My reaction to Adebowale
I thought myself very privileged to have been on the list of people to receive an embargoed copy of the Adebowale Report on Friday morning, two hours before the world saw it. Although I was due to be at work on an EARLY shift, I had made mental arrangements to prioritise reading it amidst my various duties, tweeting some headlines and expanding on a blog I had prepared in outline earlier in the week. Best laid plans …before 8am on Friday morning, I was out of my police car having driven on blue lights to an emergency and running through a local park to get to a footbridge over the M5. My Central Motorway Police Group colleagues had brought the carriageways to an eerie standstill at rush hour because of an incident where someone was threatening to jump and I was the incident commander to try to prevent this. No sooner had we talked them down after an hour of effort and taken them to hospital with mental health problems and possible hypothermia, we followed this up with no fewer than FOUR more resource-intensive incidents where people were threatening or attempting suicide. Adebowale would have to wait and hence this reaction comes quite late! But he was right, for all the reasons that delayed my digesting his report: mental health is core police business. Eighty pages, twenty-eight recommendations. A succession of headlines in national media about “police failings” and social media interest of all kinds. Some officers feel that the report attacks them individually and their profession collectively: one officer on Twitter said, “I literally give up. I cannot take this constant drubbing. I don’t know why I bother.” Others have looked at some of the inferences within the report about racism and the use of force and been concerned by the analysis and the sample sizes from which conclusions have been drawn. It has prickled a few of my colleagues, to say the least. To them I say this: You can quibble over details of academic rigour or research methodology if you want to: but we all know that the broad thrust of this report is spot on – a lack of proper partnerships and infrastructure for mental health emergencies; a lack of parity across our society and especially within our NHS for physical and mental health care; and a police service which has been hoping that the need to deal with mental health incidents would go away, if only partners would sort their resources and their responses. Well, it won’t – it’s core police business. The report Lord Adebowale makes 28 recommendations, falling in to three categories of business, which I will let you read for yourself in the full report:
- The Frontline
If you read it cover to cover – the full report – there is ample opportunity to see that criticisms of what contributed to 55 deaths in contact with the Metropolitan Police, go way beyond policing. “The Met cannot do this alone”, says the report. “The police are forced to mop up situations that mental health and social services should be dealing with” although colleagues in health and social care were quick to point out, that this sometimes works in reverse. One officer asked when the reverse is true, almost incredulous at the thought. I often find that police officers don’t realise where we cause chaos and confusion: the misuse and abuse of s136 MHA; the all-too-often poor response to allegations of violence or crime by people with mental health problems, including where they are detained patients in psychiatric units. It’s easy to wear blue and see the failings of a chronically under-funded health and social care system – harder to see what’s right in front of us in our own organisations. << Therein lies vindication for the report. But there it is in Adebowale – a lack of leadership which the report suggests needs to be rectified at the level of the Commissioner; a lack of training and effective joint protocols with health and social care organisations which leads to it being all “too common and too easy” for police officers, AMHPs and NHS staff to have on-the-ground disputes over tactics and responsibilities. Finally, a lack of established partnership structures through which to brigade all of this across the Metropolitan Police. Of course, the complexity added by the size of the Met should not be forgotten: my own force covers seven local authorities, four mental health trusts and eleven acute trusts – complex enough, thanks! London is a confederation of 32 boroughs across which (I think!) 9 mental health trusts operate alongside ??!? acute trusts and 32 Clinical Commissioning Groups. To have an effective relationship with “the NHS”, the Commissioner will need cat-herding skills on an unprecedented scale to brigade in excess of 100 organisations in the capital. Mental health is core business I was grateful for the chance to speak to the Commission: two hours of my time I was very happy to give and I’m delighted to find that my views and in particular my blog, have been represented in the report. A journalist who attended the press conference for the launch of the report informed me that my work was directly praised by Lord Adebowale whilst stating that “the popularity of [the MentalHealthCop] blog highlights a lack of education within the system.” Obviously, Lord Adebowale has stated that there must now be a comprehensive package of mandatory training, pitched at different levels for various roles within the organisation – I’m delighted to say that the Metropolitan Police have already asked me to assist with that. Some were quick to point out that training is delivered across the service and that this is updated. I’m reluctant to point out – this blog only exists at all because what training is there is not adequate for the duties modern officers must perform. No training contains reference materials about the recall or revocation of conditionally discharged or community treatment order patients; no national training specifies an approach to mental illness that seeks to recognise what needs to be treated as a medical emergency, including restraint, and certainly no training tries to affect attitude. If senior officer training were provided, there would have been little need and no appetite for the Superintendents’ Association of England and Wales to circulate the Senior Officers’ Checklist to 1,400 members nationwide (twice!). Putting our house in order has to come first – senior officers, themselves properly trained and focussed on key priorities will need to “go in to bat” against agencies who will shout “resources!” at many suggestions of what is needed. We need people at ACPO level and superintendent level who can prevent the police being “had over” by mental health trusts who are inclined to want to ‘bounce’ half of all their s136 cases on the premise of various ridiculous exclusion criteria, pushing clinical risks into custody; we need senior officers to allow the expenditure of resources at sergeant and inspector level who can build day-to-day relationships with health and social care service managers to regularly resolve problems that are caused on either side; and if we think s136 has been the poster-problem, we need them to understand and work with partners on a problem that is potentially ten times as big – criminal suspects arrested for offences who are mentally ill. We need Liaison and Diversion Services and it’s got to be something other that a psychiatric nurse working 8am-4pm who scans the cells first thing in the morning after the key legal decisions were taken last night and overnight and then refers people after the fact. All of this is predicated upon one point I’ve made before on here: mental health is core police business. It always has been and it always will be. The only question is whether we want to plan and properly prepare for it as we do with many other areas of our work, or whether we can keep busking. Adebowale contributes to the view held by many including me: the time for busking and hoping we get away with it is long since gone. It’s obviously from the court cases, the coronial inquests and the coverage in our media – we’re not getting away with it any more and we need to put our house in order before tackling the partnership structures and this work will not be a project – It will be ongoing, without limit of time.
Reactions to the report
- Metropolitan Police – press release from the Commissioner, Sir Bernard HOGAN-HOWE
- Mind – press release from our major mental health charity.
- Centre for Mental Health – press release.
Courtesy of Insp Michael Brown at Mental Health Cop