Iâ€™m not trying to get on anyoneâ€™s nerves here, Iâ€™m really not. I just feel really passionately about this and we can probably agree that it is actually my job to keep chipping away at all aspects of policing and mental health issues. So with considerable regret, I must again raise the topic of street triage, something which Iâ€™ll admit I often go out of my way to avoid discussing, not least because it tends to go down like the proverbial balloon. So Iâ€™m really sorry and not Iâ€™m trying to bore anybody here, or to undermine hard-working professionals who no-one doubts are trying to make the world a better place by supporting vulnerable people. I have to just hope it can be understood, Iâ€™ve been given a job that is around the application of the law and newly developed guidelines which needs to sit within a culture of robust evaluation. I am also subject to the police serviceâ€™s Code of Ethics, which makes it clear we have a duty to challenge, question and discuss. I do again, because I know from discussions yesterday that Iâ€™m not the only person with questions and with concerns. Others who said so yesterday, include psychiatrists, AMHPs and police officers.
An academic article was published yesterday in the BMJ (no less) about street triage in the North-East of England, operating in the Northumbria Police area alongside Northumberland, Tyne and Wear NHS Trust, undertaken by Newcastle University, a Russell group institution (no less). There have subsequently been several media pieces covering the highlights from this publication, most of them within professional online articles rather than in the mainstream and through the magic of social media further discussion by people who know of such collaborative approaches elsewhere in the country. On this occasion, the main highlight seems to be that â€˜street triageâ€™ cuts the use of police powers in half; it has brought about significant cost savings (estimated at around Â£1m for a large mental health trust like NTW) and improved outcomes for vulnerable people who now often experience a far less restrictive approach to their crisis care.
So far, so good, right â€“ who could possibly object? My objection is not to street triage, per se, my whole point is we donâ€™t know enough about it to know whether we should be objecting to it or not! My objection is to extremely partial evaluation that fails to even acknowledge, never mind address, very obvious issues that should influence any assessment of the risks versus the benefits. I keep hearing that street triage â€˜worksâ€™, but no-one can tell me what itâ€™s trying to do. I also hear some say, â€˜it works for usâ€™, to quickly sidestep the whole discussion about whatâ€™s for and what itâ€™s doing.
Iâ€™ve suggested that this article would be a good thing to give to university MSc students looking at research methods: it would allow them considerable scope to think about what this article is NOT saying and what the authors have NOT considered as relevant to an evaluation of the scheme as a whole or the use of s136, for therein lies the interest for me. I note (from what I can tell by looking them up), that none of the authors of the article appear to be police officers or lawyers â€“ yet the primary aim of their focus is an analysis of the use of particular legal power and itâ€™s mainly the legal perspective thatâ€™s missing, for me. Although thatâ€™s not all thatâ€™s missing.
So hereâ€™s a list of thoughts in no particular order â€“
I could go on â€¦ and on. It remains my view that street triage is very under-evaluated, that nothing weâ€™ve seen so far gets us close to having a clear under-standing of risks versus benefits and that this weekâ€™s publication is encouraging but an extremely partial view. And youâ€™ll have to forgive me repeating this point: my objection is not to street triage â€“ it is to limited evaluation of these new ways of working! We didnâ€™t even mention deaths following contact with triage assessment, have we? â€¦ they need looking at, too.
Thatâ€™s why when I see things like this and find that people claim itâ€™s an obvious success that needs to happen everywhere on a 24/7 basis, it does get me fairly exercised because itâ€™s put across as a self-evident truth, beyond discussion. In reality there are many professionals and services who say otherwise but then again, they havenâ€™t fully analysed it either!Â Iâ€™m far from alone in having unanswered questions, although it sometimes feels that way â€“ I actively want someone to come and show me I neednâ€™t worry, because Iâ€™d love to be convinced about all this, given the obvious upsides to a collaborative approach.
But I want loads of data, quantitative AND qualitative.Â So whilst weâ€™re on the subject: where are the patientâ€™s and publicâ€™s voices in all of this?Â Exactly.
Other posts touching on street triage and those aspects of s136 MHA referred to above â€“
Winner of the Presidentâ€™sMedal from the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award