Discussion has started again about the training required by police officers around their role responding to vulnerable people – again the proposition is that officers need specific training on autism and learning disabilities. I’ve written about this before and was interested to re-read a post I wrote five years ago because I have since been more involved in this debate than ever before, working on developing the national standards for police training which were published in 2016. I can’t say my view has changed that much, if I’m being quite frank – in fact, if anything, the things I’ve learned since writing that post have reinforced my view. And the question that always arises when this comes up, for me at least: how long does this training last and what is its depth? You can do a master’s degree in studies around autism or learning disabilities, if you want to; you could have it really badly summarised and explained for you in much less than an hour if that was all the time available.
What is appropriate for a particular professional will depend on their role, of course. Some will need the Master’s degree but in a police programme lasting 12hrs to cover all of the ‘mental health awareness’ that is needed, plus all of mental health & capacity law as well as its interface with criminal law, and then include inputs from people with lived experienced and non-police professional inputs about local services, less than an hour might be as much as can be given, without omitting some else from that list. << That’s the current dilemma given the College of Policing recommendation to forces is a two-day classroom input after completing of an eLearning package as a pre-read to getting in the room. And the worst news is, HMIC reported in November 2018 that most forces don’t deliver the 12hr package over two days, as recommended and they’ve asked forces to look again at this.
I’m not sure anybody, anywhere thinks police officers don’t need to know about vulnerabilities of various kinds and to know how to respond effectively to people in the situations they are professionally obliged to handle but once that premise is accepted, it raises important questions about the emphasis and focus of such training, the extent to which we need condition-specific training and how we ensure that is all relevant to the role police officers undertake in their legal context. My current role means I’ve had to read all the emails and consultation responses that come from various personal, professional and other perspectives around what the police need to know and do when discharging their responsibilities. To save you the trouble, there are perspectives in this debate which are utterly irreconcilable with other equally passionate perspectives.
Welcome to policing! – obliged by design or by default to make decisions and be accountable for them despite there being no obvious or easy answer, if there’s an answer at all.
DEPTH AND BREADTH
So here’s an incomplete list of just some of the particular conditions, diseases, syndromes, developmental problems and issues where at some stage in the last decade or so of me working on this, somebody has suggested to me or to the police service that officers must have condition-specific awareness.
I’m not making this up, I’ve kept a list on my computer and added to it when new things emerge. I’ve added to it already during 2019 and will do so again after the Twitter debate leading to this post unfolded —
- Bipolar disorder
- Bipolar ‘II’
- Schizo-affective disorder
- Personality disorder
- Borderline personality disorder
- Emotionally unstable personality disorder
- Anti-social personality disorder
- Peri-natal mental health issues
- Post-partum psychosis
- Peri-natal MH, as it affects men who are new fathers.
- Learning Disabilities
- Eating disorders
- Traumatic Brain Injury
- Suicide Prevention
- Serotonin syndrome
- Neuroleptic malignant syndrome
- Addison’s Disease
- Acute Behavioural Disturbance
- Alcohol / Drug disorders – acute intoxication by either is a ‘mental disorder’, according to medical manuals.
Then, you need to think again across the whole list, with an emphasis on —
- Black and minority ethnic mental health
- Child and adolescent MH
- Elderly adult MH
- Veteran’s MH
- Emergency Services’ MH – a very recent addition to this list.
And then(!), you need to have an awareness that some non-mental health or learning disability / developmental conditions can present in a way that makes them look like mental health, learning disability or development conditions —
- Urinary Tract Infection
NB: have you noticed that these sentences are becoming increasingly long because if you just say ‘mental health’, you’ll face protests that autism or learning disabilities are “not a mental health problem”? No, they’re not – but they are ‘mental disorders’ for the purposes of the Mental Health Act 1983 (whether rightly or wrongly – the National Autistic Society has very recently launched a campaign to get this changed). Police officers often have to think legally about the application of powers, for example when considering whether s136 might be the best ways to safeguard someone at immediate risk. But if you use the term ‘mental disorder’, that’s now considered outdated language which is objectionable because it’s seen as pejorative (fair enough), but if you ameliorate the word’s impact by substituting ‘health’ or ‘ill-health’ instead, then it’s assumed you’re using the term non-legally and that learning disabilities, autism or brain injury are excluded from your scope.
But we could probably imagine the complaint if a young officer trying hard to get things right arrested someone’s child instead of using the Mental Health Act to keep them safe only for the young officer to say “but autism isn’t a mental health condition!” And they’d be right, wouldn’t they? – this weekend’s discussion included me being emphatically told this fact and those seeking greater detail and distinction in police training would have us tell police officers this point to emphasise difference. So are we alive to the possibility that by over-training the point, officers might end-up feeling they have no option but to arrest and criminalise someone to keep them safe when this would be even more outrageous than emphasising the legal truth that autism is within the scope of s136 of the Mental Health Act if all the criteria are met, until such time as someone revises the law.
We’re not mental health nurses – we’re police officers and most of what we do is make legal assessments, even if most of the time we make decisions to resolve incident without invoking the law.
What emerges as a challenge when you look at things from a diagnostic or categorisation point of view, is that some of the words used above are not accepted as valid by everyone – the debate about ‘construct validity’ is ongoing. Numerous times in my career, I’ve had eminently qualified people in various medical sub-specialties tell me that some of the terms and concepts listed above are not valid ways of explaining, describing or looking at things. “Schizophrenia is not a disease” said the professor of psychiatry at one of the world’s top universities; “ADHD isn’t real you know?” said the consultant pediatrician who was a s12 doctor with a particular interest in child and adolescent mental health. Obviously, not all of this is relevant to all of the labels listed above and by pointing this stuff out, nobody is suggesting that we need to get the police to take a position on this stuff and attempt to resolve any of it. I’m highlighting this because it does beg a few questions for those making decisions about police training content – what do you want the training to include on conditions, taxonomy and paradigms?
Then you get to the final problem: if the objective here is to give police officers the tools they need to police effectively and in context, what is it from all of this stuff we need to wrap up in to some kind of training package and ensure it’s delivered?
Do all cops need this training (ie, everyone up to the Chief Constable); is it ‘just’ operational ranks (usually constable to inspector) or something in between? How long should training last to give due regard to the points raised by those asking for training on specific conditions? To what extent do specific features of these distinct conditions and human experiences Of trauma or neglect influence how a police officer might best respond to any particular incident. That needs to cover reports by vulnerable people that they are victims of crime, as well as those incidents where people are in crisis or need help as they approaching it, and those situations where a vulnerable person’s behaviour transgress over the criminal law. When is it ‘right’ for officers to investigate, arrest or prosecute a vulnerable person; or to use force during an incident? We can be frightened of discussing these things, because we know from the law that the answer to these questions is definitely not ‘never’.
WHAT’S THE ANSWER?
In my own view for what this is worth: regardless of whether Chief Constables want to give one day, two days or a week’s worth of training to their officers, there is a real, but a limited need for understanding of particular conditions. Not everything listed above needs to be expressly mentioned, in my view because the likelihood of officers meeting someone with serotonin syndrome are rare and courts have already stated that it would be unrealistic to expect officers to know that this is an urgent, potentially fatal condition – reasonable to think healthcare professionals may be alert to this, but not officers. The main reasons is this: it reverse engineers my job, all too often. I’ve been to time-pressing mental health incidents with critical consequences countless times in my career and I’ve sometimes not even known the name of the person I’m dealing with, never mind their particular label. (And labels tell us only so much: “if you’ve met a person with autism then you’ve met one person with autism” as the well-known phrase goes.)
People are unique, even if somewhere along the line they have been labelled with a scientifically valid construct label and when I’ve tried to square the circle which is inherent in all these debates, I’ve listened as closely as I can to what people are saying they actually want officers to do, when they turn up to something. What action, what manner, what approach would you like the police officers to take when they pitch up at your incident, whether that’s a pre-planned intervention involving the police like the execution of a s135(1) warrant under the Mental Health Act 1983; or a rapid response to an unscheduled crisis incident? I think that what is most interest about this question when you ask it, as I have repeatedly done over the years that I’ve worked on this, is that most people say the very roughly the same thing, regardless of the diagnostic label or perspective they’re answering from – and despite the differences in the answers, I have to wonder whether the simplicity of the solution is worth seizing, despite those subtle differences.
Most people want the police to turn up, remain calm; to use or seek relevant information from people – especially the vulnerable person by asking what htey can do that might help; try to reduce sensory stimulation from blue lights, noise, and radios; to minimise the number of officers; and they want the police to be patient and empathetic; to contain rather than restraint; negotiate as long as they can to either prevent or reduce the potential that force will be used – and that if force is implied, threatened or used, it should be the absolute minimum necessary, for as short a period of time as possible and still, with reassurance to de-escalate distress and anxiety. Of course, all of this to the extent that is possible in the particular context, consistent with the officers’ need to ensure overall safety given that they sometimes have 9hrs to do all this, but sometimes have just 47 seconds.
KEEP IT SIMPLE
So why don’t we just ask and train them to do that after summarising the differences between the groups of conditions and experiences they are more likely to encounter in operational policing and before then putting that it to context by explaining the legal and professional frameworks they are obliged to operate in?
Apart from anything else, there are two really important things to bear in mind –
- Officers rarely email me or the College of Policing asking for greater information on particular conditions – they email asking about the law, for the most part; and about partnership obligations, options and opportunities; AND
- This paragraph in bold is precisely what the vast majority of vulnerable people themselves have told me they want from their police officers – and regardless of anything else, that is the public we’re here to serve.
So why not just keep this simple and do a balanced combination of what the public want and what the officers say they need, in context to ensure people’s safety and fundamental rights?
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