline how police officers should be able to deliver section 136 detainees to the health service and leave again within 30 minutes, even if they are disturbed (p8) – I can only admit that when I first read this bullet point, I thought the standard was exceptionally aspirational to say the least and I am aware of nowhere in England or Wales where it actually happens.
DO THE MATHS
So if you came in to assess the impact of the service change, from the point of view of police time, here’s the maths. (And just so you know, a police officer working full-time will spend 2,080hrs at work, each year) –
- Police station – 800 detentions, 10hrs each with one officer conducting constant personal or camera obs = 8,000 of police time. Then deduct that half of those on camera obs, 320 were safeguarded in custody alongside someone else being watched anyway. So deduct 3,200hrs of police time = leaving 4,800hrs expended.
- Place of Safety – each detention lasts 5hrs and will usually involve two officers (because of force policy about detainees being held outside police premises), totalling 8,000hrs of time if the process has the effect of no-one going to custody.
- In reality – a lot of areas find that exclusion criteria by the NHS means that a quarter of people are still going to custody and three-quarters to the NHS and that those going to the police cells are the more difficult and demanding cases, with an average detention time of 24hrs on personal constant obs. This means 200 people at 20hrs each 4,000hrs; plus 6,000hrs in the NHS s136 suite.
- Overall impact – police officers are now spending 10,000hrs administering the process, which is 2,000 hours more than before the introduction of the NHS service. Or, roughly, the equivalent of a full-time police officer more than was previously the case.
Some while later, following reports to Wessex Police from other police forces, they seek to introduce a street triage process, to help reduce the use of s136 in that area and the use of police cells, thus saving all of the time they have been spending in custody and some of the time spent in the NHS place of safety. So they set about it: develop a small team of police officers to work alongside mental health nurses after some joint training and one year later, s136 detentions in Wessex Police have reduced by 40%. Some of the more demanding and difficult cases are still leading to detention in police custody, numbering 150 and the remainder of what is now 480 s136 detainees per year are now going to the NHS.
So having a process that was ‘costing’ 10,000hrs a year, 136 reductions are impacting upon this. 50 detentions in police custody, now averaging 20hrs each because of the challenge and complexity which amounts to 1,000hrs of time; plus 330 detentions in the NHS 136 suite amounting to 1380hrs. So street triage saves 5,620hrs of time, right?! No – because we haven’t factored in how many officer hours are spent staffing the street triage scheme. Many of these schemes have four full-time equivalent officers, who will be working 8,320hrs each year. Having started with 10,000hrs of commitment – most of which you shouldn’t be spending – you’ve then spent more than 8,000 more, to save over 5,000. You’re now spending over 13,000hrs, or six full time-equivalent police officers.
Of course, I fully acknowledge two things –
- This doesn’t even begin to address the amount of triage jobs which occur in private premises, which amounts to about two-thirds of their overall workload. That’s another BLOG in its own right.
- That police time and money spent on something is not the most important thing – up to a point.
AT WHAT COST?
Of course, the value we should place upon a far more dignified and humane process for vulnerable people should not just be measured in terms of police time or police budgets. But paradoxically, it eventually has to be and I merely enquire where the line is? If we told Chief Constables that we could reduce officer involvement in s136 detentions from 8,000hrs a year to 400hrs, they would welcome it. If we were to tell them it would cost £1m of their budget they would almost certainly reject it because it doesn’t cost them £1m of cash to continue with the status quo and £1m is a big deal these days. The current ‘expenditure’ is what some would call ‘opportunity costs’ – not a direct money saving that puts cash back in the bank but merely an opportunity to redeploy those officers to whatever the priorities are. It’s this conundrum we have to grapple with.
But a broader point I want to make about policing and mental health over the medium and long-term past: we are seeing ever more activity. Even when the IPCC published their report in 2008 they stated that 18,500 detentions were occuring, of which 11,500 were going to police custody. We are celebrating the fact that in the intervening seven years, we have turned things around so that instead of 66% of vulnerable people going to custody, just 25% are. But it is costing police resource to do this, even though the relevant national standards, agreed by all the multi-agency leads, states it should be reducing. Then, having decided to do the right thing wrongly, we are now doing the wrong thing righter by developing street triage models which
We need to think this thing through, because police time to spend is becoming increasingly precious and we need to start accounting more for the individual hours because as a duty inspector, resourcing rising demand with fewer officers, there is an extent to which I perfectly well understand comments from colleagues about why they’d rather have one officer in custody doing a constant watch than two in a place of safety, neither of which should be there at all.
Incidentally, the death in police custody in Wessex is no more likely to be prevented now than it was when there was no 136 provision because officers still find it difficult to engage an ambulance at the point of detention and are still excluded from the NHS when detainees are highly resistant and aggressive. Given that such presentations are a feature of most death in custody inquiries, some may wonder if we’re actually just fiddling at the edges of this?
Winner of the Mind Digital Media Award.