This week, the Metropolitan Police will commence its implementation Right Care, Right Person programme. You may recall from May of this year, it was reported the Commissioner had written to his healthcare partners in the capital to tell them this change in approach would take effect from September. After various responses from healthcare organisations, medical and nursing Royal Colleges and charities, it was eventually put back to November and but started this week, with a flurry of media coverage and activity.
In addition to an expected BBC News article, we also saw Sky News covering this in what you might consider to be a pro-police perspective, albeit quoting the NHS as being a willing partner in this work. I must admit, when I saw the Sky news example they chose to feature, I did wonder whether or not we were seeing an incident which was a missing person the police should be dealing with, but there we go — they didn’t and there may be reasons for that which weren’t broadcast. I was nevertheless thinking something I’ve often said when talking about people whose whereabouts is not know, “If I was to claim that person was inside his own flat having self-injured and possibly died given they haven’t been seen for five weeks, what would you tell me that would prove me wrong?”
The Metropolitan Police has published its own press release about RCRP which is also worth reading. It is keen to emphasise the core role of the police is “preventing and solving crime, supporting victims and bringing offenders to justice” as if to contextualise why they’re pushing back on this mental health related demand. I always whince slightly when I hear policing described in this way, I will also admit. Research has consistently shown policing is about much more than crime and a response to it. Indeed, one of the arguments which could be put about the more general roles that police officers often end up playing, is that some police response to mental health related demands is about preventing crime. I’ve given examples of that on previous blogs but I also notice the description of the core role of policing often leaves unmentioned the protection of life and in particular the ‘maintaining the King’s Peace’ bit.
THINGS TO NOTE
There are various points of interest in this coverage and in what is being said by the spokespersons ahead of this change. Assistant Commissioner Matt Twist has been quoted saying —
“Where there is a risk to life, where a crime has been committed, or where there’s a risk to breach the peace, the police will always still attend. Where it’s purely a health care issue, where we are not the best people to attend, we would want the best people to attend, which are healthcare professionals.”
This is noteworthy for its inclusion of a breach of the peace which I mentioned above is often unmentioned. But the National Partnership Agreement, published in June of this year and which underpins the whole initiative, makes no mention of a breach of the peace in the so-called ‘threshold’ for police attendance. It references crime (occurred or occurring now) and two immediate risks, to life and of serious injury. No mention of breach of the peace and no mention either of a perceived need for police-only powers under the Mental Health Act 1983. However, the need for police powers under the MHA is something which the policing minister thinks is part of the threshold (set out in a letter seen by me). So it’s worth noting the inconsistency of what seems to be the threshold and I would imagine that needs clarifying one way or the other because we already have confusion about what is ‘in’ and what is ‘out’ and that can only prove difficult.
Most of all: anyone dabbling in this area needs to make sure they are damned clear about what an “immediate risk to life” actually is – it was defined by the ‘Rabone’ case in the UK Supreme Court in 2012 and if you want to ensure you really understood the detail on this, read the judgment itself from Lord Dyson (paragraphs 35-41 are key). We also know mental health trusts get this wrong so mental health professionals also need a working knowledge of this phrase and what it means in practice – they are the ones who will be thinking about whether to ring the police.
UNINTENDED CONSEQUENCES
The Daily Telegraph(£) is covering from the point of view of Emergency Departments. There is a concern from the Royal College of Emergency Medicine EDs will just “fill up” with mental health patients. Dr Adrian Boyle, President or RCEM identifies a fundamental problem leading to this action being the resourcing of mental health services but also says —
“We are very worried about this and extremely concerned that this will too often see a vulnerable group abandoned. We cannot have a situation where one service unilaterally decides to walk away from their obligations. When you look at A&Es you’ve got elderly patients, and then next to them you will be seeing more agitated, frightened, disruptive patients with mental health problems. The fundamental problem driving all of this is lack of capacity within our mental health services. I suspect these procedures will eventually end up being examined quite closely by the coroners.”
There is plenty to object to here, but things with which we can probably agree. Of course, some mental health patients probably could be described as “agitated” or “disruptive”, but you can’t help but read this as something of an over-generalisation and we know patients have concerns about stigma and service in EDs. It’s also not true to suggest that “one service unilaterally decides to walk away from their obligations.” Assuming the Metropolitan Police do RCRP properly and in accordance with the supposed aims of the scheme, what they will be “walking away from” is not and never was an “obligation” at all – that’s precisely the point, actually! Now, it’s incumbent upon any police force doing this to ensure they are judging the line correctly – and hence the threshold being clearly and accurately defines is rather important! – and so I also admit I’m nervous because of the examples I hear given and statements I read, especially on social media where officers are giving examples of things which are not police responsibilities, where I suspect a court would take a different view.
But if something akin to “walking away” is going on here, it should be about walking away from non-obligations — it’s just not and never was the role of the police to attend welfare checks any more than it’s the role of the NHS to attend burglaries. Try ringing the ambulance service or walking in to your local ED and asking them about your burglary: take a guess before you do it about what might happen when you try and then see if you’re correct afterwards.
CORONERS
But Dr Boyle has legitimate reason to be worry, I think – not least because of the examples we’re hearing which involve push-back amount to over-push. His point about a lack of capacity in mental health services is a part of the reason the police have ended up over-relied upon to start with, although that’s not the only reason. Another is also NHS-driven, in my view and it’s to do with the fact NHS bodies amount to a fragmented service of disparate organisations, not always well coordinated. Your GP, your ED and your MH trust services are all managed separately and don’t easily integrate. It’s never been the case that gaps don’t exist and as a mental health nurse said to me recently, one of the reasons the police and ambulance service end up with 999 calls not really suited to their role, is because the kind of service many of us need for our various types of mental health difficulty simply don’t exist — or even where they do, they are inaccessible in practice because of geography or hours of operation, etc..
So the “right care” may not necessarily exist in all areas – however valid the legal argument about police pulling back, it doesn’t ensure anything else, in the end. “Ensure” is a word we saw in this week’s media coverage and I’m wondering how anything is ensured and that’s part of the problem here – hence the concern about unilateral change in a short timeframe, before such services can be evolved. London has been preparing for six months maximum and the discussion is now about which non-ideal agency should be the one to find themselves dealing with people they’re nevertheless not really positioned to assist either, except in the most short-term sense.
We know a London Coroner has already gone on the record about RCRP concerns after the death of Heather Findlay who was a s2 MHA patient who absconded from a cigarette break outside the hospital, with a staff escort present. The media coverage today emphasises that “hospital walkouts”, which does include patients detained under the MHA, will not see a police response unless the immediate risk thresholds are met and this is something which concerned the Coroner in Heather’s case because the jury found she was at immediate risk and the evidence was the police would not have responsed, if they had been called. So the detail of how all this works needs careful understanding to avoid further concerns being flagged by courts. There is a duty on MH trusts to report some patients to the police when they go missing (dangerous, especially vulnerable or subject to Part III of the MHA) and therefore some kind of police response is needed from time to time, and not only where there is an immediate risk to life / serious injury.
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 