Mind The Gap

Panorama’s “Locked up for being ill” programme has certainly generated some conversation this week. The timing of its broadcast dovetailed neatly with the Superintendents Association annual conference as well as the Police Federation’s Custody Forum. You only have to see the tweets coming out of each of these gatherings to see how highly mental health has featured on the agendas of both.

Following the programme I hosted my first “twitter chat” with the hashtag #mhpolchat. The reaction to that was quite staggering. A friend of mine who is not a police officer watched the chat develop through the evening and spoke to me about it afterwards. Although some of the detail was lost to them they made a startling observation “Everyone seemed to be saying the same thing.”

The broad themes which developed were:

Lack of training for police officers.
The unsuitability of police cells.
The length of time it took for assessments to take place.
The lack of provision for bed spaces which meant that cells were all too frequently used.

Sub issues centred on the use of restraint and healthcare provision in custody units.

Particular comment was saved for the various speakers.

The interviews were highly edited, perhaps to create controversy, but you were left with the impression that Chief Superintendent Irene Curtis was calling for the complete end to the use of police cells as a Place of Safety.

Irene was, in fact, calling for this but the other parts of the interview where she spoke about partnership working were edited out.

We were then left with Irene calling for an end to the use of police cells – Dr Leslie Stevens gasping in horror at the suggestion that A&E was a more suitable venue and then Norman Lamb MP claiming it was the police “abdicating their responsibility.”

If that was the intention of the edit then the rest of the programme showed compassionate but largely bewildered officers dealing with people they have had little or no training to deal with and other agencies showing all the urgency of continental drift in coming to assist them.

Although my observer noted that just about everyone on #mhpolchat was saying the same thing it would appear that elsewhere on the Internet there was another debate raging which gave a totally different view.

This was highlighted by FME Dr Jenny Holmes in a blog she wrote for @MentalHealthCop.

Dr Holmes has written for me twice already and I greatly respect her opinion and observations.

Dr Holmes observed that the points being raised by the mental health professionals on line were almost completely opposite to those on #mhpolchat.

The primary comment being made was that the people shown on the programme were not mentally ill.

Indeed I had a conversation on Twitter with someone who I presume to be mental health practitioner which left me a little stunned. This commentator was basically saying that not all challenging people are ill and the police are only making a noise about all this because we don’t know what else to with them.

There appears to have been an overwhelming sense within the mental health profession that the programme unfairly portrayed the mental health profession.

As a police officer I watched the show and thought “Welcome to my Saturday night.”

Whether you are a MH professional, a police officer or a watching member of the public the programme showed one thing very well – reality.

What the subsequent online discussion and reaction showed was a problem, that for me, is equally as big – if not bigger – than the arguments about where people in crisis should go. It showed the massive gulf in thinking between two agencies who each have an important role to play in the well-being of the most vulnerable.

This is a strategic issue which is just as big as how many bed spaces there are or whether someone is transported in an ambulance.

What you have is a situation where the police are saying “we don’t really know what to do with this person and we aren’t trained or equipped to deal with it” whilst the MH professionals are saying “this person is not ill and therefore it is not for us to deal with.”

If alarm bells aren’t ringing in someone’s head now then they really should be because what you have is a large section of the community who fall neatly between two stools and for whom there simply is no coping strategy. This is failure demand of the first order.

Look at the example of Dave in the programme. Multiple suicide attempts and now practically institutionalised in a mental hospital. What if something had been done differently after the first or second suicide attempt?

Look at the example of Tyler in the programme. He was described as a “human storm” and was shown being escorted into custody, in restraints, spitting and snarling before being taken to a cell and forcibly restrained.

Why had the police arrested him? Answer because they didn’t know what else to do with him.

He was arrested for “threats to kill” but I can guarantee (because I have been there so often) that this was a means to an end. There was no power to take him away from his address and there was no likelihood of the “threats to kill” progressing anywhere criminally.

This was an absolute example of what Michael Brown calls a “do something!” scenario.

Here is a man who is clearly in some form of crisis and who cannot be left to his own devices. The “safest” thing to do is lock him up but there is no power to arrest someone for their own safety.

He then ends up kicking, biting and angry in a police cell whilst several officers hold him down with mechanical restraints and the application of sheer force.

I would argue that the safest thing to do is to put someone in that state into a soft walled room where they can do themselves no harm and let them burn out under close observation.

The programme even showed the difference between a police cell and a room you can get well in. Police cells are hard, bare and cold. We watched at least two detainees damaging themselves on the walls and doors. The only way current way to stop that is restraint. Which is just as risky.

The programme also dipped into the world of Street Triage – or – more cynically, the Mental Health Nurse Rapid Transit and Security Service. The example shown on TV possibly wasn’t the best because it showed only one aspect of the work.

Two police officers attended, with a nurse and went into someone’s house – where they were all powerless.

In the case shown the person they had gone to see was apparently out of danger and after a period of time everybody left. It was rightly pointed out that this was a decision that the police would previously have been extremely uncomfortable with. The outcome was that the police did not then end up transporting the person anywhere or arresting them for anything and the Crisis Team had no involvement at all and nor did the MH hospital. The point is that the police DID have involvement and in the circumstances shown they were absolutely without legislative powers to deal with anything.

Lets examine a different outcome. Say the person in the house wasn’t out of danger. Say they were in crisis. The police were still powerless to deal and the situation would still have required a warrant. Which the nurse could not issue. She would have had to ring the same resource strapped Crisis Team and ask them to do it. Would a nurse ringing have sped the process up at all? It still requires physical attendance at court, delivering the information to a magistrate, having the warrant signed and then a team assembled to get to the address to assess the person.

In the meantime the two police officers and the nurse would have been required to “deal” with whatever was going on in the house – just as they are now.

Street Triage does not address these circumstances at all not does it deal with restraint, transport or ultimate destination. It is for these reasons that it worries me that the Government seem to be talking about it as some kind of silver bullet.

Street Triage only deals with ONE set of circumstances and still requires the presence of police officers.

Let us return to Tyler and the chap who was repeatedly banging his head on the cell wall. Whichever way you look at it both of those people were in “crisis.”

It could have been self induced through alcohol or drugs, it may have been psychosis but the cause at THAT POINT really isn’t important. That can be determined afterwards. Both of these people were forcibly restrained because there was no other way of stopping themselves from hurting themselves or others. Whatever the cause – the person was in crisis and their behaviour needed immediate management.

For me – the polarisation of opinions about who is responsible and the environment and manner in which a person is controlled and managed are the things which need most urgent attention of all.

Street Triage doesn’t go anywhere near far enough. The answer for me is a 24/7 multi-agency response team who can deal with “crisis” whatever it’s cause. Medical specialists, MH nurses, doctors and police who can attend together, with the right legislation behind them, who can intervene, assess and then deal with someone safely and effectively.

That person then needs to be taken to a safe location in the safest form of transport until the crisis has passed. During which time they can be medically monitored.

This facility does not exist and neither does the team of which I speak.

Yet the demand for it is clear. Abundantly clear – and growing.

We need to get beyond this issue of remit – we need to look at “crisis” holistically because the risks are equal whether it is psychosis or drug induced.

We need crisis teams and crisis rooms.
We need experts who can evaluate someone DURING a crisis and not several hours after it.

The programme showed definitively that there are many people in police custody who are experiencing “crisis”. The discussion afterwards demonstrated that “crisis” seems to fall into several definitions and this then leads to very linear responses and arguments about remit.

It also showed that what currently exists in terms of provision is hugely and dangerously under resourced and inadequate.

Until something is done culturally and in terms of training, legislation, resourcing, equipment and provision we can only try our best to span this void.

In the meantime – mind the gap!


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12 responses to “Mind The Gap”

  1. Peter Kirkham (@Peter_Kirkham) says :

    Excellent blog. Sums up the central issues perfectly.

    Worrying that the MH professionals seem so willing to simply abandon any responsibility for those in crisis who MAY be suffering from “proper” MH issues and who are DEFINITELY suffering from some sort of minor / temporary MH issue. Utter dereliction of responsibility.

    The main thing is that the “crisis rooms” MUST have immediate access to full medical support to avoid further deaths in custody due to positional asphyxia / excited delirium and other restraint & detention related issues. And that must mean that they are at medical facilities.

  2. bc (@444blackcat) says :

    I have spent years asking for a 24/7 team with AMHPs, CPNs and Doctors who can respond to a crisis immediately and I’m not alone in this it’s getting the commissioners on board, that’s the stumbling block. Also as Inspector Brown and others have said Mental Health Services are set up to deflect demand not attract more work despite how shortsighted this may seem

  3. J says :

    I hope you find this appropriate to your blog more of an eg of crisis service failure.

    2 weeks ago being in a mental health crisis, expressing suicidal intent, on my own with previous suicide attempts to my name, I was visited by 2 police officers having been asked to do a welfare check by my local m h crisis service who had failed to contact me on the phone (my mobile was on silent by mistake). It was 11pm. I had spoken to m h services twice that day.
    I had intended to drive away in my car and end my life and the officers had arrived just as I was on my way out with suicide notes at the ready.
    They called for an ambulance who arrived and decided that I needed a proper assessment. I refused to go to A&E because I knew that it would be a brief chat with psych liaison and then a long walk home. To be frank I just wanted everyone out of my house so that I could go on with plan A.

    Next was a call to the 24/7 crisis team, the woman spoke to me quickly and then talked to the paramedic who put the phone on loud speaker. Mutterings about ‘not fit for purpose’ were some of the more repeatable comments from all 4 people now in my hall. The crisis team said yes they were able to come out and the’ in 2 hours time’ was rapidly changed to ‘4 hours at best – we have a big area to cover’. The air was blue. Paramedics said they couldn’t wait 4 hours and looked meaningfully at the police. Not a lot of love lost between police/ambulance services and m h services at that point.

    Ultimately I was persuaded to go via ambulance to A&E where as predicted I was told to be more positive and sent on my way at 3.30am exhausted, with a 5 mile walk home. I wish I could meet with the lovely paramedic who assured me ‘I would get help’ and with whom I had a small bet that I would be walking home later.

    Later that day I proceeded with plan A and attempted suicide. As you can see unfortunately I failed. Crisis help afterwards was patchy and visits discontinued a couple of days later. A week later I tried again twice within 24 hours and only then did I get offered a hospital bed which by some miracle was available.
    Please don’t take me as another ‘attention seeker’ who frequently threatens suicide I suffer from PTSD and have been in such extreme distress the last few weeks that I remember very little of them but I do remember that night because I felt very calm.

    By the way one of the police officers had a keen interest in mental health and asked me more searching questions than many a mental health professional has. He cared and was kind. Thank you for that.

    • lindyb says :

      J, I am not a MH professional, paramedic or police officer, just someone else with MH difficulties. I’m so sorry to hear that you are suffering so much at the moment and even sorrier that you have been caught in the middle of the current problems with different services not knowing how to cope with people in crisis. A friend of mine was similarly left to walk home in the early hours from A&E. In her case, she found that her front door had been boarded up when she got home so she couldn’t even get in.
      Please take care J and keep holding on, if you can.

    • nathanconstable says :

      I am so sorry to hear of your personal situation.
      Your story describes the one of the sets of circumstances that bothers me the most. There appears to be a real lack of “immediate aftercare” in many cases.

      I sincerely hope that you can find some peace and enjoyment in life. Thank you so much for bravely telling your story.

  4. carl hellawell says :

    As a mental health nurse working in police custody, I do not condone the judgemental view that the people portrayed in the Panorama programme were not mentally unwell. There simply was too little evidence on display to form a definitive opinion. What this blog does highlight is that some of the presentations were not ‘normal’ and highly risky and puts the police in a very difficult position. I have followed the discussion (especially on Twitter) with interest and am left with a view that a lot of people don’t really understand the pressures on the police and the Panorama programme has to be applauded for providing some insight into the challenges for the police and the lack of responsiveness from health services that leads to vulnerable individuals needlessly suffering and, arguably, at increased risk to themselves due to the environment they are in.

  5. Rob Fitzpatrick says :

    I watched Panorama with great interest. The programme showed two things – the arbitrage which people with complex needs have to exercise with the police and emergency services in order to get ‘support’ – and also how incidental is the well-being of such people to ‘mainstream’ mental health services.

    In my opinion the issue runs much wider than a lack of 24/7 crisis cover – but also speaks to a deeper cultural and professional hostility within the mental health world to individuals who do not meet the criteria for mental ‘illness’ on account of perceived substance misuse and/or ‘personality disorder’. Despite frequently suffering very high levels of distress and presenting major challenges to a range of different agencies, these people are just not seen as being the remit of mental health services – resulting in the Police becoming default providers of respite care.

    What needs to change, in my opinion, is a move towards agencies working together better, and earlier, to prevent crisis and crime – and for greater awareness and training around complex needs, particularly in around personality disorder. Without this, rather than being a solution, ‘street triage’ and ‘liaison and diversion’ initiatives run a risk of magnifying conflict and dispute between the Police and mental health services.

  6. Myrtle says :

    “The programme even showed the difference between a police cell and a room you can get well in.”
    – My local place of safety is ok for daytime, but for overnight the person is locked into a room that is EXACTLY like a police cell, except a bit bigger. There’s a plastic mattress on the floor and a toilet but no sink to wash your hands or loo roll. Having been arrested when unwell and placed in cells, just seeing that room frightened me.

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