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:

IPCC (2008)

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:

  1. The police are not adequately equipped or trained or empowered to deal with the vast majority of mental health incidents they are sent to
  2. Should they be? Is it even a police role?
  3. After office hours care is completely insufficient – nationally
  4. There is not enough capacity to deal with the evident and very real demand.
  5. Reducing the use of 136 does not necessarily reduce that overall demand.
  6. Use of Section 136 is rising. With changes to legislation we can expect it to rise further
  7. Who said it was too high in the first place?
  8. Police and MH services have very different languages and perceptions of risk – many are simply incompatible.
  9. A crisis is not something that can wait until tomorrow to be dealt with.
  10. Perhaps it’s time that MH Crisis teams *did* become a “blue light service.
  11. 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.
  12. 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.
  13. 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.
  14. We are constantly tinkering with processes and around the edges of crisis management – the whole thing needs a fundamental review.
  15. 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?
  16. 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?
  17. Should the police be providing a de facto health service of any kind?
  18. 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?
  19. How do we stop the series of ever decreasing vicious circles which make up crisis management?

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.


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4 responses to “Ever Decreasing Vicious Circles ”

  1. J says :

    Well this patient wants a blue light service from the crisis service. I get told your care plan says you have a visit due Monday and it’s Saturday now – sorry you can’t have a crisis today. You have to take responsibility for yourself and manage it. Try a bath or a walk. Yep we all know this happens.

    Last Thursday my adult children saw a Mum they had never seen – running around acutely unwell. They sat up all night with me. The crisis team refused to come out but it had taken 3 hours to get thru on the phone anyway. I have had all my other support from mental health services removed. If my son had not physically been able to stop me from leaving the house the police would have become involved.

    Patients end up at the same suicide spot time and time again because services have a quick chat and tell them to go home. Nothing solved, no help so the despair is the same and back to plan A again and again.

    When I was first using mental health services not that many years ago there was a timely response from services. I felt supported when I needed it but over the years the response has been not even to talk to me but to ring 999. I would get a longer stay in hospital and the crisis team could support for 8 weeks not the 2 weeks which is usual now. The community team only ‘do’ short term support with an emphasis on a fast recovery setting goals and aim and if you can’t think of any then they won’t even support you.

    ‘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?’ Ask me another time to answer all these questions.

    the police quite rightly are losing patience. My support has been withdrawn with immediate effect 2 months ago. It has been acknowledged that I’m at high risk of having a ‘serious incident’ yet it seems that mh services are happy to pass on the responsibility because I cannot be helped anymore. I happened to bump into 2 PSCO’s in the loo on Tuesday – I was upset and I knew I would usually get a sympathetic response from officers. We had a long chat about my circumstances – they know me well. Already a referral to m h services was raised about me a few weeks ago. The officer is willing to raise another if I bring in letters etc about my circumstances because although I was careful not to say anything he can foresee police involvement looming without support from services. This is being played out across the country.

    I am left with ‘structured risk management’ now as my only m h help ie I can ring the crisis team. How logical is that? Why not prevent the crisis happening? Are they expecting a magic recovery from people just because they’ve run out of services?

  2. Savedbythepolice says :

    It has been my recent experience that I would probably have been safer in a cell. The NHS seemed to be hellbent on taking actions that would get me permanently off the caseload. My local police are probably sick of my name by now after last week.
    I propose that if the police get more than 2 calls about a mh concern for welfare inside a few hours that three options be given to crisis teams – 1. Be trained by the police on how to locate, search for and keep hold of people they have a statutory duty towards. 2. Agree to search, but inform them they will be getting a very large bill for the use of police time/facilities and lastly 3. Arrest and charge said mental health ‘professionals’ for wasting police time, the criminal offence of neglecting someone lacking capacity(MCA 2005) and anything else you can think of. Health & Safety should be good for a few. Perhaps if the staff were as criminalised as they often make patients it’d provide them with the incentive to actually do their jobs. Plus it would give a very clear message that people with mental distress are as deserving of protection from criminal neglect as others.
    In my experience this last option would likely improve mental health crisis services no end; especially as I believe inpatient units meet the criteria for places of safety. Instead of taking people to a general hospital take them straight to where the mental health expertise is. It’s then the mental health trusts problem about getting them home. The police are not an ancilliary patient transport service,although it probably feels like it.

Trackbacks / Pingbacks

  1. Missing The Point – Mental Health Cop - April 21, 2017
  2. A Country Mile | nathan constable - April 25, 2017

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