The BBC has published another article about the increase in mental health callouts for the police. This follows similar articles in previous years and is again based on reedom of Information Act requests to police forces. The article points out there has been a rise over the five years since 2017 and if you bear in mind that 2017 was a rise over 2014 and so on, you can see what’s happening over the medium term.
The figure sounding alarm bells is the claim Merseyside Police has experienced a 313% rise in mental health call-outs over that time, from 7,639 to 28,039 incidents per year. The lowest rise in incidents reported was in Gloucestershire: a 16% rise from 6,737 to 7,369.
Several caveats need applying to the coverage in this article —
- 21 forces replied – which means 27 didn’t and we don’t know which ones.
- Data on MH incidents in policing is notoriously bad – the “definition” of a MH incident quote in the article is actually only a part of the definition and in any event, the definition wasn’t finalised until 2018, after the period which the BBC is analysing.
- So what was being counted in 2017 is not the same as what was being counted in 2022 which in any event, still wasn’t ever counted properly.
- The article acknowledges these points: unsure whether the definition varies from force to force.
- It did until 2018, when the College of Policing came up with the current one, still reflected as the definition in the second National Strategy on Mental Health.
- The whole reason a definition was demanded by His Majesty’s Inspectorate of Constabulary is it became obvious to them they were comparing apples and pears when looking at two different police forces recording of mental health related demand.
- I’m interested in the “experts believe” claim about street triage schemes — it’s a fully anonymised claim so we don’t know who these experts are and on what research or data they base this claim.
- I’d argue there are very few true experts on this topic in the UK.
- What we do know about the evidence for street triage is that when the National Institute for Health and Care Excellence (NICE) looked at evidence for it, only three studies made it through their basic filter for examination in the evidence review and all of them were rated LOW or VERY LOW quality studies.
- There is little to no good quality evidence for street triage one way or the other and whilst it’s easy to point to individual incidents and argue a multi-agency response saved time compared to normal police-led responses, it’s almost as easy to point out that the resources required to run such schemes often significantly exceed the resources consumed by not having them.
- This kind of analysis varies by area because no two schemes are the same in terms of their hours of operation, staffing and so on, but it’s worth remember every time these schemes are mentioned: they’re barely evaluated.
- In case this sounds controversial, that’s not (just) my opinion – it was the obvious implication of reviews by HMIC, NICE and reflected in the first National Strategy on Policing and Mental Health from NPCC (2020).
- And no-one, including the IOPC in their annual reports, seems to have examined deaths after contact with street triage or the medium term healthcare outcomes after contact with triage.
Resources isn’t really the point — it should be about mental health care for the public, done in the most dignified and unrestrictive way. If you remember, from my nights out shadowing street triage schemes, it was obvious almost half the demand they were managing was generated by the NHS who were not structured in such a way as to be able to support patients who were contacting the NHS for help. I used the phrase “doing the wrong thing righter” more than once because so often, all the person needed was an available mental health nurse to talk to and make some clinical or welfare based decisions. Unable to secure that from the NHS, they got it instead under the shadow of a uniformed police officer with baton, taser and handcuffs. Hardly the ‘least restrictive principle’ in action and it’s interesting to note how some areas with street triage schemes, then cut their crisis teams thereby completing the covert commissioning of their police partners as a crisis care provider. Have to admire their boldness, given most people haven’t noticed this.
A NEW APPROACH
The article mentions they contacted the Home Office who responded “a new approach“ is on the way. Given the Home Secretary’s recent letter to all Chief Constables and Police and Crime Commissioners, I can only surmise this refers to the “Right Care, Right Person” initiative which started in Humberside Police and is now used in Lancashire and North Yorkshire. I’m yet to learn enough about this programme to have significant insight, but North Yorkshire put out a large press release on their website about what it means.
Taking it at face value, it sounds like they are pushing back against demand faced on the subject of welfare checks requested by other agencies. I’ve heard it’s also about dealing (or not dealing) with situations where people walk out of hospitals prior to completion of treatment or assessment, patients who are AWOL (which I will have to assume means absent without leave under the Mental Health Act) and on conveyance of mental health patients in some circumstances.
None of these things are actually new ideas, so I’m wondering about the extent to which it represents forces attempting to make systemic their approach to the ideas (much of which are based on well known legal issues which have been covered on this blog for the last decade). What remains unclear, even if it’s just to me, is how precisely this is being implemented. And I do mean very precisely.
DETAIL MATTERS
So, if the police receive a request from an NHS agency to do a ‘welfare check’ (and they do), how is the assessment being made as to whether the force says yes or no? It’s fair to point out, the conduct of welfare checks is not a legal responsibility for the police so they are entitled to say no and to prioritise other demands, for example around their responses to crime for which they are legally responsible. It seems to focus on whether there is an immediate threat to life which would engage the state’s Article 2 obligation, for example.
BUT! – what is sometimes phrased as a request for a ‘welfare check’ is in fact, something subtly and importantly different. We sometimes worry about someone’s welfare because they’re suicidal, for example or because they are actually missing from somewhere. Police responsibilities around missing people and their obligation to protect life need to be reflected in the approach – we don’t seem to know if they are but I heard an RCRP anecdote which made me wonder about the detail and it’s worth pointing out the IOPC have investigated police forces for failing to recognise that reports of concerns for welfare call were, in fact, missing people.
AWOL patients is another example where detail matters: there are certainly obligations in some circumstances on mental health trusts around their AWOL patients and inquest have touched upon this with Preventing Future Death reports issued in connection with NHS decisions to ensure resources can be allocated to a patient’s return to hospital, where required. It is assumed the police will often do this, notwithstanding the statutory guidance which says NHS mental health trusts carry responsibility.
Detail around all of this should be covered already in a joint protocol between Chief Constables and all relevant NHS trusts, including the ambulance service so that frontline professionals can know what angers have agreed is the appropriate handling of a particular case. But we know some areas do not have such policies, despite the requirement in the Code of Practice to have one, and we know that staff are often not trained in their contents. Again, this is not my view: such things have been the conclusions of coroner’s courts In recent years.
THE CORE PARADIGM
So I do look forward to seeing detail on the new approach and measuring up whether it falls for the same trouble all of the others have fallen for. It’s all very well for police services to pull back from demand they can argue is not their legal responsibility but if other agencies are not positioned to act, then no support is forthcoming as people fall between the cracks. The National Partnership Agreement spoken of by the Home Secretary in her letter is all well and good, but the history of this interface is NHS organisations agreeing they will act to ensure support and then not doing so properly – either because they lack the funding to ensure the resources, or because they struggling to recruit and retain staff in nursing or AMHP positions.
Probably more to observe and say about this as detail (or lack of) emerges but remember this —
“The problem is not the police – it is the over-reliance upon the police as a de facto mental health and crisis care provider”.
If we think that improving the quality of police responses is the solution to whatever we think the problem is, then we’re missing the point — that’s just largely doing the wrong thing righter. The problem is, all too often, that we have to call the police in the first place but we do that because of the expectation on the police when someone must “do something” when other mechanisms of social justice have failed, for whatever reason.
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, 2023
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 