The Crisis Care Concordat has it’s National Summit in London next week – a gathering of all the signatory agencies in order to mark progress ahead of the first big deadline.  For those who follow me on Twitter, you’ll notice that I keep uploading a developing map of England, shaded in various colours, like this (as of November 19th 2014) —

This is what the colours mean -

• Red - no progress yet recorded.  Doesn’t mean nothing’s happening or that discussions aren’t occuring.  Just that they haven’t yet delivered the first outcome.
• Yellow - the first outcome: this means that individual areas have agreed in principle to work together to deliver what the Concordat aims to do and that they are going into 2015 with the intention of delivering an area-specific action plan to work out what in particular needs doing locally.
• Green - the second outcome: this means that areas have completed and jointly agreed their action plan with that commitment to deliver upon it.

The keen-eyed amongst you will obviously recognise that nothing needs to...

Continues, Read More...

In the last few months, I’ve found myself in various rooms with professionals of all kinds, including police officers, finding myself saying the same thing over and over again that I was saying in 2004 when I first started working on this. Last week, I actually found that I was quite deeply boring myself witless when I realised that my mouth was on ‘transmit’ for some standard argument to reject a common misconception, whilst my brain was not fully engaged. I found cerebal space to remember that I have to get my car MOT’d next month and somewhere in my head I could hear my voice as if it were coming from elsewhere and my brain found space to say, “Oh, for God’s sake – do we gave to discuss this AGAIN?!”

Of course we do have to discuss it again – because we’ve still got so much progress to make and given how far we’ve come in the ten years I’ve been working on this, I’m already wondering whether this will get sorted before I retire in 2029.

For example, let’s think about the Crisis Care Concordat. The process means that...

Continues, Read More...

Here are two ways of saying exactly the same thing —

• “Most people who are violent need a policeman, not a doctor!”
• “Some people who are violent need a doctor, not a policeman!”

I raise this because the first quote comes from a medical handbook I once picked up in a book shop – probably one of those Oxford University Press handbooks with very thin paper pages that you see junior doctors carrying around the place and stuffed into the lower pockets of white clinical jackets.  It was part of a section on responding to violent or disturbed patients in A&E and I’ve left uncorrected the author’s gendered stereotyping of my profession!

IN TWO MINDS

I’ve now told the story A LOT of the poor guy who was extremely resistant (and probably quite frightened) having been detained under the Mental Health Act by some police officers who were then told to remove him from A&E because his violent attempts to self-harm.  Ongoing restraint by the police had been the only way to stop him hitting his head (which was already cut) and they were all...

Continues, Read More...

The creation of a professional college for policing – part of the professionalisation agenda – is an opportunity to work towards becoming evidence based. This is something that has been made clear to me over the last two months and something I’ve been arguing for years, incidentally! We can look around and see that the College and individual police forces are trying to engage academics to bring research skills into policing and actively build that evidence base. West Midlands Police and the Metropolitan Police are just two forces hosting research fairs and inviting academics into their organisation with the aim of understanding what works in policing – and why?

Evidence is key to this – being the police, we should be concerned about the standard and quality of our evidence, shouldn’t we?! We are in criminal trials – why haven’t we been overly concerned with it terms of evaluating interventions? We see examples all around us where evidence is not being brought to bear on the claims we make – again and again, I see this in...

Continues, Read More...

A few weeks ago – and all of a sudden – a Member of Parliament laid down a ten minute rule motion in the House of Commons, aiming to amend section 136 of the Mental Health Act 1983. After accompanying Metropolitan police officers on a patrol one evening, Sir Paul BERESFORD MP witnessed the handling of a mental health crisis in private premises. A young woman was found stood on the window sill of the 14th floor of tower block in Wandsworth and an officer managed to talk her down from it. Whilst still in the premises and beyond the reach of section 136 of the Mental Health Act, the young woman refused all offers to voluntarily access assessment, presumably by going to A&E.

Concerns for the young woman’s welfare were so serious that the officers called upon local mental health services and to be fair, were joined at the address by a mental health professional.  Whether this was a mental health nurse, an Approved Mental Health Professional or any other kind, is not clear, but we do know that they believed the young woman needed to be...

Continues, Read More...

Do you know what I mean by a ‘vanilla’ tweet? – the phrase refers to something fairly inoffensive on Twitter, quite bland information that doesn’t tell us a huge amount but whilst purports to inform. Something like, “Great meeting with partners about mental health – loads of work going on to keep you safe” or similar. Well, I’m bumping into a fair few of them on the subject of the Crisis Care Concordat and I have a couple of concerns arising from it -

• Vanilla tweets – of themselves – don’t tell us much and they never, ever have.  I can see, however, that they may be infrequently necessary.
• Vanilla tweets on the subject of the CCC imply little difficulty in resolving the thirty to fifty year evolution of problems in policing and mental health.

It’s almost as if history has been somewhat erased and it makes me wonder why we ever had any problems in this arena because just one or two meetings and we seem to be sorting it all out without much difficulty! This also strikes me as highly unlikely. Take it from me, it took five years...

Continues, Read More...

You may remember that in July the IPCC have launched an inquiry into the death of a man in Sussex following an incident in Hayward’s Heath.  The family of the man who died following restraint have suggested he was tasered and subject to the use of pepper spray as officers appeared to disregard information that he suffered from epilepsy and a seizure was mistaken for violent behaviour.  Initial reports suggest he may also have suffered a heart attack either during restraint or once in the police vehicle.  Another tragedy for all involved, regardless of what the IPCC findings may be and I can only imagine what his family have been through this week.

Of course epilepsy is not traditionally viewed in medicine as a mental illness, despite the fact that for the purposes of nineteenth-century laws on insanity, it could be viewed as such.  So could diabetes, for that matter.  However, this incident links to concerns I have written about before for various reasons:  we know that epilepsy is one of those medical conditions flagged...

Continues, Read More...

Contemplate the idea that a vulnerable person with mental health problems is arrested for a not-especially-serious offence.  In custody the Force Medical Examiner suggests they are seriously unwell and may need admission to hospital under the Mental Health Act.  An AMHP and a psychiatrist join the FME in assessing the person formally and it is decided that he or she requires admission to hospital under s2 MHA for assessment of their supposed mental disorder.

What now happens to the offence?

Well – if it was not-especially-serious and the person has never really been in trouble before, is there any public interest in prosecuting the offence? Probably not – maybe there would utility in it if the offence had been murder but where the investigation had been into shoplifting or a minor assault, government policy suggests – in Home Office Circular 66/1990 – that diversion from justice is in order.

What if it were not the first arrest?

If someone is being repeatedly arrested, things may change.  Surely, if diversion has occured a handful of...

Continues, Read More...

Statistics – everyone’s favourite topic!

We have quite a problem that has existed for years and whilst I knew things were bad, I hadn’t realised the extent of it until last week.  The problem is – on sections 135 and 136 of the Mental Health Act – that we haven’t got a barking clue what is going on, nationally because there are too many problems with the data.

• We don’t know how many times these powers are used.
• We don’t know which buildings people are taken to as a Place of Safety under the Mental Health Act.
• We don’t know the specific outcomes from 136.

I could go on!?

IN PARTICULAR!

In debates over the last year or so it has been claimed that the low ‘conversion rate’ of section 136 detentions to admissions is itself evidence that the police threshold for the use of this authority is too low. Last year it was claimed that just 17% of detentions by the police resulted in a patient’s admission to hopsital and it was barely higher the previous year, at 20%.

A question was posed to me on an email this week about what the...

Continues, Read More...