If you have been following me on Twitter or reading my blogs you will know that I have raised a few issues with regards Evidence Based Policing (EBP)
To begin with, I would like to clarify that the concept of EBP – actually knowing what works and using it – is something I have absolutely no issue with at all.
In theory it makes total sense – if there is science or evidence which suggests that a certain thing is effective then why on earth would you not adopt it as best practice.
No – it is not the principle of EBP which concerns me.
It is not the theory – but the practice.
There is much talk at the moment about the medicalisation of policing. Not only should we strive to be as Evidence Based as the clinical world but certain quarters are even adopting the language: “treatment” “dosage” are just two examples.
To my mind there are a couple of linked issues with this overall ambition.
Firstly, policing is several hundred years behind medicine in terms of an evidence base. Medicine has gone from the days of spiritual healing, through blood-letting and eventually onto the discovery of incredible treatments, equipment to scan the body, vaccines and cures. Policing is currently at the “I recommend a course of leeches” stage of clinical enlightenment.
It’s not that policing doesn’t have a vast range of tactical options and responses to various problems – it’s just that we actually have no idea on whether any of them are effective or efficient.
The second, linked, problem is the typical police rush to put something in place. It has taken medicine centuries to get where it is today; much trial and error; many false hopes and eventually a position where the understanding of the human body is massively advanced and the knowledge of how to treat various ailments and injuries leaves us with only a few major diseases left to truly conquer. More is known of these diseases than ever before and more is known every day but it has taken a very long time to get to this point.
When it comes to policing – we seem to want to have it all in place by next Tuesday so we can claim it is embedded and we too can call ourselves professional.
This is patently impossible and it is likely to end up rushed and a pale imitation of what it should be.
There are any number of problems which stand in the way of EBP. That is not to say that we shouldn’t confront them and chip away at them but this will take decades – maybe even centuries.
What we seem to be doing, as per usual, is nailing something to the promotion, lateral development, annual appraisal processes and then claiming we have embedded it.
This doesn’t make it embedded – it makes it compulsory. They are not the same thing.
By extension of the same argument we could make it compulsory to paint a picture if you wish to proceed in policing and then claim that the police are all now artists. To extend the metaphor still further you have to then ask who is judging the artwork and from what frame of reference and expertise?
Who will be assessing the contribution to advancing the evidence base or the use of the evidence base when there are so few knowledgeable practitioners in the police. Simply having a rank or two above the candidate does not suddenly make you an expert. In fact – if the candidate is more qualified than the assessor then it can’t even really be a peer review.
Simply making something necessary does not ensure full buy in or understanding. It also runs the risk of becoming a box ticking exercise with the blind leading the blind.
Policing is full of this – take risk assessing a missing person for example. The ultimate decision on whether someone is classified as high, medium or low risk usually sits with an Inspector or Sergeant. How much more training have they had in risk assessing missing people than the constable? None at all. But they have extra rank and so that assumes they are the more appropriate decision maker. Doesn’t matter if the Constable has 28 years service and the Inspector is direct entry with 18 months – the Inspector wins.
One of my concerns about insisting that you must demonstrate the use of development of EBP for what is effectively a personnel procedure is “who is assessing this?”
When you actually look at the gold standard of evidence – the peer review – you know that in academia the peer is going to be a recognised subject matter expert.
My fear in policing is that this “expertise” will simply fall to person on the next rung of the ladder. Who may have no idea at all about how to do it properly and determine whether the contribution is valid or not.
Another problem with this approach is sheer volume. Take an average force with, say, 2000 officers – if the requirement is that they must demonstrate employment of or development of the evidence base for the purposes of annual appraisal or development then this is an awful lot of experiments. The assessor must be aware of the existence of the evidence the person is applying or must be able to properly, systematically and correctly assess whether the new contribution withstands scientific scrutiny. The workforce is not currently sufficiently skilled to do this.
Thinking back to my earlier years in the service, the concept of problem oriented policing was all the rage. I was a key supporter and proponent of it.
With the absolute best of intentions I embarked on a series of Scanning, Analysis, Response and Assessment to try and deal with some of the intractable problems on my beat.
At the conclusion of these initiatives I was able to demonstrate a fall in demand and a fall in crime ergo the initiatives were a success. On paper they looked impressive. 80% drop in calls and crime down by 25%
My mistake – these were binary comparisons. I wasn’t trying to deceive anyone but the numbers seemed to speak for themselves. I never did prove causality. I didn’t have to – the awards nominations soon followed.
But the thing is – we tried to replicate the work the following year and couldn’t get it off the ground. I had more money and resources available as a result of the apparent success of the previous year but for whatever reason the interest wasn’t there.
The national media coverage had meant I was invited to a few other forces to explain what we’d done and I don’t know if they were able to replicate it.
That first year looked like “what worked” but actually it was really “might work.” It was very much of the moment. It clearly relied on factors beyond the actual response itself. There was a human factor here which simply couldn’t be accounted for, predicted or easily copied.
And this is the thing with a social science like policing compared to a pure science like medicine. Drugs do what drugs do – there are predictable outcomes and side effects. Policing relies heavily on human nature and human whim which are far less predictable.
That “treatment” I put in place worked once. I think. It seemed to. But it worked at that time and in that place. Does that mean it isn’t worth trying somewhere else – no but success is not guaranteed at all.
I had the pleasure of hearing Gavin Hales from the Police Foundation give a talk this week on two programmes which neatly demonstrate some of the problems with Evidence Based Policing.
These were detailed, scientifically designed and evaluated and ran over five years. One looked at a response to recurrent domestic violence and the other looked at burglary reduction.
If you look at the responses which were put in place you would recognise them because a lot of forces are still doing them or things very similar to them. In some cases they would be the text-book or standard responses. The perceived wisdom and common sense approach.
Except they didn’t work.
Neither of them achieved what they set out to achieve. There was no drop in domestic violence and there was no drop in burglary.
The fact that they didn’t work isn’t actually the problem what both programmes illustrated were some of the issue which will stand in the way of successful implementation of EBP.
By way of example:
1. The length of time they took. The police are a “do now” organisation and frequently operate in a short term world. Five years is a long time in policing and during that time other factors had come into play. People had moved on and priorities had changed. What was an important project in 2011 had been superceded by something new and more important by 2015 and resources had to be shifted elsewhere. By the end of one of the projects it was getting increasingly hard to get people to respond to emails. There was a huge difference between the initial ambition and what was ultimately implemented and senior managers were impatient for results. What was important was forever being overtaken by what was urgent.
2. The force of personality. One of the projects had a very dynamic force lead. Their drive and enthusiasm played a very crucial part in the operation and even though it didn’t work their commitment kept it afloat. This shows how important an individual can be in the success of any initiative. It makes it hard to replicate. If that person moves on then it is likely that the drive will go as well. People don’t sit still for long in policing.
3. One of the projects involved multi-agency strategy meetings. This led to diffused responsibility and some confusion. At the end of the project people were lauding the improved partnership working and collaboration. We hear this a lot in policing as well – it is frequently cited as a success outcome. However, it is a means and not an end in and of itself. It’s all great if the various agencies can get along nicely with each other but if they aren’t actually achieving anything can it truly be said that the partnership working has improved? Relationships may have – but that is not enough.
4. If you were to look at the measures that were put in place and see how ineffective they are it should give pause for thought. An opportunity to look at similar responses (there are, for example, many different multi-agency strategy meetings) and ask questions as to whether they are also achieving what they are intended to achieve. Lessons should be learned from this but, with the greatest of respect to Gavin and the Police Foundation, if I were to ask how many people had ever heard of this work the answer would be “not very many people.” I wonder how many people in the actual forces involved have heard of or even remember these programmes. The lessons are important but I would imagine forces around the country are still doing the things which were shown to be ineffective and are still saying they are an essential and effective response. The futility of this is actually quite staggering.
Another factor which will inhibit the development of EBP is that policing is not a Petri dish. It is not a safe, sterile and controlled environment for experimentation. You can only work with live subjects – you cannot simulate. These are real people and the consequences are real.
Look at DASH forms for example – we are being told that they are essential and life saving tool to assist in the risk management of domestic violence. They are mandatory. However, they are now being properly evaluated and the early findings are that they are about as accurate a predictor as a horoscope. But we will still get messages from the Superintendent reminding us of their value and that they are compulsory. They are, in fact – to steal again from the medical parlance, a Placebo Policy. Something we do to show that we are doing something.
This is the other problem with implementation of EBP – accountability. We are hearing a lot that it is “ok to fail” but is this really true? Is it actually ok to fail in policing? Will the IPCC, HMIC or media take a sympathetic view to a failed initiative especially if it had unwanted consequences?
I could go on but this blog is already long enough. EBP is a laudable objective but my fear is that it is going to be rushed and implemented poorly.
Professionalisation of policing is not something that can be achieved by putting labels on things to copy others. We need to live and we need to breathe it.
Yes – we have to start somewhere but please recognise where we are starting from, the barriers there are to overcome and dont make the mistake of thinking that by making something compulsory we have successfully implemented it.
In other words – slow down to speed up.
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.
Its in – its done and I am now waiting for Emma to read it and give me feedback. Except she is on holiday! This is my fault of course as I should have submitted it on the 24th March but a series of life-events has had to take priority these last few weeks.
I am talking about my literature review. The first piece of academic work I have ever written and the first formal “essay” I have written since 1992.
If you don’t know what a literature review is then you are not alone. I had no idea what one was until I started it but, in a nutshell, you try to find as much as you can in the existing academic writing, read it and then write about it.
Why would you want to do that? Well, firstly it is to see what is already known about your choice of topic. Many, more eminent, people are likely to have considered and researched it before and many will have written about it already. It is quite possible that your idea or concept has already been answered or is demonstrably and provably wrong – in which case you would be wasting your time by writing about it. It allows you to learn more about your chosen subject – a lot more.
Furthermore, it allows you to join things up and identify gaps. As well as showing what has been researched you identify what hasn’t. Or areas which could be developed further or linked. It allows you to find a space for your own research.
There are “proper” ways of undertaking this task – systematic ways – which I have not been shown and have not learned. Consequently, my research is likely to be both scattergun and snowball. By scattergun I mean I have literally thrown relevant words into academic search engines and read what has come back and by snowball I mean that I have followed the various references from papers I have read – which have led me to other papers and so on ad infinitum.
Once I got started on this it became addictive. To the point where for the last few months I have rarely had my head out of a book or a piece of research. Over the course of this period I have accumulated enough paperwork to completely fill two box files along with numerous books. In some way or other I have used them all even if I haven’t ended up using them in the final draft.
The final submitted version runs to 24 pages and has 84 citations.
The reading was the fun bit – the writing was not. I found it hard to get started and harder still to keep going. I struggled with several aspects – the biggest being trying to transition from a blogging style to a more direct academic style. I still don’t think I have got this right.
In the end I took advice from an experienced mentor who basically told me to write. Just write. I ended up writing an 8000 plus word stream of consciousness. The world’s biggest blog. It was effectively everything I could remember about what I had read but with no references included at all. Where I knew I was going to add something I just put (citation) and moved on.
In the end I barely used this epic rant but it did get me over the hump of a permanently blank screen and helped me formulate some ideas and a running order.
A light bulb moment a short time ago was what I needed to make the jump from blogger to amateur literature reviewer. I can’t actually say what clicked but I wrote a paragraph in what I thought was a more formal style – in-keeping with what I had been reading – and asked someone to look at it. When I got a response similar to “that’s it!” things started to flow. The referencing is a fiddle I still haven’t nailed but practice will make it perfect. I have also made this harder for myself by not fully embracing the technology which is available to streamline such work.
I have actually enjoyed this process but it came at exactly the wrong time personally. They say that you can’t keep saying “its a bad time” otherwise you will never do anything but this was a really bad time and I still managed to get it done – albeit a week or two late. I thank Emma for being so understanding.
I have covered a lot of ground in this review. From classic writing on the history and role of the police, through mental health policy in the UK and around the world, legislation, reviews and reports on policing, research on triage, research on police handling of mental health, government publications, psychiatry, psychology and then onto medicine and clinical conditions.
I think it leads to a couple of points but if I were going to write it again I think I would hone it. Fortunately this submission is a staging post and I will get the chance to do exactly that with the benefit of feedback.
What I have found hard is containing the knowledge.
I’m going to have to admit that this has been the most intellectually challenged I have felt in a long time. I have a busy brain at the best of times and for once, it has had something constructive to be busy about. But it is harder to remember that this is niche subject and not everyone shares my interest in it.
It is even harder not to get massively frustrated by what I am seeing in reality. Given what we see in the real world of mental health and policing – after reading what I have been reading – it has been incredibly hard not to scream “HAVE YOU NOT LEARNED ANYTHING?!”
I have found this particularly hard at actual work – where I have wanted to sit down and change things quite dramatically – which is not my job or role.
What this process has done is actually confirmed my concerns about Evidence Based Policing. I have been reading things which date back to 1936. Some of the most seminal pieces of academic police writing come from the 1960’s. There is absolutely no shortage at all in detailed research on what the police do and how they do it.
Except – very few people seem to have read it. When you look at a paper from 1979 and think “this could have been written yesterday” it adds a great deal of credibility to the writer but it also makes you weep for the fact that nothing has changed or been learned from it in nearly 40 years. It also lays bare how big a role politics plays in policing and how it always seems to win.
This frustration has boiled over more than once and particularly in relation to the issue of how excited delirium is being managed in the UK. The evidence is there – there is a lot of it – it generally all points in one direction and yet the systems in this country simply do not seem to take it into consideration at all. Consequently, police officers and paramedics are at the mercy of nature, fate and then the courts when there seems to be a series of recommended medical interventions which could avoid all of this and probably save lives.
In reverse – when you look at the evaluations of mental health triage programs you have to wonder why they are being given such credibility. It isn’t just me saying this. Yes I have had doubts about it since the beginning but it would seem as though some of these are playing out. People have evaluated the evaluations now – and it isn’t pretty. The recent report from the National Institute for Health and Care Excellence (NICE) on mental health of adults in contact with the criminal justice system runs to over 340 pages but it is absolutely scathing about the quality of the existing evaluations of triage. These evaluations contain the data and figures which are being used to claim the concept is a success and yet, here is an eminent and august body publicly describing them as having evidence of selection bias, high risk of performance bias, high rates of missing data, based on assumption and containing significant methodological limitations. These are all their words – not mine. They discounted most of the evaluations as being of insufficient quality to include. They used three and rated the evidence quality of those as low and very low.
Yet these very same reports are continuing to be used to build and justify policy. This is just one of the reasons why I fear the use of an “evidence base” in policing. Actually – it isn’t the evidence base itself I fear. It is the quality of the evidence base; the ‘doomed to succeed’ problem (which is still VERY much evident) and the question of who is actually determining that the evidence is evidence; the way it is being nailed to promotion processes, lateral moves and annual appraisals and the claim that this “embeds” it.
These fears have been strengthened as I have undertaken this research so far. An unintended consequence but a consequence all the same. I could probably write a paper on this aspect alone.
Have I fallen in love with the idea of academia in policing? No – its actually made me even more skeptical and suspicious. Do I think that a degree will help police officers? No – I think that some of the subject matters should be covered in more detail – criminology for example – but I am yet to be convinced that anything I have done or am doing will make me a better policeman.
I am enjoying this. I feel like I am using brain cells I have never used before and maybe, for me, this is a natural way to channel my frustration and curiosity. Is it hard? Yes. Have I thought about jacking it in? More than once. Do I feel a sense of achievement? Yes – even this early and before I have actually had any formal feedback.
But, for anyone who thought I may suddenly become a convert……
I am actually further away from academia and policing than I was when I first started. At least the way it is being done or proposed now – anyway.
Let me start by saying that I have no problem with actual elephants. They are intelligent and amazing creatures who need protecting wherever they live. I can assure you that no elephants have been or will be harmed in the writing of this blog.
My problem is with metaphorical elephants. White ones; ones which have a habit of being “in the room”; ones who never forget and the ones you have to eat one bite at a time. Read More…
I’m sure you will be aware by now that I am in the early stages of a research degree. Though this may change or become more refined – the question I am seeking to answer is
“Are the police the right agency to be dealing with mental health incidents?”
I have spent the last few months reading. By which I mean reading a lot. I have read historical documents on the role of the police; books on mental health policy in the U.K.;studies in police interactions with people with mental illness from across the world; evaluations of Crisis Intervention Teams and Triage schemes; writings on a new concept called Law Enforcement and Public Health; reports on the implications of using Taser on people with mental illness; medical reports on the use and effects of restraint as well as papers on various elements of psychiatry and certain mental disorders.
Amongst other things. Read More…