Namibia 

Earlier this week, the British High Commission in Windhoek, Namibia put out a press release about a joint initiative by the Legal Assistance Centre (LAC) in Namibia and the College of Policing in the United Kingdom – it concerned mental health training for the criminal justice system, hosted by the Namibian Correctional Service. This involved my being asked a few months ago to come to Namibia to deliver training to police and prison officers on mental health issues in the criminal justice system – everything from mental health awareness, improved methods to identify vulnerable people; to principles around safer detention and restraint reduction.  By a sheer coincidence of timing, this training fell in the week immediately following my family’s big holiday of the year – to Namibia!  So I have spent three weeks in this beautiful country (see picture, above!) playing and then working after packing my wife and son onto a plane bound for England last week.

Now that this initiative has been made public, I want to explain a couple of things about it. Firstly, for transparency and secondly, because the fallout from the exercise means you may well see more BLOGs on this website in coming months connected to the kind of training we delivered to support Namibian colleagues to assist them (and maybe others) in bringing that content to more people.

BACKGROUND

The background to this initiative was the growing number of people who are being detained in Correctional or Police facilities who have mental health problems. As part of familiarising myself with the Namibian system, I arranged to visit the Central Hospital MH facility in Windhoek to meet staff patients; when I subsequently moved to a town in eastern Namibia called Gobabis, I was able to see a prison for myself and meet the prisoners.  Many thanks for that go to the Legal Assistance Centre who used their connections to make it possible.

Mental health services in Namibia are, to say the least, somewhat limited: to put things into context, there are only five psychiatrists for the whole country in public practice. If you bear in mind that Namibia has a population of around 2.3m people – roughly the population of the Thames Valley Police area – and an area that is four times the size of the United Kindgom, you start to get some idea.  And having spent two weeks travelling here, many parts of the country are difficult to access – not just absence of fast motorways, but sometimes an absence even of tarred roads.  There are only two dedicated mental health units in the country: the Central Hospital in the capital and a slightly smaller unit in the very northern town of Oshakati – this reflects the two major areas of population.  Arising from this limited capacity, the Corrections and Police services are increasingly expected to detain those Namibians with mental health disorders who “are in conflict with the law”.  (Unlike in the UK, the police service have custodial facilities to detain what we would call ‘remand’ prisoners: Corrections officers detain people who are fully dealt with by the Courts.)

PATIENTS IN CONFLICT WITH THE LAW

I thought the term used in Namibia for a mentally unwell person who has offended was intriguing: I’m still trying to think it through but where a person accused of offending and is thought to be seriously mentally ill, they may be detained in hospital or custody for up to 30 days in order to be ‘observed’. This allows a decision to be reached about whether they are fit to stand trial and if they are not, Magistrates may declare a defendant a ‘President’s Patient’, known as an SPD (State President’s Declaration) and they may be admitted to the forensic mental health unit or detained in prison. My first instinct was to think of SPD patient-prisoners as equivalent to a Restricted Hospital Order in England / Wales. The difference is that there is no particular requirement for SPDs to present a “serious risk of harm to the public” – they could just be a person with a serious mental illness who has committed a relatively minor, acquisitive crime. ANd this can lead to detention in hospital or prison for many years.

So decisions prior to a person’s appearance in Court are crucial. Mental Health nurses in Windhoek spoke of it being unnecessary for some patients to be SPDs – they could have had minor criminal charges dropped and been ‘diverted’ under s9 of the (Namibian) Mental Health Act 1973.  This is like civil admission in England / Wales – it’s like being a s3 MHA patient where DRs decide when you will be discharged based on your clinical condition. Some SPD patients who have reached that clincial threshold are detained during any delay in the Ministry of Justice finalising their discharge and there was a hearing in the Namibian Supreme Court in 2012 about such matters affecting the human rights of one patient.  (Human Rights, very similar to those in the European Convention, are an inviolable part of the Namibian Constitution).

So given the role that the Corrections and Police services play, efforts were previously made to have mental health professionals do ‘increach’ work. This proved too difficult because Corrections facilties are widely spread around Namibia and the amount of travelling required to cover them all proved too great an obstacle. It has therefore been decided to focus the detention of SPDs in Gobabis – where Corrections officers can receive greater training in mental health and where inreach professionals can visit and support far more easily. Hence the initiatve to provide training to officers at that facility and relevant senior Corrections officers from the service’s headquarters in Windhoek.

RESOURCES

I fully intend to upload the PowerPoint from the training to this BLOG and to add a few lines with certain other resources.  I’m going to do that next week oin order to be able to add some slides that reflected certain flipcharts I drew along the way in response to certain specific questions. Feedback forms indicate this training was a great success at all levels and I suspect I will remember for a very long time the young Corrections Officer (you know who you are!) who said at the end that he had found the training to be “literally life-altering” – he was rightly commended by his senior officers for the effort he put in to it during the whole week.

The main objectives of the training were –

  • Create an awareness of the main kinds of mental health disorders and models of mental distress.
  • Understand the main issues in criminal justice arising from mental health issues
  • Understand the main MH / CJ legal frameworks that apply in Namibia.
  • Understand how to identify, screen and risk assessment detainees with mental health problems.
  • De-escalation training and conflict resolution
  • Restraint reduction.

FUNDING

The training was funded by the British High Commission in Namibia with £12,000 (N$250,000) that ultimately comes from the UK Foreign and Commonwealth Office bilateral fund. Most of that money related to the actual costs involved (my air-fare, the accommodation I needed for a week, other running costs for the course), the rest goes back to the College of Policing and so helps offset the costs to the public of the mental health work the College is doing in the UK to support British police forces.

My thanks go to Jo LOMAS, The British High Commissioner in Namibia for supporting the project; Rachel COOMER and Yolande ENGELBRECHT form the LAC who were superb company and effortless efficient (including in the recovery of my lost phone!) and to Deputy Commissioners William


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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3 thoughts on “Namibia 

  1. Whilst I admire your work abroad can you tell me how this helps me as fronline UK cop at 2am on a Sunday morning stood in the house of a suicidal guy refusing to go to hospital and the MH team telling me to lock up for a breach of the peace? The CoP has had 3 years to come up with something of use around the problems faced by police regarding Mental Health and so far my fellow PCs and I have seen nothing constructive. When are you as a representative of the CoP going to insist that officers get better training and then more impotantly provide that training? I love your blogg but please don’t forget your roots while taking paid trips around the world and sort out the problems on your own patch first.

    1. So much could be said here, so please forgive bullet form replies:

      1. It doesn’t help you at 2am: that help was given a) when I (partly) wrote national guidance in 2010; b) when I spent my own personal time writing this BLOG as it contains the answers and c) when you police force was briefed and helped to put in place proper training for you. It’s possible they they didn’t provide it, but that’s not an issue for the College: it’s one for your Chief Constable.
      2. If other professionals tells you to break the law; you decline, advise them and if appropriate, report them to their own managers.
      3. The College of Policing’s mental health work has been properly ongoing since September 2014: you’ll notice whislt I was taking a paid trip that the new APP modules are out for consultation amongst forces and training modules will follow – in that sense, the work I have to do on my own patch was taken care of before this initiative was even dreamed of and the timing of this was chosen because it wouldn’t interfere.

      There are two indirect benefits to you, however –

      1. It helps me in terms of my professional awareness and insight and therefore the work I do in the United Kingdom is influenced by that – I come back from Namibia with three bigs ideas in particular. More detail on that later.
      2. Much of the money expended by the British High Commission comes back to the College of Policing – they will presumably spend it as they see fit, to the overall benefit of UK policing.

      The main point I am concerend about though, is the assumption that appears to run through your comment – that the problems you face are for others to sort. If you have a suicidal guy in a house you have a few options: a) call for relevant professional support from MH; b) arrest for any offences / breach of the peace that are being committed; c) offer him advice and support before walking away; d) do nothing at all. These are the options that your Parliament have offered you; you must exercise your professional discretion to chose the most appropriate one to the situation to achieve your objective.

  2. Excellent work, dying to do something similar, with a background in forensics and A&E liaison maybe I’d have something to offer. Mark the calendar again, because we’re in complete agreement!

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