Just In Case

Sky News ran with a Story today which said that 20% of police demand involves dealing with people with mental health issues. This strikes me as being a conservative estimate and I have heard figures as high as 40% in some places but, anyway, it just goes to show that even if crime is falling the claim that demand on police is falling too is questionable to say the least.

In these austere times just think what could be done if the police service numbers went back up to pre-2010 numbers or a fifth of capacity was suddenly released for police to spend doing something else.

It is pleasing that this is getting media coverage. It needs to because it is a national scandal.

The second half of the article was dedicated to extolling the virtues of Street Triage where, in the West Midlands, they say it has reduced the number of Section 136 detentions by 51%.

This must please the local mental health trust a great deal.

I have been sceptical of Street Triage since it was first announced and I am afraid that this sceptiscism is just as strong despite a few people on Twitter assuring me it is the best thing since sliced bread.

First – a health warning on this blog. I have had no access to figures or statistics from any of the pilot areas. What follows is raw opinion and the unanswered questions I have about street triage.

What I do know as fact is that 70% or more of calls to which a Street Triage response has been sent did not take place in the street.

This is not about semantics. In my mind, by calling it street triage, it shows a fundamental misunderstanding of the issue. It conjours up the image of police coming across someone in a public place and then having to use or misusing their powers under Section 136 to detain someone for a mental health assessment.

By “misuse” in this example, I mean using Section 136 because there is no other alternative.

The concept was sold on the idea that a mental health nurse (who has no powers at all) would come to the location and either come up with a Plan B or smooth the passage of Plan A.

It appears that this is only applicable in 30% of cases.

Which means that police are still being sent to mental health calls (70% in the pilot areas) where they have no powers at all because they are taking place in private. So why are they there?

I asked this question on Twitter earlier and the answers seemed to be:

 

  • It is better to send one officer from a triage car than two officers from a response car
  • In case the patient becomes violent
  • To prevent a breach of the peace.

In response to the first I say, it doesn’t matter how many officers you send they are still powerless and if success is measured by reducing the number of attending officers by 50% but still sending police officers to health related incidents as a matter of routine then – you are still sending police officers.

The issues of “in case the patient becomes violent” and to “prevent a breach of the peace” could very well be necessary – but not in every case. If you have a police officer in the car and in attendance they are there whether violence was likely in the first place or not.

Police help many agencies who deal with violent or potentially problematic people. Ambulance, Fire and Rescue, Housing Officers, Bailiffs to name but a few but we do not go to every call with them. They tend to call us if they need us.

Now, there will be hundreds of thousands of social workers and mental health professionals going about their work every day who do not require or call the police. But what triage seems to mean (though I am aware of moves to send nurses and not police in some places) is that if a call is routed through the police and attendance is required, a police officer will still attend.

When someone calls and says they feel suicidal why is this a police matter?

Of course, the police must observe the obligations of Article 2 of the Human Rights Act which means they must protect life but – seeing as it is not a criminal offence to commit suicide – what power does a police officer bring to that situation? What action can an officer lawfully take to protect life?

These arguments amount to – it’s ok – we are sending one police officer instead of two to an incident they have no legal power to deal with (in 70% of cases) “just in case”

Much has been made of the drop in Section 136 detentions in some areas. Interestingly, the recent HMIC report on the vulnerable in custody showed that 136 detentions had, in fact, gone UP by 5% in two years in the 5 forces they reviewed. I don’t know which, if any of them, had triage schemes running.

The real statistic of interest is not whether Section 136 detentions are going down but whether demand on the police from mental health calls is going down in the triage areas.

Are police receiving fewer calls?

Are the interventions put in place by the triage teams effective in the long term?

How much has “repeat-caller” demand gone down?

I do not profess to know the answers to these questions.

There are a number of street triage pilots around the country and they all seem to be doing things a little differently. I have seen publicity on one triage scheme which operates by having mental health nurses or practitioners working in the police control room.

Officers still attend the incidents but can then call up the control room based practitioner for advice.

Forgive me for being negative but, would it not be better to send the practitioners to call instead of the police and, are the police actually paying for a service which should exist in the form of an Emergency Duty Team or Crisis Team anyway? Why should police have to pay to have their own advice line in their own control room when the information being provided should be available from EDT?

If I have misunderstood what I thought I saw on the publicity then I am happy to be corrected.

The other line of argument against my scepticism on Twitter was that this is a stepping stone. It is better than what existed before and it will encourage the other agencies to take over in time.

Problem is – I’m not sure it is either of those things.

Street triage was supposed to stop police attending mental health calls which had nothing to do with them. I’m not sure that this is happening.

And my main concern is that this will not evolve at all. I am concerned that street triage will be seen as The Solution to the complex problem of police involvement in mental health matters. If you read any government response to articles about policing and mental health it is street triage which is trumpeted loudly.  I am extremely concerned that government think that street triage is enough.

I also wonder how other agencies will be encouraged to provide a service in future which is currently being paid for by the police. What trump card exists if the police decide not to pay for it any more? Which agency will feel the effects most if street triage suddenly stopped?

The Police.

These are the reasons why I am so utterly unconvinced by street triage at the moment.

Police are still getting the calls. Police officers are still attending incidents which are primarily or entirely health related and have no more powers than they had before. It is being paid for by the police and I cannot see any incentive for any other agency to keep it running if the police stop paying for it.

I am more than happy to be corrected on fact here but it will take an awful lot to convince me that this has a long term, sustainable future.

The Government state that they want mental to health to have parity of esteem with physical health. I simply do not see how this is possible when you are still sending police constables to deal with what is a health issue and sometimes even a medical emergency by default.

Police do not respond to any other health matter or medical emergency unless it is absolutely necessary.

In order to achieve parity of esteem then the same should apply to mental health crises.

Post Script

In order to be clear – this blog was written about police involvement in the street triage pilots, police involvement in mental health related calls and the longevity of the project.

I am aware that I have not once mentioned the “person” about whom the agencies are attending.

This was deliberate but should not be read in anyway that I have forgotten that person.

The fact is – THEY are the most important person in this entire equation and the outcome for THEM is what matters.

I am still to be convinced that a police officer (often without powers but in all their protective clothing and equipment) is the best person to send to anyone in crisis. It carries the stigma of potential arrest and criminalisation.

There will be times when police powers and police use of force is necessary but they remain less frequent than someone simply calling for help.

In many cases I have heard that people have called the police because they have tried calling others first and got no response which satisfied their need.

Mental health is and forever will be a core part of the police role – but in many if not most cases the police are asked to achieve something they have neither the powers or training for.

Section 136 is solely a police power. No one else can use it. It can only be used in public and it is the only mental health related detention power police have. If a force has managed to reduce its use by 51% does it not demonstrate that in at least half of the cases attended there was another alternative and police presence may not have been necessary at all?

The less police have to do with mental health – and the more mental health is dealt with by those who DO have the training and expertise – the better the outcome is likely to be for the person in distress.

 

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8 responses to “Just In Case”

  1. Jo says :

    And lets hope that figures are collected of numbers of nurses assaulted if indeed police are no longer attending. In many respects the reality is that MH nurses are also not trained to deal with intoxicated ppl often in the throes of a domestic. The use of words like “ill”,”patient” and “vulnerable” are very emotive and could equally apply to 80% of ppl in prisons currently. in reality almost all are definitively not ppl who are mentally ill who would otherwise be on a acute psych unit or even be with a cmht. Nurses MAY be more appropriate than police in many instances but lets not pretend that it’s ideal or indeed that there is treatment available. Also, the cost of mental health assessments is high as nurses will need to spend considerable time with each case if expected to intervene at home not bundle to hospital. I’m assuming that in these austere times that would mean sacking loads of bobbies (now with 20% less work) to pay for it. Remember when intoxicated ppl with personality problems and difficult lives keep calling 999 this proposal was pushed by the police with very little encouragement from MH profs who know in their heart of hearts that evidence based treatment generally doesn’t exist. Just because these ppl are challenging, make you feel powerless and at times inadequate and don’t easily allow you to ‘do something’ doesn’t mean anyone else has the answers. In summary, by all means lets have a system were anyone described as “vulnerable” has no contact with the police and is seen by health workers but lets understand that will also have many seen and as yet unforseen consequences and that very often there will be no effective health intervention available but many other different risks. Maybe on balance this will be a better system but please don’t think it’s going to be rosy.

    • nathanconstable says :

      Why on earth would nurses attend an intoxicated person in the throes of a domestic?

    • nathanconstable says :

      And if MH nurses are indeed attending calls like that as part of a street triage pilot then why is nobody mentioning it in the publicity about its success?

      • Aaron CPN says :

        Quote “Remember when intoxicated ppl with personality problems and difficult lives keep calling 999 this proposal was pushed by the police with very little encouragement from MH profs who know in their heart of hearts that evidence based treatment generally doesn’t exist.”

        When I first began working on our Community Triage Team (we refrain from Street Triage as we are seeing many at home) it was to provide direct MH support for the Police who were bogged down with MH and, also, to cut down on what were often inappropriate use of s.136. We have cut s.136 considerably by providing officers with timely, concise advice, by offering alternatives to detention, by liaising with current care teams in the cases of those who genuinely have problems and by (most often) ruling out a genuine mental health condition. The Police are inundated with those abusing 999 as a freephone “take responsibility for my life”, those intoxicated with alcohol in the main and those who have learned that by making threats to their own self will get them an urgent response. We have developed an extremely effective, trusting relationship between Police, MH and, to some extent Amb whereby we are all working together for the greater good. We are cutting down on Police time wasted on the mythical percentage (I say mythical as it is a case of interpretation) of MH cases. We must always be aware that one agency’s understanding of what is MH may not be another’s. We have had many very healthy debates on individuals in rooms occupied by Amb, Police and myself as a CPN and, sometimes we have to all agree that there is nothing for either of us to do except provide advice.

        It’s very easy to look at a situation created by media and misunderstanding and take the stance that ‘this is not OUR problem but someone else’s’. This leads to frustrated front line staff and can, in turn, lead to heated situations ‘in the field’. Our society is struggling to take responsibility for itself and it’s the role of all front line agencies to work TOGETHER to ease the stress on Police, Amb, A&E, MH services etc. Police need to gain confidence at declining to turn out when called too as, often, there is a considered need to attend everything that is called in even if that is against advice from MH profs.

  2. Northmead says :

    I agree with this totally. As far as I’m concerned Police are going to calls that should be diverted directly to the NHS. This seems to encourage diversion of demand to the Police. People in crisis will call police instead of NHS as they know that they will get a response.

    • Aaron CPN says :

      They will also call Police (or Ambulance) as it is free phone and because they demand an immediate response. Often we attend to see people who have struggled for a while with their mental health, don’t engage effectively with services but then make contact via 999 at 0030hrs after a few drinks or other. Advice is often almost parental; “…stop drinking, go to bed, see your GP or access MH services in the morning…”. It can be rare that there is an acute MH need. If people call Police, the Police will often always attend (inc. “my child won’t go to school” etc). We need to become stronger as a society. I agree we need more responsive MH services too BTW.

  3. ian says :

    Not in case but instead of.
    My local force recently received a call from the NHS 111 service reporting an assault. This call was as the result from a member of the public requesting medical support for a family member who was suffering a massive schizophrenic episode. As a result of the seizure the subject had hit out during their seizure and struck a parent. The family had called 101 to obtain medical assistance and in no way did they require or wish to have any involvement from the law enforcement agencies.
    This call resulted in the NHS calling the police reporting the incident as an assault and requesting police attendance. As a result the police did attend. Unfortunately no medical support was dispatched despite requests for medical support from the family. Despite the attending officers attempts to obtain some sort of medical or MH support none was forthcoming resulting in the officers being left to their own devices to deal. All I will add is that as a result of the lack of any medical intervention it all went very pear shaped.

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