This post follows a short piece for service-user survey work by @DrEm_79 (from Twitter) – the nature of this is it produces a longer piece than normal BLOG post, but I can assure you it’s worth reading all the way through. Alongside the first post, it offers important insights in to crisis care responses involving the police.
Now this is complete, I just to thank @DrEM_79 for doing it: I think what she’s uncovered is very far from unimportant and given how easily social media can be deployed begs questions about why we don’t see more of this.
Incidents involving mental health issues account for 20—40% of UK police time (College of Policing 2016). Despite this there has been little research looking at how police responses to mental health crises impact service users. Some evaluations of police mental health schemes have not consulted with service users at all, speaking only to professionals.
Despite investment in Street Triage schemes where police and health professionals co-respond to mental health crisis, part one of this peer research study found that 84% of those with lived experience of police responses to mental health crisis would prefer not to have a co-response with police if they had a choice. It also found that almost half of people with lived experience of police responses to mental health found them to be harmful (48% in the short term and 49% in the longer term). Little work has been done looking at impacts of police response on service users. It is not known what aspects of response contribute most to harm, or the types of harms individuals experience. Work is also scarce looking at what it is about police responses that service users find helpful.
This peer research study of service users looked at which services people wanted to respond to them in crisis and whether they had been helped or harmed in the short and longer term by police responses to mental health crisis. It also aimed to explore people’s experiences of police responses to mental ill health in more depth and look at impacts of police response on individuals.
Part one of the study can be found here. 100 people participated in the study within two days of study recruitment commencing. As well as the questions discussed in part one, participants were asked if they would like to say more about the impact of police involvement. 61 people answered this question using free text with no word limit. These answers were analysed thematically.
1. Reasons for police involvement
Thirty participants discussed the reasons police became involved in the mental health crisis. Police involvement was associated with self harm or suicidal behaviour for many. Only two people had contacted the police direct for help. The most common reason for police involvement was because the person or their carer had called mental health services (hospital, CMHT, or crisis team) requesting help with suicidal thoughts, self harm, distress, or worsening symptoms, and health services had called the police. Participants described feelings of punishment and loss of trust:
“I phoned the crisis line suicidal and they sent the police. The crisis line refused to help and no one would come to assess me. The police stopped me from leaving and tried to force me to go from my house to the hospital trying to trick me outside but I refused. Mental health services passing the buck and punishing people for being ill sending police” – Participant 1
“My relative has been detained s136 around 30 times in last 5 years. Police intervention has kept her alive, but has also been hugely traumatising. Services work on the basis that you shouldn’t need admission to hospital, which means people are left at home when they are suicidal.” – Participant 2
Other reasons for police involvement included missing persons, concerns for welfare from other agencies, police called to attend self harm on inpatient mental health units, and people absconding from mental health units and from A&E. Nine people described being sectioned under the Mental Health Act, eight of these with section 136. Four people described arrest for Breach of the Peace connected with suicidal behaviour.
Some described the actions of the police in positive terms:
“My nephew was 4 at the time (has Downs Syndrome and Autism) and escaped from home, missing for half an hour, police sympathetic and understood the vulnerability and his being unable to know his own name and address – found safe and well – very supportive throughout ordeal – Participant 3
Others described more harmful impacts from police involvement. A number of participants made comments sympathising with police but feeling let down by health services:
“The ambulance crew phoned the out of hours doctors who refused to attend and they tried to tell the police to arrest an elderly man with dementia because he was confused in his own house, the police and ambulance did all they could but were let down by the doctor.” – Participant 4
2. Loss of trust and feeling let down
Loss of trust and feeling let down was the biggest theme in the study, and was raised by more than half of those who commented. Participants described a number of different aspects to this. Feeling let down by health services was the most common impact discussed, followed by loss of trust in the police. Some people described a loss of trust in all services after police involvement in the crisis response and said that police involvement had caused them to disengage from help:
“Since then I’ve lost trust in police and the crisis line who called the police. I don’t call anyone when I need help and suffer alone as what they did made a bad situation worse and humiliated and hurt me deeply” – Participant 5
Participants described impacts of police involvement on health behaviours, with police involvement leaving them less likely to seek help in future, or altering suicidal behaviour so that there was less chance they would be found when attempting suicide in future:
“I’m […] more wary of speaking honestly to, or dealing with mental health services, in case the police get involved again.” – Participant 6
“I felt intimidated & humiliated by police. I was told to stop being “silly” (this even though I have C-PTSD & was going through a rape trial at the time. There was a complete lack of understanding, compassion or empathy. I felt totally degraded. My experience served to ensure that if/when I attempt suicide again to ensure I do it in a place I cannot be found.” – Participant 7
Participants also reported that police involvement in the crisis had made them less likely to report crime in future. People also reported fear and avoidance of the police. This is concerning as people with mental ill health are more likely to be victims of crime than the general population:
“Afterwards I had my phone stolen and was too scared to report it to police as every time in crisis they keep me trapped in my house and I couldn’t bear going through that again” – Participant 8
“Seeing police now cross street to avoid, won’t go out if police cars in the road. I don’t trust police now” – Participant 9
“After they left I was alone and in a worse state than before their arrival. I feel frightened of the police now. I doubt I’d feel able to call them if something happened to me (ie a crime, or my abuser finding me).” – Participant 6
Some participants expressed regret at having asked for help because police had been involved:
“I wanted someone to help me when I was ill not to make things worse by sending police. I wish I never asked for help” – Participant 10
Participants also highlighted inequalities or assumptions in their treatment, some contrasting this with physical health conditions, or feeling their behaviour had been wrongly labelled as due to illness:
“Damaged my trust I was ill not a criminal why do people with mental health problems get police when people with physical health problems don’t? I am scared of police now after being kept in a cell waiting for assessment. Sectioned but no rights in reality” – Participant 11
“I was arrested by police under s 136MHA but was not told this by police only by staff at hospital. I was in fact trying to leave my husband but because I had had mental illness I feel the default position was assumed. Ended with me having to return to a very difficult household. 4 years later and I still feel very raw. Just because you have had a mental illness does not mean that every unusual behaviour is down to that.” – Participant 12
People also described a lack of communication during the incident, and feeling that they did not know what was going on:
“Was a very terrifying experience. Didn’t have anything explained to me and they were already in my home when I returned home, having broken my door. Then two wrestled me and handcuffed me, again nothing was explained. I thought I was being arrested for a crime though had no idea what. Only told when got to 136 suite where I was and that I had been sectioned.” – Participant 13
Others described a lack of follow up, feeling that although there had been a response, the crisis was not resolved, and feeling the police were only interested in their wellbeing at that moment, not in the longer term:
“After police closed involvement mental health services often did not continue to offer much or any support.” – Participant 14
“But after they left I felt worse than before they arrived, less safe, like I never would be safe anywhere (I had escaped my abuser to try and find safety), and frightened that they might come back with a warrant or show up to check on me or try to intercept me when I next went out to section me. I know that sounds paranoid, but their response to my refusal to attend the hospital frightened me and I didn’t know how far they’d go. It was also upsetting having them arrive telling me they wanted to help me, but the fact was, after they left there was no referral to mental health services or follow up or anything. I was just abandoned to carry on struggling alone. It felt like a case of “make sure she’s still alive tonight, but after that we don’t care what happens to her, she’s on her own”.” – Participant 6
The second most common theme in this study was criminalisation, and was raised by around a quarter of respondents. A number of different aspects of criminalisation were discussed. For some it was a feeling:
“I don’t trust police anymore or ask for help in crisis I try to hide it. Hospital called police when I called them for help and I felt like a criminal” – Participant 16
“The police were lovely, every time, however I’d still not like to see the boys in blue for a mh crisis, I’d feel better if it was entirely managed by Nhs staff- let the police catch criminals! Even though you’ve done nothing wrong in terms of the law, you feel like a criminal for being with the police.” – Participant 17
“Scared, betrayed, society felt I was criminal and didn’t belong” – Participant 18
Others described concerns about police involvement impacting criminal record disclosures:
“I was being held under section 136 to take me to a place of safety. As I was already going in, it seemed ridiculous and I told them that. When inside the hospital, I was upset because I was worried about it showing up on an enhanced CRB.” – Participant 19
“I was arrested for breach of the peace when I attempted suicide. Criminal record so then not allowed to do volunteer work with children.” – Participant 20
Stigma was a major factor and people felt judged or shamed by police involvement:
“I felt guilty by association, ‘mad’ by association, and degraded by having been involved in the situation.” – Participant 21
“Humiliated. Degraded. Lost confidence. Ashamed to go out. Attempted suicide soon after. Definitely made self harm worse” – Participant 22
Several people also described marked police vans being used for transport which contributed to distress:
“Crisis team called police when I told them I was suicidal. Damaged my trust in people who should be helping. Passed me off to police instead who handcuffed me and pushed me into a marked van with spectators thinking I was a criminal” – Participant 23
Participants also described Taser use, one person described the interaction of the threats of coercion with their mental health:
“My son was sectioned. The police had been called a few times before this. It’s a shame the mental health services didn’t listen to us as parents. My son ended up going manic and getting sectioned for several weeks. The police had to point a taser at him” – Participant 24
“I was threatened with a taser. It was very frightening. I already believed people were trying to hurt me and my family and police were part of that, it made the paranoia a lot worse. – Participant 25
Two participants talked about the impact of being a police officer themselves and needing help:
“I was a serving police officer , suffering from PTSD and in crisis , I was detained by colleagues I knew, placed in the same unmarked police vehicle I had placed arrested people in previously. I didn’t want to see officers I knew when I was in crisis. – Participant 26
“Because I am a police officer myself it was very awkward and distressing but the officers who helped were lovely. It only went downhill once the MH team became involved. – Participant 27
The public nature of police involvement was a concern shared by several participants:
“After hours and lots of conversations outside my house which neighbours were cross about and two police cars parked on my drive all night they left with no help not seeing anyone. Useless upsetting stigmatising.” – Participant 28
“Being held on S136 means the local police (small town) now know me and I am often stop checked while perfectly fine and just getting some shopping. It’s embarrassing” – Participant 29
Four people described having been arrested for breach of the peace:
“I was arrested for “breach of the peace” after my psychiatric hospital refused to assess me out of hours as they had assessed me previously. I appreciate (now) they were getting to keep me she and felt their options were limited by being kept in a cell overnight was not ideal.” – Participant 30
“Police unlawfully arrested me for breach of peace (there was no breach of peace at all. I didn’t even say one word to police) to get me out of my flat and into public place. Then they kept me in a cell for 8 hrs telling me to ‘get a grip’ and ‘stop attention seeking.’ Solicitor got me unarrested and despite getting compensation for unlawful arrest and false imprisonment, the mental scars from this remain 5 years on. I panic at sight of any police officer or police car. Really harmed me.” – Participant 31
“Was arrested for breach of the peace and kept in a cell for 18 hours […].” – Participant 22
Others described threat of arrest:
“Have been sometimes threatened with criminal charges which makes me scared of police involvement and also sctn 136 lead to a long stay in a police cell Other times I’ve felt the police were the only people who cared” – Participant 33
People described impacts of detention in police cells under arrest or as a Place of Safety as frightening and distressing. Some of these were for prolonged periods:
“15yr daughter held for 43 hrs in custody cell – no MH beds.” – Participant 34
“Detained under S136, as I had been reported as missing person & self harmed in public place. PoS was Police cell, I was scared & frightened.” – Participant 35
“I get locked up in a cell over night. This has happened countless times and just adds to my distress” – Participant 36
Other participants described effects of damage to their property as a result of police involvement:
“Many many ‘safe and well ‘ checks where door kicked in whether there or not. Am physically disabled and cannot reach the door quickly plus there is a keybox and police have code yet still kick door in.” – Participant 37
“Rental agency unhappy with door being forced (although I paid for repair)” – Participant 13
Blame and accusatory language was also raised as an issue:
“For me the initial focus was quite a checklist – did I need medical attention (yes), had the terms of a restraining order been breached (yes), had I caused or collaborated with that (no, but the questioning had a repetition about it that suggested that I must have been partly to blame because a mess of that size doesn’t just appear out of nowhere), was I officially able to make a statement (yes). Then, as the ‘sectioning’ process took over the checklist changed but the tone of the questioning seemed accusatory still, as if we had wasted their time and they had to start all over again with a new set of questions. I felt bewildered, and I really didn’t understand what was going on, what to expect or how my answers would be used. It was like being held responsible for something without knowing what the consequences would be.” – Participant 38
“I was not arrested but despite no legal basis I was handcuffed and stopped from leaving my living room not even allowed to go to the toilet without male police watching me. Since then I’ve lost trust in police and the crisis line who called the police. I don’t call anyone when I need help and suffer alone as what they did made a bad situation worse and humiliated and hurt me deeply.” – Participant 39
Trauma emerged in the analysis in a number of ways. This was partly participants talking about the police response triggering memories of previous trauma:
“16 year old daughter pinned down by police which gave flashbacks to previous sexual assault.” – Participant 40
“They searched me which retriggered trauma and two men held onto me and in handcuffs in my own home but I’m not violent. Not necessary.” – Participant 41
“They asked me if I would go to the hospital voluntarily and when I said no told me they might have to look at forcing me. It left me feeling violated and unsafe in my new home (some of the things they did were things my abuser did – they were aware of the background and I did specifically tell them).” – Participant 6
Other respondents described the police response itself as a source of trauma:
“First involvement with police and still traumatised now (this was Dec 2015) & have moved house as was having flashbacks etc” – Participant 13
“Police are not adequately trained to deal with mental health crisis, and being left in their care at home for over 8 hours waiting for a MHA Dr to arrive was a traumatic experience.” – Participant 43
“My relative has been detained s136 around 30 times in last 5 years. Police intervention has kept her alive, but has also been hugely traumatising. Services work on the basis that you shouldn’t need admission to hospital, which means people are left at home when they are suicidal. Could go on and on about this” – Participant 44
Trauma from the police response was described as persisting long time after the event:
“5 years on. I panic at sight of any police officer or police car. Really harmed me.” – Participant 31
5. Physical impacts
Police responses had physical impacts on participants, which were discussed in terms of restraint, physical containment to a place they did not want to be, and also physical harms. One person described a case where the person had died by suicide detained in police custody in a cell at a police station. Others described heavy handed responses contributing to problems, and physical injuries sustained:
“Erroneous claim of violence from crisis team led to heavy-handed police response. Attending officers clearly had no specialist training in mental health. Police and crisis team augmented a crisis needlessly!” – Participant 46
Four described physical harms:
“The hospital wanted to lock me in the mental health room in A&E (it’s basically a cell-sized room with high windows and a concrete bed/bench covered in a plastic-coated foam cushion). I didn’t want to be locked in (they often don’t even let you out to go to the toilet) so I tried to resist. The police and security picked me up by the arms and legs and tried to get me into the room. Once I was on the floor they repeatedly tried to shut the door with my leg in. I ended up with bruising. I’ve had some poor treatment in hospital but I never expected it from the police in a public place. I am much less trusting of the police now.” – Participant 47
“[…] All clothes taken left naked then given padded clothes couldn’t rip tried to ligature with bandages custody officer came in pulled arms back banging head on floor and called me a stupid bitch.” – Participant 22
“After Self-harming in a Psychiatric Inpatient unit, the Police were called, why? Don’t know, was assaulted by 2 Male Police officers, gave me a good kicking. Yet I had already let 2 Police women handcuff me. So I wasn’t dangerous, I wasn’t aggressive and couldn’t defend myself. The Police had a bad attitude from the first moment they came face to face with me.” – Participant 48
Limits to freedom while in presence of police were described by several people, including having to wait many hours in the presence of the police before a MHA assessment:
“I was not arrested but despite no legal basis I was handcuffed and stopped from leaving my living room not even allowed to go to the toilet without male police watching me.” – Participant 49
As well as the negative impacts described, people also talked about positive effects of police involvement. These included being a calming presence:
“[…] One of the youngest PCs present (I think, but don’t know for sure, she was on probation or training placement) was absolutely brilliant. A cup of tea, a smile, a reassuring comment when she said ‘it’s ok, they have it under control, just take a moment to calm down’ and offering to help call someone to be with me. She really de-escalated my fear in the moment.” – Participant 38
“Police totally calmed a very volatile situation down. Listened and talked to individual and didn’t judge.” – Participant 50
Participants also described police helping with practical arrangements:
“They took care of my pets feeding and making sure they had water while paramedics dealt with me. Other times they’ve wanted to take me to hospital but I refused.” – Participant 51
Others explained how police involvement had helped to ensure their physical safety and protect them from harm:
“During a period of mania I was extremely vulnerable during the night alone in my underwear in a notoriously dangerous park. Police brought a blanket in and encouraged me to their car where I was taken to a MH ward.” – Participant 52
“I was very depressed & suicidal, my husband (now ex) called them. They spoke to us both separately & thankfully could see through him that because I was so desperate was because of continued domestic abuse. They spoke to me & gave me contact numbers & advice & also arranged an emergency appointment with my GP.” – Participant 53
Some participants also described police involved in the response as being empathetic, kind and compassionate:
“I was taken to hospital semi conscious following an overdose, when I came to there was a policeman standing next to my door. I asked him why he was there and he said was to make sure I was ok, he contacted the detective in charge of my abuse case which was soon to go to court and he came to see me to see if was ok. When I was detained in psych hospital both previously and after this, same detective came to see me to see how I was doing and to remind me none of the traumatic events had been my fault. Initially the police outside my door in A&E frightened me, but they were lovely.” – Participant 54
“The 2 officers that attended were really good, they stayed out of the way and when they did need to interact they were really calm, polite and empathic, couldn’t have wished for better response.” – Participant 55
Participants also talked about how they felt police had been let down by other services:
“15yr daughter held for 43 hrs in custody cell – no MH beds. […] Generally police good, having to fill gap of inadequate MH Adult Services” – Participant 22
“Police have always treated me with immense kindness. They have spoken of their frustrations due to MH cuts.” – Participant 56
“Police often called by private company who have contract for his care on CTO if my son goes missing or there is a problem. They always appear to be helpful but often not their job. What is needed is more support from company who are paid massive fee.” – Participant 57
Some people who had experienced harm from the police involvement in the crisis response also described kindness from police. Compassionate and traumatic responses were not always distinct. This raises questions for those involved in collating feedback from crisis incidents, and in evaluating services. Although someone may describe individuals as kind and compassionate, that does not mean the overall impact will be helpful.
“Have been sometimes threatened with criminal charges which makes me scared of police involvement and also sctn 136 lead to a long stay in a police cell Other times I’ve felt the police were the only people who cared.” – Participant 58
Others had a different response with one respondent simply saying:
“They completely lacked compassion.” – Participant 59
7. Impact on mental health
Participants also discussed ways that police involvement in the response had impacted on their mental health. Impacts were unanimously negative, with police involvement worsening distress:
“Humiliated. Degraded. Lost confidence. Ashamed to go out. Attempted suicide soon after. Definitely made self harm worse” – Participant 34
“At an already stressful time this was unhelpful and made my recovery all the more difficult.” – Participant 60
Participants described a number of short and longer term harms from police involvement in the response to their mental health crisis. These have implications for mental health services, police, and those commissioning services and developing policy. Participants often felt let down that they had wanted mental health service support and help, but instead it was police that were sent to them. This diversion of health need to the police caused distress, and in many cases seems at odds with efforts and policy to divert mental health need away from the criminal justice system.
Paradoxically, although police responses in crisis are often focussed on ensuring physical safety, survey responses suggest that involvement of police leads to behavioural and attitudinal change for some individuals which may increase risk, whether by withdrawal from services, not seeking help for health crisis in future, concealing symptoms because of fears police will become involved again, or escalation of risk in suicidal behaviour. Fear and mistrust of police is also concerning. People with mental ill health are more likely to be victims of crime than the general population, yet because of police responses to mental health crisis, participants stated they would be reluctant to report crimes against them to the police.
Criminalisation and mental health stigma are also important, causing distress and lasting impacts on individuals. Some of the examples of practices such as marked police vans being used for transport to hospital, people in private premises being tricked outside so they could be detained under s136, and people being held without apparent legal basis, also suggest policy and practice guidance (for example House of Commons Home Affairs Select Committee, 2015) are not being adhered to in all cases.
Traumatic impacts of police involvement in mental health crisis response also need further attention. Trauma is associated with a range of mental health conditions, yet this study suggests involvement with the police in crisis is retriggering and in itself can be further traumatising.
The extent of the harms described by participants in this small peer study suggests further research is urgently needed into impact of police involvement in responses to mental health. It also highlights that future evaluations of schemes designed to meet need in mental health crisis, such as Street Triage, must prioritise service user participation in evaluation if the true outcomes of the scheme or intervention are to be measured and understood. That schemes are described as successful without whilst harm is being caused to service users is concerning. People experiencing mental health crisis deserve protection, not just protection of their immediate physical safety, but also ensuring that where possible further harm is prevented, and that responses to crisis do not make things worse for the person.
2015. Home Affairs – Eleventh Report: Policing and mental health. London: Commons Select Committee, Home Affairs.
2016. Mental health crisis takes huge and increasing share of police time. The Guardian.
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