A place of safety? Picking up the pieces of the UK’s mental health crisis - Isabella Health Foundation

A place of safety? Picking up the pieces of the UK’s mental health crisis

By: Josh Lowe

Josh Lowe is a freelance writer and editor specializing in public policy and social affairs.

“I can’t breathe.” Those three tragic words have become a feature of campaigning against police violence in the United States, echoing the last words of Eric Garner, killed in New York City in 2014. 

But in 2018 they were also uttered by a black man in the UK. Kevin Clarke, a Londoner who had been diagnosed with paranoid schizophrenia, called for mercy as he was restrained by police on 9 March of that year. He died following the restraint, which a jury found was enacted in a manner “contrary to guidance and training.” 

That same year, the British emergency services inspectorate found that police are “pick[ing] up the pieces of a broken mental health system”. A decade of “austerity” policies have left already-stretched provision completely lacking. The gaps mean police are left responding to events that healthcare professionals should be treating or preventing. Over-policing of mental health is also a problem in the US, where up to a quarter of people killed by police officers have some sort of mental illness. Now, officers in the UK are trying to solve the problem. But how, and what more needs to be done?

A place of safety?

Back in 2013, Norman Lamb, then a British government minister in the health department, set out a bold vision for mental healthcare. The government was working, he said, to ensure “parity of esteem” between mental and physical health services. 

Lamb acknowledged that the system had not yet achieved this target. But experts at the time felt his words hid the fact that his government was, if anything, dismantling services rather than building them up. 

“Talk to mental health service users and they paint a picture of less support, having to battle for what they have, charging and cuts in day services (which increases isolation), delays in getting help and tightening eligibility criteria to access local authority social care support,” wrote Peter Beresford, professor of social policy at London’s Brunel University, in a 2013 article

The impacts of this austerity decade are myriad, but one is an over-reliance on police forces to help resolve mental health crises. 

Perhaps the most prominent aspect of this is the role of the police in “sectioning,” a cornerstone of emergency mental healthcare in Britain. Under sections 135 and 136 of the UK’s Mental Health Act 1983, if someone is experiencing severe mental health problems and appears to be lacking proper care, or posing a threat to themselves or others, they can be taken to “a place of safety” and kept there in order for a mental health assessment to be carried out.

As a default, this should be a health-led procedure, not a criminal one. Yet official statistics show that police vehicles and properties are overly involved in it, thanks to a lack of support from the overstretched health system.  

In the year ending March 2019, in a majority (53%) of cases where the method of transport used to take someone to a place of safety was recorded, a police car was used, rather than an ambulance. The most common reason given for this was that an ambulance was not available within a reasonable time.

There are a range of locations that can constitute a “place of safety”, from care homes and hospitals to a trusted contact’s residence. Police stations are also on the list, but they are only supposed to be used as a last resort, if the unwell person’s behavior poses an imminent risk of death or serious injury to themselves or someone else. 

In recent years, however, too many people have been taken to a police station — 471 in the year to March 2018. This figure fell to 136 in the year to 2019, with 81% of detainees taken to a health-based place of safety. But the UK’s main policing union, the National Police Chief’s Council (NPCC) acknowledges this is not good enough. In a strategy published this year, the union said that police “should be working towards complete elimination of the use of custody for this purpose”.

Towards better care

The NPCC strategy, while it acknowledges that the police force is among the “safety nets” available to British people, adds that it is a safety net with “natural limitations,” Under an overall goal of “ensuring that we minimize those occasions where police officers provide responses purely because of capacity issues or other difficulties,” it explores various specific approaches.

To limit the use of police vehicles to transport mentally unwell people to places of safety, one proposal that the strategy welcomes is a long-term plan in the British health service to fund “mental health ambulances”. This approach has gained some attention internationally, including a much-publicized initiative in Stockholm, Sweden. 

There, the ambulance works closely with police to respond to mental health incidents, but advocates say the specialist care and understanding its staff provide are helpful. Some 30% of patients assessed by the service are allowed to stay in place and are connected with outpatient services. Previously, according to Andreas Carlborg, managing director of North Stockholm Psychiatry, police were far more likely to take patients to the emergency room. 

Many areas in the UK are also practicing a range of initiatives that come under the heading “street triage”. These vary but tend to involve mental health professionals accompanying police officers on duty, so that they are on hand to provide good care if police need to attend a mental health incident. 

The strategy says some of these strategies have had a “positive impact,” and have been taken at the “highest levels” as examples of good collaboration across services. However, it acknowledges that only three evaluations of these schemes exist that were adequate to be examined by the UK’s health regulator, and all were rated low or very low quality. While structures that encourage greater collaboration are always to be welcomed, more work is required to fine tune and properly evaluate these schemes. 

Ultimately, though, it may not be possible to entirely solve the troublesome interrelation of policing and mental health crisis without deeper structural shifts. A 2018 paper by Ian Cummins argues that promising approaches exist: he particularly highlights “trauma informed” strategies that can be practiced by a range of state institutions. 

However, he writes, such a “paradigm shift can only be successful in the context of the development of a broader range of policies that are committed to reducing social inequality and tackling social injustice,” The NPCC strategy, too, emphasizes the importance of health service promises to increase wider funding for mental health services. 

“The Metropolitan police service is a learning organization and we always strive to learn and improve,” Commander Bas Javid said following the inquest into the death of Kevin Clarke. Police and other services alike have much still to learn in the UK, but approaches like those presented in the NPCC strategy may represent a hopeful beginning to the journey.

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