Last week saw release of the Strategic Review of Policing, published by the Police Foundation, having been chaired over the last year or more by Sir Michael Barber.  It was heavily trailed a few weeks back, but the full document not released until recently.  One hundred and ninety six (196!) pages long, it touches on a lot but given the remit of the panel who wrote it (examine all of policing), it was always likely to examine those topics which some might argue ‘distracts’ the police from its perceived primary focus around crime.  Regular readers will know that chief amongst those topics is always the police response to or involvement in mental health related incidents and this report is no exception to that observation.  It gives us some headline findings to think about, including the 28% rise in mental health demand up to 2018, the 33% rise in use of s136 up to 2020 and then quotes something from a 2020 post of mine, “The Impact of Policing”.  It’s something I’ve often said over many years, including previous posts —

“The problem is not the police – it is the over-reliance upon the police as a de facto mental health and crisis care provider”.

The new report then goes on to quote (on p64) the National Police Chiefs Council strategy (2020) which I wrote towards the end of my secondment to the College of Policing/NPCC and which I finished drafting after I’d returned to being an operational officer.  The strategy deliberately set out to acknowledge the shortcomings in what we know and I was delighted to see the new report pick up on that.  Far too many have been ready to shout loudly that we “fixed it!” because we started doing street triage and liaison and diversion, but for reasons I’ve covered on this blog, I (still and profoundly) disagree.  And I’ve also written before, whenever the policing / mental health topic comes up, those initiatives are always shouted for being part of the solution to whatever you think the problem is, it it’s bee defined at all —

• The police need more training — on mental health awareness, inc de-escalation; and on mental health and capacity law and how it all intersects with criminal law.
• The police need to work in closer collaboration with others — street triage and liaison and diversion, typically, but there have been other ideas, such as the disbanded and discredited SIM scheme.

My main concern is that the problem is rarely defined, other than very vaguely and therefore it’s almost impossible to strike a balance in how agencies interact.  I do argue that the problem to be fixed (or balance to be struck) is deliberate over-reliance upon the police, criminal justice and emergency systems.

THE BARBER REPORT

Whatever the rights and wrongs of these particular initiatives, the Barber report picking up on my post and quoting from it, is starting to hit the nail on the head, for me.  (That said, the post was about something subtly more specific.)  Over-reliance on policing (as well as on the criminal justice and emergency systems more generally) is a massive problem.  Saying this doesn’t mean the police have no role to play and that shouldn’t be prepared to do it or understanding how they may improve; but my concern over the last ten years is it seems to have taken for granted that demand exists and that’s unavoidable, unpredictable and unpreventable – we know it’s not.  Spend a night working with triage and you’ll see that much of their workload is demand deflect to triage from the mental health or healthcare systems.  We knew this was true of police demand before triage so it should come as no surprise – but ignoring that reality meant we went on to try and fix symptoms, not causes and my main concern is that the existence of such partnership schemes makes it even easier to deflect demand, becuase it’s now being deflected to somewhere with greater competence.  So we made the problem worse, even if we ameliorated some of the symptoms (doubtful).  I’m reassured in this view by speaking to several mental health nurses who’ve worked on triage – even they complain about deflected failure demand.

You can have much less policing if you want that; it’s just that you’ll need to pay for the public health approaches necessary to ensure it.  And if you do choose not to insist on them, you’ll pay anyway in exceptionally expensive interventions by policing, criminal justice and emergency services.  The Strategic Review makes a decent case for arguing more generally about prevention – a public health approach to crime prevention – extent that idea to a public mental health approach to crisis prevention and we’ll go some way towards what everyone wants: not just a reduction in reliance upon policing, criminal justice and emergency services a mental health care supports; but also to improved service for those of us who live our lives are affected by our mental health.

If you look at the NHS Long-Term plan (2019-2024), it’s offer to improve mental health crisis access is an offer mostly predicated on telephone triage and yet any experienced mental health nurse will tell you the first thing you do in any mental health assessment is a physical or visual examination.  The reasons should be obvious.  That’s why the solutions we’ve seen in the previous decade simply don’t work, in my view – they are fixing the symptoms of problems, not the problems themselves and they are predicated on assumptions which I must insist are not borne out by evidence.  It’s not the only example of false assumptions abounding in policing and mental health related demand.

CRIMINALISING MENTAL HEALTH

In the recent joint thematic inspection by criminal justice inspectorates about mental health, it was pointed out that 71% of those referred by the police to liaison and diversion schemes were found to have a mental health problem requiring support.  Read that again: of those referred by the police … 71%.  The history of concern about vulnerable people in police custody was the fear that some people with mental health problems were not being identified (bearing in mind, there are very few benefits to telling the police you’re depressed, psychotic or suicidal – it will massively extend your stay in a cell).  So here’s my question: how many of those who were not referred by the police have a mental health problem?  By definition, we don’t know.  Liaison and Diversion should be screening everyone at the point of entry, but you can only do that if you’re there are midnight or 2am.  By morning, some big legal decisions may have had to be taken which may mean vulnerable people are being missed – indeed, some people may have been released by then, for legal reasons.  Article 5 ECHR in play.

So it raises the final issue of training – I’ve always been fascinated by police training on mental health becuase of how badly I know police officers want more of it.  (I once did an input to officers about how people doing my current role make decisions about whether to send armed or unarmed police to incidents reported to involved weapons.  At the end of that input about whether I might send unarmed officers to incidents where people have knives or guns, I asked if there were any questions.  *ALL* of them – literally – were about mental health and capacity law.)  The 2018 HMIC report Picking up the Pieces made mention in its formal recommendations that police training should be re-examined by all police forces by August 2019.  I can’t say whether this was done as I’d moved on from the role I had when the report came out but I’m not aware of it having happened.  I do know that officers frequently tell me they want more training on the topic – especially the legal issues.  This is also reflected in emails I continue to receive and I can only speculate about why they still find their way to me.

For the fact the strategic review looked at my work and cited it, I’m grateful.  The message in the “impact of policing” post was an even more cautionary one than highlighting in general terms that we over-rely on policing.  It was to sound the noise in light of a particular inquest (and it wasn’t the first which shows it) that our over-reliance is not benign, it can be outright and unknowably dangerous.  The case I used in the post was that of Lauren Finch in Greater Manchester, but I could have used Sasha Forster in Surrey as well as others.  In the context of those inquests “the problem” wasn’t something general: it was specific to factors which seem to have contributed to a fatal outcome.  The problem was that policing inevitably brings stigmatisation, criminalising and on occasion, dangerousness because of its impact on the mental state and fragility of some extremely vulnerable people.  Police responding in lieu of other, more appropriate agencies is not without collateral risk – it shouldn’t explaining why, but if you’re not aware, try reading this blog from start to finish and you’ll see 850 reasons why.

The problem is still not the police — it is the over-reliance upon the police as a de facto mental health and crisis care provider.

Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2022

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