If “Street Triage” Is The Answer – What Is The Question?
Today it was announced that the pilot “Street Triage” scheme which has been running in Leicestershire and Cleveland police areas will be rolled out to several new forces so that the trial can continue.
Despite asking, I am not fully conversant with exactly how the scheme works but from what I understand it involves a police officer and a psychiatric nurse working together and attending calls regarding a mental health crisis.
This approach was mentioned by the Home Secretary in her speech to the Federation Conference recently and I remember thinking “to what end?”
Several times today I have put up questions on Twitter asking whether or not there was any tangible evidence of success in this pilot scheme. I have not actually received a reply.
That is not to suggest that they aren’t achieving great things – the very fact that the pilot is being extended indicates that something is working – I would just be interested to know what success looks like.
• Are the numbers of people being detained under Section 136 falling in areas where these joint patrols are working?
• Does the presence of a CPN mean that alternative pathways are found which obviate the need to take someone to a place of safety?
• Does the presence of a CPN lead to a faster (or indeed different) response from other agencies within the mental health services?
• Are police spending less time and resources dealing with mental health issues as a result?
Some of the responses I have received have hailed the fact that this is “joint-working” and it is therefore better than what existed before by default. Others have suggested that anything is better than what existed before and surely this deserves to be given a chance.
It is also interesting that the vast majority of people speaking in favour of the scheme on Twitter have a clinical background.
Let me be clear – I am not suggesting for a moment that the idea does not have merit or value and I am all for partnership working.
I have two principal issues with the scheme:
1. It still requires the presence of a police officer to deal with a medical issue. In what other medical situation is this the case?
2. If the person still needs to be detained under the Mental Health Act – where do they end up being taken? Does the presence of a CPN mean they go direct to a hospital?
Additionally, if the number of actual detentions under Section 136 is indeed coming down in these areas – what proportion of those who ARE detained still end up in police cells?
In other words – whose workload is actually diminishing?
As if by magic, I came into work today and was told by my colleague of his dealings with a mental health issue during the day. I have spent some time in recent months explaining mental health issues to my peers and they are all buying into it – which is pleasing.
I asked whether he had adopted the three steps we have recently introduced when considering detaining someone under 136.
My colleague then explained that, in fact, we had been called to assist a Community Psychiatric Nurse who was meeting with the service user in a local café. This was a pre-arranged meeting – a chance for the CPN to see how the patient was doing – and it was obvious to the nurse that the patient was not doing very well at all. So much so that the CPN believed that the service user needed an assessment and quickly.
My colleague had used all the three steps. He had checked the person’s history both medical and on the Police National Computer – thereby assessing risk. The nurse was able to confirm that the person was physically well and that the behaviour being displayed was entirely the manifestation of mental illness.
The nurse then made a number of phonecalls to the local Crisis Team and others. This was to try and secure access to the hospital place of safety and to discuss options.
My colleague said that having the nurse there was massively beneficial. They were able to bounce ideas off one another and, because his knowledge of mental health issues is quite high (for which I take all the credit 😉 ) it was a meaningful discussion.
Except – guess what.
Where do you think the person ended up being taken?
Yep – a police custody unit. Where they remained for several hours under the watchful gaze of a police officer on constant supervision.
There was no space for assessment at the local mental health hospital and, even though my colleague considered options to improvise a place of safety they were simply not viable in the circumstances.
So the police were called to assist in the initial stages and had to manage the initial detention of the person for several hours afterwards. The whole time, we knew, because a Psychiatric Nurse was telling us, that this was entirely a medical matter and one of mental health.
Sick person ends up in cells yet again.
This is what concerns me about the Street Triage idea. There is no doubt that the presence of the nurse was incredibly valuable (I should point out that I do not work in a pilot area – it was just the circumstances which meant the nurse was present) but other than being able to “triage” the reduction in work for the police was nil. Other than confirming some medical facts for my colleagues they ended up dealing with it as though the nurse had not been there at all.
The outcome was exactly the same – there was no bed space for someone who we were being TOLD was having severe mental health disturbance and they ended up in the hands of the police.
Triage no doubt has values. It will confirm things. It will mean that a trained professional is present and can offer guidance and educated and expert opinion at the scene.
If the overall outcome is that the use of Section 136 detention is lowered because a viable alternative can be identified by the CPN then this is good. But – if the same proportion of those who do need to be detained end up in a cell because there is still a lack of provision elsewhere – then this is less good.
Today, my colleagues had a CPN present who told them everything they needed to know and tried very hard to get things in place. Police still ended up detaining, conveying and then supervising the person in a cell.
It is vitally important that the issues surrounding chronic lack of provision are addressed at the same time. We need to work out what the police “exit strategy” is for Street Triage. Is this something that is and will always be dependent on police presence or are we looking to hand this over to the NHS completely in time?
Street Triage is a stepping stone but it cannot work in isolation. I am not unsupportive of it. My concern is that its use will be seen as “the answer” when in fact we aren’t really concentrating on the right questions.
UPDATE – though the CPN felt it necessary to (rightly) call the police to assist; even though the CPN felt that the person needed immediate care and control and was a huge risk to themselves – having been held in police custody for several hours – the person was assessed and NOT sectioned. I can only wonder why.