We didn't properly plan and prepare for the extent to which police services are now involved in incidents where vulnerable people are in crisis with mental health problems: it evolved over the last 60 years as mental health services changed the way that care is provided. As ever-greater emphasis has been placed upon community models of mental health care, we have seen a reliance upon policing to act as one of the main gateways to unscheduled mental health for those in crisis. Over the last decade alone, the number of times that police officers have used their emergency powers under the Mental Health Act has risen by a quarter from 18,500 to 24,500. United Kingdom figures mask the true extent of this demand because the British police have emergency safeguarding powers only in public places so other legal justifications, including arrests under criminal law, can be relied upon to ensure safety when responding to incidents in people's homes; and we know from recent 'street triage' initiatives that most mental health crisis incidents for the police occur in the home.
Police officers, memorably referred to by US academic Linda Teplin as 'street corner psychiatrists', were not trained for this kind of role. Already in 2015 we have seen reports from the Home Affairs Committee and the Equality and Human Rights Commission calling for much improved training for police officers to better prepare staff through proper training to manage the demands they face and to work in partnership with health providers to reduce that demand.
Inevitably, there is only so much that the police can do alone. The Independent Commission on Policing and Mental Health (2013), chaired by Lord Adebowale, reported in 2013 that there was no possibility of the police ensuring effective responses to mental health crisis on their own. In a report commissioned by the police, which was fundamentally about policing, Lord Adebowale made 28 recommendations - the vast majority of which relate to health and social care organisations.
We have seen the emergence of new partnership approaches between mental health trusts and police forces in recent years, to better identify those coming into contact with the police and provide a more effective response. 'Liaison and Diversion' involves mental health nurses in police custody, able to ensure that those in custody are identified and assessed and that information is shared with the police to their mental health needs are better reflected in any criminal justice decisions that may be taken by the police or Crown Prosecution Service.
We also see the emergence of 'street triage' - this involves mental health nurses working alongside police officers, advising at an even earlier stage with a view to ensuring that people are not detained purely to access care that the nurse can provide or arrange. There are various models of street triage, from a multi-agency vehicle that works as a first responder to 999 calls involving mental health, to nurses being based in control rooms to work alongside call handlers, despatchers and supervisors. These schemes remain in need of proper evaluation but they have been received incredibly positively and are claiming significant reductions in the need for coercive practices for thousands of people.
Effort being put into supporting police involvement in mental health demand however, still leaves the fundamental question - often undiscussed - about the extent to which we rely upon the police service in our mental health system and the extent to which we should want them involved. Do we want people in crisis to be arrested or brought into contact with flashing blue lights before then providing a nurse-led response that is more appropriate than a police officer with comparatively limited training?
In the Mind report on Crisis Care in 2011 a service user remarked, "I feel like I haven't to have one foot off the bridge before I can get help."
Surely the objective, however aspirational, is to achieve a position where those in crisis can access effective crisis care without dialling 999, for paramedics or police officers, and instead access specialists in the way that patients can if they live with diabetes or cancer?
The Crisis Care Concordat is the multi-agency, cross-government mechanism, overseen by Mind, through which areas are invited to address these issues. By the end of March 2015, all local authorities were requested to have devised a locally specific action plan for how services can work better together and through this, we have to make sure not only the police service can do things better, but also that they can do less in our mental health system.
Inspector Michael Brown, who tweets as @mentalhealthcop, is working with the College of Policing as part of a review of training and guidance to support police officers and staff in their response to people with mental health issues