This Police Foundation Briefing - to be serialised over 4 weeks - looks at Policing Mentally Disordered Offenders - the relevant legislation and guidance, policing problems and other key issues

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The Briefings series provides an independent assessment of specific aspects of policing in the UK. The series ensures frontline officers and staff in police forces and policing agencies are up to date with legislation, policies and practical approaches to key issues facing modern policing. Topics will include: Stop and Search, CCTV, Tasers, Police Community Support Officers, The Use of DNA in Forensic Policing, Stalking, Intercept Evidence.

Policing Mentally Disordered Offenders

Some Key Issues

Mentally disordered offenders can be difficult to police because of the time, resources and knowledge required to deal with them fairly and effectively. They straddle the mental health and criminal justice systems, creating problems for the individual, the police and the criminal justice system as a whole. Ideally the police should act as efficient and well informed gate-keepers to appropriate services; at worst they may be left to ‘pick up the pieces’ in the absence of appropriate or timely assistance from other professionals.

The Bradley Report(15) highlights the importance of partnership working and the implementation of agreements between various agencies involved with a mentally disordered offender. However, the review discovered that there could be significant delays in the assessment and treatment of mentally disordered offenders, including delays in securing transport to a place of safety. The average length of time from entering to leaving detention is 10 hours(16).

From the mentally disordered person’s perspective, arrest and detention at a police station may be stressful and frightening. Custody suites can be chaotic and police cells isolating; they may actually worsen a detainee’s condition, particularly if they have not committed a serious offence and are only being held for their own safety. While the police may be aware that a detainee is in distress, suicide attempts, for example, can be unpredictable. ACPO guidelines(17) state that Section 136 detainees should receive more frequent checks than others in custody. If the detainee is judged to be very high risk, ‘constant supervision’ may be appropriate, even if this means that an officer must be diverted from other duties. A national training pack for custody officers has been recently published with the aim of preventing or minimising harm to those who come into police contact(18).

In practice, there is no rapid and reliable method for indentifying a mentally disordered offender. Custody officers face difficult decisions and in some cases may lack the time and resources to make a proper assessment. If the custody sergeant is not alert to the individual’s condition and fails to call an AA, a police interview could be very challenging for a mentally ill person. In turn, the evidence gathered could be unreliable and a confession could be called into question. The normal investigative technique, which is aimed at overcoming the resistance of a non-vulnerable adult, may be wholly counterproductive when the suspect is mentally ill. The Bradley Report(19) recommends that all police custody suites should have access to liaison and diversion schemes which could perform a number of roles, including screening for vulnerable people, advising on their needs and providing appropriate information to enable diversion away from the criminal justice system and into health and social care services.

Non-compliance with police instructions can also present difficulties for the police, particularly when they are called to respond to an incident in the community. Police officers might also confuse a genuine mental health problem with drug and alcohol intoxication. The IPCC has noted instances where Section 136 has been used unlawfully to detain individuals who were intoxicated with drugs or alcohol(20).

Appropriate ‘Place of Safety’

Each year it is estimated that only 6,400 people are detained in hospitals as places of safety, compared with almost double the number held in police stations(21). In some cases detainees are as young as 12 or on one occasion, 89 years old(22). A lack of appropriate facilities appears to be the main reason(23) - in reality the choice is often between an accident and emergency department or a police station. An emergency department, in effect a public place, is not well equipped to deal with a violent detainee and the Royal College of Psychiatrists(24) has suggested that they should only be used “where medical problems require urgent assessment and management”. A police station, on the other hand, may adequately contain a detainee but it cannot provide the psychiatric care they might need.

The quality of facilities and the availability of personnel may vary significantly between police stations and the wait for an AA takes on average 6 hours, but can take long as 20 hours in some instances(25). In terms of police time this places a burden on officers, and for the detainee prolongs the distress of being held in custody. Fortunately the Mental Health Act 2007 now permits a detainee to be transported from one place of safety to another during the 72 hour detention, which helps the police and other professionals meet the varying needs of the detainee. However guidance on the appropriate place of safety can sometimes be complicated; for example following the death of Roger Sylvester in 1999, the Police Complaints Authority(26) called for detainees suffering from ‘acute behavioural disorder’ to be taken to A&E.

Dedicated places of safety, such as Section 136 suites in psychiatric hospitals or hospital emergency departments, present a viable alternative to the police station or the normal A&E routes. Funding from the Department of Health in 2006 aimed to increase these facilities(27), however it did not cover the provision of full-time, multi-disciplinary staff. Even when Section 136 units are operating successfully many will refuse to take detainees who are violent or intoxicated as an assessment cannot be conducted unless a detainee is relatively calm and sober(28).

The Memphis Model of mobile crisis teams is an example of good practice. The aim is to quickly resolve a crisis while avoiding the criminalisation of mentally disordered offenders. The team will either deal with the mental health crisis on site or act as advisors to officers at the scene. For the scheme to operate effectively the psychiatric emergency services must agree not turn away violent or intoxicated offenders. Evaluation has shown that these schemes reduce the average arrest rate from 21% to 7%(29).

Mental Health and Cultural Awareness

Currently police officers receive only brief training in mental health awareness, usually between two and four hours of probationer training, however there are a few exceptions to this, for example Dfyed Powys Police requires its probationary officers to participate in ward activities at a psychiatric unit for several days, followed by two days training in ‘mental health first aid’(30). Mental health awareness is clearly crucial and the Home Office(31) has called for improved training so that mentally disordered offenders can be recognised and managed effectively. But it can also be argued that it is inappropriate and potentially dangerous for the police to be placed in a position where they might feel under pressure to act as if they were mental health professionals.

The Care Services Partnership provides a programme of Mental Health First Aid (MHFA) training aimed at professionals who may come into contact with the mentally ill in the course of their duties. It defines MHFA as: ‘the help given to someone experiencing a mental health problem before professional help can be obtained’. The aim is to preserve life, prevent mental health problems from becoming more serious, promote recovery and provide comfort to the person in crisis(32). MHFA is currently being used in the criminal justice system, although the Sainsbury Centre(33) advocates its wider use by the police service. MHFA might be useful at several points when the police come into contact with the mentally ill, for example to de-escalate a worsening situation, in many cases avoiding the need for arrest. The Metropolitan Police Authority has identified that de-escalation techniques should be part of police training(34).

The Sainsbury Centre highlights the importance of having a ‘proportionate’ response to people with mental health problems(35). Unfortunately it is all too easy to overlook the vulnerability of the mentally ill, viewing them instead as threatening and potentially dangerous, particularly when they have a serious mental illness such as schizophrenia. Conversely, officers anxious to avoid the risk of suicide may be over zealous in removing or exchanging clothing. In some cases detainees have reported being left naked in their cells(36).

Although the homicide rate amongst the mentally ill has risen in recent years it still remains relatively low. In 2004 and 2005, 70 homicides were committed by the mentally ill(37).

It is well recognised that people from some black and minority ethnic backgrounds are over-represented in all parts of the criminal justice system(38). Black people are almost twice as likely as white people to be held in police custody under Section 136 of the Mental Health Act 1983(39) and some black communities are also over-represented in mental health forensic services(40), however the influence of stressors that play a role in mental illness, such as poverty or racism, is difficult to quantify.

The Sainsbury Centre also suggests that some cultures may not readily acknowledge mental illness leading to untreated disorders occurring more frequently in these sections of the population(41), although this does not explain why there is little difference in Section 136 detention rates for white and Asian people(42).

Conclusion

The dual nature of mentally disordered offenders means that they may need to be both ‘treated’ and ‘policed’. In practice however, this is not widely reflected in joined up criminal justice and mental health services. Efforts to introduce, for example, multi-agency Section 136 suites or primary care services within police stations have been limited. There is however increasing recognition that this kind of policing requires a multi-agency approach (see, for example, ‘Cutting Crime: A new Partnership 2008-2011’)(43). However, more could be done within the police service itself. The Bradley Report(44), for example, recommends that Safer Neighbourhood teams should ‘play a key role in identifying and supporting people in the community with mental health problems...who may be involved in low-level offending or anti-social behaviour, by establishing local contacts and partnerships’.

The lack of reliable data on police contact with the mentally ill is a major obstacle: it is very difficult to provide adequate services for mentally disordered offenders unless the scale and nature of the problem is fully understood both locally and nationally. The wider definition of mental disorder, introduced by the Mental Health Act 2007, will mean that a larger number of offenders will have a recognised mental disorder that needs to be addressed via mental health services. The absence of effective monitoring may, for example, lead to a failure to identify disproportionate detentions among say the black community, which in turn hinders the development of measures to combat such disproportionality.

While offending behaviour may often need to be followed up by the criminal justice system, the majority of offences committed by the mentally ill are minor, and diversion at the earliest opportunity would avoid criminalising vulnerable people whose offending is often a symptom of their mental health and other needs rather than criminality per se. Originally developed to operate at court level, referral and diversion schemes have expanded to operate through some police stations, which is a positive development, but if all mentally disordered offenders are to receive equitable treatment, then this can only happen if all police stations have access to such schemes. Ultimately, policing mentally disordered offenders requires an integrated, multi-agency approach which is both timely and efficient and responsive to the needs of the individuals involved.

Notes and References

14. The deciding factor in a prosecution is not solely the seriousness of the person’s mental disorder but also the seriousness of the offence. Where the offence is very serious then prosecution will always follow regardless of the seriousness of the mental disorder

15. Department of Health (2009) op. cit.

16. Docking M. et al. op. cit.

17. ACPO (2006) Guidance on the Safer Detention and handling of Persons in Police Custody

18. Hansard, 15 October 2008

19. Department of Health (2009) op. cit.

20. Docking M. et al. op. cit.

21. Sainsbury Centre for Mental Health (2008) op. cit.

22. Docking M. et al. op. cit.

23. Ibid.

24. Royal College of Psychiatrists (2008) op. cit.

25. Jill Peay (ed.) (2008) Criminal Justice and the Mentally Disordered, Ashgate Publishing Ltd

26. The PCA no longer exists and its role is now undertaken by the IPCC and it has not revoked this guidance – cited in Metropolitan Police Authority (2005) Joint Review: Policing and Mental Health

27. Royal College of Psychiatrists (2008) op. cit.

28. Ibid

29. Lamb H.R., Weinberger L.E. and DeCuir W. J. (2002) ‘The Police and Mental Health’ in Psychiatric Services, October 2002 vol. 53, No. 10.

30. Information courtesy of Stuart Jones (Hywel Dda NHS Trust)

31. Home Office (2007) Cutting Crime: A new Partnership 2008-2011

32. See www.mentalhealthfirstaid.csip.org.uk

33. Sainsbury Centre for Mental Health (2008) op. cit.

34. Metropolitan Police Authority (2005) Joint Review: Policing and Mental Health

35. Sainsbury Centre for Mental Health (2008) op. cit.

36. Mind (2007) op. cit.

37. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness press release. See http://www.medicine.manchester.ac.uk/psychiatry/research/suicide/prevention/nci/

38. Ministry of Justice (2008) Statistics on Race and the Criminal Justice System – 2006/7

39. Docking M. et al. op. cit.

40. Rutherford M. and Duggan S. (2007) Forensic Mental Health Services: Facts and figures on current provision, Sainsbury Centre for Mental Health

41. Sainsbury Centre for Mental Health (2008) op. cit.

42. Docking M. et al. op. cit.

43. Home Office (2007) op. cit.

44. Department of Health (2009) op. cit.