Policing and Mental Health

Report: 4
Date: 22 October 2009
By: Assistant Commissioner Territorial Policing on behalf of the Commissioner

Summary

This report provides an outline of the MPS response to individuals with mental health needs in London. It addresses 18 specific questions raised within the commissioning brief and summarises a number of key changes and developments since performance was last reported 18 months ago.

A. Recommendation

That members note the report.

B. Supporting information

1. Delivering a policing service to the mentally ill community cuts across the full range of policing services and affects every aspect of service delivery. The MPS response to individuals with mental health needs is significantly wider than managing the needs of victims and perpetrators of crime. Whilst the MPS maintains a dedicated mental health portfolio as a centre of expertise, our wider response is now embedded within several areas of core business.

2. The key additional areas where the MPS responds to individuals with mental health needs arise either by discharging functions arising out of the Mental Health Act 1983, or the Mental Capacity Act 2005.

3. Examples of implementation of the Mental Health Act include:

1. Removing to hospital someone experiencing a health crisis in a public place
2. Working with Community Mental Health Teams to carry out risk assessments and where appropriate attend mental health assessments on private premises
3. Supporting staff from psychiatric hospitals to retake patients who are absent without leave, including executing warrants of entry.

4. Examples of implementing responses under the Mental Capacity Act 2005 to protect vulnerable people include:

1. Someone threatening or attempting to commit suicide
2. Someone with serious injuries who declines medical aid
3. A person experiencing dementia or with a severe learning disability found in circumstances where they are at serious risk
4. Someone in the act of self-harming.

5. In 2005 the MPA set out 33 recommendations for policing mental health in London. At the time of last reporting to the MPA in April 2008, 6 of these were agreed as requiring further development, mainly around the area of partnership working, the development of standardised S135 (illness on private premises) protocols and consultation with specific groups such as LGBT service users.

6. In general, work has been progressing on all these recommendations and in November 2008 the MPS published a new Standard Operating Procedure for policing and Mental Health. This contained policy advise and best practice which was developed and consulted on with partners and a wide range of user groups. This outlined specific responsibilities for Borough Commanders, Borough Mental Health Liaison Officers as well as standardised S135 protocols.

7. More significantly perhaps, during 2008 and early 2009 the Government appointed Lord Bradley to review how all agencies within the Criminal Justice System engaged with people with mental health problems and learning disabilities. This review, known as the Bradley Review, reported in the summer of 2009 and made 82 recommendations towards all criminal justice agencies and are grouped under a series of headings which for ease of reference:

• National Governance
• Children and Young People
• Police
• Courts
• National Offender Management Service
• Criminal Justice Mental Health Teams
• Overarching Systems

8. The significance of this review is that it focuses on all the partners working together and the recommendations will be incorporated into a wider health and social care strategy. The work will be overseen by a National Strategy Board which has already been established and a pan-London sub-regional Board. The Commander Neighbourhood Policing and Partnership is a member of this Board.

9. The National Board is currently considering all the recommendations and is expected to publish a delivery plan during November 2009. It has however already been acknowledged that there is unlikely to be significant extra resources available to deliver the recommendations for any agency.

10. As far as the MPS is concerned, we are currently scoping not only the 11 recommendations that are applicable directly to policing but also our involvement in the remaining 71, particularly how we can work and influence partners in this regards.

11. An MPS Bradley Review Board has been established that is due to meet in October to consider our current position and progress. However, it must be acknowledged that the Bradley Review is a National Document and the aforementioned MPA review has placed the MPS in an advanced position in respect of some of these recommendations such as the review of places of safety, the agreement of joint protocols and training developments for Neighbourhood Policing Teams.

12. It is suggested that a further report is commissioned by the MPA once the MPS position has been scoped and considered further, particularly with partners, perhaps in 6 months time.

How the MPS defines individuals with Mental Health needs

13. Whilst there is no universally accepted single definition of an individual with mental health needs, the definition in Section 1 Mental Health Act 1983 is the most relevant for policing purposes. This reads,
“mental disorder means any disorder or disability of the mind”

How the MPS responds in given situations

14. These examples are illustrative rather than exhaustive:

Where a person with mental health needs reports a crime, the MPS follows the Home Office National Crime Recording Standard (NCRS). The existence of a mental health need does not mean a crime will not be recorded. A victim orientated approach is taken to crime recording. Every allegation must be considered individually and on its own merits, in accordance with the NCRS.

• Station Police Community Support Officers (SPCSO) are given specific training for supporting a person with a mental health needs at police station front counters. This training includes practical advice as well as an introduction to the signs and symptoms of a variety of mental health needs including the following:
  • Attention Deficit Disorder
  • Anxiety
  • Bipolar Affective Disorder
  • Depression
  • Obsessive Compulsive Disorder
  • Paranoid Disorder
  • Psychosis
  • Schizophrenia
• Generic Police Community Support Officers (PCSO) are given specific training that reflects the fact they are more likely to engage with a person with mental health needs on the street. The training includes guidance on the following:
  • Some different types of mental disorder and their symptoms including schizophrenia; bipolar disorder (also known as manic depression); depression, suicidal behaviour; paranoid conditions; autism
  • Factual information targeted at dispelling a variety of common myths, in order to reduce stigma associated with mental health needs
  • How a PCSO might typically encounter someone with mental health needs
  • The fact that someone who is drunk or under the influence of drugs may mistakenly be believed to have mental health needs or may currently be affected by both (dual diagnoses)
  • Advice about how to approach and communicate including, talk sensitively, do not assume without investigating further, act slowly, take your time, speak softly and calmly, reassure the person and be sincere, listen carefully, build rapport, don’t make sudden movements, don’t give complex instructions; don’t ignore the person; don’t act without first telling the person what you are going to do, don’t approach from behind without warning, don’t stop talking or leave the person alone if they are suicidal.
  • How to differentiate between a person with a mental health need who is behaving abnormally as distinct from someone who is having a mental health crisis and requires an urgent police intervention
  • Passing on intelligence to Community Mental Health Teams about someone who has been identified as being at risk
  • Referring to a police officer any situation that engages the Mental Capacity Act 2005
• Where a person with a mental health need reports an incident to police the call handler receiving the call will not necessarily realise that the person has mental health needs. Where it is obvious to the operator that the person has mental health needs then the person would be identified as vulnerable as part of the call handler’s risk assessment process. This process is quality assured by the supervisor within Central Command Complex and is further checked once it reaches the despatch stage.
• People detained using Section 136 Mental Health Act 1983 following a mental health crisis in a public place are taken to a place of safety. In most instances this is an Accident and Emergency Department of a General Hospital or an alternative place of safety provided by the local health trust. In circumstances where the place of safety is unavailable or the person cannot be safely managed within health trust premises then they are taken to a police station custody suite. Joint protocol agreements are in place between local police boroughs and health trusts providing places of safety to ensure understanding of mutual roles and responsibilities. Transportation to the place of safety should be by ambulance to reduce risk and stigmatisation. Where an ambulance is unavailable or other risks outweigh the benefits of ambulance transport then a police vehicle is used.
• The mental condition of a victim or witness is a factor the MPS takes in to consideration before deciding to obtain a full written statement. Where relevant, special measures are considered and implemented in cases where the victim is particularly vulnerable through their mental illness in line with Part 2 of the Youth Justice and Criminal Evidence Act 1999. Liaison with a family member as a means of support is a further aspect for investigators to implement where appropriate. Officers are further instructed to carry out vulnerability risk assessments on victims of serious assaults.
• Designated Detention Officers (DDO) and Station Police Community Support Officers receive training about signs and symptoms to be aware of that might suggest someone has mental health needs. DDOs in particular are trained to have a heightened awareness of risk, to give detainees with mental health needs a clearer explanation about how to use the cell alarm call button and the need for more frequent supervision and monitoring including cell visits.
• Where officers are involved in a public order or other situation where prolonged restraint is used, officers are given clear tactical advice to reduce risk. This involves the appointment of a ‘safety monitoring officer’ and vital signs being constantly monitored. This is embedded within officer safety training programmes and outlined in a specific briefing document detailing considerations for safer restraint and the Standard Operating Procedure for delivering a policing service to the mentally ill community.
• Where an operation is planned in advance and is likely to involve the use of taser and it is suspected that a person with mental health needs will be present, there is an opportunity to consult mental health professionals to discuss the most appropriate approach. Where incidents occur spontaneously, the existence of a mental health need is far less likely to be known by officers responding. Even in cases where it is known or suspected, the determining factor in the response will always be the level of threat posed and not the existence of a mental health need. Standard practice is to contain the incident and negotiate with the subject concerned. Where the person is known or believed to have a mental health need, this will inform the options available to the tactical advisor and officer in charge. Every instance where a person is subjected to a taser discharge is subject to scrutiny by an ACPO officer and will include consideration of any known or perceived mental health needs.

How the MPS responds to Dual Diagnosis (drink or drugs)

15. From a policing perspective, the issue of “dual diagnoses” is mainly relevant to people detained in the street under Section 136 Mental Health Act 1983. Where their state is such that conditions of arrest are fulfilled then they will be arrested, taken to a police station and assessed and dealt with accordingly. Where their condition does not justify arrest, they will be taken to the local place of safety in accordance with local protocols.

How the MPS is reviewing its response to S135 (private premises) assessments

16. All Boroughs have a single point of contact for receiving requests from Community Mental Health Teams for S135 assessments.

17. In order to further improve business carried out under Section 135 Mental Health Act 1983, in April 2009 a team of officers from the boroughs of Haringey, Enfield and Barnet was launched with a twofold remit (i) to deal with all pre-planned requests for police assistance for mental health assessments and (ii) to investigate reports of crime taking place within psychiatric premises. The six month pilot stage concludes in September 2009 and whilst we await full evaluation, early indications of crime reduction, improved satisfaction and increased confidence are encouraging. Figures for the first three months show that every request was responded to and carried out within 48 hours of reception. This certainly indicates positive benefits for the service user and for the community.

Preventing individuals with Mental Health needs becoming victims of crime

18. The following activities, aimed at preventing people with mental health needs becoming victims of crime, have been initiated within the last year.

• Police Community Support Officers (PCSO) are reminded as part of their training to make referrals to local community mental health teams for low level episodes of mental health and to record such information.
• Police in Islington are working in partnership with the charity Revolving Doors to deliver a neighbourhood link worker scheme so that people with mental health needs who come to police attention as a consequence of low level anti-social behaviour or criminal activity are immediately referred on for assessment. This is followed up with intensively targeted support and supervision to engage with services, thereby reducing exclusion and the risk of further offending. This was the subject of positive comment by Lord Bradley in his recent report.

Partnership activity for training, awareness and best practice

19. In addition to the pan-London Board referred to in paragraph 8, the following partnerships have been developed to enhance our work with the mentally ill community:

• Imperial College School of Medicine (joint police/NHS training)
• Central and North West London NHS Trust (joint police/NHS training)
• South West London and St Georges mental Health Trust (police support to Section 12 Doctor training)
• Oxleas Acute Trust (sharing best practice)
• West London Mental Health Trust (full time police officer working with the Trust to investigate and prevent crime)
• Barnet, Enfield and Haringey mental health trust (joint work with police officers within a three borough initiative)
• London Ambulance Service (pan-London transport and mutual assistance)
• South London and Maudsley Mental Health Trust (tactical interventions relating to the Mental Capacity Act, joint training and awareness)
• The Royal College of Psychiatrists (consultation)

Activities to reduce the risk of people with mental health needs unnecessarily entering the criminal justice system include:

• Training and awareness programmes as already mentioned
• The Revolving Doors charity link worker scheme as described above
• Borough Mental Health Liaison Officers across London have been tasked to secure contact phone numbers from their health trust colleagues so that duty inspectors have the facility to obtain immediate advice and information about a mentally ill person who has gone into crisis and is involved in a siege or hostage type situation.
• As the MPS continues this work with partners to implement the changes recommended by Lord Bradley, the processes necessary to ensure the right response to offending and mental ill health will become embedded within normal day to day practice. We believe this will have the greatest effect at preventing unnecessary entry to the criminal justice system.

Community Engagement activities

20. This is an area of constantly developing practice, particularly as Neighbourhood Policing Teams further develop community engagement activity. Additionally:

• Borough Mental Health Liaison Officers (BMHLOs) are required to further identify and hold regular meetings with service users on their borough. Good practice is further shared and discussed at their regular meetings with the MPS Central Team which is now an integral part of the Neighbourhood Policing portfolio.
• A dedicated police officer works with City and Hackney MIND in East London as a mental health intervention officer. The officer encourages people with mental health needs who lack the confidence to report a crime to come forward. He supports them through the investigative and criminal justice process and provides monthly advice sessions to vulnerable mentally ill people. In a six month period he has helped to resolve six cases where a mentally vulnerable person has been targeted by criminals and had their homes invaded.
• Independent custody visitors at Southwark, Ealing and Merton have received additional training to raise the profile of mentally ill detainees and offer an insight into the risks and vulnerabilities and the interface between the detainee and the MPS custody system

Diversity data in respect of victims of crime

21. Following recent adjustments to the Crime Recording Information System (CRIS) it is now possible to examine diversity data along with issues of mental illness. However, whilst work is underway to establish appropriate analysis and evaluation of findings in this area, it must be acknowledged that mental illness is not always obvious or apparent in victims of crime.

How the MPS considers the Disability Discrimination Act

22. The MPS considers the duties of the Disability Discrimination Act (DDA) in relation to people with mental health needs through the Equalities Scheme 2006-2010. It is a requirement of the DDA that a disability equalities scheme and action plan is produced. The scheme sets out how the MPS seeks to meet the legal requirement governing disability which includes mental health. Specifically it sets out how the MPS has a duty to assess, review and consult on policies and procedures.

23. In relation to disability this means:

• remove barriers
• meet the needs of disabled people
• challenge stereotypical attitudes

24. Over the past 12 months the MPS has completed the following:

• Guidance issued to police officers and staff through a new Standard Operating Procedure (SOP) and Policy in order to highlight the impact of and reduce the unfair stigma affecting those individuals with mental illness.
• Training delivery of front line staff renewed
• New SOP widely consulted on with partners and service users to ensure correct interpretation and appropriate Equality Impact Assessment conducted.
• New guidance issued on the Mental Capacity Act addressing these issues.
• In May this year a pilot scheme between Camden Borough Police and the LAS was launched. This enables a dedicated patient transport service ambulance with crew to be reserved as part of the planning process for a mental health assessment. The early stages of the pilot show that an ambulance attends on time in 96% of cases compared to only 55% of cases previously. This provides tremendous benefits to the service user by reducing the risk of escalation or any need for restraint and releases police resources back to operational duty.
• Camden Borough Police have entered a partnership with the charity MIND to deliver a mental health intervention officer similar to the scheme operating in Hackney as described above. This initiative will ensure people with mental health needs who are vulnerable to crime feel supported and are equipped with the confidence and skills to articulate their concerns to police.

The Process of Equality and Community Impact Assessments

25. The Equality Impact Assessment (EIA) process is undertaken during the planning for a particular event or policy and a Community Impact Assessment (CIA) is conducted in response to a specific incident. The EIA process considers all diversity strands and specifically requires consideration of the Social Model of Disability and includes deliberation of the issues and barriers faced by mental health users. Specifically, the Mental Health Policy and associated Standard Operating Procedures were published in November 2008 after an extensive EIA. This involved many interested individuals and groups and was published in the MPS internet site within the freedom of information pages.

26. Whilst the potential impact of mental health issues will be a consideration, the critical nature of any incident when taking into account the full circumstances, will always be the deciding factor in determining the necessity for a CIA. Independent advice in relation to mental health and policing is drawn from a broad range of bodies. In relation to designing policies, procedures and guidance advice will be sought from individuals representing the various strands of diversity and a cross section of the community. Advice is additionally sought from subject matter experts in partner agencies and within the third sector.

27. Additionally, where any incident is recognised as involving an issue of mental illness, the central policy team will offer expert advice and support to boroughs.

The key challenges in promoting mental health equality

28. Whilst much has been achieved over recent years the scale and number of different partners and agencies involved with mental health issues remains a key challenge. Additionally, and related to this:

• Consistency of message and delivery at the front line. Agreements are reached at a senior level but these are of course, subject to interpretation at an operational level. Examples include where there are occasional misunderstandings and tensions over lines of responsibility between police and health trusts at A & E departments and places of safety.
• There are enduring cultural attitudes towards individuals with mental illness both at a wider social level as well as organisational level.
• As mentioned earlier, mental illness is not always obvious or defined.

Training delivered to police officers, police community support officers and dedicated detention officers

29. Newly recruited officers receive training input in relation to the areas applicable to their role in:

• Identifying signs of Mental illness
• Factual information to reduce preconceptions
• Making dual diagnoses
• Different types of mental illness
• Tactics to reduce confrontation
• Comprehensive guidance about Section 136
• Mental health assessments
• Mental health patients missing from psychiatric hospitals
• Community Treatment Orders and recalls
• Advice when dealing with disability
• Mental Capacity Act

30. This input is also delivered and reinforced to those attending the Crime Academy. In addition a comprehensive training package is currently being designed by the NPIA for national rollout. The MPS has provided significant material to the training design team based upon the learning and knowledge acquired in delivering a policing service to people with mental health needs.

Support to MPS staff with identified needs

31. Where staff or officers have mental health needs, the MPS HR directorate provides a comprehensive toolkit for managers to use and refer to in order to support and help the member of staff concerned. This includes options for further referral and support, the services available through occupational health welfare counsellors and a risk assessment guide.

Mental Health as a feature in the MPS Diversity Strategy

32. The MPS Diversity and Equality Strategy 2009-2012 describes the MPS’s ambitions to respond to the needs of the diverse communities it serves. As a broad strategic document it does not specifically address mental health any more than it focuses on other strands and sub-strands of diversity. The MPS Equalities Scheme 2006-2010 however is the delivery mechanism that sits under the strategy and contains a specific objective targeted at delivering services to people with mental health needs.

33. The strategy provides a clear focus on four strategic themes of governance, community engagement, fair and responsive services and developing our own people. Some helpful examples of activities within each theme are described here. These are illustrative rather than exhaustive.

• Governance - the mental health portfolio reports directly to a Chief Superintendent and to the ACPO lead for mental health in London, both aligned to the Neighbourhood Policing and Partnership Portfolio
• Community Engagement - when formulating procedural guidance and policy, the MPS engage with representatives from the deaf community, the disability independent advisory group, the LGBT sector and the BME community.
• Fair and Responsive Services - the MPS has worked extensively with a range of partner agencies to increase joint understanding and improve tactical responses to several difficult and high risk areas of business. This includes violence and restraint in hospitals, the police role at mental health assessments and interventions to tackle threatened and attempted suicide and self-harm
• Developing our own people - we have invested effort in developing and supporting our BMHLOs and have held conferences and induction programmes together with practical operational guidance and instruction. The importance of this local link has been enhanced by ensuring that this single point of contact is the conduit for every update and change that affects the policing of people with mental health needs

34. The overarching governance structure for these activities operates by placing responsibility for delivery with the MPS equalities scheme programme board. This in turn is supervised by the MPS Diversity Board which is accountable to the MPS Management Board. Finally, the Equality Standard for Police Service is the performance measurement and improvement tool which provides the opportunity to check progress of our activities in support of mental health.

C. Race and equality impact

1. By definition, every aspect of delivering a policing service to any person with a mental illness engages components of diversity and impacts upon equality issues.

2. The comprehensive EIA carried out as part of the development of the Standard Operating Procedure helps ensure that MPS policies and procedures will not disproportionately affect a person with mental illness.

3. It was recognised at an early stage that whilst these procedures will focus activity, it should be acknowledged that they are enabling in nature and designed to provide help and support rather than impose a detriment. For example a person who currently has a mental illness is much more likely to be subject to powers available to officers under the provisions of section 136 MHA 1983 than someone who is not ill. In spite of this, such detention is for the purpose of obtaining help, protecting the person and the community.

D. Financial implications

There are no known additional financial implications for the MPS in relation to the contents of this report. However, as with any subject that is constantly under review, such as policing and mental illness, future financial implications cannot be ruled out. If any such requirement is identified then this will be the subject to the normal business planning process within the MPS.

E. Legal implications

There are no new legal implications within this report.

F. Background papers

1. Standard Operating Procedure, ‘The Police Response to people with Mental Illness’ , published 3 November 2008.
2. The Bradley Report; Lord Bradley’s review of people with Mental health problems or learning disabilities in the criminal justice system.

G. Contact details

Report author(s): Inspector Mike Partridge, Safer Neighbourhoods and Partnerships, Territorial Policing Headquarters, MPS

For information contact:

MPA general: 020 7202 0202
Media enquiries: 020 7202 0217/18

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