Oddly enough … trying to wade your way through some of the most sensitive issues in all of public policy isn’t straight-forward. Deaths in police custody … the use of force on vulnerable people … when, if ever, to prosecute a vulnerable person … navigating ‘pathways’ and processes which span multiple criminal justice agencies and even more health and other services … this stuff isn’t easy and there are no silver bullets. You actually have to have a sense of what you’re trying to achieve by knowing the objective you’re pursuing, finding out what’s actually going on and working out how on earth you square the various circles, bearing in mind you will meet plenty of people who disagree with you no matter what you think the problems are, what the answers might be or how much effort you’ve put in to reaching them. Miss out the first part, as our politics (small p) often does, and you’re left with an intuitive need (for the police) to “Do Something!!”
Oddly enough … when you start trying to work out what is the “right” thing to in any given situation, it gets messy. When is it “right” to prosecute someone for an offence who is thought to be seriously mentally ill … when is it “right” to use force on a vulnerable person … to what extent should public agencies be blurring their boundaries in efforts to cooperate or preserving their individual mandates, bearing in mind that they don’t necessarily exist to achieve the same things … or any least not in the same ways? You end up quite quickly in deep philosophical territory which spans politics (small p), ethics and so much more besides. This is going to require hard work and thought and it’s no complaint about our politics (small p) that non-specialists struggle with this or avoid it completely by over-simplifying the landscape.
Oddly enough … if you don’t have decent data about what’s going on, the extent of problems are often unknown and certain specifics you’d need in order to answer these important questions simply aren’t available. So what do we do? … guess?! Do we rely upon professional judgement and personal experiences and if so, whose judgement shall we have when we can’t square away the competing viewpoints and vested interests when we have little data to separate fact from fiction?! One of the narratives to have emerged in recent years is this idea that police, untrained and uninformed non-specialists, need to be helped and supported by ‘experts’ from mental health services. Didn’t go terribly well in the cases of Seni Lewis or Kingsley Burrell and we still see policies and protocols around the use of s136 and Places of Safety in operation, having been written by those experts, which fall foul of basic benchmarking exercises against obvious legal requirements. This stuff isn’t all about a lack of training for uneducated police officers who need saving from themselves.
Oddly enough … all people are different. No two police officers, no two patients, no two psychiatrists are the same … encounters between people or groups of people, often with competing priorities, power structures and dynamics are not going to boil down to somebody bashing out a flow-chart on a page of A4 and sticking it on an office wall. It’s impossible in many cases to synthesise all the variables that may influence why one professional took a decision that someone else is busy complaining about. If police officers have strong views about who should be ‘sectioned’ under the MHA because they’re “obviously ill” they could train as social workers or nurses and qualify as AMHPs to do something about it. Meanwhile, those psychiatrists who think the police over-use s136 might like to get a uniform on and be responsible on their own for talking someone down from a bridge knowing full well the system that should support your decisions just isn’t going to (be able to) do so.
Oddly enough … there are no quick and easy wins to the big question – there are a number of professors, consultant psychiatrists, academics and other highly educated and committed social workers, police officers and nurses who have been trying to sort out the obvious problems we all complain about and are only making slow progress. If this stuff was easy to fix, I’d have helped flick that switch in 2004 and gone off to catch burglars and police in the fresh air. You should try getting all of the relevant agencies in the same room and the same time to discuss the totality of the emergency mental health issues that emerge in a given area: police, local authority, acute trust, MH trust, LD provider, CAMHS provider, ambulance trust, etc.. Some areas report that they simply cannot do this – it’s proved impossible.
So how do you improve things right across these agencies when the totality of their work represents one system to the public we all serve? … oddly enough, it’s like nailing a jelly to a wall. And someone keeps moving the wall, turning the light off and stealing the nails. And has anyone seen my hammer?! …
Winner of the President’s Medal from
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.