[Guest Post by Mental Health Cop]
The police service is key to the delivery of effective community based mental health care. There is an inevitability of police officers being called to incidents involving service-users, carers and professionals because some will occur unpredictably and because a few involve responding to significant risks.
A fact of law: it is the police who must take certain decisions and exercise certain functions required by the Mental Health Act 1983. It is a matter of ethics and law: that the police should support colleagues in the health & social care professions as they administer the Mental Health Act, in order to keep everyone safe as they do so.
Research from the Centre for Mental Health suggests that as much as 15% of police work involves some dimension of mental illness – victims, witnesses and suspects as well as those who are not involved in the criminal justice system at all. It has been suggested that by a mental health trust as many as 50% of people arrested by the police are current or previous mental health patients.
Without wishing to stigmatise a very diverse group, we do know that at least some mental health incidents are high risk business and some psychiatric emergencies occur so unpredictably that the police are going to have a key role as first responders and gatekeepers to health services.
Most police officers I know want to know more about mental illness and mental health law in order to provide the best service. Most of us know police officers with mental health problems – some incurred as a result of the job we do. Every time I have ever delivered a briefing on the subject, there appears a genuine thirst for more knowledge because most frontline cops know that there is a set of persistent challenges and they would prefer to do the right thing:
Removal of those who may be at risk to a ‘Place of Safety’ –under s136 Mental Health Act 1983.
Patients who are absent without leave from hospital.
The investigation and possible prosecution of offences involving those who are mentally ill, either as victims, witnesses or suspects.
A major is challenge is that the police know there is no such thing as ‘the NHS’ – in my region alone, it is 45 separate organisations and the detention of a vulnerable person under s136 Mental Health Act, for example, could necessitate contact with five or six separate organisations within ‘the NHS’. It also involves the Local Authority and the police themselves: eight organisations trying to something unpredicted in as a short a timeframe as possible.
Agreeing local operating policies can be like nailing jelly to a wall.
It is obvious this can lead to tension between the NHS and the police about how responsibilities are divided, both at frontline and managerial level and is it is reflected in a divergence of practices across the UK. If an AWOL patient is at their home address and needs to be returned to hospital, should this automatically be a role for the police? Well, the Code of Practice to the Mental Health Act says ‘no’ but several MH trusts say ‘yes’ because they cannot ensure the resources to recover patients themselves. That having been said, if the police try to plug the gap focussing on wanting to ensure that people in need of hospital treatment are returned there for care by appropriate professionals, service-users report being criminalised and the victims of prejudice and stigma. They report that the police have been used inappropriately to ‘control’ them.
So what is the answer and what if we can not agree how to resolve differences? The use of the police to administer the Mental Health Act should be proportionate to the actual threats, not routine business.
But here’s a controversial claim: the police, quite rightly, under-criminalise those with mental health problems. People in our society occasionally have contact with the police. A community care model cannot prevent this being true for those living with mental health problems but because it is typically argued that police involvement of itself is a criminalising experience, the service needs to ensure it knows what it is doing.
Where you put a typical crime scenario to 100 police officers and sought to understand how often they would arrest and / or charge a suspect and then repeated the exercise where it is known the offender has mental health problems, you will find a surprising result: the number of arrests will drop and the number of arrests which result in prosecution will drop. It is clear from research that where police officers have access to diversion services, they will take them and reduce unnecessary criminalisation.
But of course, most police contact with service users is not in situations where it is alleged they’ve broken the law. It is far more likely to be that someone is the victim of a crime or in need of support during crisis, either by the police or by the police supporting others.
A service user once said to me, “The worst that you can say of the police is that they are there for you 24/7. They might not always do the right thing, but sometimes that’s not their fault. At least they’ll come when you need help and try to do something.”