Do you know what I mean by a â€˜vanillaâ€™ tweet? â€“ the phrase refers to something fairly inoffensive on Twitter, quite bland information that doesnâ€™t tell us a huge amount but whilst purports to inform. Something like, â€œGreat meeting with partners about mental health â€“ loads of work going on to keep you safeâ€ or similar. Well, Iâ€™m bumping into a fair few of them on the subject of the Crisis Care Concordat and I have a couple of concerns arising from it -
Itâ€™s almost as if history has been somewhat erased and it makes me wonder why we ever had any problems in this arena because just one or two meetings and we seem to be sorting it all out without much difficulty! This also strikes me as highly unlikely. Take it from me, it took five years of my life (that Iâ€™ll never get back) just to sort out section 136 Mental Health Act Place of Safety provision in one area. Thatâ€™s before the subject of Liaison and Diversion (whatever that means); patients who are absent without leave; and the multitude of other problems that all areas face to one degree or another.
Principle amongst the â€˜other thingsâ€™ should the creation of a system that avoids the need for as much crisis care as possible, because help is available before people have â€˜one foot off the bridgeâ€™, to quote the Mind report on crisis care.
CRISIS CARE CONCORDAT
You can look at the Crisis Care Concordat website for yourself if you want to read more about it or see the local progress mapped out for us all by the mental health charity, Mind.Â They will be chivvying people along for progress updates towards the end of the year.
One problem with the Concordat always was that it simply puts into one handy document with a checklist and a schedule of work, all the issues that we know have been problematic for decades, imperatives for which already exist. This, as Winnie the Pooh said, is â€œa good thingâ€ â€“ if you want it summarised and neatly presented and for those professionals in policing and health who are relatively new to this, itâ€™s a great tool to help you start benchmarking where you are and working out how to plug the gaps. However, if youâ€™re familiar with the field, itâ€™s all very last century in some respects. Some commentators asked upon publication, this stuff is already written down in range of documents â€“ why do it again?
So the Concordat asks us to address crisis care and in some areas this will mean that everyone works out there is overuse of section 136 by the police and, even allowing for the overuse, under-provision of health based places of safety by the NHS. The Concordat would say you get these things into the Action Plan that is submitted with your Crisis Care Declaration in November 2014 and look to improve this position over time. So youâ€™d probably train your officers better on the use of the power, consider a phone or street triage approach so you reduce usage and look at expanding provision. Sounds easy doesnâ€™t it?! Hereâ€™s the problem â€”
Weâ€™ve known that these things needed doing for at least twenty years and there are already various statutory imperatives to do so â€“ what does the Concordat give us that laws and statutory regulations didnâ€™t?! If we can ignore statutory guidance on the Mental Health Act, what is it about the Concordat and its implications that we wonâ€™t ignore?
Well, the idea is that this will be driven a lead in a way that wasnâ€™t previously there â€“ this is â€œa good thingâ€. And there is no doubt that areas are now talking whereas previously, they werenâ€™t â€“ this is â€œa good thingâ€. Arising from discussions, some areas have filed their local Crisis Care Declaration, implying that they now have a jointly agreed action plan to allow progress in 2015 and beyond â€“ â€œa good thingâ€. However, there are many more areas that donâ€™t seem to be fairing quite as well.
ITâ€™S GOOD TO TALK
Iâ€™m assuming that in some areas, these joint CCC meetings have led to some of the discussions that I had when you have culturally diverse organisations coming together to discuss issues. You get doctors and NHS managers who know comparatively little about the law, getting together with police officers who know little better to discuss issues that are bedevilled by the received wisdom and inherited thinking of generations of professionals whoâ€™ve gone before them. And they are having to do it with fairly dreadful data sets about â€˜stuffâ€™, in many cases.
In some ares, no-one fully knows how many section 136 detentions take place, where they go or what the outcomes are. There are myths and personal opinion abounding about what percentage of those detentions is â€˜appropriate â€“ despite the fact that no-one seems to be offering a definition of what is appropriate. No-one looks at how many section 136 detentions are â€˜repeatâ€™ detainees or how many were already known to the MH, perhaps indicating a breakdown in the care plan. No-one knows the percentage of people arrested for offences who are known to the MH trust and no-one seems to be trying to define what â€˜diversionâ€™ means in terms of when the police push ahead with a prosecution decision for an offence when they know the offender is mentally unwell, as opposed to when they donâ€™t.
Legal training in all the professions is parlous: I learned again this week having a child in an â€˜adultâ€™ place of safety is a safeguarding risk. What do we think is not a safeguarding risk about having a child in a police cell, not too far away from a masturbating drunk who is singing sex songs or threatening sexual violence to the custody officer? I can only imagine that in just some CCC discussions about certain issues, the myths and folklore are raging hard, with professionals of all kinds arguing they canâ€™t do things they actually could do, that they shouldnâ€™t be doing things that theyâ€™d prefer the other agency to do.
LETâ€™S TALK ABOUT VULNERABLE PEOPLE
And nothing in this blog post so far is about vulnerable people is it? â€¦ their rights to effective police responses, accessible crisis care and dignity and respect for their human rights whilst in contact with the state? Those people who experience the indignity of being detained in the cells under s136 because they had the temerity to have a few drinks (or more) â€“ to stop the voices in their head, or at least make them quieter. None of this includes references to the difficulties that some patients have in Accident & Emergency despite very obviously being there appropriately to access some kind of care that is otherwise unavailable and inaccessible. Weâ€™re not even talking about the ongoing extent to which our mental health care system is being increasingly criminalised by reliance upon the police and the justice system just to make extra sure that some face the extra stigma of having cops staring at them whilst the NHS do their thing with all that we know the feels like for some.
The Crisis Care Concordat will be examined next month for progress and as things stand just four areas out of 43 police forces and 57 mental health trusts have submitted a local declaration with an action plan. Iâ€™ve already heard that some areas feel they will be unable to submit anything by the November deadline. Iâ€™ve also heard that some relevant senior people have only not read the CCC, they hadnâ€™t heard about it, as of a month or so ago. Quite remarkable, really. So we need to continue to raise awareness of its imperatives and remember, that most of them arise from existing laws and NHS guidelines anyway.
Itâ€™s what we should have been already doing â€“ for some thirty years, actually!
If one or two CCC meetings is all it has taken to get complete agreement about what we need to do, then Iâ€™m thrilled. Iâ€™m also quite unconvinced.
The Mental Health Cop blog
â€“ won the ConnectedCOPS â€˜Top Copâ€™ Award for leveraging social media in policing.
â€“ won the Digital Media Award from the UKâ€™s leading mental health charity, Mind
â€“ won a World of MentalistsÂ #TWIMAward for the best in mental health blogs
â€“ was highlighted by the Independent Commission on Policing & Mental Health
â€“ was referenced in the UK Parliamentary debate on Policing & Mental Healthâ€“ was commended by the Home Affairs Select Committee of the UK Parliament.