You may have seen that internet meme bouncing around on social media, above? This post is essentially about how this advice may be more important than things we spend much longer talking and worrying about. I’ve been caused over the years to read a lot of books that have been pushed in my direction, in lieu of any proper training on what I do; also to catch snippets of CPD really designed for AMHPs and mental health nurses when I’ve been waiting to give presentations to them, or when I’ve been hanging around afterwards. In the course of doing my job, I’ve received hundreds if not thousands of emails and social contacts over the years from patients, their families or carers about police training on mental health related matters.
Calls for training seem to be the number one recommendation of reports and complaints which examine where things have gone awry and training, I agree, is important: this stuff is an area of policing which touches up against disciplines with complicated diagnostics criteria, psychopharmacology and awkward legal structures. I can agree we need at least some training, without any pretence that we could or should build half a mental health nurse in uniform. But at the core of this feedback is something rather simple and easy to contemplate.
There are lots of conflicts and tensions in policing and in the demands we face: some people have called for condition-specific training on certain mental disorders or groups of disorders. Given we couldn’t realistically give specific training on all discrete disorders or even categories of disorders, are some mental health conditions more important than others? – should that decision on where to focus the training be based on the frequency of encounters we have or upon the extent of difference the condition makes to how we should police? Do we target the more common conditions or understand the more complex issues, however rarely encountered? Are peri-natal mental health issues more or less important that obsessive compulsive disorder; is autism more or less important than schizophrenia where these issues are competing for time amidst a training schedule? If all four of these must go ‘in’, what remains ‘out’?!
No matter the books I read, the people I talk to, the research I hear about at conferences, all things point to the same conclusion, in my view: the public just want the police to be as kind and patient as possible, even in the face of various kinds of frustrations. I don’t get emails saying that the custody officer had correctly identified someone as having bipolar disorder; but I do get them where we just knew that something wasn’t quite right and the custody officer was extremely kind and took time to explain things and reassure a person. I don’t hear stories of officers showing a depth of insight in to these issues but I get plenty praising their patience, the decency and their humanity.
When we were putting together the College of Policing APP on mental health, numerous people asked us about training to accompany it and worried out loud that by training, or even over-training, police officers on the multitude of different mental health conditions, we would strip away that which was most essential, from a service-user’s point of view: simple caring humanity. People don’t want diagnosticians in uniform or someone who can necessarily ‘fix’ them; they want to be treated with courtesy and respect, as an individual who can help them in the short-term. Help might not even necessarily mean helping achieve immediate access to NHS professionals; it might just been giving time to stay with someone whilst a crisis subsides.
A patient at a Crisis Care Concordat event once sought me out after a talk to make sure we didn’t over-train the police out of their lay-person, decent-human-being backgrounds and make them think they’ve become quasi-clinicians. She feared this would remove everything she wanted and needed from a police response. One of her experiences had been officers meeting her in acute distress and sitting on the kerb with her for over half an hour or so whilst another police officer was just along from them, talking on the radio, trying to get information, support and then eventually, an ambulance to attend. It all took so long that by the time the officer rejoined them, the patient felt relatively fine – the crisis had blown over – and she trusted them enough to let them know of a friend she’d be able to talk to and stay with. Officers who were thinking of whether to take her to A&E or use s136 were then reassured enough via the friend’s willingness to help, to do neither of these things. Each were ‘pathways’ the person was keen to avoid and MH services followed her up the following day.
This week, whilst waiting to deliver a talk to a group of AMHPs, I heard a presentation by an academic about the use of risk assessment scales for people who have hurt themselves deliberately. Read the papers about this for yourself, if you wish, but it turns out these things have been thoroughly tested and are not as reliable as simply asking the person themselves; and not as reliable as the instinctive opinion of the clinician caring for that person. They are often used to determine whether patients should be considered low, medium or high risk and that grading influences other issues on everything form whether to ensure a higher intensity of support in the community or to call for a Mental Health Act assessment. That’s a lot of resource to expend if the tools used to form the risk-rating are wrong more often than they’re right!
Also referenced within the presentation was the number of psycho-social assessments that are undertaken on patients who presented in EDs after self-harm – it has been in the NICE Guidelines for sometime that good clinical practice is to ensure such assessment on all patients and the last time I heard the percentage figure, it was around 40%. It’s apparently now risen to just over a half of all patients, but this is thought to have more of a positive, protective value than structures wrapped around patients after the use of risk assessments scales (which are wrong more often that they’re right).
Of course, despite the clinical sounding term ‘psychosocial assessment’, this is mainly a matter of listening to people and taking them seriously around their difficulties and helping identify ways of supporting them on their own terms (as it has been explained to me). The presentation just kept coming back to that point: be nice to people, be patient with them and listen to their stories.
Most police officers, when they encounter someone in distress, are meeting someone they haven’t met before. Many police areas have a small number of individuals who are known to have complex mental health and social problems who are repeatedly detained under s136 and well-known to police, mental health and social services, but in the main, those we encounter are not individually known to each officer. So firstly, this raises the importance of ensuring officers have timely access to relevant information from both the police service (other officers may have encountered this person before) and from partner organisations (most people the police encounter are known, currently or recently, to mental health services).
Other academics have mentioned the relationship between long experiences of mental health problems in adults – 75% of all mental health problems for adults being during childhood and the relationship between trauma of various kinds and adult mental health problems is well established. When meeting someone in acute mental distress in circumstances where there is considerable risk to that person, officers are potentially walking in to years or even decades worth of difficulty that may have proven challenging to even the most qualified of mental health and social care professionals. The likelihood that officers can ‘fix’ the person is limited and fortunately, that’s not waht patients who I’ve spoken to actually want. They have a very limited set of requirements that actually bode well across all policing encounters we ever have, whether related to mental health or not –
Nothing exceptional here, is there? – it’s what I’d want from the police no matter what job they went to. I know most of us do this anyway – I haven’t written this post because I sense that we usually get this wrong! A reminder of what the public say isn’t going to do any harm and there may be some officers (or for that matter, paramedics, mental health professionals or other NHS staff who hadn’t thought of some of these things) who might think of doing some things differently in future.
Policing is not about us: it’s about the people we meet and some of them are fighting battles you know nothing about and have been for years. Be kind, be patient – and let them be in charge as much as you possibly can.
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