Following publication of the National Partnership Agreement (NPA) for Right Care, Right Person in June 2023, the Royal College of Nursing has published its own position statement and it says some interesting things.
- It makes clear its support for the RCRP principles under discussion: that people in need of support should be able to access timely, relevant mental health services.
- That one of the barriers to ensuring this is possible is the lack of trained mental health nurses, which the RCN predicts will take ten years to address – we knew already this would take years because we know 20% of MH nurse vacancies are not filled, no doubt partly because of how many MH nurses have left the UK in the last 7-years.
- The RCN draws some parallels between RCRP and the SIM or so-called ‘High Intensity’ programme which was police-driven and NHS adopted before being effectively banned by NHS England earlier in the year – in all fairness to the suggestion, neither scheme was thoroughly and independently evaluated before being scaled-up for wider roll-out. It’s not the first time someone has drawn a comparison with SIM, but it’s the first time I’ve seen it said publicly by a professional organisation.
- The RCN claims they have “lobbied against using A&E as an appropriate Place of Safety under section 136 of the Mental Health Act (1983)” – this is not strictly accurate, they held a vote at their annual congress in 2017 about whether they should campaign to have A&E removed as a ‘designated Place of Safety‘ from the MHA. Since being ‘designated’ is not a thing, in law, it was a nonsensical vote on a non-topic and I wrote about it at the time.
- They point out – quite rightly – the police have certain legal powers which no-one else can utilise, yet usage of such powers is not written in to the “RCRP Threshold” in the NPA. The document points out that “nothing prevents” Chief Constables agreeing to become involved in issues like s135(1) MHA warrants, which I’m sure the Approved Mental Health Professionals amongst us are happy to learn, given no-one else can execute those warrants!
I think the RCN is missing something: the notice is effectively saying “the police should not pull back until there is sufficient capacity and contingency in health to manage”. This is missing several points which I’ve touched on in various recent blogs, but let me query that here in the context of their position statement –
- Is the RCN saying police should continue to do things they have no legal obligation to do, knowing it could harm or distress people, in situations where the police have no legal obligation to respond?
- If they are saying that, could they explain why they think this? – if they’re not saying this, what are they actually saying?
A CONTINUATION OF HEALTHCARE?
Let’s put this another way by supposing someone rings the police and says, “I’m worried about my [friend / relative] who has mental health problems – [s]he’s acting bizarrely and needs help”. Let us further suppose that all relevant background and checking questions have been asked by the police call handler to establish whether there is a crime involved in the situation or any immediate risk to life or immediate risk of serious injury. Why should the response to this call then be anything other than “I appreciate this must be worrying and difficult, but this appears to be a healthcare situation. Are you able to ring the NHS or would you like us to do that for you?” … followed by a phone call to 111 or 999, as appropriate to the circumstances.
Most people in the UK have a General Practitioner who will have an out of hours service and the NHS runs various other services which offer unscheduled care – ie, somewhere you can just ring up or turn up. Why would deployment of the police be justified, regardless of RCRP or anything else? Read the vignette again and replace ‘mental health problems’ with any other condition you like. People often like the ‘broken leg’ analogy (which I admit I don’t!), so replace this with concern around breathing problems, strange heart rate or fainting and blood pressure. The idea of ringing the police would rarely occur where there was no crime or immediate risk and it would feel strange to think of it, yet somehow we’ve lost that feeling when it comes to mental health and we’ve normalised how we stigmatise and criminalise those of us badly affected by our mental health. If you felt you needed help for those things, you’d take yourself off to an Emergency Department or ring 999 or 111.
Of course, if you repeat the vignette with any of the healthcare conditions we’ve listed so far but think of a situation where there is an immediate risk to life: ie, mental health crisis where someone is suicidal or believed to be having a heart attack. The police deploy to both of those kinds of examples every day in the UK and rightly so, because protection of life is a core police duty, enshrined in the protections afforded by Article 2 of the European Convention.
DEFLECTED DEMAND
So where the police receive a call about healthcare and all available information suggests it is not something which triggers a police legal obligation and where the NHS could or should be able to respond, should the call handlers and officers be encouraging the public to contact the NHS (and doing it for them, where they may seem unable to do so) or should they be deploying the police anyway, knowing it may traumatise the person unnecessarily, that it will come at a cost to some other policing incident which will almost always be a statutory duty and which puts the officers in a position where they may not be able to help anyway? Officers don’t deliver (mental) health care: they manage threat, risk and conflict and and can provide first-aid whilst starting to do so, where required.
This is one thing going undiscussed: the RCN position talks about police not ‘withdrawing’ from the various activities RCRP aims to address without apparent insight that many joint protocols between police and NHS areas have for years stated the police should not, for example, be asked to return detained Mental Health Act patients to hospital where their location is known. This has been in the MHA Code of Practice for at least fifteen years and it’s been reflected in joint policies I’ve authored and others I’ve read; it’s also a position which Coroners have been happy to accept when hearing the various views offered by police forces and mental health trusts during sensitive inquests. So I am left rather wondering how we’re still in a position that NHS organisations do expect to operate outside the Code of Practice the MHA by asking the police to return such patients? Is it too cynical to suggest the attitudes towards the importance of the Code of Practice seem to vary with whether the specific point in question will result in resource expenditure or resource saving for mental health trusts? I admit it can look that way.
We need to talk about what happens prior to partners in RCRP areas being “ready” – do we keep over-policing, knowing it can impact and even harm vulnerable people – especially those of us from black or other minority ethnic groups – or do we not? When attempting to answer that, it needs to be borne in mind that no answer from anyone obliges any constable to do so, if legal responsibilities are not triggered. Of course, we all hope bosses who need to review, revise or agree joint protocols for RCRP do so quickly and carefully, but the position statement implies that the police always were just saying “yes” to things and getting on with it – actually, they weren’t. Plenty of us can give our examples of where partner agencies have asked for something and because it does not involve immediate threat, risk or conflict, we’ve said no, in accordance with the law and often, the Code of Practice to the MHA.
To completely misquote von Clausewitz, “Policing is a continuation of healthcare by other means” but just as war is not politics not withstanding it has bearing upon it; policing is not healthcare and it never was.
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 