Covert Crisis Pathways

Policing and mental health as a subject cuts right across all of policing. We often end up talking about section 136 and places of safety – even when it’s completely irrelevant to the outrage prompting discussion – and I suspect that this prevents us from talking about, or even identifying, the larger and far more important issues and philosophical questions.

Remember that last September, Her Majesty’s Inspectorate of Constabulary highlighted in their report ‘Core Business‘ that Nottinghamshire Police had approximately 1,100 detentions under s136 per year, which compares very roughly with the number who are detained by West Midlands Police, before the introduction of each forces’ street triage schemes.  I’ve mentioned before that in terms of both officer numbers and resident population, the West Midlands is just short of three times the size of Nottinghamshire, so it seems superficially surprising that their use of s136 is so similar.

HIDDEN DATA

What we’ve never fully explored, nationally, is something which might help us understand the context of those s136 figures: the prevalance of mental ill-health in the group of people who are detained or arrested for legal reasons other than the Mental Health Act.  How many alleged shoplifters, drunks and other suspected criminals are assessed in custody under the MHA? – and what are the outcomes?!

I know the answer for this in the West Midlands but not for elsewhere and I have often wondered what we’d find if we looked.   What would it tell us, for example, if we learned that in Nottinghamshire, a much smaller percentage of criminal suspects were assessed under the MHA and then diverted into the NHS than in the West Midlands? – what would it tell us if it were roughly similar?!  You could repeat this exercise in any two areas where obvious questions should be asked about 136 usage. For example, I’ve often wondered why West Midlands Police – the second largest police force in England – is using s136 less than West Yorkshire, Devon and Cornwall and Thames Valley Police. Each of those places is smaller in terms of resident population and officer numbers so why are they using s136 more often than one of our country’s largest forces?

In some cases there are obvious but only partial explanations to consider – Devon and Cornwall’s resident population expands by many, many millions of people every year because of it being such a popular tourist destination. That will account, in part, for raised usage as police forces don’t obviously just use section 136 MHA on people who are resident in their area. But there will be other explanations and this is what I want to see Liaison and Diversion services looking at.

CRIMINALISATION TENDENCIES

What if we discovered that West Midlands Police were using criminal offences more often than Nottinghamshire in circumstances where a choice between MHA and criminal law could be made?  For example, a man on a bridge threatening to jump onto the motorway or railway line below is committing an offence – if he is successfully persuaded down, what do we then choose to do and how do we make that decision?  Maybe Nottinghamshire and West Midlands have two different views or more likely they have two different evolved cultures, hence different usage of the MHA?

Which of them is ‘right’ – what is section 136 for, strictly speaking?  What would a street triage nurse think – perhaps their access to NHS information might help inform the decision one way or the other.  This links to the point made by Lady HALE, the deputy President of the Supreme Court.  In her book on Mental Health Law (2010) she wonders whether s136 is in fact underused, partly because it’s potential to safeguard overlaps with our substantive criminal law.  She went so far as to say that we could argue that s136 is under-used.  It’s a though-provoking idea especially in light of initiatives like street triage which openly aim to reduce the number of people who are detained.  So I suggest we need to understand more about what is going on and have a clearer view about what we’re trying to achieve here.  We need, in my view, to articulate without prescription how we want officers to think about these decisions and exercise their discretion so we don’t unnecessarily criminalise people, but so that we don’t fail to protect the public where that is the balance to be struck.

It’s an absolute pain in the posterior aperture to collect new data in policing but we can’t work out too much about this stuff because police IT systems were not designed to capture it.  Any data gathering exercise would have to be done by designing an ad hoc form and which operational officers would need to fill in.  Having spent most of my career as a frontline cop, these sorts of ideas are usually viewed as additional bureaucracy which has to be inserted into an already busy shift but we also have to accept across policing and mental health that unless we try, we’ll continue to be blinkered, not only about what we’re doing and what we’re trying to achieve but also about how we go about making progress towards those goals jointly with our partners in mental health and social care, putting patients and the public foremost in our thoughts.

WHAT IS THE RIGHT THING TO DO?

So whether you want to get consequentialist about all of this, or whether you just have a political (with a small p) instinct about whether and when some people should be criminalised, notwithstanding some degree of mental vulnerability, you end up having to have something of a plan for how you are going to ask police officers to make detention decisions when faced with operational ambiguity or plurality.  For what it’s worth, this is something I wanted to start working on with partners after starting my current role at the College of Policing and I’m going to a meeting in Newcastle to talk about this next week.  Once I’ve been, I’ll put out a blog highlighting where I think we’re getting to, but it seems it won’t be a million miles away from what I first wrote on this BLOG a few years ago, which you can read for yourself.  If you have a view on any of this stuff, please do make it known – either write a comment on this post, below; or if you prefer not make your remark public, go to the BLOG’s homepage and scroll down: there is a contact form that sends an email straight to me.

It’s difficult stuff:  criminalisation; fairness; social justice – how do you balance these things off to provide the requisite balance between consistency in roughly similar circumstances and a population level impact that doesn’t further stigmatise already vulnerable and stigmatised groups amongst us all.


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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6 thoughts on “Covert Crisis Pathways

  1. If something happens on private property I would look for an offence and arrest. Also I know others who will arrest instead of use 136 due to problems with access to places of safety.

  2. Research wise, looking at big data isn’t your only option for understanding what’s going on in terms of the differences in approach. Local-level cultural effects within forces, the attitudes underlying practice, and reasons for those, might be better accessed and understood by other research techniques?

    Separately, from a personal perspective, I’m considering relocating because of the disparity in response to crisis in different areas. I was arrested and charged with a breach of the peace for being on a bridge/suicidal. I know other people I’ve been in hospital with who this has happened to locally as well. In my area it seems more normal for that to happen than for the mental health act be used for suicidal behaviour. It has had a significant detrimental impact on my life, and health. The postcode lottery is very real.

  3. As I have said before – I suspect Sec 136 is both overused & underused for all sorts of reasons & culture & organisational behaviour contribute to this as of course does training. Contributing Factors also relate to the the issues of resources of NHS MH Trusts & LSSAs & wider issues relating to poverty & opportunity etc.

    As you know, I see a fair bit of the requests from police custody, following on from arrest & have issues with the FME service & how it works or does not work. I have also become increasingly concerned about the inability of services to contain or accept a level of risk when making decisions that relate to an individual & the default position is to request MHA assessment. When perhaps the response should be more therapeutic & less reliant on coercion or the implied threat of it.

    1. That would be terrible and would surely reinforce feelings of worthlessness etc. I don’t understand why anyone who is suicidal and has unfortunately chosen jumping as a menthod should be arrested for an offence. If the argument is that it is a personality disorder then everyone is ignoring the fact that according to NICE personality disorders should be treated exactly the same as any other mental illness.

  4. Mental health should be looked as a reason for their actions NOT as an excuse. We all make judgement calls everyday, some more than others. We gain skills from what we learn. Slapping the cuffs on can be a decision that is made at the time by the officer, same as arrest. A crime is still a crime that in cases of MH can be judged by the officer but he still needs to get the facts.to make that decision. We are ALL unique in our own way. A police officer may see incidents more than the public but then a nurse may see things more than an officer. A family member may see more than a nurse. We are all in this together whether we like it or not. Where MH comes into the equation, we cant keep the door closed to it. The public needs to be kept up to speed about incidents not hidden behind privacy which can let the mind run wild. As you have demonstrated that some areas are due to tourist movement so can job searching and homelessness.

    I am not a great lover of statistics, as they say ” There are lies, damn lies and then there are statistics”. We need to be clear about things that affect MH. Same with guns. Guns don’t kill, the people that use guns kill.

    In my belief, the general public may be more understanding if they are told the facts. There will always be the exception.

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