I am hugely grateful to Inspector Michael Brown of the West Midlands Police (known as @MentalHealthCop on Twitter) for taking the time to write this excellent piece as a guest blog. I became aware of Michael’s work via Twitter and am amazed at what he has achieved. The issue of mental health and policing is one replete with difficulties. The police are expected to understand the complex legislation that surrounds it and how this relates to the criminal justice system. On top of this they have to understand how best to deal with individuals suffering from mental illness with the many, many challenges that can entail.
Michael has taken in on himself to develop a hugely popular and influential blog in which he provides advice and guidance for both the police and mental health practitioners in relation to these issues. He has, rightly, been recognised by his profession for his work here and I think is someone who can really be said to have brought about real change in perceptions and practice – no small feat. I urge you to follow him on Twitter and read his blog for yourselves. In the meantime, over to Michael….
I am delighted to be asked by Jez Phillips to write a guest post for his blog – what an honour. It struck me that if a serving police officer is to write for an academic’s blog, one should point towards the subject of academic research and operational policing. Apart from anything else, this is a subject dear to my own heart having taken a keen interest in academic development throughtout my career. Also, my work on policing and mental health within the service has led me to ask so many questions and often one finds there is no answer at all. I’ve said many times: there’s a lifetime of research here for someone and I occasionally I wish it were me.
I want to cover just three substantive points:
- Policing and mental health
- Policing and academia
- Research gaps in the real world
- Policing and Mental Health
Anyone who reads my blog will know that policing and mental health is a vast subject. Not only in terms of it’s potential complexity, but also it’s breadth. It gets into the most important social and public debates that we have, in some of the most challenging circumstances: public protection, the protection of the state – or lapses of both. We touch on life-threatening medical emergency, deaths in custody; the diversion or prosecution of offenders, vulnerabilities of every kind as well as emotive issues of unpredictable violence.
Some research estimates that mental health issues affect around 15% of all policing: either in connection with victims, witnesses, or suspects; or because of incidents that involve no criminal offences at all. I think this is in many respects an under-estimation. For example, I know that police officers often ‘spot’ around 15% of people coming through police custody suits and for one reason or another, ask the ‘mental health questions’. However, were the names, addresses and dates of birth to be shared with the local mental health provider, what would we find?
How many are known to the local mental health trust?
Well, there was a localised initiative in Sussex which found that 50% – yes, HALF – of all people arrested were either currently known by, previously known by or needed to be known by their secondary care mental health provider. As secondary care deals with severe and enduring mental illness, we should remember that around 17% of NHS patients needing mental health care are supported in primary care, by their GP. We don’t even know the size of the problem.
Policing and mental illness can also be about profound episodes of public confidence in policing. Death in custody inquiries are disproportionately populated by contact between police officers and service users whilst at their most vulnerable; and often their most challenging involving substance (ab)use. I have written more blog posts on the subject of s136 Mental Health Act 1983 and Places of Safety, then on any other subject within my area.
At least one contact death inquiry per year is focussed upon police detention under s136 and yet it remains the case that most people arrested by the police under this provision are removed to police stations in stead of health facilities. This happens against a backdrop of so much guidance and so many guidelines that police stations are not appropriate for detaining mentally ill people in need of nothing more than assessment, treatment and care.
Policing and Academia
Policing in many regards is the last public sector vocation-profession to tie itself up with academia. Whereas years ago teachers, nurses and social workers were taught in vocational training institutions with a good spread of placements and ‘on the job training’, this has now given way to university education, albeit it still interspersed with vocational placement within the context of that degree. We can see that policing is moving towards this, and not before time:
There are various university courses now on ‘policing’, at the Universities of Staffordshire, Wolverhampton and Teeside, amongst others. It would be remiss of me not to highlight the BSc (Hons) degree in Policing at Wolverhampton because of its strategic liaison with West Midlands Police – it is a requirement of the degree that students are accepted as special constables and serve a certain numbers of hours of voluntary service during their three-year course. Furthermore, there is a second year module on ‘mental health’ delivered by the Nursing school of the university, a recognition of the link between the two subjects that I have not seen in any other institution. It is my privilege to have delivered a guest lecture on this course for the last few years.
Of course, the University of Portsmouth entered the higher education market for all manner of criminal justice professionals several years ago, through distance learning as well as campus based provision. I know that many police officers have seen this and other higher education provision as the key to professional advancement, but we remain a distance from police training being university based. Increasing links with academia are forging this path: the Universities Police Sciences Institute is a joint venture between the universities of Cardiff and Glamorgan and South Wales Police. UPSI provides research, training accreditation and closer ties between the frontline and peer-reviewed research of national and international recognition.
The most interesting link between academia and policing is the Violence Research Group at Cardiff University. The work of Professor Jonathon SHEPHERD is truly inspirational: his analogy of how research and professional practice in medicine is a world away from that in policing, but how the latter needs to m’ve towards the former, is astounding. I can see the benefits of this and hope within my career, we’ll have stepped towards that kind of vision.
Research Gaps in the Real World
Policing will play an increasingly important part in the provision of mental health care in the future, in my view. Linda TEPLIN wrote in the early 1990s that police officers were “street corner psychiatrists” and if anything, this is truer now than ever. One theory is that as the ‘de-institutionalisation’ of mental health care gave way to ‘Care in the Community’, policing increasingly filled a gap in crisis care and crisis support. Initially, this brought law enforcement techniques and practice into crisis management and there were predictable consequences. In most countries there has been more than one controversial use of lethal force in relation to someone who is mentally ill. Andrew Kernan in the UK is just one of several such controversial deaths. Following the fatal shooting in Memphis in 1988 of a service user, US police departments started to adopt “Crisis Intervention Training”. This represented an alliance between the police and local mental health providers and universities to give officers accredited training to deal with mental health service users using techniques and approaches likely to reduce the need for the use of force and to increase ‘diversionary’ approaches to avoid arrest / prosecution. I’m looking to introduce a similar approach to this in the UK and will be trialling something later in the year.
Meanwhile, there are many other academic questions and areas of research activity that need tackling. We need to know more of the “what, where, who, when and how” of policing and mental health. Basic research needs doing to establish “what works” as so much about criminal justice approaches to mental health remain based upon assumption or upon research undertaken by interest groups such as mental health charities. There is a dearth of peer-reviewed, high quality academic research on this topic and in my own view as a practitioner with a quasi-academic interest, I’d like to see this plugged by non-political (small ‘p’) research in a neglected area of policing and criminology research.
So – does diversion work? I’m still not convinced of the reports I’ve read from various charities that the legal frameworks of the country that we have fully specified what we’re trying to do in the ‘diversion debate’. I’m still not convinced we know what ‘diversion’ is or the legal frameworks within which it actually operates. Far to much assumption, stigma and unreality. Accordingly, how do you begin to assess whether it ‘works’? Whatever that means …
So – are police shootings properly understood? I’m not convinced that we understand sufficiently the dynamics that are at play when the police use potentially lethal force against people with mental health problems, some of whom we know are putting themselves in harm’s way with a raised risk of being subjected to force.
So – how does the justice system react to victims with mental health problems? I’m not convinced that we have a criminal justice settlement for victims and witnesses. In our adversarial model of justice, focus upon what makes a ‘good’ witness, discriminates against those with mental health problems and we know from the case of R (B) v DPP (2009) that victims do not always get a fair deal in our justice system.
So – how do we find ourselves unable to guarantee effective crisis care? I’m not convinced that legal cases which have highlighted shortcomings in our social response – R (B) v DPP (2009; MS v UK (2012) – are absorbed as ‘lessons learned’ and taken forward into the development of services. I’m nearing my word limit, which is the only reason I have stopped asking questions. There are many more to be asked. This issue will not abate during the coming years: we know psychiatric services are withdrawing further from the provision of inpatient, outpatient and crisis mental health care and we know that internationally this means the police service will be sucked into the vacuum. It is therefore even more important that we understand the size of the problem and ask ourselves, “What works?” on the basis of understanding what is needed.