Painting the Forth Bridge

Mental health stuff in policing is not my job any more – not really.  I’m still asked to offer advice or opinion from time to time and most of the other inspectors on my team have used the phone-a-friend service which is inherently on offer when I’m on duty!  I’ve reviewed some incidents and policies when requested, written the odd guidance document over the last nine months but I stopped working full-time on mental health at the end of March last year.  Since April, I’ve been an operational police officer, working 24/7 across the West Midlands and in a few days, I’ll move to another 24/7 role in our force control room, working as a Tactical Firearms Commander (determining whether armed police are deployed to high-threat incidents involving firearms or other potentially lethal weapons and dangers offenders).  It was against the background of my professional role changing I decided some time away from mental health and social media was required whilst I focussed on my new role and took stock of myself as I started to see this stuff again from the perspective of an operational officer.

I largely mothballed my main Twitter account and the front page of this blog has had various holding messages during 2019, as I’ve given considerably less time to it. This was definitely the right thing to do – without any doubt. It’s made me think again as I did as a PC in Winson Green over 20yrs ago, bumping up against the demand the police service face and working alongside our NHS and Local Authority partners. I’ve had a significant number of operational incidents that have intrigued me, tested me and caused me to think that the questions we were grappling with 20yrs ago are as valid today as they ever were.  This has included incidents I’m not at liberty to cover on here, but they have included almost every kind of incident I’ve ever flagged or discussed in the years running this blog.

Cutting to the chace: I don’t think that much has changed and I remain to be convinced that much has improved, overall.  Obviously, some things are better – I’m glad to see that police officers in my force much more readily consider the clinical risks arising from crisis incidents, including where restraint was used and I’ve been gratified as a duty inspector not to have to intervene to ensure ABD (or so-called excited delirium) type cases do lead to urgent removal to ED.  The PCs and sergeants knew that’s what was needed, despite evidence still existing of others thinking the police should just remove the ‘violent’ to custody.  But I really do resist saying that things haven’t got better overall because an awful lot of people are working hard on this agenda and as we now enter the 2020s and mental health falls down the list of policing priorities, those officers like me who continue to work 24/7 need to think about what we’re being asked to do.  You see the challenges we face very clearly if you pay attention to the outcomes of Coroners’ courts.

A DUTY TO BANG THE DRUM

In a number of discussions with a senior officer in my force, whose wise counsel and guidance I’ve much appreciated during the year (you know who you are), I was mumbling on about pulling away from this stuff to focus on my main, 24/7 role as well as on improving and ensuring a proper work-life balance (lost almost 5 stone in 2019, about 4 more to go). Whilst I was seconded to the College of Policing, I worked a ridiculous number of hours – probably averaging over 60hrs a week throughout the 5yrs and I once calculated that for all the ‘extra’ hours I worked, I gave more than double the annual leave I took off during that time. So now, I’m spending time working actively on my health & fitness, spending large numbers of hours on a bike, including commuting by bike in all weathers and in the dark. I’m delighted to say that today is NEW BIKE DAY, as I’m treating myself to second decent pair of wheels to ensure I can always get out, even when a bike needs servicing and repair.  This stuff will continue as it’s become very, very important to me and my own mental wellbeing and I’m obliged to do a couple of +100 mile rides this year for charities!

But it’s been argued to me few times this summer, I have a duty to keep banging the drum on this stuff and after having a period of doing less, I’m finding it harder to avoid chipping in with commentary, for a range of reasons. I’m still seeing a narrative being driven by some which I think is genuinely destructive and unhelpful to making the real progress we’ve avoided making in the last 10yrs. Only yesterday, a mental health professional on social media suggested that I was probably ‘well meaning’ but that I should “remember the limitations of my role”. This was a response to my posting a thread of tweets to highlight certain myths about mental health law that are often repeated, including some errors which ended up being discussed in Coroner’s courts after tragic events. So I have a couple of options: I either keep riding my bike and insisting this isn’t really my job anymore, or I can keep riding my bike(!) and occasionally make use of my experience via social media to make the argument for educated and informed responses, including polite challenge where this may be required.

Let me be clear to that professional:  it is my job (and that of every supervising and senior police officer) to escalate and challenge where laws are being misunderstood, misapplied and where those things affect the public we are policing.  No doubt, I still have things to learn but it can’t be argued that where the police have professional concerns that push them towards misconducting themselves, that they should just accept it.  I’ve seen that argued this year, too.  It’s right there in the Oath of the Office of Constable if you doubt my claim: police officers have a clear and unambiguous obligation to protect fundamental human rights and I’ll be saying more on that later in the month when the CQC publish their next report on the MHA.

We misidentified the strategic problem we should be trying to fix – we took all the Big Reports and concluded that the problem is the quality of police responses to the mental health demand that officers face.  We concluded that this is done through more training for officers and more collaboration with experts from mental health and social care. << I think this is wrong and I’m not asking everyone to agree with me – but I think fixing it without even acknowledging the main problem and addressing that too, is almost pointless and risks making things worse. Yes, police officers need more training (who doesn’t? – MH professionals do, too!) and of course, agencies should “work in partnership” and collaborate much more deeply.  Who doesn’t think this would be a good idea?!  This stuff is necessary, but it’s not sufficient and it never, ever has been.  It won’t matter, if we don’t look deeper – and that’s what I think I’m seeing.

THE CJ AND EMERGENCY SYSTEMS

Focussing on a need for improved responses takes for granted the idea that demand faced by the police (and the emergency and justice systems as a whole) is unpredictable, unavoidable and unpreventable. I don’t think there’s a frontline police officer, paramedic or Emergency Department nurse in the country who would agree this is true – I don’t think mental health professionals on the frontline think that’s true, either.  And trust me, I’ve asked loads of them over the last nine months – they don’t. Many of the patients we meet in our work are known and often ‘open’ to mental health services – in some areas 88% of street triage contacts are known patients; 75% of s136 detentions related to known patients. Many police incidents I’ve handled recently, involve situations where you just wonder how on earth things got that far.  << For the avoidance of any and all doubt: this observation isn’t a pop at mental health professionals who are heroically working hard for hte most part, alongside and just like their 999 colleagues.  It’s an observation about strategic commissioning, leadership and the politics of this.

I worked lates and nights over New Year’s Eve and New Year’s Day in Birmingham – covering areas I’ve worked for years and I really enjoyed being out amongst it again.  I went to jobs in Winson Green, where I started and smiled as I drove quickly past addresses I’d known well or where the more memorable jobs were.  We had a number of incidents  over New Year which caused me to think the police were – in the language of Her Majesty’s Inspectorate of Constabulary – just “picking up the pieces”. I know that many in the mental health system think HMIC’s 2018 report of the same name was an affront, but it’s really difficult to see these incidents unfold in front of you and wonder how that description is inappropriate.  But this is also crucial: observing this fact doesn’t mean the police always get it right or cause problems for the NHS – we do!

But this stuff is not all about politics and commissioning, some of it is about something much more simple and straight-forward, that we could all do something about without cost, except time – professionals at the interface of emergency mental health need to be legally informed and understand just how many myths and folklores are raging through their organisations and their practice.

This is not (just) my view: we see it in the Coroner’s courts.  Repeatedly.

So for me, there needs to be a balance: the police are over-involved in some areas of this interface and over-relied upon to staff MH units, conduct non-urgent welfare checks and convey patients around the country in the absence of commissioned processes to get this done.  But they are also under-involved in ensuring effective criminal justice investigations after allegations which involve vulnerable people, either as victims or suspects and we could probably do better at ensuring support for MHA assessments, and get beyond the “no warrant – no police” stuff which is wrong and problematic.

PAINTING THE BRIDGE

The other night at work, we were alerted to a problem by another police force –

They had re-detained an AWOL patient in their area, who was missing from a hospital in our area.  The NHS were unable to offer a solution which returned the patient to the hospital from which he was absent – a duty which sits with them, under the Code of Practice to the MHA.  The fact there was no solution was in no way the fault or responsibility of the nurses on the ward from which the man was missing.  That sits with more senior managers somewhere in the NHS to wonder why operational staff have no available way to recover an AWOL patient from elsewhere in the country and to understand why inordinate delay in being able to sort something creates a vacuum which ends up being policed.  It was quicker for the other force to just blast the person up the motorway in a police car and get it sorted, apparently prepared to take the risk that something untoward happens in transit (as has been known, leading to an IOPC investigation) not least because they believe their local MH partners (in the same NHS as the ward from which the man was missing) would be unable / unwilling to help them ensure some temporary care until appropriate conveyance can be organised.  It’s a small incident: returning one AWOL patient but it invites immense and quite predictable questions that would be wrestled with had something gone awry.

So it’s been reminded to me: my having done a load of work on this stuff, and given I’m still finding various people wanting to tap in to my experience, I have a duty to keep banging the drum, professionally and responsibly, but whilst challenging misunderstandings and narratives, pushing for properly informed responses. And so my view that little we’ve done over the last ten years has really made things notably better is probably not popular or universally shared, but I admit it’s my view – at the population level. This doesn’t mean people aren’t working hard and trying to make the world a better place: I’m just saying as an operational police inspector 10yrs ago and being an operational police inspector now: we haven’t had the impact any of us hoped to have, despite some things getting better.

The underlying problem (as I see it) is still the same as it was 22yrs ago when I joined –

  • We over-rely on the emergency and criminal justice systems as primary mechanisms for ensuring social justice – not as the safety net or checking mechanism they really are.
  • We are still woefully under-educated (across all professions) in mental health and capacity law – neither our processes, our policies or our practice are sufficiently informed by decent legal education.

There remains as much to do as ever.  Probably more because no it’s very popular to just pretend that all the problems we have are to do with politics and austerity.  They’re not.  << Again, not (just) my view.

So whilst I’m not going to use social media as I did before, I’ve now had a word with myself after listening to others telling me to get over myself and stop moaning.  The job of the people re-painting the Forth Bridge is to paint it, then re-paint it – not moan about having to paint something they’ve just finished painting.  Fair enough, I will gladly, if less frequently go back to the beginning and start painting all over again. No doubt: being an operational police officer helps ensure the perspective on this stuff remains current and informed. And it will all come second to the need to get out on my bike(s) as I’ve got about 4,963 miles left to ride in the next 361 days! – off to get the new bike now and take it out for a 20/25 mile test spin!

Happy New Year everyone.

 
M./


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, 2020


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