Mental Health update and overview

Report: 4
Date: 21 October 2010
By: Deputy Assistant Commissioner Lynne Owens on behalf of the Commissioner

Summary

A report describing a range of activities carried out across London and involving a variety of interventions by police officers and partners in situations that include aspects of mental ill health. This update additionally contains links and background information to the previous report to the MPA together with progress on any outstanding recommendations from the joint review of 2005.

A. Recommendation

That Members receive and note the contents.

B. Supporting information

Victim and perpetrator data

1. Data revealing the number of victims and perpetrators with mental health issues for the two periods 2008-2009 and 2009-2010.

2. When interpreting these figures it is important to recognise that the MPS did not start recording perpetrator data until early December 2008 meaning that the two periods are in fact incomparable. However* the period in 2008 represents 4 months of data and extrapolating this figure would produce a perpetrator figure for 2008 - 2009 of 2703 (a decrease of 9%), assuming that the data was consistent throughout the entire year.

3. It is essential to appreciate that where mental illness has been attributed to a victim or suspect within a crime report, it is normally done so based upon the opinions of individual officers who are neither trained nor qualified to accurately recognise symptoms of specific mental health conditions. In addition, no universally agreed single definition of mental illness exists and its presence can only be diagnosed by a qualified professional. In many of the short term encounters that officers have with victims and suspects, what may initially appear to be mental illness may simply be odd behaviour and an apparently rational and lucid individual may have mental illness that is less than obvious to an untrained observer. For these reasons a degree of caution must be exercised when interpreting the data recorded.

Policy overview - victims and perpetrators

4. The MPS response to victims with mental ill health is governed by a number of policy documents and instructions. These typically include the MPS Safeguarding Adults at risk policy and associated publications, tactical options for Safer Neighbourhood teams when dealing with public protection issues and the Standard Operating Procedure in relation to policing and mental ill health. A summary of key features within these documents as they relate to mentally ill victims includes the following.

• Safer Neighbourhood Team ongoing support to vulnerable victims considered to be at significant risk
• Including mental illness as an identifying component within the definition of vulnerable adult to ensure such victims receive enhanced services
• The principle that crime reporting and investigation should be victim focused and reports must be accepted and recorded on face value in the absence of clear evidence to the contrary and regardless of any apparent signs of mental illness displayed by the victim
• Guidance with specific examples to steer officers towards better identification of mentally ill/vulnerable victims
• An explanation of the barriers that vulnerable victims often face when attempting to access Police support
• The use of Achieving Best Evidence interviews by specially trained investigators
• The use of Special Measures for example - evidence given through video links, screens to protect vulnerable victims giving evidence, video recorded evidence in chief
• Encouraging Safer Neighbourhood Team officers to make regular visits to premises where mentally ill and vulnerable people live in order to build up trust leading to increased confidence to report crimes
• Consideration that it may not always be appropriate to take statements from victims who are mentally ill immediately following the event and that it will often be in the best interests of the victim to defer this to a more appropriate time
• Requirements within the victim’s code that vulnerable victims should receive an enhanced level of service if the quality of the evidence they are able to give is likely to be diminished by reason of the victim having mental ill health.

5. The MPS response to perpetrators with mental health issues is an evolving area of activity and will continue to receive attention as part of the proposed reforms advocated by the review of offenders in the criminal justice system by Lord Bradley. Within the last 12 - 18 months the MPS has developed a number of tactical responses to improve the way in which it responds to suspect’s in custody with mental ill health.

• Clear instructions and legal guidance for investigators and custody officers to ensure that mentally ill offenders are investigated for the criminal matter at the same time as obtaining a mental health assessment whilst in police custody. This effectively ensures that both the criminal matter and the mental health detention may run in parallel, geared towards achieving the best outcome for the offender and the reduction of crime.
• Tactical options for tackling criminal offences committed by patient’s detained in psychiatric units under the Mental Health Act 1983
• Publication of best practice to reduce the risks of self-harm or deaths when considering release from MPS custody suites. Where practicable arresting officers are encouraged to use both the provisions of the Mental Health Act 1983 and criminal law powers. This provides the custody officer with a much broader range of options to facilitate the provision of mental health care for vulnerable detainees than would otherwise have been the case had the person only been arrested for the criminal matter
• In appropriate cases and where detainees are about to be released in circumstances where the risks of suicide or self-harm are real and immediate custody officers are encouraged to consider Mental Capacity legislation to impose short term restraint to enable emergency access to medical care. There is evidence from a number of boroughs that custody staff are making use of this provision to reduce risks to vulnerable people.

6. The deployment of Designated Detention Officers within MPS custody suites as part of Operation Herald is releasing custody officers to carry out more active supervision of detainees and their health needs. Many custody nurses are recruited from NHS or prison service backgrounds and are already experienced to offer enhanced services to detainees experiencing mental ill health. 30 custody nurses and 6 custody nurse practitioners area managers are employed by the MPS and cover 6 custody suites. The number of boroughs will increase as more nurses are recruited. Since the project started custody nurses have managed over 80% of healthcare referrals with an identified potential of 94% when their policies expand to include the administration of medicines towards the end of this year. This provides detainees and particularly the more vulnerable such as those with mental ill health, with a rapidly accessible and thereby safer service.

7. Custody nurses are currently deployed in Westminster, Lewisham, Croydon, Tower Hamlets and Islington. Newham, Redbridge Barnet, Bromley and Greenwich will follow in due course. The MPS is working in partnership with Professor Don Grubin and Iain McKinnon from Newcastle University to improve the way in which the screening process used by Custody Officers identifies detainees who are vulnerable (including through mental ill health) and detainees with physical illness.

An update on the recommendations from the joint review

8. The recommendations recorded in last year’s report as being outstanding are two, five, seven, nine, eleven and thirty two. These recommendations arise from a report entitled “Joint Review - Policing and Mental Health” published in October 2005 which made a total of 33 recommendations, the majority of which have been accepted in previous reports to the MPA as being complete. For those that remain, these have been completed as far as the MPS are able to do so and the outstanding aspects are beyond the influence of the MPS to achieve. This is fully explained within the summaries of progress made for each individual recommendation as describe below.

9. Recommendation 2 - Partners work with Black and Minority Ethnic (BME) and Lesbian, Gay, Bisexual and Transgender (LGBT) service user groups in order to establish best practice in service delivery to those service users

10. Work has been undertaken with a variety of organisations representing the interests of diverse groups to ensure that procedures and police tactics as far as possible do not discriminate or disproportionately affect service users. This is reflected within a number of full equality impact assessments carried out by the MPS since the publication of the joint review. Some examples include the following :

• A specialist NHS unit in North London responsible for identifying inequality in health care from a racial perspective and improving services across Camden, Brent, Kensington and Chelsea, Hillingdon, Ealing, Hounslow and Hammersmith & Fulham.
• The language department in the borough of Hounslow in relation to the needs of BME groups and the impact of the MPS Standard Operating procedure on service users from these groups
• PACE - an established LGBT charity supporting the needs of service users
• Earlier this year the MPS secured agreement from the Beaumont Society representing the interests of transsexuals and from race on the agenda (ROTA) representing BME issues to review and inform proposed changes to the Standard Operating Procedure that provides officers with tactical advice and instruction when dealing with incidents that include aspects of mental ill health.

11. Involvement with these groups is therefore firmly embedded within current work streams and this recommendation is complete.

12. Recommendation 5 - A pan-London alliance is established whose remit includes providing strategic leadership to the activities of partner organisations and aims to achieve ownership of shared objectives and outcomes. This could also provide a vehicle to drive forward the recommendations in this report.

13. In late 2008 the London Offender Health Partnership board was established to take forward the deliverable outcomes of the government’s response to the Bradley report - Improving Health Supporting Justice - the national delivery plan. The group includes members from the Department for Health, Offender Management, National Treatment Agency, Local Authorities, London Councils and the Police. This includes strategic leaders from partnership organisations and works to shared aims and outcomes through the London Regional delivery plan approved by the board earlier this year. The existence of this board together with the fact that all 33 recommendations are now largely complete, suggests the need for a group to take them forward is no longer required.

14. Recommendation 7 - Partners maintain the links developed through this joint review with key stakeholders (such as the reference group who provided on-going support and guidance to this project board). This could include deliberate engagement to provide a mechanism for monitoring implementation of the recommendations in this review.

15. In many ways this recommendation replicates Recommendation 5 and the London Offender Health Partnership Board now fulfils this role. Whilst the LOHPB was developed in order to deliver the aims of Bradley Report it also creates a forum for senior level engagement fulfilling the recommendations of the 2005 review. On this basis it is proposed that this recommendation is also complete.

16. Recommendation 9 - Agencies work together to develop appropriate s136 accommodation across London. This should include making joint bids for capital money such as the funds recently announced by the Department of Health (October 05). In our view, the ideal would be an assessment centre that can address all needs of people experiencing crisis including:

• Mental health assessment
• Restraint and violence including the capacity to resuscitate
• Medical triage
• Capacity to address the needs of people whose crisis could be caused by either mental illness or substance (including alcohol) misuse.

17. A number of discussions have taken place between senior strategic partners in health, social care and the MPS since the inception of the joint review from which this recommendation was developed. Whilst the MPS are able to exert influence and pressure in an effort to take forward the agenda, this recommendation can only be realised by NHS and mental health commissioners. It is proposed that accountability for achieving this recommendation is better placed with the Strategic Health Authority for London in the short term and from 2012 subject to successful implementation of the coalition white paper(Equity and Excellence: Liberating the NHS) it becomes the responsibility of the relevant commissioning body for specialist services such as mental health.

18. Recommendation 11 - Formalise the adoption of the revised Section 135 of the Mental Health Act protocol and develop joint arrangements for monitoring the implementation of agreed arrangements.

19. In 2009/2010 the MPS carried out considerable research into the police response to requests for attendance at mental health assessments on private premises and the use of Section 135 Mental Health Act 1983 as a tactical tool in making a safe response. This has informed and shaped the national position and was adopted as part of national guidance for police officers dealing with incidents involving mental ill health and learning disability by the National Police Improvement Agency earlier this year. An ACPO sponsored implementation support plan has now been developed and delivered to all UK Police forces to deliver. The national ACPO lead for mental health and learning disabilities will collect feedback about individual force performance against this plan. This includes a template for a Section 135 protocol agreed at a national level between police, health and social care agencies.

20. Historically, the majority of MPS boroughs have already adopted the original S135 protocol advocated by this recommendation but as protocols are reviewed as part of local monitoring arrangements, boroughs will be asked to bring their own practices into line with this nationally agreed template.

21. This recommendation was therefore largely complete before the introduction of the national systems. It is proposed that this recommendation is complete and further progress be monitored under the ACPO arrangements described.

22. Recommendation 32 - The whole systems approach to reducing violence on wards identified in this review is shared as good practice with trusts across London.

23. The “whole systems approach” refers to a wide ranging package of measures for health trusts to put in place. This initiative originated from a project developed in South London and Maudsley trust by a member of clinical staff. A number of local initiatives across London are reflective of similarly good practice and these are briefly touched upon below. It is proposed that any additional work should be undertaken by the Strategic Health Authority or other pan London body with responsibility for health across London. Good practice could be collated and disseminated by this body to health trusts within their area.

• Haringey, Enfield and Barnet field a team of police officers partially funded by the mental health trust to deal with all crimes in psychiatric units. This is expanded upon in paragraph 43 of this document.
• Bromley Police and Bethlem hospital have engineered a service level agreement to promote cooperation in relation to disturbances on wards, drugs on wards and investigations of crimes
• Ealing Police have invested in a dedicated police officer to work with West London Mental Health Trust
• Camden Police employ a specialist information sharing officer to ensure that police officers and staff from the health trust have access to information crucial to inform decisions about risk. This impacts upon public protection in the community and better ward management.
• Southwark Police employ a dedicated safer neighbourhood team officer to work with local hospitals

Progress on the Bradley report

24. The London Offender Health Partnership Board holds responsibility for delivering Bradley in London. This involves driving forward the work streams and deliverables set out in the government document “Improving Health Supporting Justice National Delivery Plan”. The board has now set out how it will achieve this in London through the London Offender Health Partnership Board Regional Delivery Plan.

25. Early indications suggest that the forthcoming austerity measures will have an impact upon the capacity of services to respond in the way originally anticipated. Arguably the most important feature within Bradley’s report was the commissioning of Criminal Justice Liaison and Diversion Services which would provide screening and assessment and drive diversion and criminal justice decision making, particularly in police custody suites. The MPS has been actively engaged with the National Mental Health Development Unit to develop the best model for national rollout. Following the change of government the Department of Health have now brought this piece of work to a close.

26. Current MPS activity involves informing and contributing to the debate around criminal justice and health issues in areas where police activity can make improvements to offender outcomes. These include :

• Links between Police Safer Neighbourhood Teams and Social Services Community Mental Health Teams
• Appropriate Adults
• Proposals to transfer responsibility for healthcare provision within police custody suites to the National Health Service
• Health screening in custody in its broadest sense
• Criminal Justice Liaison and Diversion services, with a view to building upon the existing schemes operational in 6 London boroughs
• Work to complement the proposed templates for Section 135 and Section 136 now being rolled out to all forces by the National Policing Improvement Agency

27. However given the curtailment of activities by the national mental health development unit driving criminal justice and liaison services and the forthcoming comprehensive spending review it is extremely difficult to predict with any degree of certainty the nature and scope of the changes that lie ahead. Early indications from the board are that the shape and direction of the work will change and that the NHS will take over healthcare within custody suites. Until further clarification emerges the MPS will continue to work with the London Offender Health Partnership Board to deliver the regional delivery plan for London.

The mental health project team and the progression of issues at ACPO level.

28. Significant activity across statutory agencies in relation to the delivery of services impinging upon mental ill health and related issues are regulated by the Mental Health Act 1983 and the Mental Capacity Act 2005. The most significant area of policing activity in these areas are generally related to people subject to the compulsory provisions of the Mental Health Act 1983 or people in high risk situations who lack mental capacity. The mental health project team exists to provide a centre of expertise to ensure that operational colleagues have access to the necessary tactical advice when responding to or encountering such situations.

29. These functions necessarily include a twofold monitoring function. This is primarily carried out to ensure that operational guidance and policy is relevant to and in line with the kinds of practical situations encountered by officers on the ground. The secondary reason is to ensure compliance with various aspects of diversity driven legislation underlined by the MPS Equalities Scheme. Careful scrutiny within these areas helps to reveal any over or under representation amongst certain groups within defined fields of MPS business when delivering services to anyone with mental ill health. It also ensures that policies and operational instructions can be modified to ensure that police officers are only deployed to perform functions they are responsible for. A summary of headline activities appears below; these are illustrative rather than exhaustive.

• Dip sampling police records of the use of Section 136 Mental Health Act 1983
• Scoping exercises with borough mental health liaison officers
• Analysing data compiled by the NHS information centre compiled from recorded uses of Section 136 and community treatment orders
• Analysing Section 136 data collated by a London based mental health trust selected at random
• Consultations with a variety of external groups
• Maintaining a database of operational issues
• Collating evidence and formulating strong arguments in favour of NHS funding for a dedicated team of seven police officers to deal with requests for police support and mental health assessments and crimes in psychiatric hospitals across three London boroughs. (this subject is developed further under paragraph 43 below)
• Development of a decision making and recording tool to support officers responding to high risk situations. These include suicide attempts and people with serious injuries who refuse medical aid and for whom restraint and enforced emergency life saving treatment and hospitalisation may be appropriate. This has been recommended by West Yorkshire Police as a model of good practice for adoption by the Yorkshire and Humberside region. Earlier this year the ACPO lead on mental health and learning disability requested that the tool be disseminated as good practice to any force expressing an interest in receiving it.
• Supporting the NPIA in developing ACPO guidance for people with mental ill health or learning disabilities and the associated e-learning package, several components of which were informed by the MPS Standard Operating Procedure.
• Developing tactical guidance and instructions to help borough mental health liaison officers educate and inform officers within their borough and partners within health and social care about the correct use of police powers.
• Issuing revised guidance about the use of section 136 Mental Health Act 1983 and reliance upon the Mental Capacity Act 2005 in situations where criminal offences have been committed in order to reduce the risks of deaths or serious injuries following police contact.

30. The MPS is fully committed to delivering a high quality policing service at all incidents involving any person who has mental ill health. The importance of maintaining expertise at a corporate level is recognised and whilst it is difficult to predict with certainty the outcome and associated impacts of the comprehensive spending review upon policing, the MPS will endeavour to maintain some resource to oversee its strategic and operational policing responsibilities in this area. This accords with the aims of the Guidance on responding to people with mental ill health or learning disabilities published by ACPO this summer.

The key goals of the MPS strategy are:

• Identify, understand and articulate the risks associated with policing and mental ill health
• Improve public safety and confidence by providing officers with the appropriate tactical advice and instructions in relation to those risks
• Improve public reassurance by developing improved tactics giving officers the confidence to act swiftly and decisively when required

The strategy highlights the following key areas of business risk:

• Assessments on private premises where a mentally ill person is in crisis and poses a threat to themselves or others
• Escorts of violent and dangerous offenders from secure psychiatric units in the safest way without unnecessarily impacting upon MPS resources
• Protecting the community from dangerous mentally ill offenders by responding quickly to recalls from the ministry of justice
• Deaths in custody or following police contact arising out of mental health crises in custody suites, private and public places
• Urgent police restraint in response to attempted suicide, self-harm or other high risk incidents, in accordance with the Mental Capacity Act 2005

31. Policing and issues of mental health ill health are being progressed nationally through an ACPO sponsored implementation support plan which was rolled out in August 2010 for all forces to deliver. Compliance with this will ensure that the guidance contained within the ACPO manual of guidance on responding to people with mental ill health or learning disabilities is embedded within force practice. The plan is accompanied by an e-learning package that provides clear operational guidance based upon a series of typical real life incidents that officers frequently encounter.

32. The MPS strategy and the ACPO plan contain self-assessment frameworks and performance returns from each force area will be made to the NPIA team working on behalf of ACPO.

Training of MPS officers in issues related to mental ill-health

33. An outline of training in mental ill health issues for MPS officers. Recruit initial training includes education in the use of Section 136 Mental Health Act 1983 to resolve situations involving someone appearing to be having a mental health crisis in a public place. Training additionally includes elements of advice about basic awareness surrounding mental ill health and suitable responses. Police staff assigned to station front counters receive basic training in identification of someone who may be displaying signs of mental ill health together with advice about interaction and communication. Borough mental health liaison officers attend 6 monthly conferences to be updated on emerging themes and issues, share good practice and raise issues to shape and influence MPS policy.

34. Demands in relation to Policing Mental health issues vary considerably across the capital, therefore a one size fits all approach for all boroughs would not be an efficient way to deliver the best response. In addition to the training already described in Paragraph 35 Boroughs do also initiate their own training to meet demand in their Policing Area, Typical examples include; Lewisham who are holding a number of joint training exercises with their partners, Haringey where all front line Police supervisors received additional training and Harrow where core team officers received additional input to enhance their knowledge of mental health interventions.

35. The ACPO sponsored e-learning is now available for all police officers and staff through the MPS intranet.

The work of borough mental health liaison officers - an outline

36. The range of activities across the many mental health trusts within London means that there is no single standard model of engagement for every borough to follow. In spite of this consistent themes do emerge that drive engagement between police and partners. Research compiled from centrally monitored information shows that officers within this role are most commonly involved in educating police officers, staff and partners in health and social care about police roles and responsibilities and resolving disputes in relation to operational issues. Supported by the central mental health project team, borough mental health liaison officers act as local experts in the delivery of police mental health responses in line with legislation and corporate policy.

37. Examples of some of the many challenges facing borough mental health liaison officers and for which support from the central team is most frequently sought include:

• Transportation of detained patients considered to be at risk through violence or potential violence
• Disputes around security issues at places of safety following the use of Section 136 Mental Health Act 1983
• Requests for police to restrain compulsory patients so that rapid tranquilisation can be administered
• Requests for police to support health and social care agencies effect deprivation of liberty authorisations on patients with dementia or with learning disabilities
• Management of violent or difficult patients within psychiatric settings including searches
• Security issues in relation to mental health patients detained under a hospital order following conviction for a criminal offence and who present a risk to the community

38. Such issues are generally resolved through local mechanisms including liaison meetings between police and A & E staff, mental health trusts, community mental health teams and operational management meetings. Research carried out amongst borough mental health liaison officers at the time of writing this report revealed that the following partnership activities were established on a number of boroughs :

• 22 boroughs had links with safeguarding adults points of contact within community safety units
• 19 boroughs had specific ongoing projects with health and social care partners
• 10 boroughs had links with family intervention projects

As with other areas discussed in this paper it is clear that there are different approaches across the MPS. This is beneficial as each Borough has different needs and different partners. It allows a more tailored approach to local problems.

39. Safeguarding adults points of contact and family intervention projects are not mandated within safeguarding adults policy or operating procedures and the significant numbers above are reflective of excellent pro-active work by the boroughs involved.

Identification and sharing of good practice

40. A number of boroughs have initiated schemes which could properly be called centres of excellence or offered up as good practice. Brief summaries are contained below :

• Haringey, Enfield and Barnet have brigaded their services to form a tri-borough team that deals with every request for police attendance at mental health assessments across the three boroughs. The team also investigates crimes reported within psychiatric settings, recalls following breaches of community service orders and Ministry of Justice forensic recalls, attendance at safeguarding adults meetings and improved information sharing through acting as a single point of contact for health trusts. Since its inception in April 2009 the team has dealt with 324 mental health assessments and investigated 130 crimes and can boast a sanction detentions rate of 49.53%. The team has secured funding from the Barnet, Haringey and Enfield mental health trust to pay for officers on attachment to the unit. To receive such funding at a time of financial crisis is indicative of the strength of support amongst partner agencies.
• Southwark and Lambeth employ hospital liaison officers as part of the safer neighbourhood team with specific responsibility for policing matters in and around the local hospital
• Camden employ an officer with responsibility for sharing information between police and health trusts to manage the risks associated with detained patients both within forensic and none forensic settings in addition to those within the community
• Ealing employ an officer with specific responsibilities to address risk reduction associated with criminal activities in west London mental health trust. The officer’s post is funded by the health trust management.
• Hackney have a mental health intervention officer making policing services more accessible to vulnerable victims with mental ill health and learning disability

41. Recent learning for the MPS revolves around the growing use of deprivation of liberty safeguard authorisations by partners in health and social care. Erroneous expectations have arisen proposing that police will act to use restraint and forcible intervention in situations where resistance is anticipated when removing an individual using such an authority. The majority of individuals who fall to be detained under these provisions will be people with severe learning difficulties, older people with a range of dementias and people with neurological conditions such as brain injuries.

42. In addition to the uncertain legalities that arise where police become involved, the MPS considers it to be an inappropriate use of police officers to undertake these kinds of functions and following a number of recent case studies will shortly be issuing guidance to officers about correct responses to these requests.

43. The mental health project team disseminates good practice and learning in these and similar areas through the MPS intranet to which all staff have access. Given the broad and expanding range of policing activities in relation to mental ill health and the limitations on training, a number of targeted briefings are being prepared centrally to inform and educate officers on borough about correct responses to a variety of practical situations. These will take the form of a number of short documents, typically 2-4 pages that provide clear, legally correct and easily accessible instructions when providing a response.

Joint projects with partners and stakeholders

44. A number of stakeholder relationships are embedded within ongoing business activity both locally across boroughs and on a pan-London basis. A summary of partnership linking activity is described within paragraph 7 above. Pan - London relationships include :

• Progressing the Bradley recommendations in partnership with the London Offender Health Partnership Board (LOHPB) and with support from the National Policing Improvement Agency
• Attendance at the MPS mental health programme board by a representative from the LOHPB
• MPS input to training doctors and psychiatrists who require authorization under Section 12 Mental Health Act 1983
• Meetings between the strategic lead for the mental health project team and the head of mental health for NHS London
• Extensive consultations to inform equality impact assessments, a summary of which appears within the equality and diversity impact section of this report.

Progress on objective D2 from the MPS equality scheme

45. Much of the good work already described within previous paragraphs of this report directly contributes to this objective. This together with other measures targeted at improving the service offered in relation to mental health issues may be briefly described as follows :

• Continuing activity amongst borough mental health liaison officers that includes working with partners on the ground, agreeing protocols and working practices, increasing understanding of police procedures and providing a link between partners and police at the local level
• Revisions to the standard operating procedure so as to provide clear guidance that reflects the most pressing and high risk demands placed upon boroughs and an ongoing project to create readily accessible information to officers at the time it is most needed
• Tactical advice to reduce the risks associated with releasing from custody a person with suicidal or self-harm tendencies
• The availability of NPIA developed e-learning on the MPS intranet
• The ACPO sponsored implementation support plan to drive forces towards common standards across the country
• The expectation within that plan that forces will review their locally agreed protocols and bring them into line with the national standards. This has clear benefits for people detained and requiring a mental health assessment because it will set standards that health services will be expected to deliver
• The increasing availability of custody nurses across MPS custody suites and the positive impact this will have upon providing rapid access to healthcare for vulnerable detainees
• Links with external organisations representing various strands of diversity and the contribution they make to the development of service responses

46. The MPS equality scheme raised expectations about measuring outcomes for this objective by proposing an examination of survey results for elements of public trust and confidence. Whilst the existing mechanisms for measurement within the public attitude survey do not specifically isolate mental health as a measurable component, some positive conclusions can nonetheless be drawn.

• The most recently available data shows that 73% of those surveyed in London said they were completely, very or fairly satisfied with the way their area was policed
• Confidence in policing their areas was slightly better amongst people with a disability (this includes people describing themselves as having mental ill health)
• Satisfaction with police follow up in relation to police reported crimes showed an upward trend from the first quarter of 08/09 to the first quarter of 10/11 rising within this period from 59% to 68%
• Satisfaction with police follow up generally also showed an increasing trend across the same period

Additional questions asked at Chair’s Brief

47. What does the tri-borough team deliver in terms of hard measurable outcomes?

Information from the Barnet, Enfield and Haringey mental health trust demonstrate that there has been a reduction in the number of detentions under Section 136 Mental Health Act 1983. At a time when national detentions using Section 136 have shown a sharp rise, this suggests the work of the team is having a positive impact in reducing the number of people in mental health crises.

The team investigates crimes on health trust premises and in particular involving cases where the victim or suspect is a mental health patient. The current sanctioned detection rate for these is running at 49.5%. The head of security for the NHS trust believes that the effect of the unit has been to reduce assaults on staff and violence on mental health wards.
All requests for Police officers to provide support at mental health assessments on private premises are responded to within 48 hours in 99% of cases. This is considerably quicker than the response rate prior to the team existing.
48. How do we involve users of mental health services and how do we reach out across all strands of diversity in the community?

The MPS is in the process of revising the draft SOP to ensure it reflects the most up to date tactical policing advice and has consulted a broad range of bodies representing the views of various diverse groups. These include but are not restricted to the following :

• Race on the Agenda
• The children’s society
• The multi-faith group for healthcare chaplaincy
• The Employer’s forum on disability
• MIND
• Age UK
• Revolving Doors
• Sainsburys Centre for Mental Health

The MPS is now in the process of reviewing the feedback received to see how it can be used in the most productive way to shape the revised procedures and guidance. The majority of the feedback received does not necessarily require that tactical responses be modified but proposes ways of understanding and engaging with different groups in the most constructive and supportive way.

49. Linked to the above, in cases where we have consulted, how do we act upon information received as a result? The philosophy of “we asked, you said, we did”.

It is important to the MPS that the specialist advice received from engagement exercises is made available in the most easily accessible format to operational colleagues. A decision has been made that the advice will feature within a dedicated section of the MPS mental health and policing intranet site and within a briefing sheet to support other operational briefings and material within the Standard Operating Procedure.

50. How do SNT’s support vulnerable victims considered to be at significant risk?

The MPS Standard Operating Procedures for crime investigation highlights the importance of supporting vulnerable victims and witnesses by keeping them informed about progress of their case. In particular it encourages patrolling officers and PCSOs to target patrols in vicinity of vulnerable victim locations and to conduct support visits.

51. Some examples or statistics of how often the MCA provisions might be used on detainees who present a high risk in custody?

There is currently no set procedure for recording and centrally monitoring all interventions relying upon the Mental Capacity Act. Some brief examples of successful interventions are shown :

June 2010 - a man with a head injury following an incident in Charing Cross Road placed himself at risk by continually trying to walk into traffic due to his confused and traumatised state. Restraint by police relying upon Mental Capacity Act allowed the ambulance crew to administer oxygen allowing his condition to stabilise. The outcome of this was that restraint was no longer needed and he was taken to hospital voluntarily.

August 2010 - a man due to be released from a Police custody suite was threatening to immediately take his own life once he left the Police station. He was restrained until a more accurate assessment of capacity could take place by the London Ambulance Service.

July 2010 - a man called the Police after he had attended a female’s flat and found her barricaded in her room with a lighter threatening to set fire to the flat and had cut her wrists. He was concerned she was suicidal; he also believed she may have access to sharp objects and tablets to assist with any suicide attempt.

The woman would not engage with the officers and she had recent injuries to her wrists and was rocking back and forth, but refused any treatment. An ambulance was called and she again refused treatment, the ambulance staff felt the female needed treatment. She still refused to engage with police and there was a genuine fear that she may self harm. Officers restrained relying upon Mental Capacity Act and compelled attendance at A & E to prevent suicide.

52. Are the probation service represented at the LOHPB?

Representatives from the national offender management service (NOMS) attend. NOMS includes oversight of both the probation and prison services.

53. Is there any evidence that Criminal Justice Liaison and Diversion teams are effective?

Despite a number of enquiries, the MPS is not aware of any scientifically provable research that demonstrates the efficacy of criminal justice liaison and diversion schemes. However Lord Bradley in his report when describing his views about such schemes said this “From my discussions with stakeholders and the preliminary financial work undertaken for my review and by other organisations, there are strong indications that there are efficiency savings to be made in the current system in return for this level of investment.”(The Bradley Report, Page 144)

C. Other organisational & community implications

Equality and Diversity Impact

1. The MPS has undertaken considerable research through a number of equality impact assessments and including an ongoing impact assessment still current at the time this report was prepared. This has necessitated an examination of how each individual strand of diversity is likely to be affected by different aspects of service delivery defined within the standard operating procedure. Consultations with partners that represent diverse groups provide helpful predictions about how MPS procedures are likely to affect different people. Space does not permit the reproduction of an exhaustive list but summaries of key findings are shown below :

• In relation to race issues there is evidence that people from black, Asian and other minority ethnic (BAME) communities who suffer from mental ill health are much more likely than their white counterparts to be referred to mental health services through the criminal justice system. BAME people are disproportionately represented in both the mental health and criminal justice systems. In the mental health system, BAME people have higher compulsory admission rates to hospital.
• In relation to issues affecting disability the employers forum on disability commented very positively on the MPS standard operating procedure
• In relation to age, consultation feedback suggested that where restraint was used on younger people in the context of forcible mental health interventions this would have an adverse impact but this could me minimized by taking early steps to request the support or attendance of an appropriate adult, parent or guardian
• In relation to both gender and faith issues, consultation with various external organisations and specialist faith advisors did not reveal any specific evidence that MPS policies and procedures in delivering services to a person with mental ill health had a disproportionate affect on any particular faith group
• In relation to LGBT matters, consultations with experts did not reveal any specific concerns in relation to the affect of MPS mental health procedures upon people within this strand of diversity

2. The above points represent only an extremely brief summary of feedback the MPS receives from its partners. The current equality impact process will conclude towards the end of this year and will lead to the availability of revised advice and directions for officers when dealing with someone with mental ill health. This diversity specific advice will be issued in an easily accessible format through the MPS intranet.

3. Finally it must be recognized that policing activity in relation to the use of both the Mental Health Act 1983 and the Mental Capacity Act 2005 will, by simple definition, have a disproportionate affect upon people with a mental illness. For example someone manifesting symptoms of mental ill health in a public place where risks of injury are present, will be much more likely to be detained than someone not displaying such signs. Similar arguments can be constructed regarding other interventions. However in all these cases the measures taken are in line with legislative provisions that the MPS is bound to observe and are generally taken for protective and supportive reasons in the interests of securing care and help for someone in a crisis situation.

Consideration of MET Forward

4. The following links can be established between MPS activities affecting the delivery of services to someone with mental ill health and where relevant the delivery themes of Met Forward.

5. Met Forward Strand - Met Specialist - This delivery theme includes public protection, elements of which within the revised standard operating procedure for policing and mental health include ensuring that officers understand their powers and responsibilities when responding to Ministry of Justice forensic recalls. Transportation of dangerous and violent patients who might present risks to communities is another area in which the MPS are developing guidance.

6. Met Forward - Met Streets - The work of safer neighbourhood teams mentioned earlier includes follow up support to vulnerable victims and the requirement to generate links with community mental health teams with a view to encouraging referrals of individuals for whom concern has arisen about their mental well being but whose behaviour falls below the threshold required for statutory mental health interventions.

7. Met Forward - Met Partners - The MPS approach to responding to incidents with components of mental ill health includes links with the safeguarding adults and associated hate crime agenda described earlier within this report.

8. Met Forward - Met Connect - This strand touches upon equality issues. The MPS has invested significant time in trying to understand how its approach to issues of mental ill health affects members of many diverse groups as described above under equality and diversity impact.

9. Met Forward - Met People - Shrinking resources and increasing demands place pressure upon our ability to train officers sufficiently to understand the complex legislative rules and codes of practice that underpin partnership responses to issues concerning mental ill health. It is necessary to find new and innovative approaches to ensuring staff have the advice and guidance at the time it is most needed. To this end the MPS is devising new and different ways of making tactical guidance and operational advice more easily accessible. These elements are described elsewhere in this document.

10. Met Forward - Met Support - There are two specific and related areas within the MPS approach to mental ill health and operational policing that directly address this theme. One is the provision of information in an easily discoverable and accessible format, the other is ensuring officers and partners in health and social care fully understand the scope and functions of police officers. A lack of understanding frequently leads to officers being requested to perform functions that are the responsibility of health agencies to undertake and in consequence reduces the capacity to correctly respond to matters for which police are responsible. It can also lead to undesirable outcomes arising out of police restraint and deaths following police contact.

11. Met Forward - Met Standards - The publication of the ACPO Implementation Support Plan and the MPS Mental Health Strategy with their own performance frameworks, together with the London Offender Health regional delivery plan provide clear benchmarking tools against which to operate in providing services.

Financial Implications

The adoption of the recommendations within the Bradley report has the potential to reduce public spending costs in the long term as offenders are able to access healthcare and thereby reduce offending. There are no additional known financial implications for continuing to deliver and improve the way the MPS provides the kinds of services described within this report. What will be required is the continued provision of some central resources to provide support and to drive forward the agenda. Until the outcomes of the comprehensive spending review and their impact on Service funding are known, decisions are unlikely to be made as to what precise resources will be available to fulfil these functions, This applies equally to partners funding.

Legal Implications

Much of the way the MPS does business in this area is regulated and directed by various legislative provisions including the Mental Health Act 1983 , the Mental Capacity Act 2005 and their associated codes of practice. Any changes in direction or emphasis resulting in new or amended guidance are always carried out in consultation with the MPS department of legal services. These Acts of Parliament for example contain a significant number of police powers to restrain, detain, retake and enter premises and engage police and partners in a complex web of different interventions, responsibility for which is not always clearly defined. It is therefore crucial that officers are clear about who has what power in which situation. Listing each and every aspect of police/partner powers is impractical within this report, but this could be provided as a separate document upon request.

Environmental Implications

Consideration of the various aspects of policing activity does not give rise to any known environmental implications.

Risk Implications

12. Key identified areas of business risk within the MPS Mental Health Strategy have already been identified earlier within this report. Regrettably, demands for police services from partners normally arise where there is a likelihood of violence and this is amplified within these business risk areas. Of increasing concern and mentioned elsewhere within this report are the volume of requests for police to carry out functions, the legality of which are questionable and which for reasons of public policy, police ought not to be involved. Examples of this include requests to restrain violent patients subject to compulsory detention provisions in order that clinical staff may administer rapid tranquilisation and police support to give effect to deprivation of liberty authorizations.

13. The vital role of borough mental health liaison officers in educating their officers and their partners cannot be emphasized strongly enough since they play a crucial part in ensuring that demands place upon police are appropriate and that officers have the confidence and knowledge to make the right decision. The work of the central team in providing the necessary guidance and support ensures that liaison officers on borough are properly equipped with a support network. Whilst elements of risk will never be completely eradicated, the provision of this support system provides a framework within which the MPS can operate to manage and reduce these and other risks as they are identified.

D. Background papers

• MPS Standard Operating Procedure - policing incidents involving mental ill health
• Draft MPS mental health strategy
• MPS mental health action plan
• Improving Health Supporting Justice - the national delivery plan
• London Offender Health Programme Board regional delivery plan

E. Contact details

Report author(s): Inspector Mike Partridge, MPS

For information contact:

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

Send an e-mail linking to this page

Feedback