A man in his 50s has been drinking heavily in his Loughborough flat all morning and is now threatening to kill himself. He’s tearful as he describes his loneliness and mother’s death a few years ago. He repeatedly tells the police officers to go away. But as PC Alex Crisp explains: “Police officers have to stay with him, there’s a duty of care. The police have to do something, you’re accountable ultimately.”
It’s a dilemma for the police. While officers have to do something, their options are limited. They only receive basic mental health training. Staying with the man until he sobers up consumes valuable police time, but walking away could end in tragedy.
However thanks to an initiative introduced in January, officers are working closely with mental health staff to resolve situations like this. The triage car is a partnership between Leicestershire police, Leicestershire Partnership NHS trust and Leicester probation service. The car is staffed by a police officer and a mental health practitioner and they attend calls where people are experiencing a mental health crisis. The nurse can assess the person, offer advice, and steer them to the appropriate care and support services. For example, they can contact the person’s existing care team or refer them to a home treatment service.
“We’ve got more options,” says PC Crisp, a Leicestershire triage car officer. “I’ve got an expert sitting next to me who can access pathways I can’t. As a police officer I’ve no access to any of that at all. I can’t refer into any of those services.”
The crew can access previous police and health service records about the individual to make more informed decisions.
“We can look at people’s history, their risk history, their diagnostic history, reports about how well they engage. You can start to make a risk assessment from that,” explains Dave Spencer a mental health practitioner with Leicestershire Partnership NHS trust.
The practitioner can assess more accurately than the police whether someone poses a risk to themselves or others.
For example, the man in Loughborough had made several threats to kill himself previously and had never acted on them, and it didn’t appear that he intended to now. After he refused all offers of support, the team eventually took the decision to leave after an hour and a half.
“We get called out a lot to people threatening suicide,” says Emma McCann, a mental health practitioner, involved in the triage scheme. “There’s also public order stuff, where people are suffering from mania.”
Other incidents have involved people with dementia not recognising their partner and thinking they have been kidnapped. The team carry out two to three mental health assessments a shift on average and provide advice over the phone to colleagues across Leicester, Leicestershire and Rutland. They give advice over the phone for around five cases a shift.
The aim of the triage car is to reduce the number of people being detained by police under section 136 of the Mental Health Act. When a person is detained, for their own protection, they are taken to a “place of safety”, which can be a police station or a hospital. If someone is experiencing a mental health crisis, police officers will generally err on the side of caution and use section 136, explains PC Crisp. However section 136 is a “blunt instrument”: “You’re arresting people for being mentally ill for the purpose of an assessment.”
Earlier this year, a report by Her Majesty’s Inspectorates of Constabulary and Prisons, the Care Quality Commission and the Healthcare Inspectorate Wales, said too many mentally ill people were being held in police cells. A police station is not always an appropriate place for someone suffering a mental health crisis, explains Matthew Wakely, Leicestershire Partnership NHS trust criminal justice and liaison service team manager. “You need somewhere calmer. They’ll be staying in a cell which isn’t a therapeutic environment. People can feel criminalised. All guidance says people in these situations should be treated as patients.”
Detaining people under section 136 can also be a lengthy and expensive process for the police. The person might be detained for up for 72 hours while waiting to receive a mental health act assessment – which determines whether they should be in hospital – carried out by a doctor and an approved mental health professional.
Chief Inspector Pete Jackson from Leicestershire police says there has been a significant reduction of people being detained under section 136. “40% less people get detained by police under the act than prior to the triage car. If they do need to be detained we know why we are doing it and the process is quicker.”
The decision for the police and the trust to work closer together followed discussions between Wakely and Jackson. “We were talking about people who frequently attend the police station and were known to us,” says Wakely. “We talked about information sharing, improving outcomes for service users and detainees.”
“There was a whole sequence of cases where we weren’t working effectively as partners,” explains Jackson.
The police and the trust had already begun to work closer together before the introduction of the triage car. Since August last year mental health nurses have been based at the Euston Street police station’s custody suite. They carry out mental health assessments and help people access support and treatment, which it is hoped will prevent reoffending.
To fund the triage car for a year, Leicestershire Partnerships NHS trust received £198,000 from local health commissioners and the police received a £100,000 grant from the Custodial Health Commissioner for the East Midlands.
Leicestershire isn’t the first place in the UK with a triage scheme. Cheshire Constabulary also has one, however the model used is slightly different, says PC Crisp. In Leicestershire the police officer and mental health practitioner sit side by side at the station, each with their own computer, “for data protection purposes”, and attend incidents together. In June care minister Norman Lamb announced four areas to pilot new triage schemes, in North Yorkshire, Devon and Cornwall, Sussex and Derbyshire and the Department of Health mentioned Leicestershire as an example of best practice.
It isn’t that support for mental health problems isn’t there, it’s just that the police is the first port of call for many people, says McCann. “Interestingly, with all that is out there, people will go to the police.”
This article first appeared on The Guardian UK on 13 November 2013.