A Long Way To Go

It’s been quite a while since I wrote anything blog-wise, let alone anything on the subject of mental health and policing. That is not to say that I haven’t been watching closely what has been developing though I haven’t been as close to it as perhaps I once was.

I have also spent 4 months away from the front line of policing whilst doing some project work for the force I work for. I returned to my usual role as a response team inspector last month.

My interest in all things related to mental health and policing has never waned although it was almost beaten out of me. I had to stop being involved in it for a while but, having returned to front line duties and having taken an enforced absence I am, perhaps, distant enough and well-placed enough to see whether anything HAS changed.

It is often the case that when you are very close to something it can be harder to see it changing. This is the case with children. It is not until you see a relative who hasn’t seen them in a while, and they say “haven’t they grown”, that you realise that they have, in fact, grown.

It is also possible to be so close to something, so entwined in it, that you can believe that things are changing and they aren’t. Or not in the way you think they are.

There has been much talk in the last year about the need for parity between mental and physical healthcare; much talk about Crisis Concordats and many, many summits and meetings.

In order to progress with any new project or initiative it is almost always necessary to have meetings. It is the only way to get key players around a table and agree a way forward. The key, however, is not to mistake the meeting itself for progress. Or not to believe that the occurrence of meetings alone constitutes progress.

The same can be said of protocols and written agreements. Whilst it is always an achievement to get senior partners from different agencies and bodies to “sign up to something” the mark of success and progress is not the presence of a document and the signatures of strategic figureheads. Success is how this translates tactically and operationally and how things improve “on the ground.”

It is important that I stress that I realise the importance and need for meetings, agreements and cross-agency sign up.

Unless the right people meet up and agree to change something – then nothing will change.

I have nothing but praise for the senior police officers, police and crime commissioners, front line practitioners, NHS representatives, charities and politicians who are trying to do something about the crisis in mental health provision in this country. I thank them from the bottom of my heart for talking about something that, a couple of years ago, barely registered on anyone’s radar.

There is no doubt that the one thing that has progressed in the year or so since I touched on this subject is the fact that it is being discussed. And discussed at the highest possible levels.

What concerns me, as someone who has had no part in those conversations (certainly of late) is whether there is anything tangible to show for all the summits and news coverage that the subject is now generating.

My viewpoint will be coloured by local experience. I do not work in an area where there is a triage scheme in operation. Only recently has there been an increase in provision for Section 136 assessment. There has only been one training session on the subject and even that has not been universally rolled out across my force. The local service provider for mental health care is the same as it has been for years.

I am sure that there will be places elsewhere in the country where progress has been faster and more far reaching. But this, in and of itself, is part of the problem. There is no consistency – even within force boundaries. It is still a postcode lottery where you cannot expect the same quality of service in one part of the country as you can in others.

I am sure that in some forces there are officers who are noticing vast improvements in provision, a reduction in workload and a more responsive service from partner agencies.

I believe that this is what the Crisis Concordat is trying to address. A national agreement to a certain level of standard provision which should eliminate this “it depends where you live” problem.

However, even in its creation the inconsistency is evident. I am aware of the existence of a map which has colour coded the various counties according to how they are progressing in the sign up to the Crisis Concordat.

Let me be clear that my understanding is that this map only shows progress towards sign up to the Concordat. Not implementing anything in it. With less than a month to go, most of England and Wales is still showing red.

Once they go green it means that the actual work of implementing the measures in the Concordat can begin. Which could take years.

There has been a lot of negative coverage in the press lately about mental health services and over reliance on police. The most recent, and probably the most high profile, was the tweet from an ACC in Devon and Cornwall who bravely announced that they had a 16 year old girl in police custody because there did not appear to be any suitable bed for her anywhere in the country. This went viral and then it made national news.

Funnily enough, this seemed to concentrate the minds of whoever was responsible within the NHS and within hours a “suitable bed” was found.

We then learned that the bed was on an adult ward. So really, this poor young lady had been moved from a wholly unsuitable location to one which was arguably better but not really right either.

I have no doubt that for many hours, front line practitioners from all agencies had been trying hard to resolve the situation.

I have no doubt that the problem had been escalated through the various organisational hierarchies to no avail.

In the end – no doubt out of desperation – the ACC took to social media and the problem was sorted.
All it took was a reputationally damaging tweet and national embarrassment.

Let us be frank, if that is what it takes to get a system to “work” then the system is broken.

Jeremy Hunt was asked questions about this in the House of Commons the following day. He stated that the problem had come from “poor communication on the ground.”

Which brings me back to my point about the difference between strategic sign-up and tactical, operational reality.

In the last few weeks I have seen a number of incidents where one part of the mental health service has called another part of the mental health service for assistance only for that assistance to be declined and a suggestion that the police be called.

In another incident someone arrived at a mental hospital and asked for help because of how they felt. The hospital called the police.

This person was not violent and had committed no crime. They had found their own way to the location from some distance away. They were not behaving as someone who either lacked capacity or who needed immediate care and control.

The problem was that this hospital had “no-one to assess” the person. The assessment suite is in another part of the city. The “system” did not factor in self-referral and was not intended to deal with people who just “turned up” seeking help.

Instead of perhaps having a trained member of staff talk to this person and give them advice, work out a plan of how to help and then help – the FIRST course of action was to call the police and ask us to invoke Section 136.

This situation, I am sure, is being repeated in many parts of the country. Whilst there may be pockets of excellence – progress is painfully slow.

In all the situations we have been called to in recent weeks we have been asked or expected to act unlawfully. To use Section 136 in private places. To use the Mental Capacity Act instead. To become involved in situations which remain medical problems and for which we are simply not trained or equipped.

The most frightening thing is that these requests or expectations have primarily come from mental health service providers themselves. Some ringing us in desperation because they have not been able to garner a more appropriate response from within.

In more positive news, I have, because of the increase in Section 136 assessment provision, seen a reduction in the number of people being taken to cells. What I have not seen is a reduction in the number of calls to police in the first place – and they continue to come from unexpected sources.

I know that the whole aspect of police powers in relation to mental health crises in private places is under review. It has reached the point where we are having to consider changing the law – not because the existing law is wrong – but because the agencies who are actually expected to use it (as it stands) are simply unable to do so. Unable as in – not capable due to resources whether this be intentional or not.

So instead of doing something which will bring these agencies up to the correct funding or capability – we are, instead, looking to legalise the Ways and Means Act which has been in existence for the last decade or more.

Plan B (which has usually been unlawful) is now about to become Plan A (with legislative backing.)

Again, I do not wish to criticise or dismiss the progress which has been made or the genuine hard work and good intentions of those who are at the heart of the debate.

Are the police still being called to matters in which they have no business or training? Yes.

Has police training improved? Not really.

Are we still reliant on the same restraint techniques which have led to so many deaths and problems? Yes.

Is there still a problem with mental health provision and bed space? Yes.

Is this particularly acute in the case of children and young people? Yes.

Are mental health services self-sufficient in areas where they SHOULD be? No.

Overall – is demand going down on either the police OR the NHS? I doubt it.

Is there still a VERY long way to go despite some of the rhetoric? Absolutely.

I am not sure anyone is actually denying this but it is going to take a lot more than signatures on a piece of paper, colours on a map and Ministers expressing their surprise and displeasure.

This is a very negative return to blogging, I admit. But my intention was to look, quite coldly, at whether I (personally) could see any signs of improvement after some time away from the subject.

My honest answer – is “no.”

I am happy to hear of any accounts or information which refutes my opinion and might add balance to my, admittedly local, view.

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