I have absolutely no idea at all what was going on in the United States of America in December 1862 but US President Abraham LINCOLN took the occasion to say this –
“The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise — with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.”
Rise with the occasion; not to it.
I heard this quotation in a context quite unconnected to policing and mental health, but it immediately made me think of it – there is so much that is wrong or inadequate about our mental health crisis services and we can’t just keep doing the same thing and expect different outcomes. Don’t ask me: just look at the Crisis Care Concordat (2014) and ask why it was necessary at all; just look at last month’s thematic review of crisis care. See the many and various reports over the last few years (and decades!) that keep making the same remarks – Lord ADEBOWALE’s 2013 report in which he pointed out “The police can’t do this alone” and in which proceeded to make recommendations in a report about policing that were mostly about health and social care organisations, from ambulance to mental health trust and local authorities. The Home Affairs Committee did very similar things in 2015 and although all of these documents mention the need to improve police training, I want us to pause and think about the impact on the public if that’s all we do.
The College of Policing will have a stack of training and new national guidelines for the police fully available early next year. Whatever it is that you think is wrong with police responses that you would hope training and guidelines will improve, it’s not going to be a complete game-changer. Whether greater education turns every officer into the most empathetic, compassionate individual; whether legal knowledge improves to near-solicitor standards; whether knowledge of local NHS structures becomes as good as those nurses working in the local system; whether every frontline PC could confidently tell you the difference between a learning disability and a learning difficulty; or between Autism and Asperger’s syndrome …. none of this will fundamentally change the world, however much some of that might genuinely help people.
Better educated and trained, a whole legion of officers may well turn out from parade to the next crisis call, better identify a vulnerable person, communicate more effectively, be just patient and persuasive enough to avoid the need for using force to resolve an incident by empathetic listening and communication, but what this won’t do is change anything about the NHS. It won’t touch NHS structures that currently lack the capacity to allow known patients to access a crisis team, for example; it won’t alter the experience of patients who end up in A&E (where the CQC reported attitudes towards mental health patients were amongst the worst); it won’t differently commission ambulance services or alter the capacity of the community mental health teams who have seen their caseload rise by 100% in the last year alone.
When we reflect back on those many and various reports mentioned above with our army of mental health trained police officers – we will still be without sufficient crisis care services or only with those that have already been identified as ineffective – “the police can not do this alone”, as Lord ADEBOWALE reminded us.
MENTAL HEALTH CRISIS SERVICES
At this year’s Royal College of Nursing Congress, the RCN Students put forward a resolution on holding commissioners to account for ensuring effective crisis care and it was supported by 99.8%(!) of those who voted – only 3 people in the entire session chose not to vote. You can see more detail about this session on the RCN website (and I hope at some stage to be able to work out how to make the video work so I can actually watch it!) It points out that one in five mental health trusts was found (by the CQC) to have inadequate provision – and this is where the emergency system fills a void: police, ambulance and A&E. In many areas, crisis team advice to patients – after recommendation of distraction techniques – is to call the police or attend A&E. Obviously street triage can mop up a certain amount of this but in my shadowing of street triage schemes over the last few months, I have found that much of the work is CrisisTeam work that does not and never did involve anything that would, of itself, be considered a police responsibility. It’s just that the call came to the police, not least because other parts of the NHS were pushing it there and street triage may, if anything, have accelerated this tendency.
Many police officers working in street triage are gaining great knowledge: of the law, of local NHS pathways in their areas and so on. Research on police officers volunteering for mental health related roles and their skills in handling mental health calls tends to suggest, somewhat obviously, that the roles attract people who are more interested in mental health matters and are therefore inclined to actively develop knowledge and skills. So the challenge is to take mental health as a subject and make all police officers realise that this is not some frustrating extra topic that we have to deal with that we shouldn’t touch at all. I’m always amazed to hear (just some) officers say things about mental health like, “Why do we have to do this?!” – as if to suggest that it is all unnecessary and the NHS should have prevented the need for any police involvement. Of course, it’s true in almost every area of policing that we fill a void of some kind – we shouldn’t have to police the nightime economy anything like as heavily as we do because bar staff shouldn’t be serving alcohol to drunk people – we know that many bars might as well be holding people’s mouths open and pouring it in; we shouldn’t have had to investigate various railway disasters because train companies should take their health and safety responsibilities seriously, and yet we know they don’t always. Isn’t that the very point of the police?! – to investigate people who do things they shouldn’t do and provide other safety net functions up after things happen that shouldn’t happen?
Remember by favourite Egon BITTNER quotation –
“Policing is what happens when something’s happening that ought not to be happening about which somebody ought to do something now!”
So as new training and guidance hits the real world in early 2016 the police can hope to make a better impression on the world. Some might argue that we’re building on a reasonable foundation as the CQC found that paramedics and police officers were the top two groups of professionals for positive feedback from patients in mental health crisis – way ahead of specialist mental health services, GPs and A&E. However, before any police officers become too self-congratulatory it should be borne in mind that satisfaction levels reported in the CQC report around mental health were based on a very small sample and were actually significantly worse than the general satisfaction levels reported about policing generally!
But what everyone needs to realise is that none of this is going to make a seismic difference in the real world if the problem with mental health crisis services is not simultaneously addressed – the police can not do this alone.
We must disenthrall ourselves.
Winner of the Mind Digital Media Award.