Tricks and Tools

By working in a role that takes me around the country, I get to see the various differences that exist between police areas – and I don’t just mean the 43 police forces of England and Wales, but even more local than that.  I’m a West Midlands Police officer and my operational experience has mainly been in Birmingham but I’ve also spent three years working in the Black Country.  The Brummies and the Yam Yams will hate me for saying this: but those areas are not as different as they’d like to think they are – I hope I can get away with that, being neutral (a Geordie).  But there are differences in the way that services operate: different local authorities, different mental health trust albeit the same 999 services who often work across those boundaries.  Section 136 MHA works very differently on Shenstone Road, in west Birmingham depending on which side of the road you’re detained – one side of the road is in the Sandwell LA/MH area, the other is Birmingham’s.  Or maybe it depends which are the attending police officers have come from, because they’d likely resort to the process they understand for their area, even if they had wandered to the other side.  (And there’s nothing wrong with that, by the way!)

This is just one example: ramp that up hundreds, if not thousands of times across the country and we can think of even more variables that make our areas very different. Think of Cumbria, Cornwall, Camden and Cardiff –

  • The geography differs – two rural counties, a London borough and a capital city.  But those counties are not identical are they?
  • Cost of living varies enormously, especially on house prices.
  • Populations differ: in size and type as well as in other ways.
  • Local mental health services are funded differently by their respective CCGs or LHBs.
  • The are four different police forces, with their own pressures around funding, staffing and demand, etc..
  • One of those areas has its ‘own’ MH trust because the services are coterminous – this is not true in the other areas.
  • One force has two MH trusts, another has three, another has nine – this generates different challenges on training and local policy.
  • The psychiatric morbidity of these populations vary, as do social deprivation indexes.
  • The political instincts of the areas differ, both in local and general elections.
  • Two of the areas have devolved politics, but devolution with different implications for that area because it’s a different kind of devolved politics in Wales and in London.

These are just some of the variations we could list and you may wonder: what has any of this got to do with policing and mental health?!

LOCAL CONTEXT

In my experience, both the police and the NHS like to know about “what works” – whether we’re referring to the prevention / detection of crime or helping people recover from serious mental illness. It would be great if we could ring up colleagues who’ve struck gold in their local efforts to do these things and steal their ideas for use in our area. Since the advent of street triage schemes, I’ve had a number of enquiries at the College from forces who are at the early stage of setting up something similar asking, “What’s the best model to use?!” We see mental health services contributing their part to these police triage schemes without necessarily identifying that their trust is set up in a different way to the area they’re borrowing the idea from, without realising the differences will matter in terms of impact.

Of course one massive variable I left out of the list is “how often the local police force is using section 136 MHA?” Some areas historically over-use it; and I’m quite sure others probably under-use it. Will any initiative have a similar impact on different problems? Another variable: “how often are we using police custody as a Place of Safety across that force area?” West Midlands Police didn’t use police custody at all last year: not once. But other areas used it every week, sometimes more than once. So if you’re sitting in Birmingham trying to improve the world, it doesn’t matter whether street triage in Leicestershire or Northumbria has massively reduced the reliance upon police custody as a Place of Safety or not: it’s simply not a problem you need to fix.  (It has massively reduced it, by the way.)

My point is this – policing and mental health care involve providing complex responses to human beings who are un-alike by organisations who are staffed by human beings. Standardised responses to complex social issues like crime and mental health, including causes that will involved poverty, discrimination, substance use, etc., are never going to work: history actually already shows this. What areas need to do, first and fore-mostly, is understand their local demand for services and the context in which that demands occurs; and start by asking what problem(s) they are trying to fix. It’s my own view that we have nothing like enough information about this interface between mental health and criminal justice, so it’s difficult to avoid the temptation to reach for a box of tricks and show a sleight of hand, rather than using tools to engineer a truly workable solution.

TOOLS AT DUSK

If you look around the world, you’ll notice that there are only ever two solutions to whatever you think problem is: the police need more training and the police need to work in greater collaboration with mental health services. Apart from the (obvious) point that both of these ‘solutions’ begin with “the police need …”, as if to suggest that the only problem here is the police and police officers. My own experience is I’ve often tried to work in collaboration with MH services in operational incidents and often been told they can’t or won’t – it’s not for the want of trying in some cases! And there’s also the question of what we ask the police to *do* in response: we’re hearing more and more about the police (and others) doing Mental Health First-Aid training. Some areas are looking to roll this out quite widely to criminal justice and education, etc.. I know a couple of police officers who are MHFA trainers and whatever we think of it as an idea (and having observed an MHFA course, I’m not sure it’s relevant to police officers, quite honestly) we can probably agree on this: it’s a standardised course, taught to a standardised, MHFA-branded curriculum. Anyone can pay to go on such a course, and organisations engaged in a wide variety of activity are doing so, not just the public sector. But, being a standardised course: it doesn’t survive contact with all human beings who tend to have a variety of viewpoints on causes and responses to their illness / disease / distress

Standardisation, as a substitute for thinking and understanding demand, is what risks us bring a political (small p) solution to a problem that needs careful engineering. The risk to all this is, for various reasons, that policing and mental health could be seeing the dusk of its day in the sun. We had a CrisisCareCondordat in 2014 and since Mind handed over responsibility for the ongoing push, we’ve heard little more about it. I wonder how many CCC action-plans are now complete, three years after they were introduced? The legislation that has been developed to modernise the police-MH interface is done, we just need to see an administrative commencement order to bring that in to play; we’ve seen certain pots of money kicking about to improve a few things like Places of Safety, etc.. But we’re just starting to see a sense of drift on pushing those things, largely because any challenge around things can see confident deployment of stock answers around the CCC, new law and funding. Whether this is making any difference on the ground is something we can say is the responsibility of organisational leaders.

So one risk is leaders in police forces and mental health services reaching for standardised tools and tricks as we quickly look to put these challenges to bed so we can move on with other things – highly intuitive, attractive responses to non-defined or ill-defined problems are really easy. This is especially true if we’re not also ensuring evaluation of these solutions is sound.

  • Crisis Care Concordat action plan? – check
  • Street triage? – check
  • Liaison and Diversion? – check
  • MHFA and College of Policing training? – check
  • PaCA amendments understood? – check
  • Use of 136 and custody down? – check

Job done, right?!  You’ll notice that none of those things, inherently guarantees anything about the experience of the public or improved outcomes for vulnerable people and others. They may, but recent history shows they also may not. That’s why we need to continue to understand our demand, in its local context and to define the problem. If you want to give political (small p) responses to undefined challenges, you’ll need that bag of tricks – hence some are listed above, for your ease of reference. But if you actually want to make it far more likely you’ve engineered better outcomes for the public, you’ll need tools to engineer solutions to complex problems and you won’t know which tools to pick unless and until you understand what you’re trying to engineer in the first place.


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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4 thoughts on “Tricks and Tools

  1. Great blog as ever. As you say what impact does any of it have on the ‘service user’. In a very unpopular comment I would say people need psychiatrist led services focussed on treating mental illness. Ideally that would mean that police involvement was minimal…. However society seems to have decided that it is OK to have people with serious mental illnesses living in sub standard accommodation or on the streets or in prison,. as the community services available are not enough to keep people well enough to live independently. So lets all spend time on MHFA and worrying about where best to briefly detain people under s136 and think we are actually achieving anything..

    1. But are psychiatrist led services always the answer? I’ve met a few who probably shouldn’t be allowed out on their own, never mind given control over other people.

      I don’t know if it still exists, but Leeds had a very good user-led crisis service, including a crisis house. National M*** was also given a shed load of money a few years ago to develop peer support, I haven’t heard of any groundbreaking work from them on that front. I attended a public meeting run by my local MH trust where the staff proudly declared that they had doubled the number of 136 beds…to two and that nobody had been detained in a police cell, a number of people disabused them of that notion (rather bluntly). I also know people who would rather the police looked after them than MH staff.

      I think the point is that there is no universal panacea. And while MH services are so run down that only the most basic “care” is available, the police will be picking up the pieces.
      We run a range of services in different areas targetting the needs of the people. Unfortunately, commissioners prefer a one size fits all approach.

  2. Having been involved in the last Mind Concordat conference I wondered last week what’s happened to the plans and collaboration. In vain did an ambulance crew try to get support from the local crisis team for me last week. The whole shift had been like that they told my family – one mental health patient after another and struggling to get a response from MH services.

    A few months ago I got a new ‘management plan’ for the crisis team which made me unlikely to approach them any more. I went missing having attempted suicide. The police spent a long day searching and were not impressed when they saw my plan. The inspector commented that they were probably my crisis team now (yep) and went to the local mental health team. Think he was politely told not to tell them how to do their job!

    So much for collaboration

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