Responding to mental health crises: why police and NHS partners must collaborate on a local level
Former police officer Essack Miah reflects on his experience responding to emergencies involving people having mental health crises and what could be done differently.
Picture this: you are a police officer six hours into a busy shift on a Friday night. Your radio has been going nonstop, with calls to pub fights, robberies, sudden deaths, a missing child, and a domestic incident. Your next call diverts you away to assist a vulnerable individual who is threatening to take their own life.
You are now responsible for that vulnerable person, despite having little to no mental health training. You take them to the nearest place of safety: A+E. You wait with them until a bed is available, trying to make sure they don’t make a beeline for the exit. By the time you can leave them in the care of the hospital, it’s been ten hours since you were due to finish your shift. At the start of your next shift, you find out the individual has been discharged because they have made the same threat three times in the past week already.
This example is not an isolated incident; it’s one example of many I experienced and it’s the reality of responding to mental health crises whilst on the frontline, following years of diminishing preventative and intervention support services.
The need for increased mental health collaboration across all agencies has never been greater. Where preventative measures haven’t worked the need for an effective collaborative response is critical.
Where I served in London, police areas used to be defined geographically by local authority boundaries i.e. 32 police boroughs for 32 London boroughs. Reflecting changes mirrored across the country, this has now moved to 12 Basic Command Units (BCUs) with some covering up to four boroughs. The removal of the ‘Borough’ connection is a symbolic shift – with local authorities saying that connections they had on a more local level enabled impactful working relationships.
If one BCU is managing four different local authorities, all with different requirements and needs, is it surprising that collaborative relationships have suffered? With BCU’s having more ground to cover with the same number of (or fewer) officers, it’s critical to have effective partnerships with clearly-defined cooperative working practices to ensure the right emergency response.
There are excellent examples of multi-agency working arrangements, such as where mental health trusts have effective operational relationships with local officers from Safer Neighborhood Strands within police forces. These relationships mean that officers can work closely with Approved Mental Health Practitioners to complete assessments on vulnerable people that need specialist support.
For example, in Leicestershire, the introduction of a dedicated mental health triage car consisting of a mental health nurse and a police officer, responding to all mental health related calls, had a positive impact. In 2021, Leicestershire Police reported a reduction in the number of people detained by police, and taken to a place of safety, from around 450 to 260 in just one year.
However, questions remain on the long-term viability of this approach. Demands on resources, like that Friday night in question, mean that the people dedicated to that car are often redeployed elsewhere at short notice, leaving the support for mental health calls inconsistent and patchy.
The government’s recent funding announcements are a step in the right direction, with a £150m investment until 2025 which will provide an additional 150 new facilities including 30 crisis cafes and crisis safe spaces, along with 20 health-based places of safety. This is in addition to the £2.3bn a year dedicated to transforming mental health services, intended to include 90 mental health ambulances dedicated to deliver specialist support on-scene.
More funding is promising on paper, but for mental health initiatives to succeed in the long term they must be locally designed, driven and delivered. Currently, there is no formal requirement for agencies to work together. This contrasts with Community Safety Partnerships where it is a statutory requirement for authorities to work together to tackle and develop strategies to combat crime.
Local partners are best-placed to develop novel and resilient approaches to mental health needs in their areas. Together, they can to build relationships, develop partnerships and establish new working practices with frontline services. Without this local response, areas will struggle to deliver effective support to people experiencing mental health crises. Vulnerable individuals will continue to fall through the gaps, and frontline services will experience many more Friday nights just like mine.