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?
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.
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.