Mental Health Awareness Week 2017
Last week was mental health awareness week.
I think that efforts to remove the stigma surrounding mental health are important and valuable. I admire Prince Harry’s brave decision to speak about his own problems and think that Bryony Gordon did a great job of explaining why it’s so important to speak up. I also despaired at Piers Morgan’s desperate, and somewhat sexist, attempt for attention by telling Britain to “man-up”. Stigma, and this kind of language, does not help anybody.
As the week progressed, the Olaseni (Seni) Lewis inquest documented how an attempt to access mental health support ended in the death of a young man. I also watched a friend of mine suffer her own crisis. I started to wonder whether awareness is what we need? I sit in many meetings where I discuss mental health; it’s an omnipresent issue in policing. It’s also complex and requires multi-agency working to make progress. I therefore resolved to use Mental Health Awareness week, not to just talk about the issues, but to focus in on what it was that custody visiting could do to make change for the better. I have been working on a much-requested training package on mental health.
I began my research in the canon of mental health information- The Mental Health Cop Blog. The ‘Mental Health Cop’ is also known as Inspector Michael Brown, former Custody Sergeant and now mental health specialist for the College of Policing. His work goes well beyond custody so please do have a look if you’re interested. I also recommend attending his talks if you have the chance. He conveys the history and contemporary issues surrounding mental health and policing very well.
I moved beyond the blog into legislation, policy, guidance, concordats for England and Wales as well as Standard Operating Procedures in Scotland and a post on Northern Ireland. I’ve pulled together a structure to develop into a training package. Our aim and hope is that this training will further empower ICVs to provide useful feedback on mental health issues in police custody suites. However, the topic is absolutely huge so I felt inspired to move beyond the training alone into a wider blog piece about my observations and experiences.
Mental health in custody
One of the clearest messages that I took from all of my reading and experience is that mental health issues are complex and require a lot of partnership working to resolve. Mental health in custody is no different. For the sake of clarity, I am going to split it in two:
Police custody as a place of safety
Police custody has been used as a place of safety for those in mental health crisis. This is where police use Section 136 or Section 135 of the Mental Health Act to move somebody to a place of safety for mental health assessment if they believe that this person needs immediate care or control. Whilst police custody will keep people physically safe, you can imagine that the experience can add to the distress of the detainee and police forces have been working hard to reduce this use of custody. The Police and Crime Act 2017 delivers another huge step in this direction, and is explained later on.
Police custody after arrest
Detainees may also find themselves in poor mental health and in police custody after arrest. A Detention Officer (DDO) on Twitter told me that they can often be the first to recognise someone has a mental health condition or are in crisis as they spend the most time with them. I have worked with some excellent DDOs and can well imagine that this could be the case. Detainees don’t always disclose poor mental health when being booked in, but can build rapport with staff. Once someone is in custody and has poor mental health, the Custody Sergeant takes on a great responsibility and will make nuanced and, sometimes, difficult decisions. They may need to balance the needs of the detainee with the risk of harm to the public. They also need to safeguard the integrity of the legal process. I know, from spending time with sergeants and inspectors, that they face difficult conundrums that have no clear, perfect answer.
For example, I now regularly receive reports of instances where a person arrested for a crime has been assessed under the Mental Health Act as needing hospital admission, but there are no beds available and detainees have to wait for long stretches, sometimes days, to access a bed. This is a well-documented issue for policing and one that the Home Office and NPCC are working on. However, it can leave the Custody Sergeant in the impossible situation where they do not wish to release someone who could harm themselves or others, but have no legal basis for detaining them; see this blog.
You see – it’s complicated and difficult and that’s before we even start to look at the detail.
The legislation on mental health and custody is changing. As mentioned previously, police custody has been used as a place of safety for those in crisis. Many constabularies have worked hard to reduce this and the Policing and Crime Act 2017 builds on this. The Act is nicely summarised by Mind and outlaws the use of police custody as a place of safety for children (aged 17 or under) and will severely restrict its use for adults. We wait for further guidance on when it may be used.
This change, of course, does not extend to those who are arrested. However, it does provide a clear message that police custody is not the right place for a person in mental health crisis. We wait to see how that leadership will drive changes to practice.
Restraint / use of force
The hugely sad inquest of Seni Lewis demonstrated a problem that is, again, often discussed and needs further work – use of restraint and mental health. This issue has featured in the news lately. The deaths of Seni Lewis and Thomas Orchard have weighed heavily and been widely discussed. Spithoods are frequently debated and have polarised opinion. The IPCC has stated that that, on average, mental health was a factor for two in five people (43%) people who died each year in or following police custody. Seven deaths in their report followed physical restraint or a violent struggle with the police. We need to further understand how to best respond to those in crisis in order to save lives and equip the police with the skills and knowledge that they need to safely manage restraint.
The police must call an Appropriate Adult (AA) for detainees who may be suffering from mental ill health or other mental vulnerability. The role of the AA is to:
- Support, advise and assist the person,
- Ensure that the person understands their rights,
- Ensure that the police act fairly and respect the rights of the person, and
- Ensure effective communication between the person, the police and others.
The linked guide explains more of the rights of the detainee and the Appropriate Adult. This is a crucial service, but again one that we continue to work on nationally as no one body has a legal duty to provide AA services for vulnerable adults and we’ve received reports of long waits and cuts to services. There’s a lot of work underway between the Home Office and National Appropriate Adult Network, along with PCCs (including ICVA’s Chair, Martyn Underhill) to ensure that this crucial safeguard is in place.
How can ICVs help?
ICVs are the eyes and ears of the public and their PCC, Policing Board or Police Authority. They visit custody week in, week out and have a unique perspective. I always encourage ICVs to report anything that they feel unhappy about to their scheme manager. They visit custody as a member of the public and should feel empowered to raise concerns on mental health. They may see things that others have missed.
Furthermore, our training will outline the key things that they should look out for in custody. Are people still coming into custody as a place of safety? Is there accessible healthcare to support custody staff and the detainee? Are vulnerable adults getting Appropriate Adults in a timely manner? Are detainees or staff reporting long waits for mental health beds for those assessed as needing them? Interviews with detainees, alongside observation of detainees and oversight of custody records will give schemes data that will paint a picture of mental health in custody in their area. PCCs, police authorities and boards can use this data to illustrate what’s working or failing in their area and work with partners to ensure that the right services are in place.
ICVA collects regular scheme reports and we use this data to inform national discussions and reforms to police custody. We work with the NPCC, Home Office, College of Policing, IPCC and others to improve custody. We raise issues such as long waits for mental health beds and will continue to do so until the matter is resolved. ICV reports are gold dust and make a big difference.
There will be times when it’s not appropriate for detainees to be in police custody – when it’s not good for them, prevents them from getting the treatment they needs and places stress on the police service. ICVs are part of the solution to this. The on-the-ground experience of ICVs gives voice to vulnerable people and equips us with the evidence and understanding to identify problems and enact solutions.
This blog could have easily been double or triple thing length, maybe even ten times as long. I have cut a lot of what I wanted to say. Mental health in custody is such a big topic and impacted on by many things outside of custody. I hope that this post has done its bit to raise awareness of this part of the mental health world. More than that, I hope that this blog, coupled with our training and resources, will start to make a real difference. Please do let us know.
Just an added extra for those who may wish to further build their awareness. Inspector Brown tweeted about this book, shortly after I joined ICVA. It’s an accessible source of information about mental health and the criminal justice system. I enjoyed it and recommend it to anyone looking for more information.