It is no secret that mental health services are in a sorry state. Last year saw lots of stories about the increased pressures being placed on treating people in the community and on beds in mental health wards. This was made worse as a number of policies such as the bedroom tax began to have an impact.
It’s very welcome, then, that one of the first mental health news stories of 2014 was an optimistic one: ten pilot schemes have been established which will see mental health nurses based in police stations to assist officers in the assessment and care of individuals who are in police custody and where there are concerns about their mental health.
The aim of the £25m scheme is to intercept problems before offenders reach prison and to cut re-offending – and reporting of this issue has largely focused on this second point. But this is simply another example of the conflation of mental illness and offending. Despite the media’s fixation on mental illness and violent crime, a significant proportion of police work involves people with mental illnesses who have been victims of crime. The police are also the emergency service that the public are most likely to contact if they have concerns about a relative or neighbour who is behaving in a bizarre or distressed manner.
An acutely stressed situation
A BBC Panorama programme – Locked Up for Being Ill? – showed the challenges police face in ensuring that people in acute mental health distress remain safe while in custody. A number of very distressing examples included individuals who spent prolonged periods in custody while attempts were made to have psychiatric assessments carried out.
In several cases, police had used powers under section 136 of the Mental Health Act (MHA) to detain an individual in acute distress so that they could be assessed by a psychiatrist and an Approved Mental Health Professional. The MHA Code of Practice makes it clear that the police station should only be used as a “place of safety” if such cases present themselves, and in very rare circumstances. But the pressures on mental health services across the country – and particularly in large cities – mean that there are far too many examples of this happening in practice.
In 2013, a joint review by Her Majesty’s Inspectorate of Constabulary, Her Majesty’s Inspectorate of Prisons, the Care Quality Commission and Healthcare Inspectorate Wales, revealed the extent of this problem:
We found that police custody was still being used as a primary or secondary place of safety. Its use varied between the areas we visited, from 6% to 76% of the total number of people detained under section 136.
In many cases, the reason why police custody was used as a place of safety was not documented in police custody records. When it was recorded, the most common reasons were: insufficient staff at the health-based place of safety; the absence of available beds at the health-based place of safety; the person had consumed alcohol; or the person was displaying violent behaviour, or had a history of violence.
Although they had not committed a crime, those detained under section 136 who were taken to a police station were generally treated like any other person in respect of the booking-in procedure; risk assessment; and, ultimately, being locked in a cell (rather than being taken to another part of the station).
While the Panorama programme found that regularly dealing with people who would be better treated by psychiatric professionals took up as much as 25% of police time (according to police estimates), a study from the Sainsbury Centre suggested at least 15% of police work involved people who were experiencing some form of mental distress.
‘Core business’ for the police
There have long been concerns about the training and support that police officers receive in this area. In September 2012, in response to a number of deaths in police custody where mental health was a factor, the Metropolitan Police Commissioner asked Lord Adebowale to review his force’s work in this area. The report, which was published last year, highlighted the fact that mental health is “core business” for the police.
People with mental health issues may come to the attention of the police as witnesses; victims of crime or suspects. A survey of MPS officers indicated “daily or regular” encounters with victims (39%), witnesses (23%) and suspects (48%) with mental health conditions, and 67% encountered unusual behaviour, attributed to drugs and/or alcohol.
The scale of the problem is revealed further when the report goes into the number of calls that the police took in 2012:
The scale of the problem is further emphasised when one looks at the number of calls that the Metropolitan Police Service took in 2012: 61,258 calls involved a mental health issue (an average of over 160 a day); 21,741 more than calls related to robbery and 47,203 more than sexual offences. A significant number of these calls took place outside of office hours, so at night or at the weekend, when it is even more difficult to access support for people in crisis.
The report also supports the findings of the 2009 Bradley Review that the police and all community based mental health services have to work together more effectively to ensure that vulnerable people in crisis receive appropriate and timely support. This is not an issue that can be resolved without much more effective working between all the agencies involved.
The new nurse pilot projects, along with other new approaches such as mental health triage may well provide some solutions to this deeply ingrained problem in mental health but I hope that well-funded and effective mental health nurses are an addition, not a substitute for a comprehensive community mental health service that could stop people being taken into custody in the first place.
This article first appeared on ‘The Conversation’ on 8 January 2014.