This week, two piles of data were published which touch on my area of interest: firstly, NHS Digital published their newly formatted data on the use of the Mental Health Act 1983 â€“ new format will save Â£350,000 in statistics related costs, apparently! And secondly, the Home Office published their Annual Data Return from police services which, for the very first time, includes data on the use of section 136 of the Mental Health Act (MHA).
They say entirely different things, obviously! â€“ it would be quite boring if theyâ€™d been consistent because then my phone wouldnâ€™t have rung all day long with people asking what the hell is going on. Iâ€™d have got to enjoy a lunch out with my son on his half-term and returned home to get so much work done that I might have would have wondered what on earth I would do with my Friday â€¦ local business wouldnâ€™t have been so well supported by me uncharacteristically reaching for a beer on my Thursday night.
And, no â€“ I donâ€™t have much of an idea about whatâ€™s going on, either!
Iâ€™ve argued a few times that s136 is many respects is one of the least important issues in policing and mental health, but itâ€™s about the only thing that many people put effort in to counting and itâ€™s seen, rightly or wrongly, as a barometer the state of things. Today, a force mental health lead rang up and talking about the impact of their street triage car â€“ measurement of success was the impact that service has had on the rate of s136 usage. Nevermind that more than half of â€˜streetâ€™ triage work is not in the street and only occurring in areas where s136 canâ€™t be used â€“ so maybe itâ€™s a barometer for less than half of things?
We know that many encounters between police officers and those of us experiencing acute difficulties end in arrest: some incidents happen so quickly, officers resort to powers theyâ€™re more familiar with, perhaps before theyâ€™ve had a chance to suspect someone had a mental health problem. Because we donâ€™t put as much effort in to data collection, weâ€™re not sure whether the police are arresting more people for offences who then need MHA assessment than they are using s136, but I think that would be even more interesting to know, because it gets in to more interesting territory about how we determine the relationship and behaviour that is ordinarily called â€˜criminalâ€™.
Beyond that, Iâ€™d be interested in knowing about the experience of those of us who live with mental health problems as they are made subject to these powers; I want to see data that gives us an insight in to the extent to which the police are relied upon to invade the health and wellbeing of vulnerable peopleâ€™s lives: welfare checks, missing people, attendances at inpatient mental health units, and so much more. We now know what we need to know about section 136 and I think itâ€™s time we moved on and got way more sophisticated about the role and responsibilities of the police â€“ the other stuff is just so much more interesting, but I fear weâ€™re going to keep focussing on this as a proxy measure for everything we canâ€™t be bothered to understand properly.
Look at the figures in the header image, above: I was asked to knock this together so thought I may as well share it. Within 10 minutes of doing so, I had two force mental health leads email me back to say their figures were wrong â€“ so whether somethingâ€™s going wrong â€˜in forceâ€™ or at the Home Office, Iâ€™ve no idea. For what the figures are worth, though, itâ€™s clear a few alarm bells should be ringing just so we go and check whatâ€™s going on â€“
Canâ€™t avoid mentioning Devon and Cornwall, bless them â€“ they were the only force who did not return data to the Home Office. Obviously, therefore, the national totals need to understand weâ€™re missing a force that has historically been one of the highest users of the power, 1424 last year and 1136 the year before. So you can add at least a thousand, perhaps much more as an estimate and then weâ€™d see the 2016/17 figures are not that much below 2015/16. Conscious of binary comparisons, this doesnâ€™t tell us much â€“ you need to look at the broader trend on the use of police powers under the MHA. It certainly seems to be the first year for a long while where we have not seen a continued rise in the use of this power. Iâ€™ll be honest: I was expecting to see s136 usage tip over the 30,000 mark for the first time in history. So if the data is to be believed â€“ big â€œifâ€ â€“ why have we seen the decline slow down ot start reversing?
It does seem likely some forces will want to have a deeper check of things than others â€“ some forces have seen their use of the power double or halve (Avon and Somerset are reported to have reduce their use of s136 from 1262 to 444; Humbersideâ€™s has gone five-fold from 81 to about 441, etc..) There will be some forces perhaps thinking ahead to the legal changes and realising their use of police custody is risings, others that it may have dropped but thereâ€™s still a way to go before we seen statutory Regulations that will severely restrict the use of police stations. Elsewhere in the data, youâ€™ll see there is detail about why people were taken to custody, whether ambulances attended the point of detention, breakdowns of this data by demographic factors like age, race and gender. There is more to be seen if you want to see it.
And what is missing from the figures is the understanding of what actually sits behind each of these numbers: the actually deliver of the service to those of us who live with acute mental health problems.
Weâ€™re still missing â€“
But overall, I would say this: you can find here whatever you want â€“ good news, bad news, warnings, reassurance. Whatever youâ€™re taking from this, just remember the problems here â€“ Iâ€™m not taking much from this, but instead Iâ€™m braced for impact at what may happen in December when the MHA changes. And by the time we sit here next year, the next ADR batch will be telling us ever more that we canâ€™t easily compare with anything meaningful, least of all this yearâ€™s ADR and the last few years of NPCC data. Add to that yesterdayâ€™s NHS digital publication which is full of caveats about avoiding comparisons, lists of organisations who did not contribute and a speculation that Place of Safety â€˜ordersâ€™ (ie, s135/6) were used around 15,000 times! â€¦ it does seem we donâ€™t really know whatâ€™s going on, even on this most basic of topics: how often we use long established legal powers.
So Iâ€™m just depressed that out inability to ge this right means we wonâ€™t even begin to see the importance otherwise talking about the fundamentally much more interesting and important stuff.
Winner of the Presidentâ€™s Medal from
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.