Police Leadership

I heard the Health Secretary Jeremy HUNT deliver a speech at today’s Crisis Care Concordat Summit in London, the first major speech he’s delivered on mental health, we were told. Almost the first thing he did was praise the police service for the leadership shown on the subject of mental health crisis care, driving much of the debate that led to the creation of the Crisis Care Concordat itself. I might be wrong, but my sense was the comment did not land well with everyone! One service user tweeted about this, wondering whether it should be the police driving certain aspects of healthcare provision – and of course, I don’t think there was a police officer in that room who wouldn’t happily see the issues we face being confronted head-on by senior health leaders and commissioners.

History shows another approach became necessary, for a range of reasons perhaps uniquely understood by the police.


Following his speech, the Q&A session saw Commander Christine JONES from the Metropolitan Police, the lead for the National Police Chiefs Council asking, “Mental health services are underfunded: at what point will parity of esteem be matched by parity of funding?” Almost immediately, we saw reaction about how senior health leaders were unlikely to challenge as directly as this. Again: the police driving the debate, literally, with the Secretary of State for Health on the general topic of mental health, not a question specifically about policing! Would Commander JONES be asking that question if a senior health leader were doing it or likely to do it? … I doubt it.

After I woke this morning, my attention was drawn on Twitter to an article by Lord BLAIR in today’s Guardian, a former Commissioner of the Metropolitan Police. This article was bouncing around the conference room at the Oval, in hardcopy … “have you seen this?!” and so it was handed from person to person. It quite obviously divided opinion amongst the non-police professionals present (and on Twitter). It ranged from ‘flabby opinion’ that was ‘not offering any solutions’ to some who thought it was imprecisely making perfectly valid points about the outcomes we see from our current arrangements. It’s obviously not for the police, serving or retired, to tell the health system how or when to ensure upstream intervention in mental health care any more than it is for health professionals to get specific about how the police should discharge their responsibilities under criminal law. However, it is perfectly fair comment for NHS staff at all levels to flag up problems in policing and say, “What are you going to do about it, Copper?!” Or similar.

The main agenda at the CCC today was all about health – a couple of the workshops focussed on policing and legal issues but the main room was all about health. Quite right, too! – the police should be much less of a voice in this, ideally. That they aren’t does lead to certain observations which I make very reluctantly after today’s events. We need to see achievement and progress in this area: not just activity – and this means we also need to describe what we’re actually trying to achieve. The Concordat obliged local areas to produce an action plan, uploaded to the Mind website in 2015 – I’m told this plan should be refreshed and updated by all areas in early 2017. In addition, we heard today about the Five Year Forward View plans that are required, in order to deliver on the NHS England strategy for mental health during the remainder of this Parliament. Of course, those following developments in health will know that various areas have grouped together to produce Sustainability and Transformation Plans (STPs), in order to make the NHS as a whole sustainable in coming years.


So what about those 2015 Action Plans – how many areas have ensured delivery of the majority of their contents? If you remember the mapping process set down by Mind: areas were to go from Red to Amber when they’d agreed to some principles to work in partnership; and then Green once uploaded to the Mind website. I remember commenting at the time there should be another colour for completion of the plan, even if just 80% complete. However, one police officer today described his local CCC leadership group as a talking shop where “nothing gets done”. It’s not the first time this month I’ve heard that said, quite honestly. So in addition to those plans, which now need revising, we see then need for more plans after the Five Year report and all of that has to fit in to STPs concerning overall NHS efficiency – the plan of plans!

We know from recent media coverage, that more than half of CCGs are cutting the funding they give to mental health as a proportion of their overall budget, despite suggestions from Government that the proportion should increase. That is the context within which any plan needs to be seen and we know that the trend in terms of crisis care is an upward one – barely a week goes by without coverage on increases in crisis related issues: whether systemtic or individual. No-one who follows current affairs in any detail could fail to understand that there are dynamics at play in society that effect mental health which do go beyond the health service but none of that explains decisions we see to situations ever more towards the social justice safety net that is policing and criminal justice.

I also prepared a question for Jeremy HUNT, in case no other police officer put their hand up. I was going to ask, “What should we conclude about mental health and crisis care if more people than ever before are being detained under s136 MHA, more people are going missing whilst mentally ill, more people are being arrested for offences and then being assessed under the MHA in custody?” There was a sense today amongst (at least some of) the police officers that whatever progress is being made on CrisisCare – and there is lots of it! – it seems to be at the expense of upstream interventions. Those of you who follow along on social media know I’m all too fond of quoting Archbishop Desmond TUTU: “There comes a point you have to stop pulling people out of the river, get upstream and find out why they’re falling in.”


When I first got involved in working on the policing interface with our mental health and wider health system, I remember specifically saying to myself that I wasn’t ever going to get myself in to the position of being caught telling healthcare professionals how to run their health service or how to deliver on their professional obligations. This was partly a question of manners: I’d be prepared to listen to anyone about the impact of the way we police on them, but it is ultimately for the police to square away competing demands and priorities in how police services are run, held accountable as they are through various processes. I took the view that that the reverse courtesy should be applied in how I worked on mental health.

But if I’ve learned anything in the last twelve years on this topic, it is a conclusion very reluctantly reached and best summed up in a matephor from my other area of professional interest: public order policing. Progress on mental health has come when police officers or police services form a cordon, take ground and hold the line. History shows that problems in health-based Place of Safety provision actually came not from the Concordat – no doubt it helped – but from some forces saying, “Enough is enough: this will have to change and it will change with or without the consent of the health system”. We’ve heard recently about problems in partnerships where the police are being routinely expected to handle the fallout, often unlawfully, of a health system that has decommissioned too many inpatient and specialist beds whilst apparently disregarding s140 MHA and other obligations. History shows that resolution of those operational problems has come from senior officers tweeting to publicly shame the system in to gear and from actual or threatened legal action.

So the lesson appears to be this: the police are bungling around in this arena, still – not always getting it right and we sometimes miss the subtleties or complexities. We are not experts, we are not clinicians and we’re not trying to be. We just have a unique perspective on some of these important issues and one that is all too misunderstood and disregarded. History shows that unless we shout loud and / or agitate on behalf of vulnerable people, we don’t make progress. I’m far from alone in wishing this were not so. As a natural introvert and an experienced public order commander I can tell you that shouting and agitation is occasionally a tactic in taking ground and making progress: it is to be used sparingly, recognised as a restrictive or coercive practice and it is not without collateral intrusion. However, it does remain a legitimate tactic and leadership is recognising when it is required, when the collateral intrusion may be worth the risk and involves not over-playing it. If we want that voice to quieten down, I suspect we need to see fewer, clearer plans about what the destination is and how we get from here to there without violating the rights and expectations of vulnerable people who are all too often caught up in it.

Notice the above didn’t really focus on the public we serve? – neither did today.

IMG_0053IMG_0052Winner of the President’s Medal from the
Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


AWOL from Scotland

It seems that it’s been the week for Scottish mental health patients to journey to England, in a variety of legal situations that have subsequently confused the life out of police and mental health professionals alike.  So we had the incident the other day about a Compulsory Treatment Order patient who turned up in the Midlands and today I’ve had a call about a Short-Term Detention patient who turned up on the south coast.  The first confused the life out of the local police; the second confused the life out of the A&E department.  These things being as they are: I’m expecting the third incident any time now to complete the set and I’ll just bet it has a twist or angle that I’m not about to cover here!

OK … two incidents is not that many, but it’s not the first time I’ve had a batch of ‘Scottish AWOL’ queries so I thought I’d best cover the topic in one post.  First things first: abbrevations to make this easier to both write and read! —

  1. MHA(S) = The Mental Health (Treatment and Care) (Scotland) Act 2003.
  2. MHA(E) = The Mental Health Act 1983 in England / Wales.

Your legislative resources —

  1. The Mental Health (Treatment and Care) (Scotland) Act 2003.
  2. The MH (T&C)(S) Act 2003 Consequential Provisions Order 2005.


Here is a list of the three main detention ‘civil’ provisions under the MHA(S) —

  • Emergency detention certificate, under s36 MHA(S) – this provision allows one DR, preferably with involvement of a Mental Health officer (MHO) – a professional who is roughly the equivalent of an Approved Mental Health Professional – to detain someone in hospital for up to 3 days.  The DR may act alone, if they cannot reasonably consult an MHO. Broadly, this is the equivalent of s4 MHA(E).
  • Short-term detention certificate, under s44 MHA(S) – this provision allows a DR, where supported by a MHO, to authorise detention in hospital of someone for up to 28 days. Broadly equivalent to s2 MHA(E).
  • Compulsory Treatment Order, under ss64/5 MHA(S) – this provision allows an MHO to make an application for a CTO where two DRs submit reports for consideration. This can involve admission to hospital, for up to 6 months, broadly equivalent to s3 MHA. However, it may also allow for the imposition of restrictions upon patients who live in the community, including a residence requierement and / or an attendance requirement (to attend somewhere for treatment). When considering an application for CTO, the Tribunal may decide to grant the application but only on an interim basis, allow for detention or restriction for a 28 day period.


Firstly, AWOL is the English and Welsh term, under the MHA(E) – in Scotland they refer in law to ‘absconders’.  Sections 301-303 cover the powers to re-detain Scottish mental health patients who have absconded from the above provisions and are still in Scotland.

  • Section 301 – covers those patients who have absconded from a Compulsory Treatment Order. As you’ll recall, above: there are two kinds of CTO – the sort where you are detained in hospital, the sort where you are subjects restriction in the community. If a patient has absconded from any hospital in which they are detained by CTO or if they have breached a residence requirement of any ‘community’ CTO, then s303 MHA(S) applies to them.
  • Section 302 – covers ‘other patients’, including emergency detention certificates, short-term detention certificates and CTOs, but also includes those detained under a nurse’s holding power under s299 MHA(S) and those who are subject to certain particular provisions of the MHA(S) that I’ll let you research for yourself, should you need to! If someone subject to any of these frameworks absconds OR if a Reponsible Medical Officer (RMO) issues a certificate under s114 or s115 MHA(S), then s303 applies to them.  (Sections 114 and 115 relate to breaches of CTOs which don’t automatically qualify as ‘absconded’ but which require the RMO to authorise their qualification as ‘absconded’. Those who were paying close attention to a BLOG earlier inthe week about Scotland will remember that even if an RMO has authorised detention under s113(4) MHA(S) for a breach of other, general conditions of a ‘community’ CTO, this does not qualify as ‘absconded’ … as Nottingham city centre police now know!)
  • Section 303 – covers the ability of various professionals to take anyone to whom sections 301/302 applies and return them to the relevant hospital. This includes, a Scottish police officer, a Mental Health Officer or anyone on the staff of a relevant hospital or authorised by the patient’s RMO.

Still following?! … not long to go now!! – once you’ve confirmed that the person has absconded from one of those provisions (ss36, 44, 64 or 65), or that an RMO has authorised detention of a CTO patient under ss114 or s115, then s303 would apply if they’d been encountered in Scotland so any police officer in England, Wales or Northern Ireland may take that person in to custody and return them to Scotland. This is made clear in Article 8 of the MHA(S) Consequential Provisions Order 2005. Such patients may also be taken in to custody by an AMHP in England / Wales or an ASW in Northern Ireland. To conclude this all with a little known fact: it is expressly into s135(2) of the MHA(E) and in to a129(2) MHO(NI) that a warrant may be granted by a Magistrate in connection with the need to exercise detention under Article 8 for a Scottish patient who has absconded to any other part of the UK. If you ever have that situation in the real world, I advise you to take a written copy of the MHA(E) / MHO(NI) to place under the nose of the court clerk or Justice of the Peace becasue I’m guessing they might say, “Eh?!” or simply not believe it’s a thing!

There you go! – all done.  How’s your headache?!

Next up in the Scottish series – Absconding to Scotland, based on the Mental Health (Absconding Patients from Other Jurisdictions) (Scotland) Regulations 2008.

IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.



Authorised Professional Practice

The College of Policing has now completed the production of new guidelines on mental health for the police service in England and Wales and this blog is a part of the College’s efforts to communicate this publication to the public as a whole, as well as the police service and partner organisations. These new guidelines are known as Authorised Professional Practice (APP) and they are supplemented by the first national training products on mental health for policing. These are the College’s main contribution to the 2014 Crisis Care Concordat which aims to improve the country’s response to vulnerable people right across the mental health and criminal justice systems.

APP and training materials have been available to police forces for several months and work has begun to prepare for the impact they should have because mental health issues effect every area of policing and are believed to be connected to a third of all demand: this is core police business and all officers, at all ranks, need to understand how it affects their role and responsibilities. It was being publically launched to coincide with World Mental Health Day on 10th October 2016 – on the theme of psychological first aid. The College of Policing held several events around the country in July 2016 to introduce forces to these materials and to help them understand the preparatory work that they will need to do, to prepare for the implications they have.

Mental health issues inherently demand a partnership approach: the police service cannot do this alone; and forces should use the publication of APP and national training standards to influence and improve their local arrangements. We know that challenges across the country do vary, with different challenges in urban versus rural areas; we know that mental health funding and commissioning varies across the country. That is what forces must address and what operational police officers must assist in identifying and handling.


APP represents the standards which must be met in all areas of the country and in any analysis of local arrangements, forces and officers must bear in mind that any difference between the two means something needs to change in local arrangements – this is what local Crisis Care Condordat actions plans should have already identified and every area has made a commitment to address those things. APP is based on statutory requirements, relevant Codes of Practice to those instruments and case law – as well as on lessons that need to be learned from IPCC inquiries, Coroner’s inquests and from medical and healthcare guidelines.

The aim here is to ensure that vulnerable people access crisis care without being unnecessarily criminalised by the police and that vulnerable victims and suspects are identified as early as possible and supported within the criminal justice system, where appropriate. For example we know that people with mental health problems are three times as likely to be victims of crime as people without; we also know that people with mental health problems are heavily represented within the criminal justice system.

It will be important to the success of this programme that Chief Constables ensure sufficient resources are allocated to understanding what this programme means for their organisation and their local partnerships. There local Crisis Care Concordat forum in each area is the arena in which any particular issues can be raised which are crucial to the success of the programme. It is also important that individual police officers take the time to read the guidance: they will often be far better placed to understand any particular challenges and difficulties in making the APP happen in the real world.


The public can expect to see much closer cooperation between their police service and the relevant partners in the NHS and other public bodies: this should be reflected in better access to crisis care and a greater range of options to resolve situations where the police become involved. Partner organisations from ambulance services, mental health trusts and acute care providers should expect to see their police services reviewing their overall approach as they move towards ensuring the way in which they deliver their service complies with APP. Ultimately, this is the standard against which the Independent Police Complaints Commission will hold police officers and forces to account.

The College doesn’t under-estimate the difficulties in some areas of ensuring that policing / mental health partnerships work in a way that reflects the statutory framework, the Codes of Practice and so on. However, we know that many of the most high-profile and difficult incidents which have often arise against a background of the police service being unable to operate in the way they have been expected. It is vital that the national partnership working envisaged by the Concordat ensures that operational officers have every chance to do the right thing.

APP on all police topics is available publicly on the College of policing website –

This is not the end: merely the end of the beginning – we already know that there will be further changes to come and that many challenges remain: In October 2016 a new Code of Practice for Wales was introduced; by Spring 2017 the Policing and Crime Bill will have received Royal Assent and that will amend the Mental Health Act 1983. We also know that other organisations are continuing their own work to delivery on their obligations under the Concordat and that forces still face important decisions about street triage and / or Liaison and Diversion schemes in their areas. For that reason, the College will continue to support nationally by engaging with other national bodies and supporting police services and their partnerships.

IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award