A Little Humility

As with buses coming along in groups of three or four after you’ve waited half an hour, I tend to find issues highlighted to me at the College come in groups. I remember writing a BLOG on Guardianship having had several calls in a few days to an incident involving s7 of the MHA having had no previous incidents of this kind in about fifteen years of policing! But this week has been particularly interesting because it was not a particular piece of legislation or a particular situation that leapt up several times: it was feedback and examples about the police ‘debate’ about their role in the broader mental health system. The feedback from others, including a very senior psychiatrist who I know well enough to know is sympathetic to the police position, was nervously given as only feedback is when it’s something you’d rather not have to say, but nevertheless must.  Some are obviously concerned about the extent to which the police is ‘pushing back’ against mental health related demands and I also see this from where I sit.

Firstly, I’ve quite literally forged my current professional posting and my wider career by arguing that the police are overexposed to risk, demand and complexity they should never been facing; and I continue to do so hoping to release much-needed police resources for other responsibilities. But in a decade or more of doing this, I’ve also learned something very keenly that I could not easily see as a response PC or response Sergeant: that whilst we are overexposed, we are also underexposed to the risks, demands and complexities that we should be a part of. So whilst we have police officers sitting in Place of Safety suites for hours longer than they should be there; we also have mental health nurses off to A&E with grievous bodily harm type injuries who don’t call the police to investigate the assault they have suffered. Perhaps you are reading this and thinking, “I can’t investigate something the nurse doesn’t tell me about!” and that’s fair comment. However, some incidents of this type have involved desperate 999 calls begging for urgent support that has not been forthcoming. The NHS has had to privately prosecute thirty offenders in the last few years because the police and CPS said not enough evidence or public interest: and they were all found guilty.

So whilst we have officers being asked to recover AWOL patients from home who should be returned by mental health staff because the location of the patient is known (para 28.14 CoP MHA); we also have officers declining to attend private premises with AMHPs who have already sworn out a s135(1) warrant and arguing, “You just do it and call us if you need us.”  No! – the warrant can only be executed by the police so attendance is required and this kind of response gets the AMHP in to further difficulties coordinating the MHA assessment. Remember, AMHPs are already ring-mastering themselves, the doctor, possible nursing support, the ambulance service, as well as liaising with the patient’s often upset, and distressed family. Imagine getting all those ducks in a row only for a police officer to pop up and decline to execute a warrant that a court has issued because it’s necessary to the objective the AMHP is bound by law to pursue?!

AGGREGATE BENEFITS

If I had a spare few years, it may well be possible to work over whether any achievable correction of the over and under-exposure of the police to mental health demands would lead to a net gain or a net loss to police time, but I admit I’m not ultimately bothered about it.  Firstly, I haven’t enough spare time to care; and and secondly, I’m far more interested in ensuring that all public organisations discharge their responsibilities professionally, putting the public at the front of those decisions. Maybe we’ll save time – maybe not: but we’ll have done the right thing to make sure that those who experience mental distress and disease receive appropriate, timely assessment and care in the least-restrictive, least-stigmatising way and we will have made sure that the police are a proportionate, measured contingency in a field of public policy that does involve complexity and from time to time, risk.

So if we want to prevent police officers from having to undertake, quite literally, tens of thousands of ‘welfare checks’ per month that they are utterly totally unqualified to do, we also have to make sure that when nurses report they have been assaulted – incidentally, that happened over 45,000 times last year alone – we should support them as we would any victim with an appropriate attitude and by professionally investigating the potential liability of the accused person, reaching sensible conclusions about what the police and / or justice system cannot or cannot do with them to address offending and prevent re-offending.

If we want mental health services to look at the staffing levels of inpatient wards so that they don’t call the police to assist in secluding or medicating patients, we also have to make sure that officers don’t remove people to A&E departments under s136 and then just leave them there; if we want to publicly accuse a health organisation of managerial shortcomings and under-staffing, we have to be humble enough to remember that we also fall short from time to time and that those things can occasionally be said of us and are probably best addressed by senior managers, in appropriate partnership meetings and based on evidence that is understood by those who are using it.

CORE POLICE BUSINESS

Earlier in the week an officer publicly bemoaned on social media involvement in an incident where paramedics sought police support for someone in crisis and it led to the use of s136.  Who else was going to do that? – the law allows for no-one other than a police officer to do it! The officer must have thought it necessary, because they agreed with the request and whilst sitting about for hours afterwards is an abuse of police time that should not occur, I can give examples from that same force area of stuff the police didn’t do that they should have been involved in.  But I won’t do that here!

We must remember what Lord ADEBOWALE said in the 2013 report from the Independent Commission on Policing and Mental Health: mental health is core police business and even if you had the best, most well-resourced mental health system in the world, you would still find legitimate demands on the police connected to mental distress. Some mental health problems and crisis incidents arise from human experiences, including tragedies and poverty; discrimination and all kinds of abuse. There is no realistic way of ensuring that the police are never connected to this.

The often-expressed assumption that mental health should be doing more to prevent demand on policing is getting weary: it’s also true that bars and clubs should be doing more to deny access to drunk people, to refuse alcohol to drunk people (which is an offence) and to prevent the night-time economy mess we see in too many cities each weekend. The impact of that on wasted police and NHS time is absolutely colossal, probably dwarfing any demand around mental health, and yet we see very little said about it. I wonder why? – in the absence of knowing, one could be forgiven for wondering whether it’s because of stigmatizing attitudes about mental health?

THE ONGOING NARRATIVE 

My job involves trying to persuade NHS and other organisations to change certain things so that demand on policing reduces, if possible; and to ensure that we improve in our abilities to better manage the demand we must face through new guidelines and training. We all need to be humble enough to remember that the Time To Change initiative on mental health stigma indicated police and mental health professionals are the two groups with the greatest distance to travel in terms of improving their professional attitudes to those of us with mental health problems.

Some service users do see these tweets, comments and news articles and feel like they portrayed as an irritating burden – I know this because many of them are kind enough to email or tweet about it. Even the CQC have provided evidence that some professionals actually say these kinds of things when they are dealing with vulnerable people! I suspect the ongoing, often subliminal narrative that most things are the fault of either under-resourced or dysfunctional mental health services misses two important points:

  • we in the police are far from perfect, too and have much to improve upon – not least our attitudes;
  • we’re not going to solve either NHS problems or police problems unless we do it together by working out a way to manage the complexity.

And to end on a positive: none of this means that most professionals aren’t out there doing a great job, improvising through the problems that exist despite the frustration of perfectly legitimate concerns about how services operate and how we define the boundaries and the overlaps between mental health and criminal justice – this is complicated stuff!  I just plead for us all to show a little humility in how we conduct the debate and make it mostly about the public we all serve: and less about the organisations we work for.


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 “A Little Humility

  1. Brilliant article – so few can take into account the complexity of it all when emotional narratives and rhetoric are around yet you not only take into and write about the complexity but do it in an understandable, clear way – and in non mental health professional or police speak!!

  2. Great piece. It would be good if all agencies involved could stop talking about how much time and money the care of mentally ill people costs. It is endlessly depressing. As you say the rhetoric has become standard, and really isn’t helpful for people who use the services.

  3. Mike. This is an excellent piece, such a complex minefield of responsibilities – often misunderstood by Police, NHS, and Social Services alike. This should be required reading in all of these services – particularly the two points in the final section.

  4. A great blog. Sadly, the increase in police awareness that stopped us blindly just doing as asked will inevitably allow the pendulum, in some cases, to swing too far.

    For me the really important message is partnership. Not the “police have got this so now we can all go and leave it with them.” Too often over the years the cops have become servants to other agencies and that fear of being left holding the baby is still very present in policing. Particularly as we, like many others, have seen huge cuts to numbers.

    It surely has to be about working together to the best result for the patient. That might mean working outside our “remit” (shocking word) to expedite a process. However that needs buy in from everyone.

    As far as assaults on medical staff are concerned. I will deploy staff to them every single time.

  5. Excellent article, I find we butt heads less these days! In our area we have joint meetings around various things (eg, 136) but they’re often between those of middle management grades in both organisations. Are there examples where the top bosses are getting together in partnership groups?

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