A new report has been published by the Independent Advisory Panel on Deaths in Custody (IAPDC). It focusses on policing in particular (the panel‘s remit is to take an overview of all deaths in state custody, including prisons and psychiatry) and mental health is a core theme within it. It’s not longest report you’ll find so it may be worth your time reading the report itself for yourself.
For what my thoughts are worth, my attention was first pricked by the opening line of the whole report: on page 3, in paragraph 1 –
“Police leadership is key to keeping people safe and honouring the duty to take active steps to protect lives”.
Indeed it is – no argument on that from me. But whilst this observation is necessary, it’s not sufficient. Police leadership is not the only thing that’s relevant so I was keen to see where the report went after its opening volley. As I kept reading, I saw a lot of focus on policing and by page 5, I wondered whether the report would identify to the extent to which it’s been argued developed societies now over-rely on policing and criminal justice and whether it might link systemic over-reliance to fatal outcomes? Does this report start from the position that there are problems with police responses and so that’s where our attention should be, without wondering too deeply about why we see police response to mental health and medical emergencies as often as we do? To contextualise this quickly with a very recent Coroner’s outcome in Thames Valley, the father of Neal Saunders now says he regrets calling the police to help when Neal became agitated and distressed. His call for a specific crisis care service with trained medical or mental health professionals is a call in the direction of less reliance upon policing, just as the Law Enforcement and Public Health organisation is doing.
So what about health leadership to assist in creating the conditions which give the public options?
I was also struck recently about a civil case where the police have settled a claim for their response to a patient with borderline personality disorder who had called the police on 999 as part of her care plan. The NHS has been known to instruct patients to do this, for a variety of reasons and my experience has been this is sometimes because care plans have encouraged ‘therapeutic jurisprudence’ (ie, prosecution) and you can think back to other failed schemes which thought the answer to care gaps was prosecution. If we want reliance upon policing and criminal justice to reduce, the other options need to be there for the public and they need to be there so when police (or for that matter ambulance) services are brought in as first responders, they have the option to refer efficiently in to schemes which reduce criminalisation of the vulnerable.
PARTNERSHIPS
The report focusses a lot on partnerships so as to suggest how we do all of this — and a lot is given over to the outcome of report authors writing to Police and Crime Commissioners and forces to ask about schemes which have potential to improve things, as presumably this includes preventing deaths in custody or following contact, which is the report’s primary objective. Inevitably, and as I’ve argued on this blog before, there are only ever two things which are highlighted when the question is asked about improving police responses –
- Partnerships – emphasis is always placed on ‘street triage’ schemes, as well as ‘liaison and diversion’ schemes which operate in police custody. There are and always have been dififculties with these schemes, in addition to the obvious successes they can claim. But given the report is about deaths in custody or following contact, it may have been expected they would touch upon the subject of deaths which followed contact with these ways or working. I wrote recently about a 2022 PFD from a Coroner which highlighted problems with Liaison and Diversion, there are others which touch upon street triage and I know there are other inquests pending from high profile events which will probably touch upon partnership working like this. All unmentioned.
- Training – for police officers to better identify and / or deal with mental health related demands. This report is no exception on this point, either: calls for improved training for custody officers is just one example given. But whilst this report does make mention of His Majesty’s Inspectorate of Constabulary’s 2018 thematic inspection Picking Up the Pieces, it fails to point out HMIC had highlighted forces not ensuring delivery of training programmes developed by the College of Policing in 2016, despite this new report’s emphasis on ‘good progress’ made by the Crisis Care Concordat which directly led to the new College programmes.
Notice again: these two issues are both about improving responses, not about reducing reliance and as Dr David Baker from the University of Liverpool has pointed out, many deaths in police custody / contact have explicitly relevant healthcare contexts on which this report is largely silent. Moreover, the report is also very light on the evidence base for these schemes and the problems which we can see exist if we pay attention to the signals which surround them. The report claims that “many forces have forged partnership with allied health and justice services to play to professional strengths” going to on claim that “partnership work can reduce inappropriate use of police time and service to prevent deaths in custody.” I bristled at this a little, because I have written before about how street triage schemes, depending how they work, can involve a significant increase in the amount of time police are committing to handling demand in this new way. Despite claims that triage offers a point for ‘early intervention’, the report doesn’t seem to understand or acknowledge that much demand in triage services is generated by NHS organisations deferring demand, something recently criticised by a Coroner when done by the police. The report doesn’t acknowledge these points, largely based as it is on self-reporting from forces themselves.
PFD NOTICES
A further difficult point is references in this report to Coroner’s Preventing Future Death reports. Quite reasonably, it cites the reports from the cases of Kevin Clarke and Leon Briggs which are two very high-profile cases which I’ve covered on the blog. Of course, any serious treatment of PFDs would have led to mention of others: the cases of Gary Hutchings and Khalid Yousef show some problems with initiatives this IAPDC report takes time to praise and is one of the reasons we would all benefit from further research on those schemes. We know research quality on street triage is limited because of the evidence for it based cited by the National Institute for Health and Clinical Excellence – all the evidence good enough to survive initial sifting by NICE was either “poor” or “very poor” quality evidence.
The report goes on emphasise the need for national learning mechanisms and calls for improvements in that – quite rightly. There are a range of improvements we need to see –
- Improved leadership in policing, mental health and criminal justice – as Lord Abebowale wrote almost a decade ago, “the police cannot do this alone”.
- Improved legal training for professionals in all of the organisations working at this interface – there are far too many basic legal mistakes and omissions made and endorsed and they often become relevant at inquests.
- Effective joint protocols which give those professionals a working chance of delivering safe, proportionate and defendable outcomes.
- Mechanisms for the public to access time and relevant mental health care, in both primary and secondary services, to negate the need to ring 999 for the police or ambulance services.
NECESSITY AND SUFFICIENCY
There is much more to this than good policing: whilst good policing is necessary it is not sufficient and it never will be. You can only define good policing relative to the other options you have instead and as Egon Bittner said in my favourite quotation about police work —
“Policing is what happens when something’s happening that ought not to be happening about which somebody ought to to do something now.”
So you can have as little policing as you’re prepared to pay for and if you choose not to do that, you’ll end up paying anyway in criminal justice costs, prison incarceration and the significant costs associated with investigation and inquiry of deaths after police custody or contact. One of my blog posts was quoted earlier in 2022 by the Police Foundation in their strategic review of policing and it’s something by which I increasingly stand —
“The problem is not the police – it is the over-reliance upon the police as a de facto mental health and crisis care provider”.
So you need to decide what problem you’re trying to fix: I submit that improving police responses and learning lessons are not at the top of the list and as long as we over-focus upon them, we will miss the real problem before us.
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, 2022
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 