One of the main reasons the Home Secretary emphasised that we need to make progress on policing and mental health is to free up police time to concentrate on other issues – mainly around the broader crime prevention agenda. I don’t think she is trying to imply that police time so the most important thing in the world or that there is no overlap at all between mental health issues and core police functions. She just seems to be making the point that the police time committed to this overlap is considerable and could very obviously be reduced. So various things have been happening to deliver progress on this under the overall banner of the Crisis Care Concordat agenda. It certainly can lay a highly intuitive claim to some impressive results –
- reliance upon police stations as a Place of Safety massively down since 2010, from over 11,000 to the cells down to about 4,000;
- the overall use of s136 MHA in street triage areas massively down, typically by 25-33%; and
- overall satisfaction of those professionals and members of the public who have experience of this stuff seems to be up.
What’s not to like?!
One of the main problems is that we need to fully analyse this to understand whether or not the ‘progress’ we claim is actually just making this problem worse, from the point of view of police time. If it is, it raises some interesting public policy questions for us all.
Before I get in to details, I want to make one thing clear: progress at the interface of mental health and policing is not and should not just be about saving police time. The service benefit to the public is obviously more important and nothing is free of cost or unintended consequences. Improving the experience of vulnerable people who come in to contact with the police is about far more than the amount of time the police will expend and I will highlight some examples where it will quite rightly involve greater time and effort. But what follows are mainly examples of where, in an effort to save time and resources, we’ve managed instead to spend time and resources. It begs the question: if we have also improved the experience of those vulnerable people for whom the police have had to provide a response, to what extent should a Chief Constable be paying – quite literally – to improve that crisis pathway to assessment and care for vulnerable people? My final caveat on this post, is that we still don’t have proper data on this stuff – people saw fit not to collect it, notwithstanding that they were advised, so I’ll try to bear that in mind as I am inevitably forced to generalise and over-simplify!
PLACE OF SAFETY
In an ideal world, your local police officers will use s136 responsibly and correctly, leading to the removal of vulnerable people to a Place of Safety only where necessary and that person will be handed over to the NHS within half an hour for assessment and the police will leave. Such a process doesn’t happen anywhere in the United Kingdom, to my knowledge, but it’s what we all agreed to in the Royal College of Psychiatry standards on s136 which were published in 2011 and were slightly updated in a guide to NHS commissioners in 2013. Always amazes me that our NHS can transplant human organs and knows what will happen tomorrow if there is an Ebola patient, but we don’t know how to staff a building to accommodate a vulnerable person in crisis for an assessment of their needs and we certainly don’t know where they will go tomorrow afternoon if they’ve also consumed half a bottle of vodka to quieten the voices in their head.
Less than a decade ago, 66% of the 18,500 people detained under this power were taken to police custody; and none of the 33% who were spared this indignity benefited from a service that worked according to the national standards, referred to above. Since then, ‘progress’ means we now see only 20% of 24,500 people taken to custody – we can agree this is a good from the point of view of more timely, dignified assessment for the person concerned (albeit someone should be examining why the use of the power has gone up by around a third in a decade).
- The average assessment time in police custody is still around 10hrs, where the cells are still used.
- The average assessment time in an NHS PoS is around five hours.
If the police remove someone to custody, they don’t always have to leave an officer there to undertake one-to-one or camera observations of someone. Custody staff can often do it, and if camera observation is required, one member of staff or police officer can watch multiple cameras at the same time. Where someone is taken to an NHS PoS, it is still usually necessary for two officers to remain there until the assessment is completed; and if an inpatient bed is required after admission, it will take longer again. Do the maths on this at your leisure, but you’ll find it means more police time is invested in staffing unstaffed NHS Places of Safety than if we used the cells as often as we did a decade ago. Many NHS areas will simply say they don’t have the funds to properly staff their Place of Safety in such a way as to ensure it complies with those RCPsych standards so the police will have to remain.
In other words, the ‘progress’ we’ve made is now costing the police more than it was before, because NHS trusts often don’t staff their Places of Safety.
Meanwhile, of course, in an effort to reduce the use of s136 and avoid the use of custody, we have seen street triage schemes emerge. I won’t repeat here what I’ve already covered but we know that from the point of view of s136 reduction, many ST schemes now mean the police have tripled their resource committment to managing the workload. And we know that the very existence of triage schemes is resulting in existing NHS structures like out of hours GPs, crisis teams and community teams, asking street triage to pick up work that the police would not have previously been involved in, because nothing in the referrals is anything that you might recognise as a core police responsibility? (Yes, I’m aware of the other, non-s136 related workload in private premises but someone in the street triage world forgot to record that, never mind analyse it.)
It must be right that I acknowledge the impact of particular triage schemes varies depending on the model operated by the force you look at; and depending upon the number of days and hours that are covered. The resulting mathematics therefore varies and I’m more than satisfied that some models of triage are saving police time, but for me this only reinforces the importance of understanding not only the demands we face, but also the reasons why we face them – it’s about the overall flow of patient demand right through the mental health crisis and police system. We do nowhere near enough of this mapping, currently.
So I ask –
To what extent is it appropriate that a Chief Constable pays – both literally and in resources – to improve NHS Place of Safety and other crisis care pathways when it is also involves more demand being deflected to 999 than was previously the case?
The amount of police time spent is not the most important thing in the world – but it’s not irrelevant either and it only becomes a discussion in the first place as a result of choices some areas have made about the accessibility of the unscheduled care services they offer. When I have mental health nurses and AMHPs themselves telling me that there are conversations going on in rooms to which the police are not invited which involve explicit discussion about how much more crisis care demand can be deflected to 999 (including to A&E), then it means we cannot totally ignore the impact on police resourcing where it is connected to deliberate decisions by NHS managers*.
* If anyone is tempted to point out something political about cuts – 1) I’m a policeman, so I’m not going to do anything party political; 2) police budgets increased by less than the NHS MH budget in real terms 2001-2011; and have since decreased by more since 2011.
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