Yesterday, Her Majesty’s Chief Inspector of Constabulary, Sir Tom Winsor said something extremely important in his annual review, known as the “State of Policing” report. The main headline from the document was his argument that the police are now filling gaps in mental health services and that this represents a drain on resources which are being diverted from other policing responsibilities. It was his clear view that “the provision of mental healthcare has reached such a state of severity that police are often being used to fill the gaps.” He makes the point that the police “have often been used as the service of last resort. In some areas, particular where people with mental health problems need urgent help, the police are increasingly being used as the service of first resort.” He goes on, “We are still finding cases of mentally ill people – who have not committed any crime – spending the night in a police cell. This is because they are too vulnerable to be left alone but there is no bed for them in a healthcare facility. The provision of mental healthcare has reached such a state of severity that the police are being used to fill the gaps that other agencies cannot. This is an unacceptable drain on police resources and it is a profoundly improper way to treat vulnerable people who need care and help, not incarceration among criminals.”
He makes a comparison for mental health care with the police approach to crime prevention, “It is far cheaper to prevent a crime than it is to investigate and arrest the offender after the event. The same is true of mental ill-health, which is not a crime. It is an old adage that an ounce of prevention is better than a pound of cure and this is particularly true when the cure fails and an emergency intervention is required to protect the safety of an individual in distress and, often, people nearby. By the time depression or some other mental disorder has been allowed to advance to the point that someone is contemplating suicide, or engaging in very hazardous behaviour, many opportunities to intervene will have been missed by many organisations. When that intervention takes place on a motorway bridge or railway line, or when someone is holding a weapon in a state of high distress, the expense to all concerned is far higher than it should be. The principal sufferer is the person who is ill, especially when it is realised that his of her suffering could have been much less or even avoided altogether.”
I’m sorry to keep going, but his words are well worth reading, “There is the economic cost in terms of the expenditure of time and effort by the police and other public services, as well as the expense and trauma sustained by those adversely affected by the crisis at the time. The economic arguments for earlier intervention intensify the health and moral ones ready in play. Furthermore, research, carried by Ipsos MORI for HMIC, shows that only two percent of people think that the police has the greatest for responsibility for the safety of people with mental ill-health or learning difficulties. With an estimate one in ten young people having a mental health problem, this is not a matter for the police alone. The inadequacy of mental health provision and the lack of parity with physical health provision in this country should disturb everyone. It should never be the case that someone who requires treaetment, for any condition, should become the responsibility of the police simply because other agencies do not have the resources to act.”
I did not know this report was coming out until it was published and I started to receive media enquiries about whether the College of Policing would allow me to be interviewed (listen from 19:55). Having downloaded the report, abandoned a colleague I was having lunch with to read it on a Tube on the way to a BBC studio, I couldn’t help but smile and shout “Yes!” to myself as I travelled down the Victoria Line in London. After tweeting the report, my reaction was to add, “I’ve been saying this for fifteen years – glad to see everyone’s catching up!” And this links to the way I’ve been recently summarising where we are with things now. We can talk all day and night about various things that have gone wrong in policing and mental health, up to and including controversial deaths in custody following restraint. When we do, we tend to find people saying “the police need more mental health training” and “the police need to work in real time collaboration with mental health services”.
Well, Sir Tom’s intervention doesn’t address either of those things, specifically – it goes far more directly to the real heart of the problem, to his credit: a problem I’ve flagged for many years now. Neither intervention even begins to address why we now rely so heavily on the police as part of our model of healthcare – what is driving people towards the police in the first place?! Professor Louis Appleby (former government tsar on mental health and criminal justice) was quite quick to dismiss the HMCIC’s assessment, tweeting –
Again, this misses the point being made. Positive collaboration isn’t addressing the reason why the police are being called in the first place and evaluations on these collaborations are known to be poor so we don’t know whether it’s decreasing police contact for vulnerable people, regardless of whether it’s improving it. Helping the police respond better is the second of the two solutions and it’s not necessarily preventing the deployment. Some so-called ‘street triage’ schemes will claim that they have identified calls coming in which don’t need the police and the triage nurses have handled callers directly, without officers deploying. But we also know that some healthcare professionals have started diverting more demand to policing because “the police have nurses now!” and the triage nurses have complained like hell but be unable to avoid deploying to situations police officers aren’t required at. I’ve seen that with my own eyes several times whilst shadowing.
And no, we don’t have data – those who designed these things didn’t appreciate the need for it. They were told, but they didn’t listen. Can only say that I tried! … the blog posts are there to prove it!
We’re simply not sure whether demand because of triage is rising or falling, because it’s not being evaluated properly and in fairness to Mr Winsor, it’s not HMIC’s job to do research! — whereas it is Professor Appleby’s. Research funding for policing and mental health projects seems to be hard to come by. Professor John Baker mentioned on Twitter recently that his attempt to secure funding hadn’t been successful but that he’d be interested in doing it. I’m aware of two other academic bids for funding to take a more thorough and critical look at these collaborations which have been turned down by health funding agencies. What more can you do that try?! It’s not HMIC’s fault that ‘positive collaborations’ are collecting very limited data sets, that academics are choosing not to really look at this stuff and that research funding bodies are turning down applications. Until then, you might just have to make do with people blogging, and offering their opinions.
Of course, HMCIC’s views are not just opinions – this is the professional judgement of Her Majesty’s appointed adjudicator: he has a formal position in our society and a statutory duty to call it as he sees it, even if there are some remaining questions of detail. I hope his intervention prompts research to prove him right or wrong, then at least we’ll know, won’t we?! But however, you look at it, Sir Tom’s views will no doubt be predicated on impressive quantities of information and opinion that HMIC collect from forces in their various routine inspections around custody and around general effectivenss, amongst others. The CQC are involved in advising on some of those inspections because of the obvious overlap with health issues in custody and CQC is an organisation on whose board Professor Appleby sits and for the record, their opinions and reports don’t always survive contact with reality, either! … but I can’t just dismiss the statutory regulator for healthcare and the Mental Health Act out of hand, can I?!
Meanwhile, my good friend Nathan Constable has blogged very well and very quickly on this new report. I’d encourage you to read his views. He’s also busy working his way through a Master’s degree looking more deeply at the issues around the role of the police and his early work has uncovered much that supports HMIC’s position: that mental health professionals thirty odd years ago could see where community care was going, where the use of s136 MHA was going (up) and where the role of the police was going. You only have to look at other countries with non-public healthcare systems to see how the criminal justice agencies end up playing a massive role, because there are inadequate social justice mechanisms to stop it from becoming necessary. If some people have a problem with uneducated police officers with 4hrs of training trying to fathom out what the hell is going on and making some kind of in-roads in to handling the rapidly increasing demand faced by British policing, they should feel free to step up: do some quality research that I can’t climb through and I’ll stop blogging and go an arrest someone for something. Until then, it seems a valid use of police time to try and understand how we address some of these issues, firstly and foremostly by actually understanding them and then do what the police are charged with as their primary duty: prevention.p>
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