For the first time, all 43 police forces in England and Wales and the British Transport Police have been inspected for their responses to mental health problems. The picture looks bleak. It turns out police have become the “default” service to deal with mental health, so stretched is the UK’s mental health system.
A report entitled “Policing and Mental Health: Picking Up the Pieces” by watchdog Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Service (HMICFRS) finds that the Metropolitan Police receive a mental health call once every four minutes, and send an officer out to deal with one every 12 minutes in London. In Wales, mental health issues take police on average three hours to deal with.
The report’s argument? Police are being forced to step in where mental health services should be – which is unsustainable for them and bad for patients. It’s time to radically overhaul the system and find a long-term solution to what is described as a “national crisis”.
“Over-stretched and all-too-often overwhelmed police officers can’t always respond appropriately, and people in mental health crisis don’t always get the help they need,” commented the inspector of constabulary Zoë Billingham.
Yet squeezed resources are no explanation for the nature of some police responses to mental health crises, which are not mentioned in the report.
Deaths in custody are at their highest in over a decade. In 2017/18, over half (52 per cent) of police custody deaths were people with mental health concerns, at 12 out of 23 deaths (and four people who died during, or following, their time in custody were detained under the Mental Health Act).
That’s a higher proportion than the 47 per cent of those suffering from mental health problems who died in, or following, police custody in the 11 years between 2004/5 and 2014/15. Last year, in 2016/17, 57 per cent (eight out of 14) people who died in or following police custody had mental health concerns.
The report rightly points out the age-old problem – exacerbated lately by austerity – of stretched mental health resources, and the lack of a joined-up approach with other services.
But it omits the growing trend of deaths in police custody of people with mental health problems, and the disproportionate suffering of BAME people as exposed in last year’s Angiolini review of deaths and serious incidents in police custody.
“We have deaths in police custody that are still happening that should not have happened. What we need is care. I don’t think lack of resources can affect that,” said Marcia Rigg, the sister of Sean Rigg, who suffered from paranoid schizophrenia and died in police custody after restraint by police officers ten years ago, on the BBC’s Victoria Derbyshire programme.
“When somebody’s being restrained, somebody’s vulnerable, the excessive force that’s being used – that shouldn’t happen,” she said. “We are where we are: police are involved in this. There’s not a 24-hour [mental health] service and if somebody comes into a police station then… they should be treated accordingly, not restrained to death and excessive force used.”
This problem is persistent, seen also in the deaths of Kevin Clarke who died earlier this year after being restrained during a mental health crisis, James Herbert who was found unresponsive after being restrained by officers, taken in a van to a police station and left naked in a cell eight years ago, and police admitting to breaking health and safety law after Thomas Orchard collapsed in custody in 2012 after a heavy webbing belt was held around his face.
It’s so persistent that earlier this month, an act known as Seni’s Law was passed to increase protections and oversight regarding the use of force in mental health scenarios. The Mental Health (Use of Force) Bill was passed on 1 November eight years after the death of 23-year-old Olaseni Lewis, who died after prolonged restraint by 11 police officers for more than 30 minutes at a mental health hospital in 2010.
The inquest last year into Lewis’ death found “excessive force, pain compliance techniques and multiple mechanical restraints” used by police on Lewis “were disproportionate and unreasonable”, although the six officers investigated were cleared of misconduct.
Seni’s Law will require hospitals to publish when and how physical force is used on a patient, and will ensure independent inquiries into non-natural death in mental health units.
But families of mentally ill people who have died when coming into contact with police want action on restraint and detention.
“This is what the public are concerned about – why are people being restrained to death when they are vulnerable and not criminals?” asked Rigg’s sister.
Although fewer people suffering from mental ill health are being put in cells (a fall of 95 per cent since 2011/12), the Police Federation’s national chair John Apter warned that – because of stretched NHS and police resources – they are being held in other inappropriate places instead: “They’re going into police canteens or police restrooms or the back of police vans, until suitable transport or beds can be found available – that’s simply not acceptable.”
The first line of the report describes the police approach to people with mental health problems as “generally supportive, considerate and compassionate”. This is a characterisation that Victoria McNally, a caseworker for Inquest who has focused on the use of force and restraint, questions.
“That doesn’t really sit within the picture we have experienced in terms of the cases we’re working on,” she tells me.
Although she praises the report for drawing a “full picture” of the need for coordinating services, and agrees that there’s a “crisis for those in need of accessing urgent mental health care”, she believes it doesn’t focus enough on the response and responsibility of police towards those people.
“I think it would be wrong to describe the police as ‘picking up the pieces’,” she says of the report’s title.
Although she backs the call for more resources, McNally argues that nevertheless the police “need to be ready” for more people using them as a port of call in a crisis. “To treat these people as patients with health needs, not applying a criminal justice response,” she says regarding use of force and restraint resulting in “horrifying deaths” in the past decade, and “disproportionality when it comes to BAME groups”.
Since 2010, the government has cut police funding by 19 per cent. It’s putting an extra £460m into overall police funding in 2018/19 but that hasn’t stopped police chiefs warning about unsustainable budget cuts.
Although the government is investing £2bn in mental health services (including mental health liaisons in A&E and other crisis services), it’s only half of what’s needed to meet the 2012 Health and Social Care Act’s “parity of esteem” between mental and physical health (as calculated by the IPPR think tank). But mixing up a resource problem with a response problem could bury cases like Rigg’s in the avalanche of problems resulting from austerity.