I’m really conscious that there will come a point where the focus on policing and mental health will wane – my view would be, it has already peaked and we need to capitalize on the time we have until the sun sets. During that period, the College of Policing will publish its national guidelines and training, forces will have the chance to do something with them and by the time we get to the end of 2017/18, attention will begin to focus on other issues, both within policing and without.
I’m not necessarily sure we’ll have sorted the relevant issues by then: but we’ll have found some ways to make them seem less outrageous and attention will begin to fade as other priorities take hold. Within policing, the view may be taken that once we have national guidelines and training, reflecting on the former in local policing and delivering the latter, surely that will do?! Some police officers still think (or hope?!) mental health is something we can ‘sort’ as a project and then move on to real policing. If Lord ADEBOWALE’s vision of core police business is to mean anything, it may rather be something to which we will need to pay ongoing attention just as we do with domestic abuse and youth justice issues, amongst others.
There are few problems we need to start watching for –
Towards the end of 2016, forces will have realised that the contents of College APP don’t necessarily accord with their local practices and will be experiencing the cognitive dissonance that comes from trying to adhere to national guidelines as well as to local partnership practice. There will be combination of reasons for that, some within policing itself; others without. As APP focuses on the essential and non-negotiable aspects of this interface, forces will need to realise that where it doesn’t easily fit, this will be connected to their internal policies and their partnership arrangements. Work will be required and some of that won’t be easy.
Section 136 of the Mental Health Act and the whole ‘Place of Safety’ debate still exemplifies this: police forces point out that word games about the meaning of ‘PoS’ are still rampant – despite it being very clear in the Act! – and exclusion criteria are still applied by MH service providers notwithstanding what the CQC say in their reports. The reality is that there remains work to do on conveyance arrangements for those detained under the Act with ambulance trusts arguing that they are not commissioned to undertake various functions and of course, we know that forces still approach the use of section 136 very differently. That all needs ironing out and it will be about partnership work, not policies.
You might imagine training is the silver bullet in all of this: it is mentioned with monotonous regularity whenever a report is written on this topic and partners in health seem fairly determined to make sure we realise the problem is with officers not sufficiently understanding mental health. Of course, it’s quite likely that there are significant training needs amongst health professionals – especially legal education for them – as well as remembering that the bulk of police training requirements are around legal issues. I receive almost no queries at all about how to raise officers’ awareness of conditions; ongoing relentless deluge of questions about legal duties, legal opportunities and legal difficulties. So the key thing about training may well be the way in which trained staffed are deployed and used, rather than anything else – we have some trial and error to work this out.
There is also the issue of information retention – police officers will encounter the situation of recalling a CTO patient perhaps once a career, if they’re lucky … or unlucky, depending on your view! We need to be realistic about what we’re asking officers to achieve after their training: I would expect them to know that whenever you detain or re-detain anyone under the Mental Health Act 1983, you transport without using a police vehicle wherever this is possible, you consider the health & welfare of the person detained at every stage. I wouldn’t expect any front-line police officer to freely recall the three different ways in which to serve a recall notice under s17E MHA or the subsequent time at which they allow officers to remove the patient back to hospital. It’s the job of mental health professionals to know what they’re doing around recall and be able to explain that legal point where officers have the power to act. << That’s why this is not just about policing!
Of course, who knows what will take the focus of inspectorates or independent investigators? If history tells us anything, it is that there will be one or two deaths and half a dozen or so ‘near-misses’ each year, following the use of section 136 of the Mental Health Act. Some of those will mean independent investigation of the circumstances by the IPCC who will use the College of Policing APP and training as a benchmark – did forces’ policies adhere to the national guidelines; were officers properly trained; did officers adhere to the basic requirements of their training?
It wouldn’t surprise me if mental health featured in future inspections by HMIC in conjunction with other partners. We’ve already seen focus on these issues in the Core Business reports, the PEEL inspections as well as other in thematic inspections around custody and vulnerability. I would add a word of caution to those who are goign to start inspecting: make sure you understand the stuff you’re looking at before judging it and remember that the main Act of Parliament for mental health law received Royal Assent in 1983, not in 2007!
I repeat my point: I wonder whether we have reached or are just approaching the peak of interest in this subject? – we seem to think we’ve found the solutions in guidelines, training and street triage. I also suspect we can infer this from ongoing force rationalisations, some of which may see full-time positions as mental health coordinator vanish – and this is despite the net effect of ongoing pressures in the health and social care system is to deflect greater demand in crisis care to the whole emergency system (including A&E and the ambulance service) and initiatives like Liaison and Diversion and street triage raising newer questions and challenges. We also know that we haven’t even begun to properly discuss the role we want the police to play – I think this is where we should have started to avoid the conclusion that we see activity at the expense of achievement in this arena.
The trap to fall in to – and I see evidence that it’s proving to be an effective snare in the meetings I attend – is to think that ‘improved’ policing responses to ever greater demand, some how represents early intervention. Yesterday we saw publiciation in the British Medical Journal of an article which evaluates street triage: the first such academic paper to arise, instead of local evalution documents. It claims that street triage is more or less cost-neutral, bordering on cost-saving but it takes for granted the arrangements in Sussex as the basline and it fails to consider the data that the street triage scheme did not gather.
The police service needs to make sure it does get lost in the smoke and mirrors that can surround these issues: the danger of not driving through national guidelines and training to have the necessary impact upon partnerships is that vulnerable people will continue to find themselves criminalised and stigmatised by the impact of the justice system upon their crisis care. We need to make sure that as focus and resource may deplete, we maintain our ability to tell the difference between that which appears highly intuitive and that which will be highly impactive – to do so, we need to start that proper conversation about the role we are attempting to forge for the police in our broader mental health system whilst keeping a very close eye on the direction overall mental health provision is headed. We haven’t really started to do so, distracted as we are on the minutae of whether A&E is a Place of Safety and whether or not street triage and training are the silver bullet. We ignore history and context at our peril.
What are we actually trying to do here? – we don’t have very much longer to decide.
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