Guidance Launched To Give Consistency to Mental Health Policing
10 Oct 2016
New authorised professional practice (APP) and training has been launched to end a “postcode lottery” of policing encounters with vulnerable people with mental health conditions.
The guidance and training set minimum standards against which Her Majesty’s Inspectorate of Constabulary will assess forces.
The development comes as over half of clinical commissioning groups have reduced their funding for mental health services, which is expected to lead to increased demand for police officers to deal with mental health issues.
A report by the National Police Chiefs Council in September showed the number of times section 136 of the Mental Health Act has been used to detain someone in a crisis increased last year to 28,271, up more than 10,000 in the last decade.
While some of this increase can be attributed to better data capture, the growing number of cases are in spite of initiatives being implemented that are reducing the need for the power, such as street triage.
The APP is designed to help officers understand:
• That mental health is core business;
• Their legal powers and responsibilities; and
• How to access care and support for someone who is vulnerable.
Inspector Michael Brown, mental health lead for the College of Policing, says forces have invested to varying degrees in policing mental health issues, mostly driven by adverse incidents.
There is huge inconsistency in the use of section 136, with little correlation to force size and population, the APP prompts forces to question why this is.
Hampshire Constabulary was praised for having a chief officer lead, a superintendent in charge, a full-time inspector, two sergeants and a constable working in the mental health team.
It also operates a street triage programme, has nurses in control rooms and runs an innovative programme – Serenity Integrated Mentoring – that involves working in a multi-agency team with the most demanding, repeat subjects of demand to improve their lives and reduce the demand on police. It has reduced the need for police custody and section 136 for these individuals enormously.
“Forces pay different levels of attention and tends to be when they have seen one or more adverse incident. Those that have not had adverse incidents still need to learn from those that have,” Insp. Brown explained.
The APP updates the 2010 national guidance to take account of legal developments including lessons learned from the Independent Police Complaints Commission and Coroner’s Inquests.
For the first time, police training and guidance will include information to assist officers when responding to calls relating to suicide and bereavements. It also includes incidents that involve mentally ill, mentally vulnerable and those with learning disabilities.
However, lessons include that officers have previously believed someone was mentally ill when they were suffering from a different serious health issue that needed urgent care. In one incident officers mistakenly believed a woman was having a mental health crisis when in fact she was suffering a brain tumour.
The college is also producing a report on the role of the police in psychiatric units. This is due to be published soon but the APP suggests it is not usually appropriate for police to be called to help administer medication and use force in mental health establishments as the health service has its own obligations under the Mental Health Act and health and safety legislation.
The APP addresses criticism by partners that the police service is inconsistent in how it investigates criminal offences that take place on psychiatric wards, whether that is an assault by a patient on a member of staff or another patient.
Many officers believe that someone who is detained under Section 3 of the MHA cannot be prosecuted but this is not the case.
There are approximately 67,000 assaults recorded by the NHS on its staff in England, 45,000 of which take place in the mental health sector, by far the majority are not reported to police.
If an incident is reported, police should take allegations seriously and assume the patient can be held responsible, explained Insp Brown.
The college examined whether training should include the recognition of autism, dementia and other mental health conditions following adverse incident reports that proposed additional training. However, there are at least 24 conditions, such as Asperger’s Syndrome, schizophrenia and personality disorders, for which the solution that has been recommended is specific training for officers.
Insp Brown said: “When we asked the representative organisations what they actually want the police to do better or differently it was to make the best use of information they have, be calm, de-escalate the situation as best they can, be unrestrictive as they possibly can in the context of being consistent with safety, and treat people with dignity, empathy and how you would want your relative to be dealt with.”
Extra resources are provided on these conditions that can supplement this training should forces wish to add to the minimum standards.
“The guidance aims to inform officers of the limit of their role, they are not expected to diagnose or take a decision on the form of vulnerability of the subject,” Insp. Brown added.
“It is about officers recognising that despite whatever strategic or partnership decision or local circumstance that has created the demand they have a role to play in responding.
“Why the guy is on the bridge threatening to jump off is irrelevant until we have made him safe.”
The APP and training will enable officers to become more confident and to communicate and be influential in dealing with any circumstances that arise.
While the APP and training attempt to achieve greater consistency, they also recognise the difference in force size and structure, and the environments in which they operate.
“The chief constable of Cumbria and the commissioner of the Metropolitan Police Service will take a view on which officers get the training packages and how it is operationalised in their particular environment,” explained Insp. Brown.
Workshops held around the country in July explained that the APP and training cannot simply be “taken off the shelf and delivered to staff”, forces will need to consult partners to make the standards relevant to their areas and ensure they remain compliant with the findings of inquiries.
The training is set out in five modules:
- E-learning package designed either for someone who takes few decisions in relation to a vulnerable person or as a pre-read for those that receive the other training packages
- Training for first responders/neighbourhood officers, which last one and a half days, supplemented by:
- Half a day training on suicide prevention
- Enhanced training for specialists, such as those undertaking mental health street triage roles, and will include information on partner obligations under the crisis care concordate; and
- An awareness raising seminar for strategic leaders, for senior officers and those coordinating policy and activity on their behalf. This includes lessons that need to be learnt from major inquiries and information on the debates taking place within the health service about the role of police.
Part of the training includes a requirement to seek input from partners, such as a mental health nurse to inform on the provision of mental health care locally. The enhanced package could be used as the basis for multi-agency training.
Inspector Brown commended some forces that have already implemented quality training in advance, such as Thames Valley Police which gave a full day’s training to frontline staff over a year ago and has been added to since.
Insp. Brown said the training packages represent the minimum level of training needed, but some forces are aiming to go above and beyond this. For example, Leicestershire Constabulary has taken the learning descriptors from the guidance and run a whole week of training for officers who deal regularly with mental health incidents, including role plays and scenarios. Another course will take place in November.
Alison Cobb, Senior Policy and Campaigns Officer at Mind, the mental health charity, welcomed the publication of the training and guidance.
“Mental health is core police business and that’s why it’s so important that all policing staff have the knowledge and expertise to help support someone with a mental health problem, including people at their most vulnerable in a mental health crisis and victims of crime,” she said.
And Dorset police and crime commissioner, Martyn Underhill, said: “PCCs welcome this new training package.
“It will help ensure consistency across the service and remove postcode lotteries for those with a learning disability or a mental illness.”