In a lot of the work I’ve done and still do, the subject frequently comes up public funding for services and, in the last eight years or so, of public sector cuts. We all understand how important money is and I don’t think there’s a public sector professional around who isn’t keenly attuned to these kinds of debates because most of us are seeing how stretched things are. This post comes off the back of a financial bomb-shell to the police service that Chief Constables are, they claim suddenly, being required to fund a £457m hole in the police pension scheme and many of the bosses are warning of ‘dire consequences’.
Today, we’ve also seen two publications which are not unimportant – the Home Affairs Committee have published their report in to the ‘Future of Policing’ after hearing evidence from across the service over the course of 2018. As a complete aside, you’ll have to forgive me for briefly expressing my surprise and satisfaction that some of the more contrary things I said seem to have influenced the committees conclusions, after I sounded some reticence about street triage schemes. More broadly, the report sounds a warning and calls for increased funding for the police after setting out various problems with the core business we deliver, whilst sounding alarms about the changing role of the police. On mental health the report points out the police are now ‘the sole emergency service for mental health crisis in some areas’ and it calls for NHS funding to be spent in such a way as to reduce this burden on policing.
Also, we saw the publication of the 2017/18 UK Government statistics on policing: of interest to me are those statistics on the use of s136 of the Mental Health Act 1983. We are now topping out at 29,662 uses of this power each year, of which 471 people were removed to custody which is a 5% rise in the use of this power (despite those efforts of street triage schemes to reduce its use), but the proportion of those remove to jail is now just 1.6% of all of us detained under this power in crisis. << If you remember when I got started and interested, West Midlands Police alone were taking over 1,000 a year to jail for being unwell: it’s now less than half of that for the whole country and whilst this should be a success story, it comes at a cost which links to this context about funding, pressure and the expanding role of the police.
SOLUTIONS AND PROBLEMS
In my work, I have a growing number of particular phrases, questions or observations I find myself using again and again and again – like a dripping tap – to help ram home various important points I need to keep making, to be consistent. The one I need to pull out of my drawer on this occasion is my observation that “the solutions we’ve introduced to the problems we think we have are more resource intensive for the police than the problems were.” Everyone wants to focus on helping people, reducing stigma and criminalisation and working in partnership with all of the other statutory and non-statutory agencies relevant to our country’s wider system of mental health.
But at what cost? If you said to a Chief Constable, that for a few resources being spent we could massively improve a process which would then save resources overall – they’re probably going to bite your arm off, especially now. If the resource cost would lead to no resource saving, but better outcomes for the public, they’d still be interested – Chiefs have encouraged greater reporting of under-reported stuff in the past and that doesn’t save resources, it only increases work but because improved reporting of things like domestic abuse, hate crime and sexual offences. But that’s a good thing.
Where the issues become complicated is when a development costs the police significant resources, where we all agreed in advance that it wouldn’t and that position is forced upon the police at massive cost. For example, average detention time in police custody for s136 was 10.5hrs last time I checked. Most detentions which do occur in custody require both detaining officers only initially and then either, both are back on the street, or at least one of them is whilst the other does enhanced safety observations. Average. time in an NHS Place of Safety is around 5-6hrs – it’s often as much as 9/10hrs in some places. If you have a force detaining 500 people a year and you work out the police resource implications, it is MUCH more resource intensive to take people to health buildings if the officers must remain there for 5/6hrs.
WHAT PROBLEM ARE WE FIXING?
I’ve just returned from a conference where it has been genuinely useful, as well as both inspiring and frustrating in equal measure to spend a some days talking and listening with other officers and academics about all this stuff. Britain is not massively different to the various other places, but of course we have our particular peculiarities. We stand out because a) we’re not routinely armed – generally considered to be a good thing when it comes to de-escalating and safely resolving mental health calls; and b) we, along with New Zealand, have no legal powers in private premises – Australia, Canada, the United States, etc., all allow their police officers to keep people safe when they are in crisis at home.
There has just been a two-day discussion about policing and mental health, reviewing the evidence for the various ideas and interventions that we see applied around the world. I will be blogging about that on another occasion, but suffice to say here that the evidence is limited, it’s not great quality and to the extent that it tells us anything, it suggests that most things aren’t having a massive impact. We looked at Mental Health First Aid, co-responder models of various kinds as well as the world-renowned CIT programmes which started in the US. Before the event began, I kept saying that all of these things suffer from the problem that nobody involved in them seems to have defined the problem they’re trying to fix. This was acknowledged in the discussions.
So here’s what I think is going on, behind the more obvious difficulties of public sector funding restrictions and the particular position of UK policing at the moment. I think we’ve just spent 60years de-institionalising mental health care, only to find that we’ve accidentally just re-institutionalised everyone to prison; now, because the funding of NHS community MH services has never been great, we’re shifting associated costs of being unable to respond to everyone to other parts of the health system and to the police. Remember what the Home Affairs Committee said today, their words – “the police, are the sole emergency service for mental health in many areas” and the burden of this must be reduced.
DOING THE WRONG THING RIGHTER
For what it’s worth – and it’s probably not worth much – I think we’re trying to fix the wrong problem. Looking at the s136 data, we see more use of this power by the police – and you should bear in mind the street triage schemes which have been associated with significant reductions in 136 are probably saving us several thousand detentions a year, so the 29,662 figure for 2017/18 is a suppressed number, compared to the 18,500 in 2007/08 that the IPCC researched.
- Police contacts leading to s136 or calls for triage appear to be going up, and rapidly.
- The amount of resources per s136 contact is greater, on average, than 10yrs ago because the police are effectively staffing MH unit places of safety.
- We are now in a position where around 4,000 to 4,500 people a year are being ‘cared for’ by the police in custody after their arrest, pending an inpatient bed emerging.
- We are seeing instances of a dozen or more police officers in a single Emergency Department because the MH trust has used the MH unit Place of Safety as a bed.
I am receiving emails from colleagues stating that so many resources are tied up with MH unit staff, ED beds watches because of MH unit closure, requests for care in custody taking days because of a lack of available inpatient beds.
In a very significant way, we appear to be aiming to transfer the cost of crisis and emergency mental health care from health to policing and believing that it would assist in forging partnerships which would provide a return on investment in the future, senior officers have gone for it. And now, eight years down the line when we have parliamentary reports warning of ‘dire consequences’ to policing as a whole, I feel I have to pose the question: if policing has been cut by 24% and MH services by 8%, for how long can we continue to see ever greater demands made of the police by the MH system to staff street triage, MH units and provide short-term pre-inpatient stays in custody?
One Chief Constable has already stated that it costs much more to run their street triage scheme than it would to not do so. If Chiefs are pushed for resources, they could genuinely re-coup a lot by thinking about whether this is an essential or a luxury they can’t afford because it’s not sustainable against other competing demands. None of this has to mean poorer service, because as we found in Toronto, the evidence sitting behind the solutions we’ve come up with is actually very far from great!
The real issue before us, we’ve set about resolving the wrong problem.
- We’ve decided to assume that demand faced by the police is largely unavoidable, unpredictable and unpreventable demand – that the problem is how to help the police manage it better.
- All the reports internationally tell us that policing is not the majority of the problem here: and yet the solutions always focus on policing, not on society OR health and social care organisations.
- The real problem is what we’re demanding of the police and the extent to which we’re choosing to rely on them for things they can’t do.
I sat yesterday listening to an academic tell a familiar tale of a police encounter gone awry, involving a person with a traumatic brain injury. It inevitably led to a description of some training offered on TBI and some more recent incidents better handled. It’s all about training and partnerships, right?!
Wrong – it’s about accepting the police have a limited role to play within our wider system of social responses to mental health emergencies and other incidents: anything involving time-critical responses, threats to life or crime, etc.. Beyond that, choosing to rely on the police is to make the strategic mistake.
It’s then we start Doing the Wrong Thing Righter.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions 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