Give Me Two Days

I dread some calls more than others. Strangely, it is not the calls involving death or horror which cause me anxiety. A murder, though high profile, is often a relatively simple investigation. Large-scale public disorder is unnerving but the police receive extensive training to deal with it and can usually rely on force of numbers to help out. If it’s a crime – we investigate. If it’s anti-social behaviour – we try to tackle it. If there is an upset victim or witness we try to comfort them. We are largely in our comfort zone when dealing with any of these circumstances.

The jobs which tax me most are those which involve any element of mental health.

There are a number of reasons for this.

Firstly, the boundaries of whether something is or is not a crime can become blurred. Does the person know what they have done is criminal or are they too unwell to be aware?

Secondly, it is highly unlikely that I am going to be able to resolve whatever is going on quickly.

Thirdly, I am not sure I can count on other agencies to support me whilst I try and resolve the situation.

Fourthly, and honestly, I don’t have the first damn clue about what I am dealing with nor do I really know how to resolve it.

Police officers are extensively trained. The initial training lasts months and you are then in a two-year probationary period where learning continues. You never stop learning as a police officer but training helps. Although there has been a reliance on “e-learning” over the last few years (something I loathe) officers are usually (eventually) brought up to speed on changes in legislation which will affect them. Training days are often built into the shift pattern and allow for dedicated learning time. Courses are available for any number of specialist knowledge or skills. It is a legal requirement to receive annual personal protection equipment (PPE) training (self-defence, baton, CS spray, handcuffs) and this training concentrates on the legal aspects of the use of force as well as its practical application.

In the vast majority of cases it would be safe to assume that if a police officer turns up to deal with an incident then that officer or their supervisors will have received some form of training in dealing with it or something like it. Unless it involves mental health.

I have a passion for this subject. This is the third guest blog I have written for Michael so let me be candid about why I am so passionate.

I am a police officer AND I am a mental health sufferer.

I have battled with serious depression for the best part of twenty years so I have some understanding of where it can take you. I can relate to the sense of utter despair, loneliness and hopelessness. I can understand the way a depressed person might think. I can feel their pain. I can offer insight and talk about how things can get better but this does not make me an expert.

Put me in a room with a suicidal person and I can make a pretty good attempt at talking to them and talking them around but the only reason I can do this is because of personal experience. I have never received any training in how to do this. For all I know I could be saying all the wrong things but the point is – I don’t know.
Change this situation slightly and put me in a room with someone who is floridly psychotic and I am no more use than the next person. I have absolutely no understanding of what is going on and can only look at the threats this person presents to themselves, to me or to others.

The vast majority of police officers do not suffer with depression or any form of mental health illness. They therefore don’t even have personal experience or empathy to fall back on. It is guess work pure and simple.

This wouldn’t matter if police officers didn’t have to deal with people suffering from mental illness but they do – and frequently.

When I started as a fresh-faced probationer I got involved in one particular mental health sectioning. I went along with the social workers and doctors and with other officers to a Section 135 warrant. I had absolutely no idea what was going on. No-one explained to me what the process was and we sat waiting for something to happen. Nobody took the lead and we watched as the assessment team talked to the patient in their own home for the best part of an hour, wondering the whole time why we were there. It seemed to be going nowhere. The doctors were telling the man he needed to go to hospital and the man was saying he wasn’t going. Suddenly, and without warning, my sergeant lost patience and pounced on the man. He told me to take an arm. There then followed an almighty bundle as we took the man to a waiting police van and drove him to a mental hospital. At the conclusion of this process I was still none the wiser as to what had just happened. This was many years ago but the event is lodged in my memory.

Since that day – almost two decades ago – I have received the sum total of zero training in mental health policing. In the same period of time, police involvement with mental health has increased from being relatively infrequent to occurring several times a day.

I work in an area where there is a mental hospital on patch. As an inspector who leads a team of 20 others I have had to make it my responsibility to learn about mental health policing fast. My officers have had the same amount of training I have had – none – and so someone needs to have a clue and, as the buck stops with me, it has to be me. I have been able to share my knowledge with my team and their confidence on the subject matter has grown along with mine.

Where did this knowledge come from? From Michael’s blog. Nowhere else.
Michael and I have become friends as a result of my interest in this subject. Not only have I read and absorbed his blogs and guidance but we have spoken many times on the phone, we talk quite often, we have even met.
Michael’s blog is the single biggest resource for all matters relating to policing mental health in the United Kingdom. It is gold-dust. Yet he has written it in his own time! No-one asked him to do it and if he hadn’t done we would be much the poorer for it.
How can such an important topic as this have been missed off the training list?
Is it right that most of the service now looks towards a blog, written by an officer in his free time, for guidance on issue which could have fatal consequences if handled with incorrectly?

Dealing with mental health issues is fraught with risk and danger. When I see someone behaving in a way which appears to suggest that they have a mental health disturbance. there are any other number of medical emergencies which could be the cause. Most of these are fatal – stroke, head injury, diabetes. I had never come to even think about mental health as a potential medical emergency until I read Michael’s blog.

I knew nothing of the problems of restraining a detainee with a mental illness. Restraining violent prisoners is one thing and we are taught to look out for the risks of injury to them or the possibility of positional asphyxia but I knew nothing of the other issues regarding restraint of a mental health patient. This too is classified as a medical emergency. If the restraint happens in a clinical environment there would have to be defibrillators on hand and doctors present who can ultimately rely on the use of a chemical intervention to subdue the patient. In custody suites we have ready access to defibs but nothing else.

I had been led to believe that a police station was a suitable “place of safety” for a person detained by police under the Mental Health Act. It really isn’t! The Royal College of Psychiatrists says not and the Independent Police Complaints Commission would prefer it if police cells were never used. But they are used routinely and they shouldn’t be.

I have no idea what to do when I turn up and am faced with an individual who is experiencing a psychotic episode or who wants to throw themselves off a bridge and yet it is me (or most likely one of my team) who is going to be first to the scene of such an event. I also have no understanding of the role of an Approved Mental Health Practitioner (AMHP) and it has become painfully apparent to me that they have no understanding of my role either.

This isn’t something we come across now and again – this is daily business. Sir Peter Fahy, Chief Constable of Greater Manchester Police, has said that “mental health is the single biggest issue facing policing today” and he is right. As other services contract due to financial and budget cuts it is the police who are increasingly likely to be the first point of contact in a crisis.

These are issues which require strategic intervention. The use of police cells needs to be addressed at a national and governmental level. The legislation relating to Section 136 of the Mental Health Act needs to be re-examined to include private places (or amendments made to Section 17 Police and Criminal Evidence Act to allow police to enter a property to protect life and to DETAIN to protect life.)

Work is underway on these subjects but progress remains very slow indeed. The correct changes at this level could greatly reduce the demands which mental health places on the police but, in the meantime, officers across the country are having to deal with things “as they stand” and without proper training.

So I am asking for two days. Two days’ initial mental health training for all police officers across the country. Followed by one day a year subsequent to that. For two days’ mental health training to be put into the initial curriculum for new officers in the future.

Two days probably isn’t enough but it is two days more than we get now and in that time you could cover a lot.
· Inputs on the legislation relating to the Mental Health Act and Mental Capacity Act
· Inputs on what to do when you DO detain someone under Section 136
· Inputs from Approved Mental Health Practitioners and doctors on the mental health assessment process
· Inputs on the various conditions and their presentation
· “First aid” training for mental health – including rapid de-escalation techniques, what not to say to a suicidal person
· Responding to allegations of crime committed by Mental Health Act patients
· Dealing with AWOL or missing patients – who is responsible for what and when
· Handling intelligence relating to persons who present a risk through mental illness

Separately I would ensure that the restraint techniques used in hospitals are taught as part of the annual PPE training for police. My understanding is that it involves a completely different set of tactical options and we need to know them.

I would encourage AMHPs to join in the training so that we could foster a better understanding of each other’s roles.

I would encourage joint training days with supervisors and managers from all the organisations involved so that the lines of communication can be “greased” at a tactical level.

What would the benefits be?
It would give us a police service with a far better understanding of a massive and complicated issue which they are otherwise dealing with blind.
It would lead to better working relationships between the agencies who should be working together.
It would create a far more sympathetic police service which might be able to use options other than force to deal with a situation
It would empower staff in their decision making and to recognise when the right thing is not being done.
It would improve the way that risk is managed
It would improve knowledge, understanding and leadership
It would lead to better patient care
It would save lives and prevent injury
It would save money (albeit uncosted)

There is no way you can cover all this using “e-learning” no matter how good that computer package is. It is too important and the risks are too great.

Two days would not make us experts but it would give us a much better understanding and a fighting chance of dealing with events properly.

Given these potential outcomes is “two days” an unreasonable request?

And if there is any question as to who might prepare or create this training package – you wouldn’t have to look too far to find two Inspectors who would jump at the chance to help.

This blog was written for and appears on mentalhealthcop

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12 responses to “Give Me Two Days”

  1. Me says :

    A really good post, I can’t comment on the main point with any degree of authority but from an outside perspective it certainly seems to make a lot of sense.

    I just wanted to thank you for sticking your head up above the stigma parapet and being honest about your own mental health. The more respected, trusted figures find the courage to do that, the better. I hope I’ll never find myself at the business end of s136, but if I ever do, I hope I’m lucky enough to get nabbed by a cop with your knowledge, humanity and compassion.

  2. Vicki says :

    A really sensitive, empathic and compassionate blog.

    1 in 4 have mental health problems so the chances are many of your colleagues will have had similar experiences but may not feel able to share their stories. Hopefully the more people feel able to talk about their own experiences of mental health, the more stigma can be challenged. And as for not being an ‘expert’, you are an expert through your own experience which is as, if not more, important.

    As a mental health nurse I have dealt with many situations with support from the police, including many positive ones where I have been truly impressed by officers attitudes and skills in de-escalating situations.

    Our mental health service provides awareness raising sessions for local police trainees ~ how about approaching your local service and inviting them to do something similar in the meantime?

    Thank you for caring.

  3. Paul Crosbie (@pnxb1019) says :

    Nathan, an excellent blog and your request seems very reasonable, I really hope it is listened to.
    I am a little sad things do not seem to have improved much since I retired some 6 years ago but with contributions like this from yourself and Michael I am sure things will get better. Good luck with it.

  4. Chief Scott Silverii, Ph.D. says :

    NC, I am moved, humbled, in awe and appriciative of your honesty and ability to capture depth in this brief artricle.
    You are the best of Blue,
    Scott

  5. Chief Scott Silverii, Ph.D. says :

    Reblogged this on Bright Blue Line and commented:
    My Brother in Blue from the UK @NathanConstable. Mental health & Cops. It’s incredibly written.

  6. Juli222 (@juli2221775) says :

    Nathan, what a wonderful post and testament to your perseverance, not to mention selfless service! Though I’m retired now, I’ve also “been there” and having been there was able to respond to the troubled souls effectively even without training.
    I’m glad you are putting this information out there which I have no doubt will save lives, much trauma of both sufferers and officers. Very well done!

  7. Domestic Princess says :

    A brilliantly written piece, which as a member of the public was both fascinating and worrying to read. I truly hope that the people who have the power to make the two day training happen, have read this blog. Also, so brave of you to speak about your mental health issues. The police force is extremely fortunate to have such an admirable person in their camp.

  8. Rachel Rogers (@DorsetRachel) says :

    Effective mental health training is about keeping everyone safe – public, patients and practitioners. I worked for many years in the Prison Service where the wider understanding of mental health was also very poor. I don’t recall ever having any specific mental health training though we now know that the incidence of mental illness in prisons is very high. Male prisoners are 14 times more likely than the general population to have two mental health disorders and female prisoners an astonishing 35 times more likely. Given that these prisoners will all have passed through custody suites, it gives some indication of the levels of mental illness that both police and prison officers deal with as a matter of routine.

    In this context, you are clearly right to suggest that a minimum of two days’ training in mental health and learning disability should form part of a police officer’s initial training. It will, however, be some time before the College of Policing is convinced of this need and even longer before the training programme is amended accordingly. In the interim, I am interested in the level of support that exists for the NCALT e-learning Mental Ill Health and Learning Disability training package. Whilst I accept that e-learning is by no means ideal, compulsory completion of the online course would at least go some way towards raising awareness of key MH issues and concerns.

    When i read the IPCC report into the stabbing of Sally Hodkin by Nicola Edgington, I was particularly struck by paragraph 138 which reads: ” It is the responsibility of the Borough Commander…to ensure every police officer on the borough has completed the e-learning package for mental health and learning disability.” This appears to be part of Standard Operating Procedures rather than a recommendation.

    The sentence in question indicates to me that it is compulsory for officers – in the Metropolitan Police Service at least – to complete the NCALT package. However, I have spoken to a number of MPS officers who appear to be unaware of the existence of the NCALT package. This raises questions about how long the course has been compulsory, how the training requirement is cascaded into probationary or annual staff reports, how compliance and completions are measured and how borough commanders are held to account.

    Furthermore, the IPCC report gives no indication as to whether or not completion of the NCALT package is compulsory in other forces. I appreciate that police forces operate on a quasi-independent basis but it would seem odd for something of such fundamental importance to public safety to be obligatory in one force area and not in the next. I wonder if you could shed some light on this matter….

    All in all, a fantastic blog which raises a really important issue not just for the police but for the community as a whole. And there will undoubtedly be many officers who are extremely grateful to you for having the courage to put your head above the parapet in acknowledging your own experience of depression. That is an achievement in itself. Thank you.

  9. Mark Naylor says :

    Boss, absolutely 100% spot on post and this is now a daily challenge, at least where I work. The time is right for this to be addressed, hopefully before the next tragedy. Cometh the hour, cometh the blog. Keep them cometh-ing!

  10. Mike Faulkner says :

    Nathan, as the custody training skipper for D&C, whose partner is a general adult psych who has a massive experience of MHA both in and out of custody, we have produced a 1 day package that is currently being delivered to all custody staff…. The content almost mirrors what you propose, and delvered jointy, so police and nhs. We also have interest from comms and initial training, and hope to get response involved too. Interested??

  11. moira says :

    Wow, I am in Canada and presently struggling huge with this issue of policing and mental health. We have something called a Mental Health Act here in Ontario and it needs seriously revised. The police need serious changes to their approach, atleast from my perspective for sure. It just seems all over the map. My son put a gun to his head to take his life and the police didn’t care, they took him to jail! They charged him with being a criminal. I really struggle with that and a whole lot of other abuse, the cops won’t do a damn thing about. Yet, because I have these devastating annoying thoughts of suicide, they want to brandish me a criminal too. Handcuffs and thrown in the back of the cruiser is just their protocol! You wouldn’t believe how much talkin I have to do to keep myself safe from the people who are supposed to keep me safe! Quite frankly, it’s crazy. I intend to not shut up and start educating these cops. One actually had the audacity to ask me if I have these thoughts for attention! They’re my thoughts. I can’t do anything about them! I can only control how I respond to them and the behavior I place around them. I do an amazing job of it, in the face of crushing complex circumstances. I tried desperately to get our Community Policing Officer to put a Dosier type of document beside my name or something I could have to carry with me. I got tierd of being retriggered with every explanation they would force me to make, to see if I was ok today! I never call them to help me this way. Other people do. I’m not prepared to lie about my reality. I just keep reassuring everybody I’m ok and safe today. It’s ridiculous. We have all of these National campaigns about speak up, break the silence, let’s talk, care to share, and whatever else; yet, we make it so incredibly difficult. The Stigma is so bad that little old me, 5.2 in a business suit, chatty and obviously ok, was so frightening for the paramedic that he limited patient contact for paramedic safety, while a cop sat beside him! Seriously. This was all because he heard from another who heard from another who heard it from another I was gonna jump in a creek six hours earlier. I wasn’t and I had just spent 3 hours with a local support group and was simply moving my car. I was so ok and all the supports I had in place, for me, that day, were quickly taken away. The Community Policing Officer with all his expertise in Mental Health thought it safer for me to spend seven hours in Emergency. Finally, I get home, hugely traumatized because those in emergency believed what someone else told them, which was completely fictional. Two weeks later, the boys in blue themselves and the paramedics get to duke it out to put right my legal health record. This has done nothing but hurt me and reinforce so much, that is not good. Honestly, thank you so much for your humbleness. I wish there was more of this and a willingness to learn. I am going to do my best to capitalize on the confusion that has personally impacted me, to educate my local police and paramedics now too. I wasn’t even near a cruiser. Wish me luck, I think I’m going to need it.

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