This is a written version of a talk I gave last night, where I had fifteen minutes to summarise my thoughts on the overall topic of policing and mental health. It’s a while since I had such a short period in which to condense my thoughts and it was a useful exercise in rooting out the extraneous junk from my mind!
If you look around the world at adverse incidents that cause us to discuss the police roll in mental health issues, you see a range of problems:
- The extent to which the police are relied upon as first- responders
- Problems in the use of force:
- Restraint related deaths
- Fatal police shootings
- Controversial use of things like Taser
- Normalisation of the police as a de facto crisis service
- Criminalisation of vulnerable people:
- Prosecution almost entirely for the purposes of accessing clinical services
- Incarceration in prison where upstream interventions would have prevented the need.
From that lot and much more besides, you can start to form your own view about whatever it is that you think the fundamental problem might be. Whatever conclusion you come up with, you will find that there are only ever two real kinds of response to that problem, if people have bothered to define it all –
- The police need more training: mental health awareness, de-escalation and legal education.
- The police need to work in closer collaboration, preferably in real-time, with experts from mental health services.
Do you spot the problem with this? – there is a fundamental difficulty at the heart of how we understand the problem and how we design solutions in response to it. The police are not all of the problem here – so they cannot be all of the solution.
REPORTS AND MORE REPORTS
Look at the Adebowale Report (2013), the Crisis Care Concordat (2014), the Home Affairs Committee report (2015) on policing and mental health – they ALL began as conversations and pieces of work to examine what is going wrong in policing and mental health and they ALL ended up concluding that this is not just about policing. In fact, it’s not even mostly about policing! Lord Adebowale was asked by the (then) Metropolitan Police Commissioner to report on what the Met needed to do to improve: twenty-eight separate recommendations, fewer than half of which were exclusively about policing. Many of the recommendations were aimed directly and solely at non-police organisations and Lord Adebowale made it crystal clear in the report that the police could not be expected to sort the problems on their own.
The Crisis Care Concordat is a national structure by which to promote cooperation between police and non-police agencies on all issues affecting 24/7 crisis care. In a national action plan containing sixty separate actions about what we must do to make the world a better place, the police are named on five of them. You could also look at the amendments to the Mental Health Act 1983 which are on hold whilst we have a General Election and will be introduced later in the year: all of the amendments bar one is legislating to push for what some areas have been able to do for many years now, with the pressure falling mainly on non-police agencies to improve access to services, provide alternatives to detention, undertake both assessment and admission much faster than we currently see. The Home Affairs Committe report made very few police-specific recommendations in the twenty-nine observations made: they were mostly concerned with the lack of commissioning and provision which made police responses necessary.
These reports are more besides make it clear that we have problems in NHS commissioning, provision and education, this is not just about poor, untrained and ignorant police officers making poor decisions because, bless them, they don’t really understand these matters. Actually, there are plenty of mental health professionals around who argue without being prompted by me or anyone else, that officers are usually not bad at all at spotting that “something’s not quite right here.” Of course there are issues with mental health presentations that are sometimes less obvious or where mental health problems co-represent with other issues from substance abuse to comorbid physical illness, but then that’s also a problem on occasion for Doctors so what standard are we holding the police to here?
FIX THE PROBLEM
Many will and do make the political (small p) point that the expanding role of the police is inevitable around mental health: they argue that cuts and politicals (large p) mean that all that can be done is being done and if that’s not enough it’s because of under-investment in mental health. No-one anywhere, is arguing that politics (small or large P) is irrelevant: but the narrative that it’s all about the politics of things just doesn’t fit the history we’ve seen or the facts available to us now.
The real problem here is: we haven’t defined the actual problem … we’re still in the “Do Something!” phase of developing our police responses and as long as we keep thinking it’s just about police training or police partnerships, we’ll keep missing that 2/3rds of stuff from those reports which tell us it’s much more complicated and that actually, on occasion, it’s the health service taking its own decisions about the services it provides which is important. No amount of training for front line officers or those like me who work around policies and partnerships is going to ensure that a CCG complies with s140 of the Mental Health Act – it wouldn’t cost CCGs anything to start doing so, but they’d need to be aware of the provision first! I can’t ensure before every 999 is made to the police about difficulties on mental health wards that they are adequately staffed so that response police don’t walk in to ‘Seni Lewis‘ style vacuum against which backdrop they are then being asked to undertake various tasks they are inappropriate for police officers. No Chief Constable can make an NHS provider have a Crisis Team that is equipped to operate beyond the telephone or to stop them from reducing the size of that crisis or community team because of the apparent ‘success’ of their street triage scheme. All of these things (and much more besides) are, ultimately, a matter for the NHS to determine.
So one of the problems in policing is how to prepare officers so they don’t become too far involved in things after inappropriate requests to plug gaps. In a recent example, “Inspector, can you transport this distressed and agitated patient who requires a psychiatric intensive care unit 300 miles away, in a police van without us being able to administer sedation that they require for the journey because of other medical reasons.” Oddly enough, the answer to that will be “No!” – it’s just far too bloody dangerous for a start, but it would be an entirely undefendable course of conduct if it came under scrutiny from those who hold the police to account! And, actually, the patient themselves has certain legal rights that are not protected by the police agreeing to do this … so the answer is “No!”. To think any officer would agree to that is quite worrying but whether the officers know how to say “No!” constructively … who knows?! The answer to that situation is not ‘better partnership working’, it’s clear and effective commissioning by the NHS of methods of conveyance and the patient will have to remain where they are, with static police support if there’s a risk, until you sort it. And if you don’t sort it soon, we’ll have to start speaking to lawyers to start extricating officers from a situation that is rapidly becoming illegal, if it isn’t already. Sometimes the most necessary partnership is the one between the police and the public.
THE ROLE OF THE POLICE
I personally think the real problem IS the over-reliance upon the police and our inability so far to define the role of the police in our wider mental health system. Not all of that is about politics and / or resources: it is, as often, about the choices we make whereby legal knowledge and a greater understanding of individuals’ rights are absent from our assessment of what must be done, what may be done and what might be done. That world wide experience does show, if you don’t provide alternatives, the police and the criminal justice system will end up using blunt tools to fix complex health and social problems crudely. The role of the police should be –
- To remain as uninvolved in our crisis mental health system as possible, consistent with safety – this is not arguing there is no role; it is arguing against the ‘normalisation’ of policing in crisis mental health care. Quite frankly, many patients simply don’t want the police involved in their healthcare, and it always comes at a cost of one kind or another.
- To throughly investigate all allegations of crime received where someone involved is vulnerable because of a mental health problem or learning disability – and to bring to justice those offenders who may have unmet health needs, but where the public interest is served by doing so, for the individuals own benefit in long-term as well as that of the public.
- To work in partnership with health, mental health and social care services, mainly in the sharing of information and joint problem solving and prevention, rather than ever-improved ways of responding to crisis that is all too often an example of merely ‘doing the wrong thing righter’ and the very opposite of early intervention.
We can have as many or as few alternative to policing and criminal justice as we like: we’ll either pay for them directly, or through increases in the need for secure mental health care after the police inevitably find themselves having to prosecute some people for more serious offences, something which is a phenomenally expensive in each and every case where it happens and our secure mental health system is currently more than full.
That’s the choice to be made here.
Winner of the Mind Digital Media Award.