Today is the Opposition Day debate in the House of Commons and I type this as I watch it on my iPad. Firstly, it was amazing to see that as Luciana BERGER, the shadow minister for mental health, introduced the debate, the first interjection from another MP was to highlight the pressure on policing, arising from the amount of demand they face connected to mental health. This was not the last mention of policing: frequent reference was made to the unacceptable reliance upon police cells as a Place of Safety and the Secretary of State for Health, Jeremy HUNT, reference the progress that was made in reducing the use of police cells but that it was still unacceptably high at over 4,000 people a year.
Whilst this figure is right, it is also wrong! And where it is wrong, it is wrong by at least a factor of ten. Yes, a factor of ten! … at least. Let me explain –
Whenever discussion is made about the use of police cells in connection with those in mental health crisis, the figures are normally those relating to the use of section 136 of the Mental Health Act 1983. The Health & Social Care Information Centre tells us that around 24,000 people a year are detained by the police under this power and that 25% of them are detained in police custody as a Place of Safety. Clearly we must do more about this to reduce that number even further. But this is just about the use of the Mental Health Act – what about all the other legal situations?
ARRESTS FOR OFFENCES
The very first comprehensive piece of work I did on mental health in policing, was an examination of what we do in connection with people are not detained under the Act, but arrested for substantive offences – things like assault or robbery, criminal damage or burglary, right the way up to sexual offences, attempted murder or firearms offences. What I found from that work and what other research tells us, is that around 15% of everyone arrested is identified by the police as having a potential mental health problem. I was pleased to find that in every case, medical assessment and advice had been sought to determine what needed to happen. 5% of all people arrested were recommended for assessment under the Mental Health Act and almost all of those were found to have mental health problems: many of them serious.
Now, the police in England and Wales arrested around 1.2m people last year. Working on these snap-shot figures, 5% is well over 50,000 people who are arrested and then assessed under the Mental Health Act. And of course, that only counts people thought to be so acutely unwell as to need admission under the Act. We know that some people are living with a mental illness but are not acutely unwell – we don’t know what those numbers are. Then, you still have to count the thousands of people who are detained under the Mental Health Act and where the cells are used as Place of Safety, as highlighted in the Commons today! … so the problem is actual much, much worse than the common headline figures that are based on the more obvious MHA figures.
Just in case anyone is thinking, “Well, if there’s an offence involved, that is quite different and custody is less of a concern” – there are two things to say to this –
- We know that mental health crisis incidents to which the police are called occur mainly in private premises where section 136 cannot be lawfully used – so officers who feel obliged to safeguard someone by making a detention, will have to choose another legal justification for doing so, hence we hear about arrests to prevent a Breach of the Peace; or arrests for what is mostly minor crime.
- We also know that whatever the clinical issues for individuals, they are not going to be improved by the feeling of being criminalised by incarceration; and it does not mean that you get access to the clinical care that you need.
AND WE’RE STILL NOT DONE
But this is still not enough to fully understand the depth of the problem! – everything I’ve covered so far is based on the police recognition of people coming through the system and perhaps unsurprisingly, police officers don’t spot everyone because they are not experts and do not have routine access to NHS records. Not much work has been done, that I am aware of, to cross reference police arrest records with NHS patient records – but in one case where it was done in the south of England I’m aware they were stunned to find that 50% of everyone arrested was currently or previously known to the local NHS mental health trust. So the police are potentially only spotting one in three of those vulnerable coming through the system. (Important to bear in mind from a suspect’s point of view, that if you tell the police you have a mental health problem, you are immediately doubling or tripling the time you will spend in custody because of the practical implications of the safeguards upon which we rightly insist. Reality is, some people would prefer to get out quickly than benefit from the safeguards – they’ve told me so in custody, quite directly on occasion!)
So the number of us detained in custody whilst in crisis and potentially acutely unwell is potentially ten times the size of our normal public narrative, and certainly ten times the size of the problem referred to in the House of Commons today. However, if you also then examine those of us with mental health problems who are not acutely unwell but nonetheless living with a mental health condition and you think about the impact of detention in custody: what do we think that could do to some? What emotions would you feel, what distress would you feel if the police locked you up in a concrete room than made you think about your predicament for hours whilst they sorted the situation? Whatever the reason and however justified that action may have legally been, it’s not going to improve your mental health and bearing in mind that two-thirds of people who end their lives after contact with the police are thought to have had mental health problems, it shows that detention in custody is serious business that should be undertaken somberly and only where necessary.
The problem is at least ten and potentially twenty times the size of the problem we all too often think we’re dealing with and we’ve known for years, if not for decades, that the solution is timely, available and accessible mental health services for those who want them. What we also know is, that if you don’t provide them, you’ll end paying even more anyway in criminal justice costs so whichever way you look at this, you’re going to pay for it: the question is whether you’d like to pay less for appropriate support to vulnerable people or pay more for outrageous injustices that degrade is all? Norman LAMB summed up the debate for me today, “We spend £105bn on the failures in mental health – it is a moral injustice and economically stupid!”
Winner of the Mind Digital Media Award.