I’m a mental health professional – but I didn’t realise this when I first joined the police.
When I retire, the operational incidents that will live with me beyond my career are almost exclusively those which have involved very vulnerable people. The poor guy who set himself on fire; the man who killed his mum and neighbour; the young woman who inflicted more harm or herself than I’ve seen when people have been brutally attacked by others; the guy who was so profoundly and utterly terrified of us purely because he thought the police were there to kill him; the middle-aged woman who was so psychotic in police custody that she spent days and nights screaming without sleep; the man who barricaded himself in to his bedroom with a knife for his own protection in his own home and we spent hours attempting to resolve that without using force and even more hours disagreeing about police powers and the grounds for getting a warrant under s135(1) MHA. I could go on and list more … as could most police officers. There have been so many vulnerable people who were surprised to find we were compassionate and caring a point where they really needed us to be – we were there when others weren’t.
I’m a mental health professional – but you may not realise it.
I am entrusted with my own legal powers under the Mental Health Act that no doctors or nurses are allowed to exercise – so we need to see that as a privilege and a responsibility. In addition to an urgent power of detention for those in crisis, I am also empowered to ensure that patients concerned in criminal proceedings are brought back to court where they abscond from assessment or care. Only I can execute warrants issued by the courts in connection with assessment or re-detention of those already subject to the use of the Act. I am routinely relied upon by other professionals, even where they have their own legal powers, to be the professional who ensures someone is receiving care under the Mental Health Act, by ensuring safe detention, conveyance and repatriation. There is a long list of things about our mental health system that only I can do; with some extras that frequently come my way where others would prefer we acted rather than them. It may be you didn’t realise because no-one asked you either: I’m often disappointed by how little evidence I see of the public being asked about the role they want to see the police playing and I’m all to aware of the look of fear and shock on the faces of people who have had the police called upon them by other services.
I’m a mental health professional – but the system doesn’t want what I know.
I have a whole host of information about mental health issues that the NHS doesn’t know: details about the use and re-use of s136 MHA, how many calls received out of hours for people in crisis struggling to access other forms of care, how many suspects arrested for alleged offences are then assessed under the Mental Health Act; I know which mental health units see the highest number of AWOL patients, including which of them have problems with environmental security issues and which of them call the police to involve officers in restrictive practices; and finally, I know where some of the gaps are: those places where patients struggle to access care directly or bounce between different parts of the NHS. I’ve always wondered why this information isn’t more sought after – it’s as much a part of the public’ experience as what happens when they ring a CrisisTeam or go to A&E. I know much of the learning that has come from mental health related deaths following police contact which often seems unknown to our NHS and I’m all too aware that many of the major reports we’ve commissioned in to what goes wrong in policing ends up saying more about the NHS than it does about the police. This insight is often absent from much of our dialogue about partnerships and where it is present, it seems not everyone is reading the reports and learning the lessons.
I’m a mental health professional – but no-one asked me if I wanted to be:
The history of this business is that the police were not consulted – we are, frequently, still not consulted – about the role we play in the wider mental health system. Over the last twenty to thirty years, decisions taken by others to change the role of the police have not involved us in those discussions and this has two implications: there is uncertainty in the minds of officers about what their role actually is; no-one structured those policies to take account of our views when we would increasingly be dealing with things. It wasn’t the police who decided to push a position where we were the agency who exercised legal powers that are available not only to Constables, but also to AMHPs or others authorised by the NHS. It wasn’t the police who failed to show up at local, regional and national discussions about areas of mental health care that quite obviously involve them – things like the prosecution of inpatients who are alleged to have offended on wards; the role of the police in undertaking ‘safe and well’ checks; the extent to which the police are relied upon to undertake restrictive practices on under-staffed inpatient wards. We need to be careful about this, too: if we don’t involve the police in helping fashion the role they play, we risk ignoring their particular perspective and then end up over-policing people, which can be as dangerous as under-caring in the first place.
I’m a mental health professional – but I have quite limited training.
The nature and extent of my training is seen as key to all of this by many – everyone agrees, I need more of it. I need a four-hour training input on autism, three days on personality disorder, a two-day mental health first-aid course, awareness of schizophrenia and bipolar disorder, learning disabilities, learning difficulties, acquired brain injury, perinatal mental health issues, other conditions that can present as mental health problems from diabetes to epilepsy, even Addision’s disease. Of course, whilst improved training is important and whilst we’d all hope it enables the police to respond more effectively to those situations they face, how that addresses the fundamentally far more important question of why an increasing numbers of responses is becoming necessary, I’m not quite sure. We seem to be living in a time when very deliberate public policy decisions are being taken to push mental health demand further down the line, until police involvement becomes inevitable. Whilst we need awareness, we also need detailed and comprehensive legal training because I’m rarely deployed to a condition-specific incident. I sometimes don’t even know someone’s name.
I’m a mental health professional and I probably always will be: it came as quite a shock, I can tell you – and I’m still adjusting now.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – http://www.legislation.gov.uk