Expected to Deal – Set Up to Fail

This is a reproduction of an article I wrote for the last edition of Greater Manchester Police Federation’s Magazine “Manchat.”

As always I thank my friends at GMP for allowing me to have another channel through which to speak.

The Mental Health Act celebrates its 30th year in existence in 2013 but you will forgive me if I don’t put up the bunting. At the moment it is arguably causing the police more work and placing officers and detainees at more risk than any other piece of legislation we commonly use.

Police involvement with mental health matters has increased dramatically over the last few years and the situation seems to be getting worse rather than better.

There are very few areas in the country with sufficient bed spaces to accommodate patients for assessment. Where these spaces exist you will find that many mental health trusts have put barriers in the way which makes accessing them very difficult. The term “Emergency Duty Team” is possibly the most over-optimistic title I have ever come across.

The upshot of this is that whilst demand has risen – provision hasn’t and it is the police who have been called upon to plug the gap.

Coroners, the IPCC and a number of charities have been challenging and criticising the police for their handling of the incidents following the deaths of Mental Health Act detainees in police custody.

More recently, the Metropolitan Police commissioned Lord Victor Adebowale, the Chief Executive of mental health charity “Turning Point”, to conduct an independent review of their handling of mental health detainees over a five year period.

The results were damning. In that timeframe up to 50 deaths were potentially attributable or linked to police involvement. In six of those cases the direct cause of death was linked to restraining the person in a police van or cell.

The Adebowale Report demands change and rightly so.

Fundamentally, the problem is that police officers are being asked and expected to deal with a medical emergency without the necessary understanding, training, equipment or legislation to protect or assist them.

When it comes to restraining mental health detainees police officers are actually entering into a world beyond their training and experience. Whereas we are taught to use pain compliance and mechanical restraint NEITHER of these techniques are advocated when dealing with restraining patients. There is good reason for this – the risks are different and inherently more dangerous.

Police are also left with the awkward situation of having no powers to deal with a mental health crisis in a private place. We can use Section 17 PACE to force entry but once inside, officers are forced to criminalise the sick by using Breach of the Peace inappropriately.

The Government are taking notice. In her keynote speech to the Federation Conference, the Home Secretary announced an urgent cross-department review of mental health provision. Tom Winsor announced that HMIC will be reviewing Section 136 of the Mental Health Act.

It is now being realised just how much demand (approx. 20% of police work is directly linked to mental health) is being diverted to the police when really it is the function of the NHS.

There is a unique opportunity and a public mandate to make significant improvements to the way in which mental health crises are managed.

The NHS should be expected, resourced and equipped to deal with these situations and police involvement should be reduced to absolute necessity – with unrestricted handover to the NHS at the earliest opportunity. Officers must be trained in recognising mental health issues and how to deal with them properly and safely.

In the meantime we are set up to fail – and that simply isn’t fair or right to either officers or, more importantly, the patients we are dealing with.

For further discussion and information on these topics you can follow me on Twitter @NathanConstableor my blog.

I also highly recommend following @MentalHealthCop This is the twitter feed of Inspector Michael Brown of West Midlands Police. He is widely acknowledged as the national front-line expert on mental health and policing and his blog is the best training resource in existence and should be required reading for all operational officers.



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12 responses to “Expected to Deal – Set Up to Fail”

  1. The other Frankie says :

    Every time I have been involved in requesting the emergency team recently for people in crisis in their own home, the first question has been ‘can you not just arrest him for something?’ Yet it is US who are criticised for criminalising people?? If someone calls us saying they are going to do themselves harm, the last thing I want to do is arrest but it is often the only option, other than leave them to potentially get on with it. Infuriating and as you say, becoming more and more frequent!

  2. mike says :

    Again No.MH services see people who are ill. Clear psychosis or severe affective disorder ie.mania. NOT 99% seeing police who are not ill.
    What makes you angry/uncomfortable is that there is no easy solution/no law /not black or white therefore natural instinct is to pass onto other agency. There is no evidence for treating such ppl. Society will always have problem ppl who noone has answer too. Suck it up.

    • nathanconstable says :

      If that is the case then why have the legislators seen fit to create a law which places the police under a positive obligation to protect life.

      It is not as simple as “suck it up” – I am not naive enough to think that there aren’t people who don’t fall into one bracket or another.

      You say I am all about “black and white” but come out with a sentence which says that MH services only deal with people with psychosis or mania. THAT is a black and white definition.

      You also miss the fundamental point – if the police are to be required to deal with crises of these kinds then rather than “sucking it up” I would sooner that officers be properly trained and equipped to deal with it.

      That is in the best interests of everyone concerned – not least the people in crises – mental health generated or otherwise.

    • Sectioned Detection says :

      Then why does most of our contact come from people asking for help. The help they’re not getting from the NHS. You’ve prattled on in other bloggs about we see MH patients as ‘too difficult’ but you failed to suggest an alternative.

      So how would you like me to deal with a person who’s taken on overdose on their home but won’t go to hospital?

      • mike says :

        Often there is NO alternative .As many physical illnesses cannot be cured /ameliorated neither can some MH probs. Particularly personality/substance use type presentation. Not easy to accept or popular. Unfortunately happens to be true.

  3. Mal says :

    Less of the “prattle” comments from SD perhaps and more of the constructive comment.?

    Surely the point is that: the person isn’t a criminal or committing a criminal act, so why should it always be a police response matter?
    s. 136 is used inappropriately within the system, and it’s not the local response bobby’s fault. It’s always loaded onto the grass roots officers though. It should not be their “job”.

    Why should police officers, constantly be used to support a failing MH support system? There should be a properly resourced Health response to this sort of thing, but there isn’t.
    People in MH distress should only have police officers there as a matter of last resort. The fact is that police are there often as first responders when they shouldn’t be. it’s increasing not decreasing imho.
    Police get calls for all sorts of things, the fact is, that it is only the police and the Fire Service that will actually consistently turn out these days.

    SD, respectfully, your question would be better framed to the Health or Home Secretaries.

    • Sectioned Detection says :

      Thank you but my comments stand as the poster has made other inappropriate comments, Prattle, on other blogs.

      Care to explain what is loaded into RPT officers that make them abuse Sec 136?

      Finally it the fire service always turned out why don’t the ambulance service use them to force entry to addresses? It’s because even they say no to some jobs!

      • Mal says :

        The Fire Service do in fact force entry if there is a persons reported situation. My understanding however of 136 is that it could not be used within a persons home/ private premises?

        Re officers and 136. I was not criticising officers at all. Far from it, and apologies if I gave that impression in earlier reply.

        Response/ other officers. at times, are used imo to prop up a failing MH system.
        e.g. distressed person calls Crisis team as per Care Plan. Crisis team call police on a concern for welfare, when really it is medical support needed.
        MH distress does not always equal being violent, far from it.
        Crisis team haven’t the staff, but call police as a backside covering exercise for Crisis team, knowing officers will take said person to hospital for them on 136, or as a last resort to a police station cell, “as there are no beds.”

        That’s why I think use of 136 is inappropriate in some circumstances. Hope that is a bit clearer, and again apologies if I gave the impression that I was criticising officers who find themselves in such a frustrating situation.

  4. Neill says :

    As Mike suggests, many avenues of life would be much simpler if they were clearly divisible. The lines between mental and physical health are blurred, linked and often obscure. The line between criminal misconduct, and conduct beyond the bounds of ‘ordinary’ society perhaps more so. In policing we talk about the intent to commit a crime, the “Mens Rea”, the malicious aforethought. In medicine we speak of the capacity of a competent adult to comprehend and interpret information, use that information to make a reasoned decision and to communicate that decision.

    Mental Health is not so simple as to allow divisions between the well and unwell, or even to characterise certain behaviours (psychosis and mania being the suggested examples) as within or without the remit of the NHS. An individual with bipolar disorder may be asymptomatic with appropriate treatment, but that does not make them “well” any more than a cancer patient receiving treatment for their physical condition. Diogneses Syndrome (i.e. hoarding with severe self-neglect) displays neither manic nor psychotic traits but could come to the attention of any of the emergency services first. Perhaps the police get called by a concerned relative because they are no longer answering their phone, or the ambulance service are first on scene but need assistance to enter the property? It falls well within the definition of “a danger to self” and is a manageable condition but if diagnosed late, may need complex medical and mental health input.

    Conversely those who come to police attention for alleged criminal conduct may themselves be at need of diversion into acute mental health services. Is their behaviour merely a consequence of drugs and alcohol, or are they attempting to self medicate against an untreated mental health condition?

    The NHS has a role to play, with the police in dealing with everyone as an individual. It is not merely about passing the difficult cases to another agency. It is about working in partnership to ensure the safety of the individual and the general public. Regrettably, this is one partnership that does not always go as we would hope.

    • mike says :

      In reality thresholds for treatment exist. While I agree M health services do not exist in a vacuum ,it is quite an idea to promote the massive expansion of services to treat 000s where no evidence base exists for intervention. Personally i’d prefer money spent on police officers.

  5. Mal says :

    But again, MH distress does not equal violent behaviour or criminal behaviour. Capacity and mens rea are not identical in definition at all, but not the place here to have a discussion on an academic point of jurisprudence.

    People call the police for all sorts of things, including their girlfriend blocking them from Facebook.

    I have seen hospital doctors and staff call the police, expecting them to arrest distressed patients on spurious charges of breach of peace or criminal damage. Said person needed a secure ward ( bed not available, so need to get rid) not a cell.

    The criminalisation of distressed people sometimes comes from lack of support by the MH/medical people themselves.

    Admittedly, there are, however, people who act criminally and hide behind an MH defence, as most desk Sergeants will wearily relate.

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