Policing and mental health have had a complicated relationship in the past and this continues today. Sadly, a large proportion of the incidents that police are required to attend have mental health at the core. Nationally, it is estimated that mental health related incidents are responsible for about twenty percent of police time (Adebowale, 2013).
Unfortunately, I have regularly found myself having to deal with these types of incidents during my four years as an operational officer and continue to do so on an almost daily basis. I frequently have sole responsibility for the immediate care and welfare of vulnerable people, often people expressing suicidal ideation, who have presented at the railway and are in a position of danger. It is often their intention to end their life, and I am expected to attend the scene and ensure that these people do not come to any harm.
Approved Mental Health Practitioners (AMHPs) are Social Workers, Mental Health and Learning Disabilities Nurses, Occupational Therapists and Practitioner Psychologists, who may train to become qualified to carry out the role (Health and Care Professional Council, 2020). They are required to complete a post-graduate professional development course, which takes one year (Social Work England, 2020). AMHPs are approved by a local authority to carry out certain duties under the Mental Health Act 1983. These duties relate to decisions made about people with mental disorders, including the decision to apply for compulsory admission to hospital (Health and Care Professional Council, 2020).
In contrast, although it is going through the process of change, you currently do not need any form of degree or further education qualification to become a Police Officer. Police Officers have powers under Section 136 of the Mental Health Act 1983, to remove a person from a public place to a place of safety, when they appear to be suffering from a mental disorder. Despite this they do not have any formal training to identify or recognise mental disorders (HM Government, 2019).
During my twenty-two weeks, or eight hundred and eighty hours at police training school, I received a total of eight hours training about the Mental Health Act 1983 and the powers available to me. Over half of these hours were completed using online e-learning. Furthermore, out of the numerous ‘realistic operational training scenarios’ that I undertook throughout the training process, I can only recall a small handful of them being related to mental health. In hindsight, it was certainly not reflective of the amount of mental health related incidents that I have dealt with since becoming an operational Police Officer.
Unsurprisingly, I have not received additional mental health training since I have completed my initial course. However, I have had approximately eight hundred contact hours working with vulnerable people suffering with a mental disorder or expressing suicidal ideation. Over my four years on the ‘frontline’ of policing, these hours are responsible for the development of my ‘knowledge’ in relation to mental health disorders and the relevant processes.
From the ‘Picking Up the Pieces’ report, by Her Majesty’s Inspectorate of Constabulary (2018), it was recommended that all police forces needed to review their mental health training. However, there was no national guidance provided, which would subsequently cause disparities between police forces. It is my view that this should not be happening when the police have national bodies such as College of Policing, who should be overseeing the input to ensure all forces address safeguarding and vulnerability with the same approach.
I have often been expected to attend a railway station and deal with a suicidal person who is standing at the end of a platform and threatened to go onto the tracks. As a police officer, should I be able to identify whether this is a result of their life circumstances, depression or paranoia, delusions or hallucinations that are linked to mental health disorders such as schizophrenia?
I have been requested to speak to the person in the ticket hall who is pacing around and showing ‘aggressive and unusual behaviour’. Is there an expectation that I should be able to assess and determine whether this person is frustrated due to missing their train, or are they suffering from a psychotic episode?
These are all everyday situations that Police Officers are required to attend as their routine calls to duty.
A Police Officer’s perception of risk is very different to that of an AMHP (Reveruzzi and Piling, 2016). Police Officers often detain people under Section 136 of Mental Health Act 1983, who they believe is suffering from a mental disorder and are at immediate risk of harm. Whereas, AMHP’s often complete an assessment of the same person, and do not come to the same conclusion. Therefore, it is felt that members of the public are detained unnecessarily, causing the person unnecessary distress, and taking up space in already limited facilities. This adds weight to the argument, that Police Officers should not be making decisions without further mental health training or guidance from more qualified professionals. However, when AMHP assessments are completed, the person is often in a place of safety e.g. dedicated Section 136 assessment suite. This assessment is often undertaken a few hours after the initial incident. Whereas, the police have had to act in the heat of the moment to ensure a person’s immediate safety. These circumstances are likely to have an impact on the decisions that are made.
Approved mental health professionals, alongside doctors can formally detain people under Section 2 of the Mental Health Act 1983. This allows them up to twenty-eight days to conduct a full mental health assessment whilst a person is detained in hospital. This assessment will allow them to gain a better understanding of their disorder, which will ensure that they are correctly diagnosed and receive the relevant intervention. Meanwhile, there are different expectations of Police Officers on the ground. Police have the pressure and external factors of a live ongoing incident and are required to make these decisions in a matter of minutes, sometimes without the option of seeking any professional advice.
To relieve some of the pressure from frontline officers and enable them to make more informed decisions, the Department of Health set up the Street Triage initiative in 2013. This enabled a trained AMHP and Police officer to work together in the same vehicle, to deal with live incidents (Care Quality Commission, 2015). Research has suggested that detentions under the Mental Health Act were reduced when street triage teams were involved, as they can make more informed decisions (Reveruzzi and Piling, 2016).
Unfortunately, I have realised that the demand exceeds the capability of the street triage team. Based on my experiences the street triage team are oversubscribed, and frequently have a backlog of people requiring an on-scene assessment. I have often experienced delays of up to four or five hours before acquiring the relevant advice. This adds further pressure onto Police Officers on scene, who are having to safeguard vulnerable people from immediate risks. Vulnerable people experiencing mental health issues should not be sitting in the back of a police vehicle, but rather be taken to a healthcare setting at the earliest opportunity. These delays may also lead to Police Officer’s detaining people unnecessarily, as they do not have the appropriate advice and support to make a more informed decision.
That said, street triage teams have assisted me on multiple occasions and allowed me to safeguard individuals by referring them to the relevant services that are able to assist with their needs. The professional advice that is given to Police Officers by the mental health professionals in street triage teams provides a confidence in safeguarding individuals. It also highlights that detaining a person should be the last resort, and not feel like the only option. This is reflected in the work of Keown et al (2016), suggesting that the involvement of street triage resulted in a 78% reduction in use of the Section 136 detention power within the first year of its introduction. However, I have lost count of the number of times that it has felt like the only option, without any professional guidance to fall upon.
In short, Police Officers are often the first port of call, when someone is at immediate risk of serious harm or intending to end their life. Police Officers are expected to attend the scene, remain calm, remove the identified risks which often involves negotiating with people in dangerous positions and then make informed decisions about a person’s mental health which could have life or death implications. The assistance of mental health professionals is not always guaranteed either. I strongly believe that Police Officers are underqualified for the decisions that they are required to make and the powers that they are given. Although the introduction of street triage teams has begun to bridge the gap between the police and mental health professionals, there is major flaws with the lack of training processes within the police and that there continues to be no agreed national guidance for all forces to work towards regarding safeguarding and vulnerability. Policing still has a long way to go to achieving a perfect collaboration.
Adebowale, V. (2013) ‘Independent commission on mental health and policing report.’ London: House of Lords.
Care Quality Commission. (2015) Monitoring the Mental Health Act in 2013/14. Care Quality Commission [online]. Available at: https://www.cqc.org.uk/sites/default/files/20150204_monitoring_the_mha_2013-14_report_web.pdf, [Accessed on 29th May 2020]
HM Government. (2019). Mental Health Act 1983. [online] Legislation.gov.uk. Available at: http://www.legislation.gov.uk/ukpga/1983/20/section/136 [Accessed on 8th July 2020].
Health and Care Professional Council (2020). ‘Our expectations of professionals who complete approved mental health professional (AMHP) training’ [Online]. Available at: https://www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/amh-criteria/ [Accessed on 4th July 2020]
Her Majesties Inspectorate of Constabulary (2018). ‘Police and Mental Health – Picking up the pieces’ [Online}. Available at: https://www.justiceinspectorates.gov.uk/hmicfrs/wp-content/uploads/policing-and-mental-health-picking-up-the-pieces.pdf [Accessed on 29th June 2020]
Keown, P; French, J; Gibson, G; Newton, E; Cull, S; Brown, P; Parry, J; Lyons, D & McKinnon, I. (2016). Too much detention? Street Triage and detentions under Section 136 Mental Health Act in the North-East of England: a descriptive study of the effects of a Street Triage intervention. BMJ Open.
Reveruzzi B and Pilling, S. (2016) ‘Street Triage: Report on the Evaluation of Nine Pilot Schemes in England.’ London: University College London.
Social Work England (2020), ‘Education and Training: Approved Mental Health Practitioners (AMHP) Guidance’ [online]. Available at: https://www.socialworkengland.org.uk/media/2971/amhp-guidance_final.pdf [Accessed on 3rd July 2020]