What value do we place on personal experience, especially where it comes down to individual opinion? I’ve been struck recently by the number of attempts we make to infer from individual opinions and experiences, lessons which might influence our overall approach to things. Last night, I was interviewed by the BBC about policing and mental health issues to coincide with the College of Policing publishing new APP (guidelines) and training packages. North-West Tonight are running a two-part feature about the story of Neville, a young guy from Manchester who has mental health problems and who, we learned, was imprisoned for assaulting a police officer whilst they were dealing with him whilst in distress. Understandably, having been detained by the police, subjected to a use of force and taken to police custody, his recall of events was fairly negative overall. The line of questioning from the BBC was along the lines of “Don’t the police and criminal justice system fail people like Neville with mental health problems?” … “aren’t we unnecessarily criminalising people here?” … “isn’t there an institutionally ingrained problem with officers’ attitudes towards mental health?”

All from one story! Fair enough: many other people have got negative stories too, so I’m not suggesting this is an isolated example but it has to be seen against the background of incidents where the police have been found to be quite exceptional, in variety of ways. More realistically, the majority of encounters will be somewhere in between – officers ensuring a professionally acceptable response to situations where the option of doing the right thing may not always exist and where the time for an earlier, less stigmatising intervention by anyone is days or weeks behind the encounter.

The irony here is: this is just my opinion – which I fully accept needs broadening out with some theoretical frames of reference and some proper research! In the next life and / or after I win the lottery, I’m going to do research on this stuff because it’s quite badly needed and long overdue.

CRIMINALISATION

I’ve written about ‘criminalisation’ elsewhere: there are two general theories around what it means –

• Processes which have the effect of making people feel criminalised around healthcare issues – if the police, custody blocks and the courts become involved in what are, in essence, responses to healthcare difficulties, are we not criminalising people?!
• The nature of decisions when CJ professionals know they are dealing with someone who is mentally ill – are these decisions different to the decisions those professionals would take if mental vulnerability were not thought to be a factor within the incident?
• So, if you like, it’s the different between the subjective and objective experience – small consolation to individuals, but relevant to looking at the impact of public policy. Of course, this is a false dichotomy: any sophisticated society would blend the two to understand the dynamics at play.

So, it probably depends on your perspective, your politics (small p) and the context of it all – if you have a health problems, have not offended in any way and can only access mental health services via the criminal justice system, then yes: you’re going to feel criminalised when compared to those with other kinds of health problems. If you have come to the attention of the police after members of the public saw you in the High Street in possession of a knife, then we need to think differently. People in public with knives are usually arrested and then quite frequently prosecuted or cautioned for the offence. If the outcomes for people with mental health problems are different, then we can take another view about whether they are more or less ‘criminalised’ than the norm.

In reality, once officers suspect or know you have mental health problems, you are less likely to be arrested and prosecuted for possession of a knife and more likely to be detained initially under the Mental Health Act or entirely diverted from justice. You could argue, as various academics have, that this amounts to people being less criminalised than would otherwise be the case – research over fifty years in various countries show that if diversionary mechanisms are made available to the police who are properly trained in how and when to access them, they will use them. So even by this yardstick, the extent to which we criminalise people is within our control.

ATTITUDES

This idea that police attitudes are culturally ingrained and in bad need of a sort out requires a few responses. Nobody doubts that there are attitudes in society around mental health that need challenging: we draw the police from society and then subject them to a very perverse perspective on mental health issues, so I think it would be genuinely stunning if we didn’t see examples in policing of poor attitudes. We see it everywhere else, including in mental health services, on the news and in politics – so why would the police be any different?! But look at last year’s CQC report on mental health crisis care: your police service were thought by patients who have experienced a crisis in their mental health crisis to rank second only to the ambulance service in exhibiting positive, patient and compassionate attitudes towards those in distress.

This is not that bad when you think the others who were rated by patients included mental health teams, GPs and A&E. The police has work to do, no doubt, but it’s hard to land a claim of ‘poor attitude’ when this recent research suggests patients themselves value their attitude more than most and despite the overall crisis care system often forcing officers to take decisions they’d rather not – like removing people to police custody as a Place of Safety, which still happens too far often.

Extrapolating conclusions about attitudes from individual actions is also fraught with worry. I’ve been known on occasion to authorise a ‘serial’ of officers in heavily protective equipment (riot gear), armed with tasers, batons and shields to detain a man under the Mental Health Act. This no more reflects my general attitude towards mental health issues than the colour of my car says anything about it but it would be stretching things to expect the extremely unwell man who was thereby safely removed to hospital to see it that way when he was no doubt, very frightened and unwell. I can’t rule out that if I was being spat at or bitten by someone with mental health problems, that I wouldn’t use force in order to protect myself from assault. The allowance that is often made for mental health problems is in the criminal justice outcome, rather than the immediate actions in ensuring everyone’s safety – which includes police officers’ safety.

FAILING PEOPLE?

One thing I’ve heard repeatedly throughout my decade of work in this field, is that people value the fact that they police are always there for them. Even where people can see that officers haven’t always been at their best, haven’t always done the right thing (for whatever reason), they have often valued the fact that they are, at least, there. Of course, the police have got improvements to make, lessons to learn and I hope that the new APP and training packages go some way towards ingraining those learned lessons. Of course, there are many examples of people’s we would probably all agree people were ‘failed’.

Your police service is responding to millions of mental health related events every year: using Mental Health Act powers over 28,000 times in England alone, over 50% more than they were a decade ago; encountering hundreds of thousands of crisis incidents every year. It’s easy to keep bringing out that half of people who died in police custody had mental health problems without remembering that many of those had other complications and complexities, like substance abuse and / or other underlying health problems. It’s a shame we don’t have a mandatory duty to refer incidents somewhere every time officers saved somebody’s life, often by risking theirs – I suspect the second number would dwarf the first; and I don’t say that to diminish to in any way the importance of ensuring all police forces learn the lessons from each death in custody. It’s vital that they do.

But credit where it’s due – and as national guidelines and training are yet to have effect, it’s mainly due to the tens of thousands of frontline, untrained operational police officers who police with common sense and compassion the vast majority of the time. If we want to talk about whether people are ‘failed’, we should look at the overall system within which those officers are required to make black and white decision, arising from endless shades of grey about what the ‘right’ thing actually is. And if we ever want to check their attitude, we need as a society to look at our own.

And this is just my individual experience and opinion – it probably does need triangulating with far better research!

Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award