A mother provides regular care for her adult child, who has a history of mental illness. One night she is concerned for his welfare and believes he needs to attend a medical facility to receive treatment and be kept safe. She calls 000.
It is late at night so personnel from the PACER program are unavailable. A police car is the first to arrive in their street.
Police make a call to see if a health vehicle is available to transport him to an Emergency Department and find that there isn’t one available. The police have no other option but to enter the house.
The presence of uniformed police causes him to become agitated, which escalates the situation. He is yelling and will not voluntarily be transported to the Emergency Department.
Without another option available, police officers are required to transport him against his will. He resists which requires police to use force to restrain him.
He is lead from the house, yelling and struggling, and placed in the caged police vehicle. This occurs in full view of their neighbours.
The officers then drive a number of hours to the nearest hospital that is a declared mental health facility. For much of the drive, police can hear him banging into the walls of the police vehicle as he becomes more agitated and scared.
They arrive at the facility, but the facility is not ready to receive him. He is required to wait in the back of the police vehicle. He has now been in the vehicle for hours.
By the time he is accepted by the facility, he has been apprehended against his will and transported in a vehicle not fit for that purpose. He is traumatised and agitated, and his loved ones are upset and worried. At the end of the process, he is dissatisfied with the health services accessible anyway.
At the same time, that community has spent hours with reduced police coverage. With car crews completely tied up responding to mental health incidents, the Command is not sufficiently staffed to conduct core policing work, like responding to urgent calls for assistance, detecting and preventing crime.
The police officers that attended the scene are stressed and potentially traumatised: they just had to resolve a situation that really requires clinical skills to support a person with mental illness, not something police are trained to do. They are aware that the situation could have gone worse, to the point it could have ruined the lives of everyone there. This is one of multiple such incidents they will attend this year.
The experience of the mental health system: why does it so often start with police?
Too often, police officers are the first and primary contact point between a person in mental health crisis, and access to support and treatment.
Too many people who need an ambulance or a mental health bed are instead staying in a police car or a police cell.
Too many people who need mental health support instead get police officers who are trying their best, but for all the valuable and unique skills sets police officers possess, we are not doctors, nurses or mental health experts. Our attendance at these incidents is not the best option for anyone;
- not for people that need support or treatment from mental health experts but have police attend instead,
- not for the community who have reduced service from their local police who spend entire shifts performing mental health roles rather than preventing and detecting crime, and
- not for police who have to attend incidents and provide services that is not within their responsibility or training, in circumstances are disproportionately represented in dangerous critical incidents.
Police officers around the world, including the PANSW, have been calling for solutions to this for years. And it seems governments are starting to listen.
United Kingdom commences major overhaul for mental health incidents.
The UK solution to the major challenge of coordinating police and health services has hit international attention in May this year when the Commissioner of the Metropolitan Police, Sir Mark Rowley wrote a letter to all health and social care services, giving notice he would direct his police officers to stop attending certain mental health related incidents by 31 August.
While it was the Met’s actions that gathered international attention, we have to go back to 2019 for the origins of this solution.
Humberside Police
Humberside Police is about the size of a Region in NSWPF; approx. 2,000 officers.
In 2019, they were at dangerously low staff levels after years of austerity cuts.
At the same time, they were receiving 1,566 incidents per month about concerns for welfare, mental health incidents or missing persons. Estimates equated this to approximately 11% of police officers’ workload. 75% of the calls they received to attend mental health incidents were not from the public, but from other government agencies or care providers.
Police were constantly being called to apprehend a person, and then sometimes having to hold them for 16 hours while a mental health bed was found.
This stretched police resources that were already cut to the bone.
Humberside Chief Constable Lee Freeman implemented what is now known as the Right Care, Right Person (RCRP) model that is now underpinning the entire UK reform.
By only deploying his officers to incidents that required police, and diverting the rest to health services, Chief Constable Freeman estimates Humberside Police reduced the number of mental health incidents that police attended by over 500 per month, saving 1,132 officer hours each month.
In a police force the size of a NSWPF Region, that makes a big difference - Humberside Police were able to redeploy those officers to core policing duties, and the results were significant for the community:
- They formed teams dedicated to disrupting drug dealing,
- Humberside Police quickly achieved the highest crime detection and arrest rates in the UK, and
- Humberside won the ‘UK Police Service of the Year’ award in 2022. \
Jump forward to London in 2023.
London Metropolitan Police
With over 34,000 sworn police, the London Metropolitan Police is the largest police force in the UK.
In Commissioner Rowley’s letter in May 2023, he outlines to health services that Met police officers spend 10,000 hours per month dealing with mental health issues. To demonstrate the point, he showed the urgent response call data from a day where the Met received a record number of calls; 9,292 calls, only 30% of which were categorised as crime related.
In his letter, he says:
“We are failing Londoners twice. We are failing them first by sending police officers, not medical professionals, to those in mental health crisis, and expecting them to do their best in circumstances where they are not the right people to be dealing with the patient.
We are failing Londoners a second time by taking large amounts of officer time away from preventing and solving crime, as well as dealing properly with victims, in order to fill gaps for others.”
Commissioner Rowley notified health services that on 31 August, he would direct his police officers to cease responding to emergency calls related to mental health, unless there is a real and immediate risk to life or serious harm.
Initially, health services were resistant to the move, concerned they could not coordinate the resources necessary to take over that work from police officers, and were worried it would leave people with mental illness without any response to assist.
But the Met Police had expert legal advice that there was no legal obligation for the police to perform that work, meaning any legal challenge by health services would be unsuccessful.
Since then, health services have been highly cooperative, getting around the table with police to work out a plan to transition the work from police to health personnel.
The deadline of 31 August has been extended to 31 October, and the implementation will be phased. The plan is built around the Right Care Right Person model developed in Humberside.
And now the UK has adopted the Right Care Right Person model as a national agreement.
Right Care, Right Person
“When people are in mental health crisis, they need timely access to support that is compassionate and meets their needs … police are increasingly involved when they are not the most appropriate agency to respond, and they are not able to handover care to a more appropriate professional in a timely manner. This impacts on the ability of the police to carry out their other duties effectively, and importantly, can result in people with mental health needs experiencing greater distress and having poorer experiences of the mental health care pathway.”
UK - National Partnership Agreement: Right Care, Right Person (RCRP)
At its core, the RCRP is a decision-making tool to determine when police should attend a call relating to a person with mental illness, or when a health service should be responsible. The express purpose is to reduce the number of incidents that police attend and increase the number that are handled by health services.
The threshold for a police response to a mental health-related incident is:
- To investigate a crime that has occurred or is occurring; or
- To protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm
There is a phased approach to ceasing police involvement in:
- Initial response to people experiencing mental health crisis.
- Responding to concerns for welfare
- Persons going missing from health facilities, and
- Transport of patients in police vehicles.
To improve mental health services, the objective is also to ensure universal access to 24/7 advice, assessment, and treatment from mental health professionals, and address delays of handover to health facilities.
After the initial concerns from health services, health services are supporters of the principles of RCRP, even if they still hold concerns they do not have the resources to pick up the workload. The RCRP has been expanded into a national agreement, with local police and health authorities now responsible for implementing the agreement within their community, developing working arrangements and timelines that meet their local needs.
It is crucial to the success of RCRP that health services have been brought onboard and develop working arrangements with police. That is required to ensure they meet the demand, and the calls don’t just fall through the cracks for police to pick up the pieces after all. The signatories to the national agreement include the Mental Health Director of the National Health Service (NHS) and the Parliamentary Under Secretary of State for Mental Health.
What is happening in NSW?
The challenges facing Humberside and the London Met probably sound very familiar to police here in NSW: already understaffed Commands devoting a huge amount of police time to responding to mental health incidents. Whole communities are left with reduced police coverage as officers spend entire shifts attending mental health incidents, transporting people to health facilities, and waiting at hospitals when health resources are not available.
Police officers are also highly concerned because they are not mental health experts: they are responding to people who need health services, but instead have uniformed police attend. This escalates the situation, increasing the danger for everyone involved.
No matter what people in the media or parliament say about mental health training or the PACER program – those strategies are inadequate as they do not fundamentally change the status quo; they still rely on a police response to people that need a health service.
It is then a huge blow when police officers do their best to perform a job they are not trained to do, that should be done by another government service, and yet they face intense criticism from the Coroner and the media, that impacts their careers, their own mental health and their lives.
Recent perspectives
The PANSW wrote an article about this in the July 2023 Edition of Police News Magazine.
You can review that article - click here: Mental health crisis … and police asked to pick up the pieces
In response to the PANSW article, there was a flurry of political support.
Rod Roberts made an impassioned speech in NSW Parliament, urging people to “not fall into the trap of placing the weight of the world on the thin blue line while washing everybody else's hands of responsibility.”
View the video: click here for Rod Roberts standing up for police in NSW State Parliament
This was quickly followed by NSW Minister for Police Yasmin Catley and Commissioner of Police Karen Webb APM addressing the PANSW Commissioned Officers’ Branch promising to review police involvement in mental health incidents.
PANSW President Kevin Morton again went into bat for members, publicly calling on the Government to make this a health issue, and to pull the Coroner in to line. “Like the UK, we call on all sides of government, all sides of the parliament, to have police stop attending any of these mental health incidents. Health should take over.” President Morton said.
“We have tried to do the right thing … we have had enough. Whenever there is a critical incident at the coroner’s court and there is some element of mental health about it, it seems only the cops are put under the spotlight.’
You can review that article – click here to read PANSW President Kevin Morton’s message: Police sick of copping it at coronial inquests
As a result of President Morton’s advocacy, NSW Premier Chris Minns is reportedly sending a contingent of senior NSW police officers to the UK to understand the model being implemented there.
Minns is said to be considering following in the UK’s footsteps. Police want to keep people safe, and will do everything they can to do so, no matter the challenges.
For years, we have been saying that for the health and safety of people with mental illness, and police, it is time that mental health experts take responsibility for mental health incidents.
It seems the NSW Government is finally listening.
Original Article publish in PANSW Police News Magazine – October 2023