Policing is inherently everything that good mental health care tries not to be, everything that it tries to minimise. It’s coercive, even if only by implication, it’s also restrictive and can be stigmatising and criminalising. Choose any decent textbook, guideline or Code of Practice on these matters and you will see prominent discussion about the ‘least restrictive’ practice as well as respect for dignity, the need to build consent, to maximise autonomy and crucially, for the voices of those of us affected to be front and centre in how systems operate, even when they must be restrictive to some degree.
Nothing about me, without me.
Most of the previous decade saw a lot of discussion about policing and mental health – consideration of what the role should be. Early in the decade the (then) Home Secretary, Theresa May called for a reduction in reliance upon the police so they could focus on crime, a political priority at a time when policing was being considerably reduced in size. We subsequently saw investment in certain pilot schemes and national programmes around “street triage” and “liaison and diversion” (both, nurse-led liaison schemes in police contexts – the first outside of police custody when reports are received of crisis incidents; the second inside police custody after people are arrested for alleged offences). The assumption seemed to be that if mental health services were “there” more, the police could do less and be freed up for crime. This followed on from the Bradley Review (2010) which took another look at mental health issues in the criminal justice system – it was the latest report to do so after the Reed Report and the Percy Report in the 1990s and 1970s.
I think we’ve just ended up normalising criminal justice responses to mental health issues, starting with policing – the whole thing has been replete with mostly unforeseen consequences. We can discuss whether normalisation was intentional because no-one is going to openly say that gateways to crisis support or mental health care should come via the criminal justice system, but we probably need to acknowledge that intentions behind initiatives are not the only important thing to analyse. The actual effect of them – how they land – is important and understanding issues like perception and the law of unintended consequences matters. Any cursory examination of social media will reveal debates by those of us who’ve used mental health services or sought support, giving insight in the experience and you may recall the Twitter hashtag #crisisteamfail which reinforced what I already suspected: that many of us seeking crisis support are simply advised to “call the police”, irrespective of whether anyone thinks the police are needed or indeed, whether the hypothetical police officer would have any legal duty or authority in that kind of incident. Many mental health demands on policing simply do not need the police.
GATEWAYS TO SUPPORT
This blog has covered before the question of deflected demands, such as requests by services for welfare checks, which is fraught with conceptual difficulty for officers. Whether the police are appropriate, whether they have the skills or competence to actual assess the mental well-being of someone or assess their safety in anything other than the immediate sense, is often far from clear and you may have seen Newsnight earlier in the year where a police force was featured for their responses to mental health demands. Towards the end of the piece, I was struck by something one of the officers said about their role in responding to mental health crisis.
“We are the 24/7 service and if people can’t get through to a mental health team for whatever reason then it’s better that they call the police and we do the referral rather than that person not get the help.”
This might be right, albeit the assumption that police “referral” leads to help needs checking – there’s plenty of evidence it often doesn’t. We do know that police officers and referrals to agencies can be effective in ensuring immediate and subsequent support and much positive feedback has been known about officers’ compassion and empathy – we also know the police can sometimes get things in ‘health’ moving when individuals and families haven’t been able to do so. At the same time, though, it’s not right for everyone (that it’s “better” to call the police) not least because we know it doesn’t always work. Indeed, the opposite can be true, for reasons that are literally unknowable. You don’t have to look far to see this and I’ve written before about the impact of policing before – you don’t know the impact will be before you’ve decided to risk it.
In recent months, two families whose relatives died in contact with police forces have made public comments about their regret at calling the police during a mental health crisis. I make no judgement at all about the cases and am not specifying which comments I’ve noticed because no-one knows the full details and they remain under investigation, but comments in the media show they really did believe it may help but they now deeply regret that assumption. Coroners have concluded inquests in the past where the impact of policing (and in one case, its mere mention) was thought relevant to a fatal outcome. Lauren Finch died after being lawfully, necessarily and reasonably removed by force back to a mental health unit from which she’d absconded – there was no criticism of the officers at all by the Coroner’s Court and the Preventing Future Deaths report which flagged areas of concern was not directed at the Chief Constable of Greater Manchester. And yet in that PFD, the impact on Lauren of being forcibly returned to a mental health unit by officers was cited as a contributory factor in her death. This case ended fatally so we can see and understand the impact: what about cases receiving far less scrutiny because they thankfully ended with less serious outcome? Who knows what people then do in terms of coping or agency avoidance after a negative experience of being policed for being ill.
LEAST INTRUSIVE / LEAST RESTRICTIVE
Policing is coercion, even if just by implication – police officers have a wide range of responsibilities, legal authorities and so on. Mental health patients are as aware of this as anyone else and they live with the potential for coercive intervention not just around something that transgresses a criminal law, but with that potential around their health because officers also have legal authorities under the Mental Health and Mental Capacity Acts, if thought needed. We also know of the conceptual difficulties which demonstrate some human behaviours can be easily (or lazily?) characterised either way, to justify one agency pushing towards another. How are you defining ‘mental health’ and ‘crime’ – and how are you drawing your distinction to ensure the ‘correct’ approach to each?
In most areas of policing and mental health care, we hear and understand discussion about the proportionality of impact. Policing often refers to the least intrusive approach (for example, around the deployment of armed police officers to an incident) and mental health professionals of the ‘least restrictive principle’ – this is a phrase used in the Code of Practice to the Mental Health Act. For my purposes in this post, they are essentially the same thing – insert cliches about nuts and sledgehammers if you wish, or you could just argue state intervention in our lives should be minimised to that which is necessary to achieve the objective. We must not over-police and must manage the ‘collateral intrusion’ policing has on third parties who are affected, but uninvolved.
Do we think someone is killing themselves now in their flat? – policing may well be the least intrusive response because it’s potentially the case that only the police will have the legal authority to force entry to that premises to safe life, whilst also having the basic skills to ensure safety and assess whether someone is seriously ill or injured in way that requires urgent attention by an ambulance. But if the concern is less serious and less urgent, does this change what we might consider to be the least restrictive or intrusive approach? Of course – if there is a concern for welfare that is not suspected to be any kind of threat to life, then the police are probably not the best agency. I hope the reasons didn’t need explaining again.
LISTEN TO PEOPLE
I’ve learned most about this topic by listening to people – psychiatrists and nurses, social workers and paramedics have been extremely generous to me with their time. But listening to people who’ve been sectioned or had the police forcing off the door to their home has been the real gold dust. (It’s partly for this reason, I’m constantly amazed to find police-NHS initiatives being considered or evaluated without reference to the views of those of us who receive public services – street triage has been a great example of that. Whatever you think of it, I submit you won’t be able to show me a single peer-reviewed, qualitative or mixed methods study which includes views from those who’ve experienced it and yet these programmes are running in almost every police force.) We see many initiatives assessed by organisational impact on demand reduction or cost savings and it invites awkward questions: if your initiative to reduce demand and complexity saves money but worsens healthcare outcomes, did it work or not?
What problem were you actually trying to fix?! … over policing is just as bad as under-caring, if not worse and I do worry it’s deeply and potentially, irrevocably normalised.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2021
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 