Parliament Street: Preventing demand, not just managing it

Parliament Street: Preventing demand, not just managing it

A policy paper first written for the Parliament Street Joseph Chamberlain Policy Centre on the need to prevent mental health demand, not just manage it.

Summary:

  • The demand on Policing as a result of cases involving mental health continues to rise, with some Forces reporting that demand takes up to 57% of their time in some parts of the country
  • However, in some areas, Police Forces don’t know the full picture or fully understand the demand on their time
  • The cost of searching for missing persons where mental health is known to be a contributing factor is around £200 million per year, the same as investigating burglary
  • Police Forces have made good progress in reducing the number of people detained under section 136 of the Mental Health Act, and fewer are ending up in Police cells
  • Police and Crime Commissioners, as elected representatives, can and are raising awareness and enabling public debate on this key challenge by funding projects and holding all agencies to account
  • More progress needs to be made in preventing demand, not just managing it

Proposals:

  • Police Forces need to undertake detailed work to understand what demand looks like in their own areas
  • Wellbeing cafes could be set up in all parts of the country where they don’t exist to provide people support and help them manage their own mental health
  • Consideration needs to be given to expanding telephone services, such as 111, to include mental health more distinctly
  • Information sharing between agencies could be improved so that we can be more proactive, but in a way that is safe and fair
  • The ban on the use of Police cells for detaining young people under section 136 of the Mental Health Act needs to be implemented, and a similar ban brought in for adult detentions too
  • Substance misuse service providers could look at their substance misuse and addiction services to see if alternative places of safety can be provided when someone has been detained by Police due to concerns about their mental health when they are intoxicated

Police and Crime Commissioners are elected by the public to set Policing priorities, be a voice for victims and commission support for them, work on community safety schemes with partner agencies and hold their Force to account for service delivery. We set the budget and the council tax precept and have a role to play in the complaints process. Due to our political roles, we also have the ability and freedom to raise concerns with and make complaints to other organisations that Chief Officers may not be able to do. This paper is an example of how Police and Crime Commissioners are not just holding our own Police Forces to account on behalf of taxpayers, but how we are making representations when extra demand is being placed on Officers and Staff from cases involving mental health and standing up for people in need, above and beyond the valuable work done by Mental Health Crisis Care Concordats.

Parliament Street’s campaigning to raise awareness of mental health and the impact it is having on policing is welcome, and I am pleased to have written for their report recently on this matter. I strongly believe that the challenges faced by Police Forces across the country by the demand placed on them by cases involving mental health is one of the biggest that needs to be addressed. This is not to say that British Policing UK is responsible for the solution – they absolutely are not. However, we need new ideas, programmes and investment in mental health so that Police Forces are not either picking up the pieces for other statutory agencies or placed in difficult situations by a lack of care prior to the individual’s interaction with the Police.

The principle must be, as I have put in my own Police and Crime Plan, that people suffering from mental ill health need the right care from the right person at the right time. In too many cases locally and nationally, this is not what is happening despite more Police and Crime Commissioners making it a priority.

The demand on Policing

In my area, in Kent, the Police spend around one third of their time dealing with cases involving mental health. In Medway, the figure is 57% and in Thanet it is 50%. This is not sustainable in the long term, not the right attention that people suffering from crisis need and not fair on the individual Officers who have to attend the calls received.

Most of the attention with regards to mental health and policing has been focused on detentions under section 136 of the Mental Health Act. It gives Police Officers the power to detain someone who is in a public place and they feel that they need immediate care or control. They need to check with a health professional first and they can either keep them where they are or move them on so that they can get a mental health assessment.

In the last twelve months, the use of section 136 by Kent Police Officers rose by around 240 to 1333, but due to improved care pathways, there has been a dramatic drop off in the number ending up in a Police cell in the last six months. Due to various schemes nationally, Police cell use has fallen and some Forces report a drop in section 136 detentions. But this is just the tip of the iceberg.

The National Crime Agency recently published data that showed that Police Forces dealt with 335,624 missing persons reports in 2015/6. This means that a report was made every 90 seconds. The data showed that 21% of the people who went missing suffered from a mental health condition, depression or anxiety. To put this into a financial context: the Centre for the Study of Missing Persons (CSMP) at the University of Portsmouth estimated that a missing persons investigation costs Police Forces between £1325 and £2415 each time, based on a Force spending 14% of all its time looking for missing people. I have not included dementia in this estimate or commentary, which is specified as a reason in another 3% of cases where people go missing.

Dr Karen Greene, from the Centre, estimated that the annual cost to Policing nationally of missing persons investigations could be as high as £800million. Using the figure of 21% of missing persons cases having an element of mental health as a contributing factor, it could be argued that this aspect alone is costing Police Forces well over £200 million per year – the same as it costs to investigate burglary. The more we can do to help people manage their mental health, understand the reasons why people go missing and provide earlier intervention, can prevent demand to Policing that sadly often occurs.

Missing persons and crisis are just two examples of demand that the Police face from cases involving mental health. There are many more, from those victims who are being exploited by organised crime gangs to commit crime on their behalf or give them the premises to do so, to fraud and sexual exploitation, or even just instances where they meet people whilst on patrol. Demand is rising and this is acknowledged by Policing and NHS bodies.

Managing demand

There are many schemes now that have been set up to help Forces manage the demand that they experience. One of the most popular is street triage, where Police Officers and mental health professionals go out to calls together. In parts of the country this has shown some statistical success. Policing areas that have this scheme have seen a reduction in the number of people detained under section 136 of the Mental Health Act by Officers, and thankfully, a reduction in the number subsequently held in a Police cell whilst they wait for a proper health-based assessment to take place.

The reason why I include this scheme under the heading of “managing demand” rather than “preventing demand” is that whilst some Officer time is potentially being saved and custody facilities freed up, there is still a cost to Police Forces for providing the Officer(s) to drive the mental health professionals to the calls. So whilst the person is getting support from a mental health professional, which is what we want, it still comes at a cost to Policing.

In Kent, we have another scheme that helps manage demand. I have commissioned counsellors from MIND to work in the Force Control Room, where 101 and 999 calls come into the Police. Nationally it is estimated that 6% of all calls to the Police involve mental health. In one month, Kent Police will answer 75,000 calls to 999 or 101, which means we can estimate that 4500 calls will involve an element of mental health in some way every month.

At specific times of the week, these trained counsellors can take on calls from handlers where a mental health issue has been identified and it is safe for that person to be dealt with in this way. This helps to free up call handlers and does, on occasion, mean that the individual contacting Kent Police gets better advice than they would have done otherwise and Officers are not dispatched. Their presence also means that call handlers and Officers can also ask for advice on cases.

The scheme has recently been extended so that they are looking to do more proactive work and outreach, potentially with those who are known to Kent Police and contact them frequently. This would be to see which agencies can better support them, where appropriate.

However, this is not always possible, as there are various standards of information sharing between agencies in different parts of the country. Essex, for example, has a very good working relationship between agencies to share data within the county but others do not. Another issue is that Essex would not be allowed to share their information with Kent Police so easily. This problem needs to be addressed in a fair and proportionate way.

Many other Forces have similar telephone-based schemes, but recent plans implemented in Cambridgeshire are taking a different approach. If you ring 111, the NHS Direct number, you will be given an “Option 2”, which will be to talk about your mental health. I was greatly heartened by this as this is a good example of NHS bodies working together to prevent, not just manage demand and challenges the mindset that the Police should be the response to mental ill health, not the NHS. I would like to see this rolled out further if the model proves to be successful.

Intoxication

Intoxication is another issue that can cause real difficulties for Policing. For example, if someone is intoxicated, then they cannot be assessed if they have been detained under section 136 of the Mental Health Act. This adds to further pressures and stresses between the NHS and Police when there is no capacity or any place for them to wait until they can be looked at.

To put this problem in context, it has been suggested to me by clinical commissioners from other parts of the UK that intoxication is a factor in between 20% to 50% of section 136 detentions. So we do need to ask public health commissioners if they can look at their drug and alcohol services and see what more can be done to link better with mental health services and provide a place of safety for those who are being detained and intoxicated. This would provide a safe place for the individual, potentially act as an intervention and help manage demand on police resources such as custody.

Here you have an outline assessment of what we have at the moment, and a proposal for another scheme to help manage demand from the appropriate provider. Programmes that help Police Forces to manage demand are welcome, but sometimes require the investment of the Police and Crime Commissioner and Chief Constable in order to get them off the ground or to ensure their continued presence.

What we also need to see more of are schemes that fall into a “preventing demand” category, as Police contact is too late and options for earlier intervention may have been missed.

Alternative places of safety and earlier intervention

The previous Government had already started work in this area. Last Summer, they ran an Alternative Health-Based Places of Safety capital funding campaign that allowed local Mental Health Crisis Care Concordat groups to bid for a share of £15million to provide some of these earlier interventions. Much of the funding focused on improving hospital settings or section 136 suites and the pathways, but Kent was successful in receiving a small proportion of this money for outreach and community support.

I was recently invited to open one of the successful projects that received funding from the Department of Health in Kent. MIND in Tonbridge received £9000 in order to upgrade their facilities in order to provide a wellbeing café for people who wanted a safe space to talk about their own mental health and perhaps support others too. Money has also been provided by West Kent Clinical Commissioning Group and me in order to pay for professionals to run the café and provide guidance on managing conditions and referring people into the services that they need. They are open presently for eight hours a week, in the evenings, and dovetail with another scheme that both the CCG and I fund, so that from Thursday to Sunday, in West Kent, there is an alternative place of safety available for someone to access.

The outcomes from the first month have been positive. 48 people have attended and feedback has been sought. If the facility had not been there, one in three would have contacted the mental health crisis team for help, and one in four would have gone to accident and emergency instead. Whilst we cannot draw any long term conclusions from one month of data, similar schemes elsewhere do show similar benefits. The impact though cannot just be measured in statistics or funding – behind every number is an individual. The Solace café received feedback from one person that said “Attending the Hope and Solace Café has helped to save my life”. I think that speaks volumes.

“Crisis” or “wellbeing” cafes are not a new concept. In fact, there have been some running in Kent and other parts of the county for several years. In 2014, the Safe Haven Café opened in Aldershot. As an alternative to visiting accident and emergency. It provides out of hours care and advice to people who want it and is staffed by both NHS workers and third sector partners. It had a dramatic impact on their A&E attendance numbers of a drop of around one third. The feedback from users shows that it has helped to prevent suicides, and helped people deal with loneliness, homelessness and general crisis.

Using a model of out of hours support via a wellbeing cafe could provide one of the solutions to preventing demand, if the NHS and others can work together to commission more of them. For example, if a charity could be loaned an appropriate premises by a council, GP surgery or private enterprise, for a few hours week, or use their own if possible, a scheme like this could get off the ground in every area quickly and cheaply. You could in theory have one such alternative place of safety in each council area in England for an amount in the tens of millions, rather than hundreds of millions of pounds, providing much needed service when other avenues aren’t available.

There are two challenges that I am aware of to these schemes. The first is making sure that the right organisation is picking up the bill for the costs of providing these services, so that it does not always fall to the Police and Crime Commissioner or the Police to pay for reducing the demand caused by a lack of other services. The second is that by making it easier to access these types of services that you in turn do not create a dependency, but you empower people to support themselves and one another to manage their mental health in the longer-term. Many wellbeing programmes look to develop peer support programmes as part of their offer, and this is welcome.

The night time economy

There are also examples of where schemes run during the night in town centres can support better mental health and wellbeing. In Maidstone, the Urban Blue Bus, funded by the Council, sponsorship and myself, has two functions. By day, it travels the area raising awareness of educational / awareness programs on health, substance abuse, sexual health, self harm, suicide, race / hate crime, drug and alcohol abuse, fire and rescue and road safety. On a Saturday night, it is an alternative place of safety and treatment for people in the night time economy, providing first aid, a place to wait and counselling on emotional and substance misuse issues. This helps reduce demand on the NHS and on Policing because the demand is prevented, not just managed.

Similar schemes run in other parts of the country too and have shown some success in reducing pressure on the emergency services. Buses like this are a great asset, and I am supporting not just Maidstone’s but Medway’s. We must also remember the positive work being done by Street Pastors too, who provide this service on their patrols in town centres. They give out advice, directions and basic equipment to help people stay safe on a night out and prevent injury, and someone to talk to. I know that in my area, some of these groups are looking to expand their capabilities by undertaking mental health first aid training, which would be of real benefit to people they meet in an evening, whether they be revellers or homeless.

Conclusions

Policing has always had an element of responsibility for dealing with cases involving mental health and they will continue to do so. This will never and should not change as we are talking about people in need, not just rules, finances and statistics. However, there has to be a fundamental shift away from just managing the high demand we have to real schemes to help prevent demand in the first place. We need to see greater awareness of the support that is on offer and not simply a mindset that says the response to a crisis or mental health call should always be by the Police, not the NHS. That’s why I believe the Cambridgeshire model, using NHS Direct, should be considered by all areas as a means of reducing call demand on Policing services.

Statutory bodies should be providing alternative places of safety such as wellbeing cafes, investment in resilience and helping people manage their own mental health so that we can provide the earlier intervention that is needed to help prevent mental health demand falling to the Police. The proposed ban on the use of Police cells for children detained under section 136 needs to be pursued by the new Government. The proposed limitations on their use for adult detentions extended to ban this practice as well, a plan which I know that Chief Constables are voluntarily working towards. More needs to be done to enable better data sharing, so more proactive work can be done to support those in frequent contact with the Police to get them the care they need.

The benefit to Policing is clear. For every demand reduction of 1%, Kent taxpayers get back at least £2.5million of Policing time, or around 50 PCs. That’s what I am working towards and my colleagues are looking at too in each of our counties and will be a big factor in increasing Police visibility. When the election is over, I will be lobbying the next Government to see if some of these changes can be made, as I believe that these proposals I believe could go along way to delivering a demand reduction but also ensuring that people suffering from mental ill health get the right care from the right person at the right time.

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