Ever Decreasing Vicious Circles
This is a short and immediate response to the publication of HMIC’s state of policing report.
The top headline is that the police can no longer continue to plug the gaps of other agencies and the primary example of this is around the provision of mental health crisis care.
Sir Tom Winsor identifies that the police have become the first resort of MH crisis management and that this is not right for anyone involved – least of all the person who is unwell.
It is hard not to read these words and say “I told you so” and I have just taken to Twitter and done exactly that. I have been saying this since 2010 publicly and Mental Health Cop beat me to it by a good five years.
Let’s go back further – my research for uni located a paper from 1992 which warned that unless community care was properly funded, Section 136 would become a fundamental tool in psychiatric crisis management “the unwanted doppelgänger of community care.” (Turner et al, 1992)
There have been numerous official reports warning of this:
The Bradley Report (2009)
The Adebowale Report (2013)
The CQC “Right Here – Right Now” (2015)
All of the academic research shows an increase in police involvement in mental health matters since the closing of asylums and institutions commenced following the Mental Health Act 1959.
People have tried to flag that this was coming. They have done so loudly and publicly. The inquiries and investigations post tragedies should also have acted as wailing sirens that there was a problem. And yet here we are, in 2017, hearing it all over again but now from yet another source.
How many more warnings are needed?
Who is actually listening to them?
The reality on the ground is pretty much in the face of every police officer, mental health worker, paramedic, A&E doctor or nurse every minute of every hour of every day.
It is quite simple and I can and will only speak from a police (my own personal) perspective:
- The police are not adequately equipped or trained or empowered to deal with the vast majority of mental health incidents they are sent to
- Should they be? Is it even a police role?
- After office hours care is completely insufficient – nationally
- There is not enough capacity to deal with the evident and very real demand.
- Reducing the use of 136 does not necessarily reduce that overall demand.
- Use of Section 136 is rising. With changes to legislation we can expect it to rise further
- Who said it was too high in the first place?
- Police and MH services have very different languages and perceptions of risk – many are simply incompatible.
- A crisis is not something that can wait until tomorrow to be dealt with.
- Perhaps it’s time that MH Crisis teams *did* become a “blue light service.
- The current schemes designed to assist police have not been properly evaluated. This is fact – not simply my opinion. (National Institute for Health and Clinical Excellence, 2017) We don’t know if they work – we aren’t even sure what they are trying to achieve.
- It is easier to get Search and Rescue to the scene of something than it is to get MH support to the scene of something.
- We absolutely have to address the whole issue of excited delirium / acute behaviour disturbance and get an immediate and agreed medical intervention before someone else dies.
- We are constantly tinkering with processes and around the edges of crisis management – the whole thing needs a fundamental review.
- Starting with a complete understanding of demand. Who is calling police? Who is calling MH services? Why are they calling? Why are they repeatedly calling? Why are they ending up at suicide spots three times in the same week? What is missing? What is needed? What are the gaps?
- You could have a smaller police service with fewer officers IF they weren’t dealing with so much MH overspill. Are police budgets too high? Are MH budgets too low? Is money going to the wrong place and are we now compensating for that when the police start funding MH triage schemes or other such things?
- Should the police be providing a de facto health service of any kind?
- Is this information sharing actually ethically sound and necessary or do the police now need to know someone’s full medical history simply because they find themselves dealing with it? If so – is that right?
- How do we stop the series of ever decreasing vicious circles which make up crisis management?
- WHAT DO PATIENTS WANT?
These are just 20 points to start with. I could have gone on a lot longer.
The time for incremental change is over. The tide is overtaking us. We are getting left behind.
We have been warning and we have been warned – it is all coming to pass.
Whatever is currently on the table to attempt to resolve the issues around MH provision and policing – it isn’t enough.
We need to go back to square one and start from a position of understanding what we are trying to solve and who should be responsible for it.