In 2022, the National Police Chiefs Council and the College of Policing published the Police Race Action Plan (“the plan”). This is not specific to mental health and policing, but it does contain many references to the overlap, hence this short post to emphasise what has been proposed. The plan contains much which is general to issues of race in policing and you can see a summary of that broader work in a “plan on a page“. But the full document is required to see the detail on mental health and you need to refer to page 45 for action point number 5 in the delivery plan.
However, before reading the below it’s important to understand what the report means when it refers to “black people” throughout this plan. It means –
“Black African, Black British, Black Caribbean, Black Other and Mixed Black backgrounds. Disparities also exist in policing’s relationships with other ethnic minorities, including the UK’s Asian communities and Gypsy, Roma and Traveller communities. We do not intend to minimise these issues. The plan is in addition to ongoing efforts to ensure that policing is inclusive and fair to all, and that concerns from minority or under-represented groups are acted on” (p7).
The plan goes on to explain the need for black-specific plan is because racial disparities are so much more pronounced for those of us from the backgrounds listed in the previous quotes – see p8/9 of the plan for more detail on that.
ACTION POINT 5
“5. Develop a greater awareness of mental distress within Black communities to use that knowledge to improve policing interactions.
To achieve this ambition:
- the NPCC and the College will review IOPC recommendations on how police officers react and interact with Black people suffering mental distress, then will consider the levels of disproportionate contact between the police and Black people suffering mental distress to establish whether this is as a result of a request for help, a police incident or a request from another agency
- the College, working alongside relevant NPCC portfolio leads, will review its current curriculum of training and CPD from initial police contact onwards, to ensure that police personnel have the knowledge, understanding and awareness to deliver the most appropriate care to a Black person suffering from mental distress
- the College, working with the NBPA and external partners, will amend the current APP and co-design appropriate training material
- forces will work alongside their local BPA, Race Equality Network and external partners to review local policies, guidance and training delivery, to ensure that police personnel have the knowledge, understanding and awareness to deliver the most appropriate care to a Black person suffering from mental distress.
- we will invite HMICFRS to include mental distress, either in thematic inspections within portfolios or in their annual assessment of police
efficiency, effectiveness and legitimacy - the NPCC will engage with PCCs and local authorities to identify a more effective public safety response to identifying and improving the service given to Black people suffering mental distress.”
THE LANGUAGE OF DISTRESS
First things first: the plan is not clear what it means by ‘distress’. Is this synonym for mental disorder, which is the legal term to consider when applying the Mental Health Act 1983, or is it broader than that? Of course, language around mental health, as with language around race issues, is a sensitive topic on which whole books could be written. But that’s also true because it’s important: using a term which includes the word ‘disorder’ can be seen as pejorative and stigmatising. In much work I’ve done before, the legal term ‘mental disorder’ has been subject to legitimate and profound objection – I understand why. So is NPCC / College use of ‘distress’ an attempt to sensitively resolve that language question or does it mean something wider than the MHA definition?
I suspect it’s both – ‘distress’ is a word found elsewhere in policing where consideration or discussion must occur around, for example, emotional or mental distress (EMD), which is a term from the firearms world of policing. You can be ‘EMD’ for many reasons, not just connected to your mental health and I therefore suspect that’s what NPCC and the College are getting at here. However, it because ‘EMD’ can mean, for example, someone who is just profoundly upset for non-health, non-medical reasons, I was wondering whether it’s meant in that way for the race action plan. You could be mentally distressed because of job loss, relationship breakdown or because you’ve just failed to secure necessary exam results in your A-Levels for university entry. Do we mean that kind of distress in the context of this plan, or not?
I’m less convinced we do because of how the overall report reads and hope I’m not wrong because there’s much to be interested in here, summarised in the bullet points above. When I was involved in the Mental Health Act review by Professor Sir Simon Wessely in 2017/18, there was sub-group about race issues and those who know much more about this than me often spoke there about the ‘double jeopardy’ of black mental health and criminal justice. Not only is there disproportionately in policing and criminal justice outcomes, but also in mental health and Mental Health Act related outcomes. So it is interesting to consider the Police Race Action Plan’s venture in to mental ‘distress’ (whatever is meant by that) in the context of knowing about inequality in mental health care.
DOUBLE JEOPARDY
The plan talks about policing having “a much higher obligation than any other public service, given its ability to deprive liberty and use the most intrusive powers. The collective trust of society is critical to a police service built upon consent.” I understand the point being made and probably wouldn’t disagree with it, but I’d argue mental health services are right up there along with policing. They also command the coercive authority of the state over those of us who come within their scope and there has been a lot of detailed work over decades in the NHS about black mental health because of disproportionality observations, including a huge “Delivering Race Equality” work programme at the start of this century. Black people remain more than five times more likely to be ‘sectioned’ under the MHA and more likely whilst detained to face cooercive interventions like enforced medication. This all remained a discussion point during development of the Five Year Forward View (FYFV, an NHS mental health strategy published in 2016) and there is an interesting blog post by Jacqui Dyer on this topic which gives some detail about mental health outcomes and disparities as well as the ongoing equality monitoring programme. Jacqui is exceptional and in addition to co-chairing the FYFV she was also on the advisory board of Professor Wessely’s review.
Add in to that mix the policing or criminal justice considerations which emerge when officers are called to an incident, and you see the potential for a complex mix of variables combining on a vulnerable person and we know from the race related work on mental health in the Wessely Review and the FYFV that black people are more likely to access mental health services via the criminal justice system than people from non-black backgrounds. We know that mental health issues are contributed to by things like poverty, exclusion and discrimination and we know a disproportionate number of black people face such things every day. Indeed typing that last sentence made me remember a comment by Professor Sir Michael Marmot, the renowned public health specialist and lead author of the Marmot Review (in to public health inequalities). He spoke at a conference I was lucky enough to attend and opened with the line “the determinants of poor health and the determinants of crime are the same.” … and it all went forward from there in one of the most compelling talks I’ve ever heard.
It is in that context, any police race action plan sits, especially in respect of actions which aim to address disparity around mental distress. As a closing point, I was interested to note the bullet point which talks about revision of the College of Policing’s APP and development of training material. In 2018, (the then) Her Majesty’s Inspectorate of Constabulary published a report entitled Picking Up the Pieces which was the first thematic inspection of policing and mental health ever undertaken. It highlighted in its recommendations that forces revisit the question of delivering mental health training because most had not yet delivered on the public commitment to deliver training developed as part of the Crisis Care Corncordat (2014). Despite that basic, functional training (about mental health conditions, disproportionality and legal powers) remaining undelivered, there is another training commitment around policing and mental health, which will be in addition to any training requirement which may emerge from the National Partnership Agreement for Right Care, Right Person.
Lots to think about in a congested space with limited training time.
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 