The third Law Enforcement in Public Health conference is being held in Amsterdam in the first half of this week and it was a massive privilege to be invited to attend and address the main conference on Monday morning. Professor Nick CROFTS from the University of Melbourne is the main driver behind this and having ‘met’ him over the internet and by email, it was great to finally meet him in person. He made an important point at a pre-conference meeting, “There is only one Master’s degree in Public Health that touches on the role of Law Enforcement: at the University of Melbourne” … oddly enough! And this links to the issue about whether police organisations are sufficiently tapped in to the public health agenda and whether or not health and other social services see the police as an important partner?
As a police officer: I know stuff health professionals don’t know, about health issues – everything from the percentage of people presenting under arrest who are seriously mentally ill, to the location and nature of mental health crisis presentations. Police data could amplify metrics owned and controlled by health: how many people encounter the police whilst in crisis are known mental health service users? – what does that tell us about mental health care, discharge from hospital or revolving doors of crisis >> admission >> recovery >> discharge >> relapse?! The police are also in control of factors which directly affect health and wellbeing: from the right to use reasonable and proportionate force which includes mechanisms which seriously damage physical and psychological health; through to the right to initiate prosecution proceedings on behalf of the sate which can themselves prove pathologising.
WHAT IS THE ROLE OF THE POLICE?
There things to argue about here: I’ve really enjoyed this conference, it’s been amazingly intellectually stimulating not just because it is attended by academics, health professionals of various kinds and enough police officers to make our presence felt in the debate. I’ve been massively influenced by various people here and even just reflecting on the police officers present, they hail from the Netherlands, the UK, the US, Australia, Ghana, Zambia, South Africa, India and Vietnam – and I’m sure I’ll have missed some in that list. Obviously public health professionals are interested in improving health outcomes at the population level, reducing and minimising harm to people, especially in vulnerable populations. That immediately gets us in to the discussion about what we mean by ‘harm’ and what we mean by ‘vulnerable’. I’m told the United Nations use the phrase ‘key populations’ as euphemism for vulnerable – that, in itself, opens up a whole new perspective on things. The conference isn’t focussed specifically on mental health so other health issues under focus include things like, alcohol abuse, obesity, drug use, sex work, violence reduction, etc.. And so I’ve found myself asking outloud and on social media: “what is the role of the police, then?” to understand where out public health colleagues are coming from.
It gets us immediately in to difficult territory, both legally, politically and ethically. If you accept the evidence that the ‘war on drugs’ approach over the last forty years has been a spectacular failure in terms of the fact that it had cost trillions of pounds or dollars, incarcerated millions of people across the world and we’re no better off in terms of health outcomes, to what extent should the police take decisions about non-enforcement of drugs laws because that improves health outcomes when Parliaments have deliberately chosen prohibition? We know the police in a lot of countries enjoy considerable discretion in their enforcement decisions and that policing is more often characterised in low-level, day-to-day situations by non-enforcement of the law. But to what extent should that lead to a deliberate city or country-wide decision not to enforce possession offences because health services want to set up supervised drug use clinics as part of improving health and safety and reducing the use of hard drugs? We heard from Allan ROCK, former Attorney General of Canada about exactly such an approach in Vancouver which massively reduced overdose deaths in the city – he authorised the police to support a drug use programme by ensuring there was a legal exemption from criminal liability for those involved in it. Officers didn’t have to feel ethically compromised by referring people to services that were predicated upon violation of Canadian drug laws – those laws had been set aside by politicians, for those particular circumstances.
This raises those difficult questions, however, for police officers not working in such an environment: to what extent can officers turn a blind eye to offending behaviours even where they suspect it is ‘for the greater good’? – and does it matter whether that is an individual, situationally-specific decision by a patrol officer or something more amounting to a policy approach by a far more senior officer, as we saw in some years back in Brixton under Commander Brian PADDICK? One point that I’ve made at LEPH – and which has been made or supported by others in their presentations – is to look at the extent to which police services become involved in responding to incidents and ongoing problems which are predicated upon health issues because the wider design or absence of public services means there is a deliberate reliance upon the police? This is true in most of the work I do: I’ve argued for years that we rely too much on the police as an agency that creates a buffer between the public and mental health services, thereby creating time and space to make it easier – and let’s be frank, cheaper – for mental health services to respond. I see evidence for this all over the place and it’s obvious from this event my thoughts are not restricted to the UK.
WHAT DO YOU WANT US TO *DO*?
There are some disagreements still to be had: everyone here seems to agree we should all be focussed on harm reduction but in a pre-conference meeting where attempts were being made to agree some principles which should influence a policing approach to public health, it struck me there were two problems: firstly, the principles were mainly about what the police should do better or do more – training, awareness and collaboration, etc., etc.. The first principle for discussion was borrowed from Hippocrates: first, do no harm.
The problem with this, however, is we do ask our police services to undertake activities which cause harm: we even require them to lawfully kill people, on very specific occasions and that can, very controversially, be the case with a someone in a key population group. But more routinely, we ask them to undertake tasks which affect health and wellbeing at the population level: we ask them enforce various kinds of drug and other ‘lifestyle’ laws, we ask them to enforce laws on sex work and immigration; in addition to volume offences like assault and theft (including their aggravated variations) which can lead to imprisonment. We know that these activities disproportionately affect key populations for a variety of complex reasons. Disentangling all of that will probably require far more than senior, informed police leadership – these are both political and Political issues, very directly.
And finally, it struck me that this further leads us to another two equally important points, alluded to above: firstly, the police know things and can do things that contribute to this agenda but are often conflicted by the legal responsibilities entrusted to them by elected governments. Mental health – and after LEPH, most public health issues around addiction, sex work and poverty – are issues about which police officers have various things to say and various data to offer … whether they yet realise or not. Secondly, the police cannot do this alone and for as long as we don’t include the police in the discussions, health and social care professionals, as well as politicians and societies will miss out on understanding the very unique viewpoint that police officers of all ranks have on policing and public health.
There is a lot to think about following this conference – the police need to get much, much more interested in this and others need to let us get far more involved in it. A great conference – I look forward to following the next one in two year’s time! Hopefully they’ve be able to livestream it by then, too?!
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