IMG_1498

Not Quite An App!

This post is mainly to provide a list of the internet links that I used to create my own quick-reference folder on my phone, as shown in the picture. If you know how to drive your iPhone or other device or you know  that you don’t want such a folder in your’s, then this post is not for you and I’d recommend you put the kettle on instead!

Over the last week, I’ve had feedback from various kind folk about the usefulness of the BLOG.  One of them included a paramedic screen-shotting his phone to demonstrate to colleague that he’s got the BLOG ‘on tap’ to be used at jobs, if need be. This is something I’ve had for some while – the amount of times I’m in the BLOG writing posts, replying to comments and so on, I use the thing as much as anyone else. And of course, one of the secret reasons behind writing the damned thing(!) was that I find myself receiving more or the less the same email queries across the main topics of policing and mental health that it remains a real time-saver to be able to quickly pull up a link to a post and invite the person to read it rather than me re-write the answer all over again.

So on my iPhone and on my iPad, I have a little folder in which I have quick links to various pages of my own BLOG – the ones that I use the most to look stuff up. I also have three links to the HM Government legislation website, covering the Mental Health Act 1983, the Police and Criminal Evidence Act 1984 and the Mental Capacity Act 2005. It just makes my work so much easier and last night on Twitter, I recommended the idea to people who might benefit from using it and had technology queries about whether I could do an App – I’m afraid I haven’t got a spare thousand pounds kicking about to get it done properly and without irritating adverts all over it so that’s ruled out for now!  But I also had a query about how to do the folder thing.

CREATING A FOLDER

It’s not quite an App, but it’s all I’ve got for now! –

  • Create the icons you need –
  • Get onto your internet browser on your SmartPhone and search for the BLOG.
  • Once it’s opened in the browser, click the icon that allows you to ‘share’
  • You’ll probably then have an option to ‘add to home-screen’, or similar.
  • You’ll probably get the change to label the icon – the word that appears under it;
  • Once you’ve named it and confirmed, the labelled icon will appear on your home-screen like an App icon.
  • When you click it in future, it will open your internet browser and take you straight to the page for your greater convenience.
  • Repeat this process for as many pages as you need – you don’t have to choose the ones I have chosen.
  • Combine those icons into one folder –
  • On Apple devices you press and hold them then place one over the other and it creates the folder.
  • Keep adding your pages to the folder in the same way, as required.

THE LINKS

The links I used if you just want to save them were –

There you go – if you read this and thought, “I knew that!” or “How patronising!”, I was asked to explain how I did it for the benefit of some.

Hope it helps!

Michael./


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

Winner of the Mind Digital Media Award.


AL

The Dogmas Of The Quiet Past

I have absolutely no idea at all what was going on in the United States of America in December 1862 but US President Abraham LINCOLN took the occasion to say this –

The dogmas of the quiet past are inadequate to the stormy present.  The occasion is piled high with difficulty, and we must rise — with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.”

Rise with the occasion; not to it.

I heard this quotation in a context quite unconnected to policing and mental health, but it immediately made me think of it – there is so much that is wrong or inadequate about our mental health crisis services and we can’t just keep doing the same thing and expect different outcomes. Don’t ask me: just look at the Crisis Care Concordat (2014) and ask why it was necessary at all; just look at last month’s thematic review of crisis care. See the many and various reports over the last few years (and decades!) that keep making the same remarks – Lord ADEBOWALE’s 2013 report in which he pointed out “The police can’t do this alone” and in which proceeded to make recommendations in a report about policing that were mostly about health and social care organisations, from ambulance to mental health trust and local authorities. The Home Affairs Committee did very similar things in 2015 and although all of these documents mention the need to improve police training, I want us to pause and think about the impact on the public if that’s all we do.

The College of Policing will have a stack of training and new national guidelines for the police fully available early next year. Whatever it is that you think is wrong with police responses that you would hope training and guidelines will improve, it’s not going to be a complete game-changer. Whether greater education turns every officer into the most empathetic, compassionate individual; whether legal knowledge improves to near-solicitor standards; whether knowledge of local NHS structures becomes as good as those nurses working in the local system; whether every frontline PC could confidently tell you the difference between a learning disability and a learning difficulty; or between Autism and Asperger’s syndrome …. none of this will fundamentally change the world, however much some of that might genuinely help people.

Better educated and trained, a whole legion of officers may well turn out from parade to the next crisis call, better identify a vulnerable person, communicate more effectively, be just patient and persuasive enough to avoid the need for using force to resolve an incident by empathetic listening and communication, but what this won’t do is change anything about the NHS.  It won’t touch NHS structures that currently lack the capacity to allow known patients to access a crisis team, for example; it won’t alter the experience of patients who end up in A&E (where the CQC reported attitudes towards mental health patients were amongst the worst); it won’t differently commission ambulance services or alter the capacity of the community mental health teams who have seen their caseload rise by 100% in the last year alone.

When we reflect back on those many and various reports mentioned above with our army of mental health trained police officers – we will still be without sufficient crisis care services or only with those that have already been identified as ineffective – “the police can not do this alone”, as Lord ADEBOWALE reminded us.

MENTAL HEALTH CRISIS SERVICES

At this year’s Royal College of Nursing Congress, the RCN Students put forward a resolution on holding commissioners to account for ensuring effective crisis care and it was supported by 99.8%(!) of those who voted – only 3 people in the entire session chose not to vote.  You can see more detail about this session on the RCN website (and I hope at some stage to be able to work out how to make the video work so I can actually watch it!)  It points out that one in five mental health trusts was found (by the CQC) to have inadequate provision – and this is where the emergency system fills a void: police, ambulance and A&E. In many areas, crisis team advice to patients – after recommendation of distraction techniques – is to call the police or attend A&E. Obviously street triage can mop up a certain amount of this but in my shadowing of street triage schemes over the last few months, I have found that much of the work is CrisisTeam work that does not and never did involve anything that would, of itself, be considered a police responsibility. It’s just that the call came to the police, not least because other parts of the NHS were pushing it there and street triage may, if anything, have accelerated this tendency.

Many police officers working in street triage are gaining great knowledge: of the law, of local NHS pathways in their areas and so on. Research on police officers volunteering for mental health related roles and their skills in handling mental health calls tends to suggest, somewhat obviously, that the roles attract people who are more interested in mental health matters and are therefore inclined to actively develop knowledge and skills. So the challenge is to take mental health as a subject and make all police officers realise that this is not some frustrating extra topic that we have to deal with that we shouldn’t touch at all. I’m always amazed to hear (just some) officers say things about mental health like, “Why do we have to do this?!” – as if to suggest that it is all unnecessary and the NHS should have prevented the need for any police involvement. Of course, it’s true in almost every area of policing that we fill a void of some kind – we shouldn’t have to police the nightime economy anything like as heavily as we do because bar staff shouldn’t be serving alcohol to drunk people – we know that many bars might as well be holding people’s mouths open and pouring it in; we shouldn’t have had to investigate various railway disasters because train companies should take their health and safety responsibilities seriously, and yet we know they don’t always. Isn’t that the very point of the police?! – to investigate people who do things they shouldn’t do and provide other safety net functions up after things happen that shouldn’t happen?

Remember by favourite Egon BITTNER quotation –

“Policing is what happens when something’s happening that ought not to be happening about which somebody ought to do something now!”

So as new training and guidance hits the real world in early 2016 the police can hope to make a better impression on the world.  Some might argue that we’re building on a reasonable foundation as the CQC found that paramedics and police officers were the top two groups of professionals for positive feedback from patients in mental health crisis – way ahead of specialist mental health services, GPs and A&E.  However, before any police officers become too self-congratulatory it should be borne in mind that satisfaction levels reported in the CQC report around mental health were based on a very small sample and were actually significantly worse than the general satisfaction levels reported about policing generally!

But what everyone needs to realise is that none of this is going to make a seismic difference in the real world if the problem with mental health crisis services is not simultaneously addressed – the police can not do this alone.

We must disenthrall ourselves.


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

Winner of the Mind Digital Media Award.


DBS

The Disclosure and Barring Service

New statutory guidelines, issued by the Home Office, come into effect tomorrow concerning the Disclosure and Barring Service. For those of you who have not (yet) heard of the DBS; it replaced the old Criminal Record Bureau in 2012 and took on certain other responsibilities to maintain lists of professionals who are barred by law from working in particular professions. This is obviously of massive importance where it comes to the employment of people who work with vulnerable groups and this new guidance strikes at the heart of concerns that were raised during last year’s consultation on the operation of the Mental Health Act 1983. The Government review was in connection with police powers under sections 135/6 of the Act but a point repeatedly raised in passing was the disclosure by Chief Constables of such incidents during DBS checks.

This is clearly a very sensitive subject and it has been discussed for some years – you may recall that Alastair CAMPBELL published a BLOG back in 2011 where he reproduced (with permission) a letter from Eileen O’HARA, a mental health campaigner. She highlighted how some of her mental health history had been disclosed to a prospective employer during an enhanced CRB check. Fortunately for her, she was seeking to work for a mental health charity who took an enlightened view that this represented no automatic barrier to her position. But it highlighted a point affecting many others: mental health history is not automatically disclosed by mental health services, indeed it would be regarded as medically confidential. Therefore when, if ever, is it acceptable for a police service to disclose information without the consent of the person that officers were privy to purely because they became involved in a situation in support of mental health services or because they had instigated section 136 of the Act for someone in crisis?

A LITTLE BIT OF HISTORY

For those not familiar with the history: under the CRB regime, Chief Constables were bound by the Police Act 1997 to disclose information that “might be relevant” to the employment of a person seeking a position that requires an enhanced check – typically those involving children, vulnerable group and security issues. And to an extent, anything might be relevant to anything else! If you didn’t read Eileen O’HARA’s letter, it contained the quotation from the police disclosure –

Devon and Cornwall Constabulary are (sic) aware that in 2009, Eileen O’HARA was a patient of the Glenbourne Mental Health Unit in Plymouth; we are not aware whether she has any current mental health issues, or whether she presents a risk to vulnerable people.

You could spend a whole day wondering about the implied meaning here: indeed you’d have to because it doesn’t actually say anything! What are they trying to convey to the prospective employer? Does the final, subordinate clause indicate an assumption that a patient in a mental health unit inherently must represent an risk to vulnerable people?! – that’s certainly not the criteria for detention under the Mental Health Act! Patients can be admitted under section 2 or section 3 merely because they are a risk to themselves; and not necessarily from self-injury either. It could just simply be that a patient is at risk from significant self-neglect – unable to care for themselves, take care of finances, etc. – or unable to protect themselves from the exploitation of others.

But of course, under the law in 2009, the Chief Constable had a duty disclose information that ‘might be relevant’ and this responsibility was debated in the courts including both the Court of Appeal and the Supreme Court. Various opposing judgments were given over the years. Without some kind of guidance, how do you start to weigh the various factors and comply with the requirement of Article 8 ECHR (the right to privacy)? The Supreme Court case gives the binding view and provides the legal backdrop to how interpretation of the Police Act should be approached.

What we still don’t know from disclosures like the above, is anything about the actual nature of the incident. Police involvement with patients who are admitted to hospital could take one of many forms and I can imagine several that would by utterly irrelevant to prospective employers but which involve application of the Mental Health Act or admission to hospital. Greater, more detailed judgement is required because the police often fulfill roles better undertaken by other agencies and not because anything inherently required police officers’ skills, equipment or legal powers.

In any event: all of that is history.

THE NEW GUIDELINES

Chief Constables and PCCs have already received copies of the Home Office’s guidelines. The statutory basis of them is important because it means that any decision taken after after Monday 10th August 2015 must be rationalised against the new framework and a more thorough, thoughtful approach will have to be taken about mental health related information. I fully understand that some commentators will read the guidelines and will have hoped they went further: incidents involving the police or that were legally handled using powers under the Mental Health Act can still be disclosed: the difference introduced by the Protection of Freedoms Act 2012 was that the “might be relevant” criteria was replaced by “reasonably believe it to be relevant” and the law has long upheld the right of Chief Constables to disclose information that did not result in a conviction where it is directly relevant on a balance of probabilities.

These new guidelines cannot introduce a total barrier to disclosure – that remains permitted by the Police Act 1997, but they can require the decision to be taken against consideration of factors considered relevant by the Home Office.

Their new guidance states

  • Detention under the Mental Health Act, which does not constitute a criminal investigation, is unlikely in itself to be sufficient to justify disclosure.
  • The behaviour of the person during the incident must be a key consideration for officers when considering checks. This could include assessing whether the person presented a risk of harm to others or whether they were involved in multiple incidents.
  • The date of the incident is an important factor. In cases where it took place a long time ago, officers should consider giving the applicant an opportunity to make representations about their current state of health.
  • If information is disclosed, the certificate should provide an explanation so the employer or voluntary organisation clearly understands the relevance of the information to the application.

Finally and perhaps most importantly: it remains the case that individuals have a right to appeal to an Independent Monitor regarding information that they believe should not be disclosed and this appeal mechanism can insist that a new certificate be issued, where it is upheld.  This is a step in the right direction: whether it is sufficient will probably depend on your view about the relationship between mental health, crime and risk.

MENTAL HEALTH, CRIME AND RISK

As the guidelines rightly point out, detention of someone under s135/6 is not a part of a criminal investigation. However, the origin of this power and its use in practice, is that it allows officers to deal with mental health crisis incidents even where they involve the commission of a minor offence – remember the power was part of consolidating other offences under outrageously outdated nineteenth century laws. The last time I was present at an incident where s136 was invoked, the person concerned had committed a clear offence under modern legislation – they had brought a major motorway to a halt, a serious offence under the Road Traffic Act 1988 (and as my colleagues in motorway policing often tell me, it costs a £1m an hour to the UK economy). That said, the major issue in the incident was not a relatively short period of inconvenience to motorists, but the chance to save someone’s life whilst acutely distressed and such s136 incidents are the exception. In the main, police powers are used to safeguard people at risk, mostly from themselves – as is the case with the Mental Health Act as a whole.

So there it is – a presumption against disclosure of police-related Mental Health Act incidents unless something very specific within the actual incident higlights something that the Chief Constable reasonably “believes to be relevant” because of potential risk in the context of that potential employment. But individuals are no longer at the total whim of a system beyond their control and they have a right of appeal.  Not perfect, but certainly better than it was!


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

Winner of the Mind Digital Media Award.