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Are mental health triages just papering over the cracks?

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Police Oracle interviews chief constable and senior officers to find out what they really think about the initiative.

(Image credit: Oxford Health NHS Foundation Trust)

(Image credit: Oxford Health NHS Foundation Trust)

Date - 1st October 2018
By - Sophie Garrod - Police Oracle


Mental health triages are becoming an increasingly attractive option with almost all police forces in England and Wales using them – but how effective are they?

The scheme was first launched in Cleveland in 2012 with mobile nurses joining officers responding to a call out involving a mentally ill member of the public.

Six years on and the initiative is expanding with 42 forces signed up in some shape or form.

The Metropolitan Police Service has even began to use mental health nurses to work alongside the Marine Unit given the amount of people who try to take their lives by jumping into the Thames. British Transport Police has also began to explore the model.

However, there is still a lack of evidence over their benefits or whether or not the scheme can save forces money. Are triages just papering over the cracks of a struggling NHS?

Police Oracle spoke to National Police Chiefs’ Lead for Mental Health, Chief Constable Mark Collins; Inspector Michael Brown, mental health co-ordinator for the College of Policing and Chief Inspector Jaki Whittred of Bedfordshire Police to gain insight into how the scheme is panning out so far.

CC Collins explained the scheme is beneficial as officers have swift access to mental health records and care plans, but is concerned it is filling a large gap for crisis care teams.

“There are examples around the country where triage has been set up and trusts have withdrawn the number of crisis care teams and numbers in their crisis care teams – relying on the triage to go and be the frontline responder,” he said.

The Dyfed-Powys Police chief, who calls for demand to be passed back to the right agencies, added: “I think triages should be used for emergencies, someone on a building, someone who is threatening to jump, someone threatening suicide – we should be going out to those kind of calls, as opposed to routine calls where other agencies and organisations haven’t got the capacity to do that, it’s wrong.

“I think street triage has got a place but it’s not a panacea to all our problems - some do see it as papering over the cracks. It needs a full evaluation.

“My ideal solution would be having enough in-patient beds across the country while we’ve got a service that is regulated and staffed to the right levels to manage the demand we’ve got with mental ill health.

“Police have definitely got a role to play, but increasingly on occasions that seems to be more of a leading and frontline role than it should be, we should be supporting, not leading.”

A street-based triage team could also help reduce friction between police and mental health workers - because of the delays faced by officers when handing over detainees - by forming relationships, CC Collins claimed.

Some forces are stationing nurses in control rooms to relay information to officers over the radio whilst others have a nurse ride along with them in the car.

But CC Collins explained the control room approach is probably not the best option as it is difficult to provide accurate information over the phone to determine whether or not a person needs a section 136 assessment and that a face-to-face response is more effective.

Inspector Michael Brown, mental health coordinator for the National Police Chief’s Council and College of Policing, gave our reporter a more analytical overview of triages with a more sceptical stance given the evaluations to date have been “limited and partial.”

Mental health triages are currently hailed as a success if it is proven they have reduced the use of section 136.

Insp. Brown described it as a “hotpotch” initiative given the wide range of approaches used by forces up and down the UK and the variation in the number of hours mental health nurses are available to work which can be anywhere between eight and 18 hours, but explained issues vary greatly between counties therefore different approaches are often needed.

When the scheme was first launched in Cleveland it was funded locally, as was the case in Leicestershire, however the next nine pilots were funded by the Department of Health.

An evaluation by the University College of London rated their effectiveness overall as poor – only three were considered good enough, two were very poor and one was poor, according to Insp. Brown.

The last PEEL inspection by Her Majesty’s Inspectorate of Constabulary said triage schemes were highly attractive but lacked objectives.

But mental health triages could potentially save forces £100,000 for every 100 less detainees sectioned under 136 due to not having to pay health care professionals for assessments – not to mention the amount of officer time saved, Insp. Brown said.

In Northumbria the scheme has seen those detained under the mental health act fall from 800 to less than 100 a year - a saving of £700,000 a year.

Insp. Brown said: “We have quite a long way to go to see if it is saving resources. West Midlands is putting in 14,000 hours with six officers and a sergeant – but  is it getting 14,000 hours back?”

Nearly half of police demand is generated from NHS services such as the ambulance service and not the public he added. Highlighting 46 per cent of all work involves a patient with no weapons or threat of self-harm, calling for an ambulance. However, the NHS will still call the police for help.

Nurses are also not permitted to attend self-harm incidents later than 8pm, so have no choice but to call for police to accompany them.

Insp. Brown added: “With the mental health service being cut, the police are being cut by a massive proportion – what job is it of chief constables to pay for a scheme that isn’t reducing crime?”

Bedfordshire Chief Inspector Jaki Whittred praised the scheme highly in her force describing it as a “real game changer".

Launched in 2016, the triple-crewed approach comprising of a police, nurse and paramedic in a car has resulted in a dramatic reduction in the use of section 136.

In its first year, it saw a 40 per cent fall in the number of detainees.

Ch Insp Whittred said: “It’s amazing how a nurse working with us can speed up the process for police to be released back on duty.

“Twenty per cent of police time in Bedfordshire is spent dealing with people suffering from a mental health crisis and the average time of four hours is spent per patient.”

When asked if it is the perfect solution, she replied: “No. I think street triage is effective for the here and now and the way forward is for the public to have access to 24/7 mental health care.

“We are in the position where police need to deal with mental health issues, but mental health services in the future need to be taking responsibility for the mental health crisis. I want to see it flipped on its head.”

An NHS England spokesman said: "Investment in NHS crisis care is increasing and while transformation won’t happen overnight, the NHS is continuing to work towards providing 24/7, responsive, crisis care in every area. This includes ensuring mental health expertise is always available to partners such as police and ambulance services who have an invaluable role as first responders, and the NHS long-term plan will set out further priorities for the years ahead.”

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This is perhaps where PCCs actually have a role to play by sitting down with NHS mental health Commissioners to crunch numbers.

The innovations- whilst novel and nuanced- are operationally led and are not being driven by financial considerations. Rather than ‘what does a platinum model look like?’, we need to answer the question of ‘how can police and mental health best align resources to reduce the cost of demand on both agencies?’

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Zulu 22

It is trying to paper over the cracks but without any paper.  Having said that it is better what most forces have available to them at the moment.

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