MPA and NHS joint review of mental health and policing

Report: 11
Date: 29 March 2007
By: Assistant Commissioner Territorial Policing, on behalf of the Commissioner

Summary

This report is a follow-up to the report in June 2006. The report sets out the current position in respect of the review of mental health and policing. In particular the report sets out the structures that have been put in place and the progress that has been made in implementing the recommendations.

A. Recommendation

That the report be received.

B. Supporting information

1. In October 2005 the MPA published a joint review of policing and mental health, which followed the MPS Review of Mental Health and Restraint (September 2004). The review, which was jointly chaired, by the MPA and NHS commenced in September 2004. Deputy Assistant Commissioner Brian Paddick represented the MPS.

2. The review made 33 recommendations in the areas of mental illness, key interfaces and management of violent behaviour.

3. The MPS supported the review and endorses the recommendations while recognising that some of them are not directly deliverable by the MPS.

Governance of implementation

4 Many of the recommendations require joint implementation. The report recognises the need for the commitment of organisations to work together to implement the recommendations. An implementation board has been set up consisting of Greater London Association of Directors of Social Services, Strategic Health Authority, health trusts, MPA, MPS and the London Development Centre (Care Service Improvement Partnership).

5. NHS London agreed to host and provide the project managers who looked after the day-to-day management of implementation. The existing programme managers completed their secondment in November 2006 and have not been replaced. The programme board has not yet negotiated the future arrangements.

MPS infrastructure

6. In May 2006 the MPS appointed Commander Rod Jarman an Association of Chief Police Officer rank officer as the lead for the mental health strategy that is developing the following areas; safety of service users, public safety and safety of police and other agencies.

MPS programme

7. A programme of work has been put in place to develop the MPS approach. While this programme pre-dates the Report its’ development was informed by the emerging findings and so the MPS has already started work on many of the recommendations.

8. Since 1994 the MPS has had staff on boroughs that take on the role of borough mental health liaison officer. The role was reviewed in December 2004 and has resulted in a Territorial Policing ACPO lead (Cdr Jarman), an induction programme, continuing professional development every six months, intranet based guidance and support from the project team. A borough level action plan will be put in place and a new Mental Health Standard Operating Procedure will be implemented for 2007/8.

9. Mental health has now been incorporated within the TP diversity framework, which is also within the lead of Commander Jarman.

Progressing the recommendations

10. Appendix 1 outlines key progress made by the MPS. A small mental health project team of a superintendent and two inspectors has been put in place to support both the programme and to work with the project managers. The MPS has seconded part of one of the inspector’s time to work, with the London Development Centre, on implementing the recommendations.

C. Race and equality impact

1. The MPA project board was careful not to perpetuate the prejudice toward people with support needs. It investigated issues of discrimination and made a number of recommendations aimed at dispelling the myths around illness. The MPS mental health project team has adopted this approach, which has included briefing and advice from a sub-group of the disabilities independent advisory group. The work already undertaken on the recommendations illustrates this approach.

2. Early in 2007 the MPS will be implementing a new Mental Health Standard Operating Procedure for which an equalities impact assessment is being undertaken.

D. Financial implications

1. The financial implications of the recommendations have been largely born by the stakeholders. Work carried out by the MPS team have supported some of the recommendations around training and protocols for ‘places of safety’ and assessment on private premises.

2. However, two recommendations have been identified as having significant additional cost to implement:

Recommendation 15. That agencies work together to improve the availability of Appropriate Adults.

Currently there is no statutory provision of appropriate adults for the mentally ill. Some Approved Social Workers consider there can be conflicts of interest. The development of schemes is likely to require funding. The programme managers have sought further advice from the Home Office on future national strategies around increasing the availability of appropriate adults. As of 16 November no additional information has become available.

Recommendation 20. The MPS puts in to place a comprehensive training programme aimed at ensuring that all officers have an appropriate level of awareness of mental health and illness to enable them to deliver more effective services to people with mental health support needs. This should be developed with, and involve a diverse range of service users and where possible partner agencies.

A training needs analysis has been initiated. Training for all officers will incur a significant opportunity cost. Any recommendations from this will need the approval of the MPS training management board.

E. Background papers

None

F. Contact details

Report author: Superintendent Simon Corkill, MPA.

For more information contact:

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

Appendix 1

The appendix is split in two based on work undertaken by the MPS and that requiring action by the NHS/the alliance.

Progress by the MPS

Recommendation 1. Multi-agency partners ensure training and awareness programmes highlight the need to eliminate discrimination and stigma to all communities and that all programmes are subject to full equality impact assessments.

The MPS contributed to a London Development Centre joint review of mental health act assessments. Multi-agency training supported by the MPS has now been delivered across London and highlights aspects of stigma and the context of mental illness in London. The MPS has involved service users in the production of a training DVD that will be delivered in early 2007 and the new IPDLP programme involves enhanced mental health awareness training.

A multi-agency meeting took place on 30 November to consider further action required to maintain and improve (where required) existing inter-agency training. The work undertaken by the MPS was considered by the other agencies to be good.

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

A joint conference was held with Mind in September 2005 involving service users and Borough Mental Health Liaison Officers.

In May 2006 the MPS and the London Development Centre collaborated to undertake a race impact assessment of pan-London protocols in relation to taking people to places of safety, assessments in the home and absent without leave from hospital.

The MPS is developing a new Standard Operating Procedure that has taken account of the views of service users. Engagement will form part of the borough action plan in 2007/8.

Recommendation 3. The MPS develops an awareness programme aimed at destigmatising mental illness and dispelling the myths of the links between certain types of mental illness and violence. The MPS leadership should champion this.

A training needs analysis has been initiated. Any recommendations from this will need the approval of the training management board.

The MPS programme board has approved a guide on the content of existing training. This includes stigma issues and the social model.

The first induction programme for Borough Mental Health Liaison Officers was conducted in May. The programme included training from a service user and the London Development Centre.

Stigma issues have been incorporated into recruit training from September and included in the new Standard Operating Procedure.

Recommendation 4. The MPS and the NHS agree and apply a joint media strategy that will minimise the extent to which the press report on the mental health status of people accused of serious violent crimes including murder. Such a strategy should also aim to minimise the negative reporting on mental illness and the occurrence of violent crimes and murder.

The MPS has met with communication leads from mental health trusts and jointly agreed media guidance. The guidance has now been adopted. (Complete)

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.

A partnership group has previously been established with the London Development Centre. Commander Jarman the territorial policing lead for mental health is a member of this group.

At present, the Project Board acts as the high level alliance. This will be reviewed in the light of the new NHS structures within London but no timetable is in place for such a review. (Complete)

Recommendation 6. Leaders of police, health and social services and local government, in London should convene annually as a matter of course to discuss the health challenges facing London, including mental health. This could provide direction and leadership to the pan-London alliance recommended above.

The Board will consider this in the New Year.

Recommendation 7. Partners maintain the links developed through this joint review with key stakeholders (such as the reference group who provided ongoing 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.

The MPA have continued to chair and support this group that have migrated to an implementation board. (Complete)

Recommendation 8. In the short term current Section 136 of the Mental Health Act agreements in each borough are reviewed to ensure they address the following:

• Identifying a place of safety that meets the requirements of the code of practice and the pan-London protocol, and is operationally conducive to local working arrangements (this may require a culture change from some organisations)
• Addresses how s136 detainees who also appear to be intoxicated should be dealt with
• Identifies designated health facilities best able to meet the immediate needs, including those which concern issues of diversity, of people who are extremely agitated and in need of restraint for their or other people’s safety
• Outlines handover procedures so that all necessary/relevant information is passed on to clinical staff
• Auditing processes are developed to ensure the implementation of s136 is evaluated and lessons learnt on an ongoing basis (as per the Code of Practice).

In July 2005 the MPS tabled a paper to the London Development Centre partnership group recommending a joint review into the operation of Section 136 of the Mental Health Act. This was agreed and the review project was lead by a seconded inspector. The review is complete and awaits final agreement by the London Development Centre Partnership Group. Recommendations from the review project will form part of the work of the MPS Mental Health Project Team.

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.

The MPS contributed to a London Development Centre joint review of mental health act assessments. Multi-agency training supported by the MPS has now being delivered across London that highlighted aspects of stigma and the context of mental illness in London.

The new Standard Operating Procedures require Borough Commanders to have these protocols in place. (Complete)

Recommendation 12. Ensure a timely evaluation of the revised protocol (the emphasis should be in following up the recommendation of the multi-agency review).

Awaits recommendation 11 and the revision of the existing protocols based on the review report. A review is programmed to start in April 2007/8.

Recommendation 13. The MPS ensures that mental health is given a high priority within the requirement of 24 hours training per year that Forensic Medical Examiners (FMEs) are required to undertake.

At the April 06 Forensic Medical Examiners training event a mental health module was delivered. (Complete)

Recommendation 15. That agencies work together to improve the availability of Appropriate Adults.

The Home Office is currently reviewing the provision of appropriate adults.

Recommendation 16. If someone with mental health support needs commits an offence, it should be followed up through the criminal justice system. At the same time, it is important their mental health needs should be assessed and addressed appropriately, which may involve diversion to the mental health system.

The MPS is undertaking work with Crown Prosecution Service, Borough Mental Health Liaison Officers, Forensic Medical Examiners and custody officers to progress this. Changes to the Home Office circular 66/90 are potentially needed.

The development of local arrangements will be part of the borough action plan in 2007/08.

Recommendation 18. The MPS further raise the profile of the role of the borough MHLO within the organisation.

The MPS have put in place a small team that provides support. The team has developed an intranet site, arranged twice yearly professional development days and in May 2006 ran an induction day for officers who were recently given the role.

In February 2006 Commander Jarman surveyed borough practice through an audit completed by borough commanders.

In 2007/08 there will be a borough action plan for Borough Commanders that will focus the work and interaction with MHLOs. (Complete)

Recommendation 19. A key function of the MHLO should be to proactively develop relationships with local user groups and voluntary organisations. Performance management mechanisms will need to be developed to monitor this.

In February 2006 Commander Jarman surveyed borough practice through an audit completed by borough commanders. The survey identified that relationships needed to be developed.

In 2007/08 there will be a borough action plan for Borough Commanders that will focus the work and interaction with MHLOs, which includes developing relationships.

Recommendation 20. The MPS puts in to place a comprehensive training programme aimed at ensuring that all officers have an appropriate level of awareness of mental health and illness to enable them to deliver more effective services to people with mental health support needs. This should be developed with, and involve a diverse range of service users and where possible partner agencies.

A performance needs analysis has been initiated. Any recommendations from this will need the approval of the training management board.

Recruit training as part of the Initial Police Learning and Development Programme (IPLDP) will be comprehensive and involve service users and partner agencies.

Recommendation 21. Local partnerships develop joint training opportunities such as scenario-based workshops, particularly where practitioners are engaged in delivering services together.

The MPS delivered a Borough Mental Health Liaison Officer development conference in May 2005 that included local officers inviting local partners.

The MPS contributed to a London Development Centre joint review of mental health act assessments in 2005. Multi-agency training supported by the MPS has been delivered across London and highlights aspects of stigma and the context of mental illness in London.

Recruit training as part of the Initial Police Learning and Development Programme (IPLDP) will be comprehensive and involve service users and partner agencies.

The MPS has involved service users in the production of a training DVD based on a scenario that will be delivered in early 2007. (Complete)

Recommendation 22. Partner agencies develop training programmes aimed at ensuring staff are aware of the role of police and their responsibilities. Likewise, the MPS should ensure that its officers understand the roles and responsibilities of partner agencies.

The MPS contributed to a London Development Centre joint review of mental health act assessments in 2005. Multi-agency training supported by the MPS is now being delivered across London and highlights roles and responsibilities.

The first induction programme for Borough Mental Health Liaison Officers was conducted in May. The programme included the roles and responsibilities of other agencies. (Complete)

Recommendation 23. All training programmes are subject to an equality impact assessment to ensure that they identify and address the needs of service users from different communities in London and that they avoid perpetuating the stigma attached to mental illness.

Recruit training as part of the Initial Police Learning and Development Programme will be comprehensive and involve service users and partner agencies.

The first induction programme for Borough Mental Health Liaison Officers was conducted in May 2006. The programme covered stigma and included training from a service user and the London Development Centre.

The MPS programme board has agreed learning aims for mental health training that includes stigma, discrimination and the social and medical models. The completion of equality impact assessments is now part of MPS policy making. (Complete)

Recommendation 30. Locally based networking is facilitated though Safer Neighbourhood teams and Community Mental Health Teams aimed at ensuring appropriate responses to individuals who appear to have mental health support needs.

The MPS mental health project team has worked with the safer neighbourhood implementation team to develop an awareness package and briefing for ward teams. (Complete)

Recommendation 31. Borough arrangements are formalised to reflect good practice.

The MPS is piloting an information passing process to Community Mental Heath Teams. This will form an objective within the borough action plan for 2007/08.

Recommendation 33. Multi-agency work is taken forward to gain a better understanding of joint risk assessment and that lessons learnt and good practice are shared across London in a coherent and co-ordinated manner.

The MPS contributed to a London Development Centre joint review of mental health act assessments in 2005. Multi-agency training supported by the MPS is now being delivered across London and highlights aspects of stigma and the context of mental illness in London. The guidance includes a common approach and standard form to joint risk assessment. (Complete)

Recommendations requiring activity by the NHS/wider alliance

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.

In March 2006 the MPS tabled a paper to the London Development Centre partnership group reviewing the use of s136 and the nature of accommodation across London. The paper recommended a pan-London approach to bid making and suggested accommodation standards. The recommendations have been passed to the lead strategic health authority.

The Board have agreed for a joint understanding to be drafted.

Recommendation 10. The MPS and NHS work with government departments to develop good practice on identifying the ideal place of safety.

In July 2005 the MPS tabled a paper to the London Development Centre partnership group to prompt a multi agency review on the use of s136 and the nature of accommodation across London. This has now been completed and awaits the approval of the London Development Centre Partnership Group.

Recommendation 14. In order to reduce the amount of time detainees spend in custody, agreements are established with mental health services to ensure that Approved Social Worker (ASW) attendance will be timely.

From the steering group not clear if this is a substantive issue.

GLADSS have stated that it is not on their priority list at present and this is not considered to be a general issue across the MPS.

Recommendation 17. As part of their approach to reducing violence on mental health wards, Trusts should adopt the approach taken by Southwark police and the Maudsley in developing a prosecution policy and educating staff about how to deal with the police should the need arise.

The MPS have worked with London Development Centre to develop guidance on the prosecution policy. The London Development Centre is leading a pilot of the guidance on a trust.

The development of local arrangements will be part of the borough action plan in 2007/08.

Recommendation 24. The MPS, NHS and other partners continue to explore the benefits of good practice models identified (such as the American models (see main text for detail)), with a particular focus on the context in which they are delivered and how this could be applicable to improving the quality of service delivery in London.

In March 2006 the MPS tabled a paper to the London Development Centre partnership group reviewing the use of s136 and the nature of accommodation across London. The paper recommended a pan-London approach to bid making, places of safety and suggested accommodation standards. The recommendations have been passed to the lead strategic health authority.

The London Development Centre has now commissioned a research paper.

Recommendation 28. The development and promotion of the use of crisis cards.

The MPS is working with the MedicAlert, a charity that provides a life-saving identification system for individuals with hidden medical conditions and allergies. This includes mental illness.

The Board is considering a project proposal to consider options across London.

Recommendation 25. There should be a clear policy statement from a pan-London alliance that confidentiality will be respected, information will only be shared when it is either in the best interests of the individual or there is a concern for public protection and information will only be used for the purpose for which is being shared. We recommend that there will be regular data cleansing in recognition that people’s mental health status can change and improve. Systems and processes will need to be developed in order to achieve this.

The Board is scoping the development of a Memorandum of Understanding across all stakeholders. The recommendation states the principles of the Data Protection Act.

Recommendation 26. There is a need to clarify the legal framework, for example using case studies, making it easier for practitioners to understand the circumstances within which information should be shared.

This would be included within the Memorandum of Understanding around information sharing. The MPS is collaborating with the London Development Centre CSIP project on a simple algorithm for information sharing.

Recommendation 27. Where possible (and we recognise that this isn’t always possible), the individuals should be told that information is being sought from/shared with other agencies. The reasons for this should also be explained.

This would be included within the Memorandum of Understanding around information sharing.

Recommendation 29. All agencies hold accurate lists of key staff in partner agencies, along with their roles and responsibilities and that arrangements are established for ensuring that they are kept up to date.

The programme managers were considering this.

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

NHS representatives are raising this with Chief Executives of Mental Health Trusts.

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