One Size Fits All
“A nation’s greatness is measured by how it treats its weakest members.” ~ Mahatma Ghandi
Her Majesty’s Inspectorate of Constabulary (HMIC) have just published their report on “The Welfare of Vulnerable People in Police Custody.” For those who have been championing the apparent recent progress in this area it makes for sober reading. That is not to suggest for a moment that there hasn’t been progress but the report lays bare the scale of the journey still required. It is a long one with many obstacles.
Before writing this blog I have looked back at many of the previous ones I have written over the last three years. I am a relative newcomer to the field of policing and mental health. Others, such as @MentalHealthCop have been leading the charge for a decade but as I read the report from HMIC I couldn’t stop myself from thinking “said that” “been saying that” “I raised that three years ago.”
The good news is that there is now an Inspectorate report which says some of it as well. The bad news is that they will probably still be saying it in another three years. Negative though this sounds, I say that sadly but with every confidence. HMIC and others have been saying that police cell suites are not suitable as a “Place of Safety” for over ten years but only recently has any government come close to doing something about it. Even then they seem destined to ensure that the most vulnerable of the vulnerable (those whose condition makes them ‘unmanageable’ anywhere else) will STILL find themselves in a police cell.
Reading the entire report is a bit of a roller coaster. For every reference to good practice there is more detailed mention of instances where things have not gone so well. Before you get to the Conclusions chapter you would be forgiven for thinking (as I did) that it is very narrow and heavily focussed on the negative. Then you read the Conclusions chapter and the tone seems to change.
The report concentrates on a number of key issues and was commissioned to answer the following question:
How effective are police forces at identifying and responding to vulnerabilities and associated risks to the welfare of those detained in police custody?
This is actually a very tight remit as the question does not set out to explore the role of any other agency in how someone came to be in police custody in the first place or whether those agencies are fulfilling their responsibilities once someone is taken into police custody.
When you come back to the question it is just looking at what police do with the people in their care. I was initially annoyed about this but, on reflection, the report does answer that question whilst having a reasonable poke at a variety of other organisations.
I wish there had been an examination of the reasons why vulnerable people end up in a police custody unit but the question is actually once they are there – how are they being treated?
I have blogged before about the reasons why vulnerable people find themselves in police custody. The long and short of it is that the police have become the default option for other agencies when things get tricky.
The report talks about unnecessary criminalisation of children and vulnerable adults but it is a sad truth that the police are positively encouraged to take the criminal justice path. This encouragement comes from within the service and from outside.
- The NHS has a zero tolerance policy against violence towards its staff. Absolutely right if the assailant is a drunk or angry patient in A&E but things start to get a bit muddy when the patient is disturbed or mentally ill. Having said that, I am yet to meet a patient whose consultant has not declared them to have capacity and know the difference between right and wrong. Indeed I have often heard “they need to understand that their actions have consequences.” Those consequences? Call the police.
- Crisis Teams are actively telling people to call the police. There is more than enough evidence that this is happening. “My husband is suicidal and self-harming. I called the Crisis Team and they said to call the police.” I have had heated discussions with Crisis Teams over such incidents. I have been asked many many times by mental health practitioners “can’t you just arrest them?”
- Care homes for children seem to have a universal policy of calling the police. If a child fails to return or even storms out following an argument with carers they call the police because the child is now absent or missing. One such caller told one of my team that they had “no intention whatsoever” of doing anything other than reporting it to the police.
- Care homes frequently call the police when one of the children in their care “kicks off.” This is sometimes justified. I have been to a number of very violent and dangerous incidents in care homes but on other occasions it has been because the child has thrown a tea cup in temper.
- The report itself highlights how the “positive action” policy with regards domestic abuse is interpreted as “arrest.” It even talks about how a target culture makes this worse. The definition of what constitutes a domestic incident is quite wide. Words within that definition are then sub-defined. Critical to this context is “Family members”. There is a list of what defines a family member and it includes children of, siblings and even in-laws. Historically and even culturally, most people would perceive domestic abuse to be between partners. It isn’t – it goes much further than that.
There is a theme with each of these. The response from the caller and the police is blunt. One size fits all.
The same can be said of the definition of child. A child is any person under the age of 18.
In the United Kingdom, the government have determined that the age at which a child can be held criminally responsible is 10. I make no comment on that other than to say it is one of the lowest in the world.
What this means is, that from the age of 10 years old, a child can be taken through the Criminal Justice system. Liable to arrest, subject to the same laws and procedures (with amendments) and potentially imprisonable.
There is, in reality, a world of difference between a 16 or 17 year old and a 10 year old. But not in the eyes of the law.
Nearly all political parties are saying that they want 16 year olds to have the vote. They deem them adult enough to determine the future of this country. The age of consent is 16 which means you can lawfully have children of your own at that age. You can marry at 16.
But you are still a child and should therefore be treated as a child if you should enter into the criminal justice system. Outside of that system – and even in the world of working with children – you are likely to see the term “young adult”.
According to law – you are a child until your 17th year and 364th day passes.
The point the report makes on this is that a custody unit is a pretty bleak place for a child despite the best efforts of the staff within it. This is true. A secure facility for convicted children is a very different environment from an adult prison. Police custody is police custody. Blunt. One size fits all.
Use of force and restraint is examined in the report. Concerns are raised over the fact that too many officers didn’t recognise a mental health crisis as a medical emergency. I can’t speak for the individual cases seen by the HMIC inspectors but it must be hard to remember that something is a medical emergency when much of the medical world is declining to help. When a hospital refuses to accept a medical emergency because the patient is “too violent, too drunk, too drugged” then where do you go from there?
Remember that, despite just about everyone pleading for police stations to be taken off the list of Places of Safety the government had recently chosen not to do this. It is even stipulated that police stations are where you can take someone whose behaviour cannot be managed elsewhere. Arguably the highest risk and most “medically medical emergency” cases you are likely to find.
The report makes the point that many of us have been making for a while. That the restraint techniques taught to police officers are intended to deal with violence from ill-will and not violence caused by mental health crisis. They are two very different things. Police are expected to deal with them both and have had no training in the alternative.
It still amazes me that this is not higher up forces’ strategic risk registers (if it is even on there.) there are more than enough tragic cases to demonstrate that restraint, when used in mental health crisis, kills people. I would put money on the fact that more people have died through contact with the police this way than have ever been shot.
Casual reminders about positional asphyxia and excited delirium once a year at refresher training are not enough. Officers need to be taught to recognise it and deal with it a different way. Until then, they have the training they have. Blunt. One size fits all.
The report goes on to look at the elderly in custody. There really isn’t too much to say on this except that it is not uncommon for the police to be called to an elderly persons residential home to deal with an “aggressive” octogenarian dementia sufferer armed with a walking stick. Don’t get me wrong – you would be surprised at how powerful and strong someone like this can be. It is a risky and dangerous situation. I just don’t think that the police have any business whatsoever in dealing with it.. Yet we get called to it.
The police have become, by expectation and demand, the coercive arm of mental health, childrens and elderly persons services. This has to change.
The police service has custody units which are built for dealing with suspected criminals. They are not nice places – they are functional – but they do not always suit the functions for which they are used. Functions for which their design was never intended.
I asked once whether we could consider a secure room for detainees under the Mental Health Act. Something which wasn’t like the other cells but where someone could be left without risk of being able to harm themselves. A room officers wouldn’t need to enter and enforceably restrain someone. I was told we didn’t want to do that because it would mean – as we had such a facility – other agencies wouldn’t have to provide one. The fact is that such a room remains necessary. Police stations will still be a Place of Safety and will potentially house those most seriously at risk.
If nothing else I would urge you to read the Conclusions chapter of the report. It is here that HMIC venture into criticism of other agencies and say that, on the whole, the police are often left isolated and dealing with things they simply do not have the expertise, training, equipment or facilities to deal with. This is the cause of the problem. Overuse and over-reliance on the police.
The symptom is that police then end up getting it wrong in custody as they try to make what they know, what they have been taught and what they have fit the circumstances. Blunt. One size fits all.
The reports recommendations are primarily about data gathering to inform future strategic work and allow greater accountability. This will be helpful and should arm the police with a very convincing amount of evidence to present to joint commissioning bodies. Evidence which will show exactly where the gaps are. Evidence which is currently lacking to the point that no-one actually understands the true width or depth of the problem.
The problem with this is that meaningful data will take time to gather. Comparative data will take years. We cannot wait that long.
Whether the police like it or not they will still be expected to deal with these kinds of calls. There is no room for complacency. The report even shows that use of Section 136 detention has gone UP in the last two years.
There is work which could be undertaken immediately which could help how the police treat the most vulnerable. It starts with empowering call-takers to assess threat and risk – deferring or referring callers away at the point of source. It involves difficult strategic level conversations internally and with other agencies about what police will and won’t do. It involves changes in working practices and the removal of sledgehammer policies and targets.
It involves training staff in alternative methods of dealing with violent MH crisis. It involves considering whether police might need to invest in bespoke areas of a custody suite which are situation and detainee appropriate.
It is about teaching people to think differently.
It is about giving people sharper tools to use rather than the blunt, one size fits all ones they have now.