Care in the Community: But who pays the (old) Bill?

Many of you will have read the recent coverage of the Met’s intentions to withdraw from attending mental health calls, and the accompanying furore over who then is going to provide a service with the NHS not in a position to cope.

Not many are looking at where this problem came from, or some wider impacts on the police per se. I hope to give you that context.

While still serving I, like senior police officers across the country, regularly conducted an ‘on call’ role. This involves being the officer contactable for matters outwith the norm, and acting as authorising officer for telecoms requests.

In respect of the latter responsibility my weeks ‘on’ involved call after call during the night. Generally, there was one common feature – the response inspectors telephoning at all hours to report to me their concern that the individual they were calling me about was a genuine threat to themselves, and intended to commit suicide. Old, young, male and female, the circumstances related to me were a variation on the same theme.

And – as you would expect – having explored all other avenues, the tracing of the missing person’s phone is a proportionate and necessary tactic. Requests were authorised, and I am pleased to say in the vast majority of cases the missing person traced safely. But is this really a good news story?

I am sure that my colleagues up and down the UK continue to face similar challenges as I type this, with resources marshalled and searches being made.

Now, let’s get this out there. The police are never going to abandon someone in distress to an apparent tragic fate. One of the core roles is the preservation of life. But, we have to ask some hard questions. At what cost? Is this really the role of the police? Where does this end?

Lead agency

The situation we now have, where a plethora of individuals with significant mental health difficulties are at large in our communities, can be traced back to the 1988 Griffiths Report, Community Care: Agenda for Action.

Against the backdrop of scandals over institutional care, and the eye-watering costs of such places with questionable results, the Government of the day commissioned this report and responded to it with the ‘care in the community’ format of health and social care we see today.

This was over 30 years ago, and matters have changed dramatically in British society since then. There is widespread acknowledgement that the police are finding themselves more and more as the agency of first and last resort for individuals who would previously have found themselves likely institutionalised, with numbers appearing to be exponentially rising.

There was certainly no talk of policing budgets being affected as a result of the Griffiths Report and the action that followed; nor is there talk of this today. Resources that could be applied to criminal investigative activity are instead being utilised for the sticking plaster approach to mental health crisis provision we see across the country.

So, this brings us to the question, is this the role of the police? I have read of many (nobly intended) initiatives where mental health professionals are being brought into work with the police. This is where we need to get back to the ethos of ‘care in the community’ and its (lack of) reference to policing. Nowhere was it stated that the introduction of this paradigm shift in approach to mental health service provision the Griffiths report engendered was intended to result in the police becoming a lead agency.

My contention is that it is not the role of the police to be responding to these incidents, but instead the role of mental health professionals.

When such a shift is muted, the normal counter arguments in respect of lack of skill in tracing individuals and around violence towards staff are utilised. Let us deal with each in turn.

Technology

In respect of tracing individuals we increasingly rely on technology to do this. The smartphone has arguably become (however contentious this may be) an enabler for some in taking forward their ‘cry for help’, knowing full well the emergency services can trace their location.

Far be it from me to query the legitimacy of these missing persons in crisis, but it is obvious the numbers are rising out of control as the sophistication of the technology increases.

The two factors are not causal, but there would be significant worth in investigating the ‘security blanket’ technology provides. This requires removing emotion from consideration, and being open to the possibility not everyone who claims they are suicidal actually is.

Difficult territory to enter, but with the numbers faced there is a necessary nettle to be grasped. In doing so, and approaching such in a sensitive manner, the lead agency should no doubt be the professionals in the area: those working in mental health.

A police inquiry in this area would be incendiary; however a pragmatic, evidence-led inquiry – perhaps by an external body independent of policing or the health service – would no doubt have more chance of success.

Only through such a change in focus, using the professional assessment of those with the appropriate skill base, could we move beyond the current ‘all of these calls are a priority’ situation.

Violence

In my experience very, very few missing person incidents with mental health as a root cause led to violence towards a professional.

This is not to say it isn’t a possibility, but this is the case with every individual with mental health issues who professionals deem appropriate to be at liberty in our communities.

By all means the police should be involved in those known to be violent, but at the request of health professionals. The relationship has become topsy turvey, where the police are responding to all and involving health, while health should be responding to all and bringing in the police where appropriate. It would be very interesting to gather data on the number of individuals who the police deal with as suicidal risks, make efforts to trace, locate, take to hospital and who are then (eventually) assessed as no threat to themselves or others.

In my experience, this was the vast majority. Were we to evidence this as actually being the case beyond my experiences the argument for this responsibility lying with health from assessment onwards becomes more pressing.

Resources and purpose

Really, this comes down to what the police and health services are for. If, like me, you believe the police are there to deal with crime and the health service are there to deal with, well, health, then the argument for change becomes fairly clear.

If the police are to continue in the current manner, with many officers seeking the missing, then a revisit of the Griffiths Report and its reallocation of funding away from institutions into the community is required, with a rebalance of resourcing no doubt to follow.

If not, and my contention is in this vein, then a proper evidence-gathering exercise into the extent of this issue is required, and a strategic review should follow where a public health role in respect of mental health falls to public health agencies.

The discussion about what the NHS is for and can deliver is writ large at present across society. We hear much about how policing should follow a public health approach. How about public health share the policing burden of the mental health crisis that exists?

This is a health issue the police can help with, but were never intended to lead on. It has happened by default and it is high time that consideration of a rebalance occurs, with primary responsibility allocated to where it should lie. For this old copper this needs to be part of the debate on the future of the NHS too.

Our own house

However, one other factor I think that needs close inspection is the mental health approach in our own service. I encountered well intentioned schemes (welfare champions and such) that do try to help but are not equipped to deal with systemic issues.

I had an officer who had been seriously assaulted and placed on restricted duties. For five years. No one had spoken to him about this since. It was just the way it was.

After talking to him, and ascertaining his motivation for wanting to stay in the job I built a bespoke ‘re-engagement’ programme for him. It started with an hour a shift out in the community accompanied by a sergeant – not going to calls, just out in uniform. This built to routine calls, then routine calls with a cop, and an increasing time period. At his pace. He is now fully deployed as a community cop and tutor.

I had inspectors and sergeants suffer mental health issues. Phased returns are great, but what about the stresses and toll of line management and leadership at incidents? For each I built a bespoke plan and established a buddy system to do a gradual return to full responsibilities. All returned to full duties, with differing time frames.

Outsourced occupational health understood my command concerns but had no policies for such, they just want folk back at work.

The removal of ‘in-house’ occupational health with senior (operationally competent) police officer input has created these gaps. So, as we ask other services to look at their approach to mental health, shouldn’t we look at our own?