Training and Collaboration

If we look around the world at policing and mental health issues, it doesn’t matter whether we are looking at the incident-specific tragedies we read about or the wider issues raised by taking a broader overview: we only ever hear of two solutions in response to whatever we think problem is —

  • Training – the idea that if only police officers were better trained, outcomes and encounters would be very different. They need more ‘awareness’ training about various mental health conditions, de-escalation techniques and alternatives to detention that may be available locally.
  • Collaboration – the idea that if only the police and mental health services only work more closely together. And in real time, then we would also see improved outcomes and encounters because more appropriate people are then dealing with people in crisis, with police support to their decision-making.

I’m unconvinced, quite honestly. There is some obvious, intuitive merit to these ideas – my point is not to dismiss how important they are – but I wonder if you can also see the obvious problems here?! … there are several.

Even where there is evidence that these two solutions improve things – and there is some evidence they may help – it is all predicated on improving encounters people have with the police. It doesn’t even begin to touch on why people have encounters with the police in the first place; and what we could do to avoid that. I suspect there is much more than we can and should do.

POLITICS AND HISTORY

Look back over the last fifty to sixty years and you can see a series of political decisions (big ‘P’ and small ‘p’) about how we deliver mental health services which have significantly increased the likelihood of contact with the police. This, in turn, increases the likelihood that some people, following that contact, will experience detention, the use of force or criminal proceedings. This remains true notwithstanding efforts we may make to ‘divert’ people from the justice system. We regularly hear complaints about the prevalance of individuals suffering from a mental disorders in death-in-custody reports, fatal shootings and prisons statistics all over the world: this is what happens regardless of national Politics (big P), governments or wealth … although the extent varies, obviously.

This is not just true in the United Kingdom – look at the USA where police officers are frequently criticised for their actions: why are so few people asking the question about why US citizens have so little access to mental health services and why they are coming in to contact with the police? It’s not that it’s illegitimate to wonder about the police’s use of force OR to think that anyone is putting an argument that officers should not be held to account. This doesn’t preclude the support of ideas like Crisis Intervention Training but the idea that these things are solutions, is to assume that contact with the police was unavoidable, inevitable and the first possible point where society could intervene to support the vulnerable. We know this isn’t true – and if we could reduce the over-policing and criminalisation of people with mental illness, we have less of a policing problem to fix.

Look at some developing countries where there are often very few mental health services – the criminal justice system absorbs people where social capacity, tolerance or patience for their distress has evaporated. I saw this whilst working in Namibia just over a year ago. This doesn’t mean efforts by Namibia’s prison system to improve training for correctional officers was pointless, just that a junior prison officer can’t do that much to ensure support for someone two years before they are jailed. In Pure Madness (2003), award-winning journalist Jeremy LAURENCE reminded us that we don’t know whether or community care for mental health works, because we’ve never really tried to do it – at least not properly. We don’t resource mental health or community mental health services, anywhere, then when as a direct result of that decision, the criminal justice system becomes involved in responding to things that occur – from crisis incidents and minor crimes through to occasional high-profile incidents – we wonder about the nature or quality of the response and forget about the main problem here.

CRISIS RESPONSES

Only this month, we read of yet another inquest where the ‘crisis’ advice to someone who is already receiving care from a mental health trust is to ‘ring 999’, despite the fact that the police would inevitably be drawn in to a situation where they had no legal powers whatsoever and where no-one really knows whether fluorescent, paramilitary uniforms are going to be a positive addition to the situation or not. If you want to improve the experience of vulnerable people when they are in need of unscheduled care, they actually have to have unscheduled care options that are able to meet their needs.

There police are not always going to get it ‘right’, when it comes to mental health – look around the news and you’ll see examples of health services and professionals getting things wrong on mental health and they come pre-loaded with a three or five-year university degree plus years of post-qualification experience. There was a recent complaint on Twitter that police officers don’t have the skills of a consultants psychiatrist – it’s probably a good thing they don’t, given we don’t really want police officers prescribing meds and I’ve never seen a consultant psychiatrist rolling around the floor attempting to restrain someone. Policing and psychiatry are different jobs: we don’t want the skills to match!

There are many reasons why all of this is vital: we can’t always control the circumstances in which the police come in to contact with vulnerable people. A call may come from a person seeking support for themselves which they cannot otherwise get; or from a third-party because of concerns they have. That could be a family member, a neighbour or unknown members of the public who feel the police should be informed in order they can “do something!”. However, some incidents are what I usually call deflected demands – calls that were made to health services for a health care response to someone who is unwell, but which are then directed to the police. We need to know more about whether this is about the urgent management of risk and an inherent need for the police, or because we are demand managing.

By the time of police involvement in anything, the tools they have available to them, irrespective of their training and irrespective of their collaboration arrangements, are potentially very blunt. Whether they are appropriate to the situation in ensuring we don’t make people feel stigmatised and criminalised … who knows! By the time a police officer and mental health nurse turn up to private premises where most incidents occur, even the best trained police officer on the planet and the best mental health nurse co-pilot will still have just three options: do nothing; hope that talking achieves a different outcome; leave and hope you can persuade an Approved Mental Health Professional to obtain a warrant under the MHA.

TRAINING & COLLABORATION

So these two responses to problems may be helpful – this post is not arguing that they aren’t. If someone has come to police attention, a nurse sharing information, offering an assessment or an alternative way of dealing with a situation may well be helpful. Police officers better recognising the need for that can only support a diversionary approach is vital. It just isn’t the major problem to address here – unless we start talking about why and how those of us with mental health problems and in distress increasingly come to police attention and are less able to access established pathways of help and support when in distress, I fear we may just keep on trying to do thing wrong thing righter.


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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3 thoughts on “Training and Collaboration

  1. Great post. As a relative, accessing mental health care is incredibly difficult, and there are all sorts of criteria that have to be met for different levels of care that patients are never told about…. Community care is typically seeing someone once a month and a psychiatrist once every six months. Long term inpatient care is virtually impossible to access as there are very few beds, as I think care has been structured in line with the theory that people don’t need long term admissions, despite all the evidence to the contrary. Everyone’s crisis plan, I think, has dial 999, even though everyone knows this result in police being called. I think mental health professionals need to sit down and have an open honest discussion about what people with mental illnesses need to help them get as well as possible and stay as well as possible, At the moment there seems to be a vast institutional acceptance of a service where many people are left so unwell that they attempt suicide or serious self harm, with the police left to pick up the pieces time after time.

  2. As Judy says accessing crisis care is difficult

    Before Xmas I was becoming increasingly unwell. The only acute bed would be hundred miles or more away. I was referred to the crisis team who were too stretched to contact me more than 3 times a week. Not an adequate replacement for inpatient care. Things got worse and in the week before xmas I ended up in A&E but no one knew so I was reported missing. I did then get an inpatient stay but only for 10 days. I was discharged still unwell. After a day at home it was obvious I wasn’t coping but no inpatient beds so I got put in a crisis bed for 4 nights. Discharged again still unwell. Between these stays no contact for about 2 days from services. Eventually I left home for 4 days and despite calls to crisis services I was left pretty much to get on with it. Then a week ago the police ended up having to search for me including helicopter (I was unconscious and had hypothermia when found). If I’d had the right support at the right time I need not have been a bother to the police. The only person who seemed to care during this period was the local PCSO.

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