If I fall down the stairs and fracture my skull, if I’m the innocent victim of gun crime or I collapse at work with chest pains, I can be reasonably confident I won’t find myself in a police cell shortly afterwards.
Physical traumas are rightly considered emergencies and our accident and emergency services respond accordingly – in most cases with great speed, care and professionalism. Ambulances are called, paramedics deployed and, if necessary, further treatment given in hospital.
So why is this not the norm for mental health crises? They can be just as debilitating - in some cases life threatening – and like major physical injury, may only get worse if not dealt with in a timely and appropriate way.
How distressing must it be to feel out of control, terrified and confused, only to discover the ‘place of safety’ is not a hospital or acute mental health unit (such as the one I recently visited at Oxleas House in Greenwich), but a police cell? And what if our means of conveyance is a police vehicle, not an ambulance, and the people around us not medically trained professionals but police officers, who – understandably – are focusing on immediate practicalities rather than a person’s emotional wellbeing?
Let’s quantify the issue as best we can. We know the number of detentions police officers make under the Mental Health Act is rising. In 2008/09 there were nearly 9,000 detentions where the person affected was taken to a hospital. For the last three years this figure has risen and stabilised at around 15,000 per year. Just to be clear on this point: this is what happens when things go right.
In 2011/12, police custody suites were used as a place of safety in an estimated 8,667 cases. Whilst there was a welcome 10 percent reduction in 2012/13 to around 7,761 cases, this is still not as rapid a decline as we would like. That’s why we challenged the health and care system to halve the 2011/12 figure by the end of March 2015.
Some of these transfers will have been the consequence of an on the spot decision by an officer, but many will have been because health services were not able to respond quickly enough. In these situations, police may reluctantly have had no choice but to place people in cells rather than the appropriate medical environment.
It is why the recently launched Mental Health Crisis Care Concordat is so very welcome and why I am heartened by a unity of purpose which spans the health and care sector.
The Concordat (signed by this department and twenty signatories including NHS England, Local Government Association, Association of Directors of Adult Social Care and the leading mental health charity MIND) commits all localities to bring together their police, mental health, social work and ambulance professionals, to review procedures and work together to reduce the number of times police custody is used.
We firmly believe together we can bear down on this problem and halve the number of people detained in police cells simply because they are mentally ill.
Let me reiterate – the police are not at fault here and I am sure many individual officers would agree a police cell is the wrong environment for someone experiencing a mental health crisis – it can only make their condition worse, certainly in the short term.
The Concordat tasks the NHS to review its crisis care provision with local services to avoid such scenarios. It requires local areas to have plans in place to stop people being unnecessarily detained in police cells. In particular, I have instructed the NHS to make sure every community develops a plan to guarantee no one in crisis will be turned away from the services they need.
It will provide agreed response times for ambulances to respond to mental health crises in 30 minutes, and 8 minutes if their condition is life threatening.
And more work is being done to improve services for people with mental health and substance misuse problems, which also requires proper liaison psychiatry services to be available in A&E.
I am not saying good crisis care doesn’t already exist – it does and there are many excellent examples which are testament to this fact. The challenge now is to propagate this and other successes throughout the system.
Successes like the 136 phone line in Lincolnshire. This dedicated number connects officers to a mental health duty nurse at a local, designated place of safety. Police officers benefit from immediate advice on incidents involving individuals in crisis and nurses can offer rapid referrals to healthcare services.
Elsewhere, we are seeing new local collaborations between organisations, such as those between the British Transport Police and NHS London, where a pilot scheme is bringing together psychiatric nurses, public protection officers and transport staff. It’s a new combined approach to identifying and helping vulnerable people at risk to themselves and others on the railway network. Getting these individuals out of crisis situations and into safe, caring environments as quickly as possible is the aim.
So, a mental health crisis is an emergency. I want our care and support services to reflect this reality and be supported in their efforts to deliver help where and when it is needed. Heart attacks, attempted suicides, brain hemorrhages, self-harming – these events are tragic enough – let’s not add to the tragedy by treating any of them differently.
The Concordat is our latest, best chance to make sure this doesn’t happen.