In this article, Chief Inspector Michael Brown OBE, Mental Health Coordinator for College of Policing & NPCC, reflects on some of the points from his keynote session at the event and the discussions throughout the day.
The profile of mental health issues as a thematic in policing has risen considerably over the last fifteen years. In addition to a number of high profile reports (Adebowale, 2013; Angiolini, 2017) there have been a succession of untoward critical incidents which have been featured on the front pages and the evening news and inevitably lead to calls for greater police accountability, police training and awareness of mental health issues. Indeed, Prime Minister Theresa May has made mental health a priority theme, mentioning it during her first public speech after taking office, having introduced a range of initiatives in her previous role as Home Secretary.
The United Kingdom is not alone in placing focus on this theme: most countries have seen police controversies involving vulnerable people with mental health problems, although more often the focus is on fatal police shootings given the tendency of most countries to routinely arm their police service with firearms. Notwithstanding that crucial difference, political and social reaction has tended to be similar: calls for greater police accountability, greater training and awareness of mental health conditions and in particular, calls for the police to work in closer collaboration with mental health professionals and their organisations.
This all sounds highly intuitive: police officers have limited training around mental health, they are certainly not qualified in any clinical or meaningful sense as mental health professionals; introducing mental health nurses to such situations where they can access health records, share information and offer clinical opinions seems sensible. However, in practice this raises several further question which seem rarely asked, never mind answered, in the discourse and the evaluations of these new ways of working.
Training and Collaboration
Around the world, notwithstanding slight variations in laws, politics and culture, attempts to improve policing and mental health most usually focus on just types two initiatives –
- Training – Crisis Intervention Training; Mental Health First Aid; other bespoke training approaches.
- Collaboration – the placement of mental health nurses, or less often mental health social workers, in police vehicles, control rooms or custody areas.
Some areas have gone in for a blend of these solutions: by improving training and introducing qualified staff to more than one kind of environment. Whilst there is little doubt that we need better training for officers, these efforts focus upon the need to improve police responses, through improved knowledge and confidence of better training and closer clinical support.
This takes for granted something quite important about the problem we have decided to fix – we’re concerned about the quality of police responses and determined to improve them. What this approach does little to address, is the problem of why the police, and by extension the criminal justice system, have become so relied upon in the first place.
Lessons from History
If we apply a detailed eye to the thematic reports from Lord Adebowale and Dame Elish Angiolini, we learn that the problem is not just about policing. They both endorse training and collaboration ideas but point out that whilst this is necessary it is not sufficient: “While the [Metropolitan Police Service] has accountabilities in this area, the MPS cannot and should not replace the NHS and social care services who need to play their part in the delivery of safe services.” (Adebowale, 2013, p5). This notion is perhaps best seen in the Coronial inquiry in to the death of Sean Rigg. Mr Rigg died in contact with the police in London in August 2008, having run from accommodation operated by mental health services. The jury’s found that two things had ‘more than minimally’ contributed to Mr Rigg’s death and the nature and handling of police contact was certainly one of them. However, the jury also found that neglect by mental health services in the days prior to this encounter also contributed significantly.
The Rigg case is not isolated in raising questions about healthcare contact or preparation prior to a police encounter. Furthermore, we know that in some cases individuals who have died by suicide have ended their lives within just a few moments of discharge from A&E, and that the police were still responding on blue lights to secure initial details from NHS staff, without an opportunity to intervene. The reports cited reveal more recommendations aimed at health and social care organisations then those aimed exclusively at the police. Of course, many are pitched towards all organisations who have contact with vulnerable people in emergency situations involving mental health, encouraging the closer collaboration that is undoubtedly necessary.
What is obvious however, is that requirements to improve operational responses cannot just sit with policing; and that all organisations need to work preventatively. There are a great many questions which need to be addressed in the future regarding the ways in which we’ve chosen over the last few years to collaborate. In the United Kingdom, as elsewhere, the attraction of the co-responding model, known as ‘street triage’ schemes is obvious. Most police forces now operate at least one kind of scheme, where nurses are placed in police vehicles or control rooms, to improve inter-agency partnerships and real time information sharing. And yet, despite their prevalence, the best we can say about the majority of the evaluations is that they are ‘low quality’. This is not my choice of words: it is the rating system applied by the National Institute of Health and Care Excellence to studies used in the production of their guidelines; and it is the highest rating achieved by a triage study in the 2017 guidelines on the ‘Mental Health of Adults in the Criminal Justice System’. This sentiment was also echoed by Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Services.
What better research, including ethnography, would be able to determine is whether 46% of triage incidents are generated by the NHS when they are struggling to handle demand for their services which do not require the police; how many deaths in custody or following contact have there been and what do we need to learn from this; what training has been given to the nurses involved, given anecdotal reports from officers that they have been advised to do things which are unlawful, to resolve incidents?
In consultation work for the College of Policing on the production of guidelines and training for the police service, it was notable that the public want different things from their police service when it comes to mental health, than the National Health Service wants. Of course, one only has to follow the news and use social media to see there is often a disconnect between the public and the NHS about what vulnerable people want from mental health services. It should therefore be no surprise that police officers are placed in to positions of conflict when responding to mental health related demand. They know they are often called upon because members of the public have been attempting to access services without success, or to undertake functions on behalf of the NHS which may or may not belong to them (welfare checks, medicating patients, returning patients to hospital from their own homes).
If we are to negate the conflict and ambiguity created for operational officers, we need to reconcile the conflict we place them in; we need to determine what problem we’re actually trying to fix and have better understanding of the reality of those efforts in order to evaluate whether or not we are successful in our endeavours. But it always needs to be borne in mind that policing is, inherently, a restrictive practice and is to be used sparingly, lest we further stigmatise and criminalise vulnerable people. If we don’t address those problems in our efforts to collaborate, we are at risk of just doing the wrong thing righter.