Earlier this week, the British High Commission in Windhoek, Namibia put out a press release about a joint initiative by the Legal Assistance Centre (LAC) in Namibia and the College of Policing in the United Kingdom – it concerned mental health training for the criminal justice system, hosted by the Namibian Correctional Service. This involved my being asked a few months ago to come to Namibia to deliver training to police and prison officers on mental health issues in the criminal justice system – everything from mental health awareness, improved methods to identify vulnerable people; to principles around safer detention and restraint reduction.  By a sheer coincidence of timing, this training fell in the week immediately following my family’s big holiday of the year – to Namibia!  So I have spent three weeks in this beautiful country (see picture, above!) playing and then working after packing my wife and son onto a plane bound for England last week.

Now that this initiative has been made public, I want to explain a couple of things about it. Firstly, for transparency and secondly, because the fallout from the exercise means you may well see more BLOGs on this website in coming months connected to the kind of training we delivered to support Namibian colleagues to assist them (and maybe others) in bringing that content to more people.


The background to this initiative was the growing number of people who are being detained in Correctional or Police facilities who have mental health problems. As part of familiarising myself with the Namibian system, I arranged to visit the Central Hospital MH facility in Windhoek to meet staff patients; when I subsequently moved to a town in eastern Namibia called Gobabis, I was able to see a prison for myself and meet the prisoners.  Many thanks for that go to the Legal Assistance Centre who used their connections to make it possible.

Mental health services in Namibia are, to say the least, somewhat limited: to put things into context, there are only five psychiatrists for the whole country in public practice. If you bear in mind that Namibia has a population of around 2.3m people – roughly the population of the Thames Valley Police area – and an area that is four times the size of the United Kindgom, you start to get some idea.  And having spent two weeks travelling here, many parts of the country are difficult to access – not just absence of fast motorways, but sometimes an absence even of tarred roads.  There are only two dedicated mental health units in the country: the Central Hospital in the capital and a slightly smaller unit in the very northern town of Oshakati – this reflects the two major areas of population.  Arising from this limited capacity, the Corrections and Police services are increasingly expected to detain those Namibians with mental health disorders who “are in conflict with the law”.  (Unlike in the UK, the police service have custodial facilities to detain what we would call ‘remand’ prisoners: Corrections officers detain people who are fully dealt with by the Courts.)


I thought the term used in Namibia for a mentally unwell person who has offended was intriguing: I’m still trying to think it through but where a person accused of offending and is thought to be seriously mentally ill, they may be detained in hospital or custody for up to 30 days in order to be ‘observed’. This allows a decision to be reached about whether they are fit to stand trial and if they are not, Magistrates may declare a defendant a ‘President’s Patient’, known as an SPD (State President’s Declaration) and they may be admitted to the forensic mental health unit or detained in prison. My first instinct was to think of SPD patient-prisoners as equivalent to a Restricted Hospital Order in England / Wales. The difference is that there is no particular requirement for SPDs to present a “serious risk of harm to the public” – they could just be a person with a serious mental illness who has committed a relatively minor, acquisitive crime. ANd this can lead to detention in hospital or prison for many years.

So decisions prior to a person’s appearance in Court are crucial. Mental Health nurses in Windhoek spoke of it being unnecessary for some patients to be SPDs – they could have had minor criminal charges dropped and been ‘diverted’ under s9 of the (Namibian) Mental Health Act 1973.  This is like civil admission in England / Wales – it’s like being a s3 MHA patient where DRs decide when you will be discharged based on your clinical condition. Some SPD patients who have reached that clincial threshold are detained during any delay in the Ministry of Justice finalising their discharge and there was a hearing in the Namibian Supreme Court in 2012 about such matters affecting the human rights of one patient.  (Human Rights, very similar to those in the European Convention, are an inviolable part of the Namibian Constitution).

So given the role that the Corrections and Police services play, efforts were previously made to have mental health professionals do ‘increach’ work. This proved too difficult because Corrections facilties are widely spread around Namibia and the amount of travelling required to cover them all proved too great an obstacle. It has therefore been decided to focus the detention of SPDs in Gobabis – where Corrections officers can receive greater training in mental health and where inreach professionals can visit and support far more easily. Hence the initiatve to provide training to officers at that facility and relevant senior Corrections officers from the service’s headquarters in Windhoek.

I fully intend to upload the PowerPoint from the training to this BLOG and to add a few lines with certain other resources.  I’m going to do that next week oin order to be able to add some slides that reflected certain flipcharts I drew along the way in response to certain specific questions. Feedback forms indicate this training was a great success at all levels and I suspect I will remember for a very long time the young Corrections Officer (you know who you are!) who said at the end that he had found the training to be “literally life-altering” – he was rightly commended by his senior officers for the effort he put in to it during the whole week.

The main objectives of the training were –

  • Create an awareness of the main kinds of mental health disorders and models of mental distress.
  • Understand the main issues in criminal justice arising from mental health issues
  • Understand the main MH / CJ legal frameworks that apply in Namibia.
  • Understand how to identify, screen and risk assessment detainees with mental health problems.
  • De-escalation training and conflict resolution
  • Restraint reduction.


The training was funded by the British High Commission in Namibia with £12,000 (N$250,000) that ultimately comes from the UK Foreign and Commonwealth Office bilateral fund. Most of that money related to the actual costs involved (my air-fare, the accommodation I needed for a week, other running costs for the course), the rest goes back to the College of Policing and so helps offset the costs to the public of the mental health work the College is doing in the UK to support British police forces.

My thanks go to Jo LOMAS, The British High Commissioner in Namibia for supporting the project; Rachel COOMER and Yolande ENGELBRECHT form the LAC who were superb company and effortless efficient (including in the recovery of my lost phone!) and to Deputy Commissioners William 

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

Winner of the Mind Digital Media Award.

Tyne Bridge

18th November 2015

Claire ANDRE from Northumberland, Tyne and Wear NHS Foundation Trust (NTW) is the only ‘police liaison mental health nurse’ in the country – a coordinating role in her trust to work on all issues that interface with the police from s136 and street triage, to liaison and diversion of vulnerable people in contact with the criminal justice system.  She is single-handedly flogging her way around Northumbria Police changing the world and last night was award-winning in the Positive Practice Collaboration awards hosted in Newcastle:  highly commended for the work she does – quite rightly, too!  So this short blog by (the award-winning!) Claire, gives notice of a free learning event she has coordinated in the North-East, supported by NHS England and by the Positive Practice Collaboration.

Since starting my role as Clinical Police Liaison Lead for NTW for over a year I have been privileged to work with Police on many areas. Work has been led by national agendas but some also local initiatives.  We have seen many new bits of guidance which affects this world like CQC report ‘Safer Place to Be‘, a new Code of Practice to the Mental Health Act practice, and a Government review of sections 136/S135 – and, of course, the Crisis Care Concordat.

There has been a lot talked about and some work completed with the first part of this partnership journey including Street Triage schemes and Criminal Justice Liaison and Diversion.  As those of us who work in the NHS & Police know there is much, much more to be done, with some areas much further ahead than others and both organisations feeling financial pressures already with more in coming years – so we need to work better together and understand each other more!

18th November 2015 in Newcastle-upon-Tyne

Register to attend on EventBrite.

So on that basis the mental health Positive Practice Collaboration has worked with NHS England to secure funding for a ‘mental health and policing learning event’.  The even better news in my humble opinion is that it will be held in the Newcastle-upon-Tyne and I will be facilitating this event with Michael Brown from the College of Policing.  We both want it to be productive and to add value for those who come and we are very aware that there are areas of policing and mental work that could be focussed on beyond street triage and section 136 – issues such as missing people, partnership roles, police deployment to mental health wards to mention just a few … Michael and I are both keen to push legal education for all professionals – but we really want those of you who work in this world to attend and shape the event, to tell us what they would like covered and how the day should be.

  • Do you want presentations & workshops and what would these look like?
  • Do you want to see and share good practice in policing and mental health?

We have confirmed keynote speakers including Kate DAVIES from NHS England who heads up strategic development on mental health and criminal justice; and Commander Christine JONES from the Metropolitan Police who is also the lead on mental health from the National Police Chiefs Council.  We now want your ideas about workshops!

We want the event to focus on issues beyond street triage: that subject was well covered in the EXPO hosted by Leicestershire Police in August and there are other issues which are often in the shadows of street triage that need discussing, as mentioned above.

Please let us know if you would like to be a part of this and if you would be willing to run a workshop.  You can either leave your idea / details on the BLOG comments, below or email either Michael or me.  Full details to attend this free event in the best city in England(!) will be on EventBrite very soon.

Claire’s email address –

Michael’s email address –

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

Winner of the Mind Digital Media Award.

Tour of the new Patchway Police Centre. Inside a custody cell.
Photo by Dan Regan
Reporter - Rachel Gardner
Copyright - Local World


Working as a police officer has forced me to be a part of some of the most unbelievable indignities I’ve ever seen and I wasn’t a willing participant in many of them – and unfortunately the worst of them have been mental health related incidents. After almost eighteen years of experience, I’ve seen and done some things I’d really rather not and it’s influenced my thinking about what I believe we should be trying to achieve here.

I wanted to share just some of them with you —

  • I don’t want to see a complete, unequivocal end to the use of police custody as a Place of Safety under the Mental Health Act because it saves the custody officer some grief – it’s absolutely degrading to see someone in distress in custody where they have done nothing wrong. In many cases it is also legally degrading and no-one should pretend that cases like MS v UK aren’t being repeated in the United Kingdom notwithstanding the court’s ruling. I’ve seen several such cases since that judgment and I’ve flagged every single one of them: the answers that always come back are answers which are never legally acceptable … “not enough money”, “not enough beds”.
  • I don’t want to have to criminalise someone in order for them to be able to access a service which meets their needs and which would otherwise be unavailable – some mental health services are not open to people purely on the basis of clinical need, but require legal conditions to be imposed that only the justice system can determine. This tendency to criminalise people for the sake of accessing clinical services is something I cannot get used to and to have your future DBS record marked by a prosecution is especially degrading when the real issue was you needed empathy, compassion and support. We would never stand for it in any other kind of healthcare and I really don’t see why we insist upon it in mental health.
  • I don’t want to be forced to determine whether or not a vulnerable person in need of care and a safe space should be illegally detained or illegally neglected – I’m actually quite happy to take decisions in legally ambiguous circumstances; it’s not the decision-making I object to. I actually resent be obliged to manage a position where someone suffers such indignity because we cannot plan services to ensure basic human rights. I’m referring here to the rights not to be detained other than in circumstances the law has taken trouble to specify; not to be degraded whilst detained and not to be held in an environment that is irrelevant to my particular needs when I’m unwell.
  • I will admit that I don’t want to be connected to forcing medication on patients because it is utterly degrading to see an adult woman being restrained by mixed sex nurses who are pulling her trousers down in order to force medication upon her by injection to the backside – I’ll be honest: it’s not what I joined the police for! There would be no question in other legal contexts that forcing someone into a situation where their clothing is removed would be done by same-sex professionals. I’ve got huge ethical objections to it, never mind the question of whether it’s even lawful for the police to be involved in such things. If you’re interested in doing that to other people, you should plan and prepare adequately so you can do it yourself, as envisaged by the Act itself and required by Health & Safety law.

Today is World Mental Health Day – the theme is dignity. To begin with, I struggled to think what could be said in short post. It was only when I reversed the proposition to think of indignity that I was over-run with examples, ideas and frustrations from my experience. It has always been at the heart of my concerns in policing and mental health that we need to do much more about very obvious indignities and degradations our broader system of mental health and crisis care inflicts on people and in particular, we need a far deeper understanding of how policing, coercion and a lack of compassion can unwittingly contribute to some of the the greatest indignities we’ll ever see. I suspect some of the things I worry about are easily dismissed by many but having now been actively working in this area of policing for well over a decade I would conclude this:

I blog for World Mental Health DayMental health care seems to works best when it is designed and delivered in such a way as to maximise the engagement of those of us who use services and is built around their needs, not those of organisations or professionals; it minimises power imbalances with those professionals and involves coercion, criminalisation and custody only to the extent that is utterly unavoidable.

I fear we still have a long way to go; indeed I worry that we’re actually going backwards.


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

Winner of the Mind Digital Media Award.