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Theresa May: The police must treat people with mental health problems with respect and compassion
I am delighted that the Home Office is hosting this event in conjunction with Black Mental Health UK - and I particularly want to thank Matilda MacAttram for putting this hugely important subject on the agenda and raising the profile of this issue.
Since I became Home Secretary back in 2010, I have been determined to take on policing’s toughest and most intransigent issues.
I am not talking here about the decisions to reduce police funding, abolish police authorities or reform police pay, terms and conditions – although all of those have been difficult and necessary.
I am talking about those issues that can be stubborn, and hard to resolve. Issues that are difficult to spot, often neglected, and sometimes even harder to confront. Subjects such as domestic violence, public trust in the police, modern slavery and stop and search, all of which go to the heart of a just, decent and humane society.
And today we are here to confront another complex issue – the police response to people with mental health problems.
Most members of the public won’t think of the police in relation to people with mental health needs. The police catch criminals, arrest lawbreakers and deal with violent thugs. Unless you have done something wrong, or been a victim of crime, you won’t expect to come across a police officer.
So imagine what it is like for the thousands of people with mental health problems, learning disabilities or other vulnerabilities who regularly encounter the police: people suffering from a breakdown or a psychotic episode; people acting in a way that is dangerous to themselves or others; people who are vulnerable and have been attacked or robbed; people who are confused, distressed and disorientated.
And then imagine if that encounter also leads to physical restraint, or even being Tasered by the police. Imagine being transported to hospital not in an ambulance, but in the back of a police car. Or being detained in a police cell rather than a health-based place of safety or mental health ward. That encounter must be terrifying.
The police are not medics. They are not mental health nurses. They are not social workers. But if the relationship between the police and the public is critical, then how the police and other agencies respond to vulnerable people is even more important still. It goes right to the heart of the British model of policing by consent.
That is why I am clear that it is incumbent upon every officer to treat every person in crisis, every vulnerable victim of crime, and everyone in need of assistance, not just with respect and professionalism, but with care and compassion too.
And it is incumbent on all of us here – as well as those in the Department of Health and the NHS – to make sure police officers are not put in impossible situations they are not trained to face.
People with mental health needs
Everyone in this room knows the scale and complexity of this issue.
Every police officer, from constable to chief constable, and every Police and Crime Commissioner I speak to, tells me how complicated it can be dealing with those with mental health problems, learning disabilities and other vulnerabilities.
We know too from the work of Black Mental Health UK and similar organisations the sometimes appalling experiences of vulnerable people who encounter the police.
And tragically, there have been instances when things have gone fatally wrong and there have been deaths in custody. I understand that Marcia Rigg is here with us today, and of course I know the sad story of her brother Sean’s death. We should take a moment to remember him and others who have died in similar circumstances.
While it wouldn’t be appropriate for me to go into detail on these cases, each is a terrible loss for their families, friends and indeed for the professionals involved. I am clear that we must learn the hard lessons and do our utmost to stop anything similar from ever happening again.
Nationally, we know that the issues surrounding this important subject are wide-ranging.
In 2013, Lord Adebowale reported that MPS police officers specialising in mental health estimated that mental health issues accounted for at least 20% of police time.
We know from other surveys that a similar picture can be found in other police forces. Of course some of this time will be spent dealing with people who have been arrested for an offence. But some of it will be spent dealing with people who have come into contact with the police simply because of concerns about their wellbeing.
Successive reports have also pointed to the excessive use of police custody for Section 136 detentions. This is despite the fact that both police and health guidance make crystal clear that police cells should only be used as a last resort.
In 2013, a joint inspection report suggested that in some forces in up to 76% of cases police cells were still being used as a primary or secondary place of safety.
Again in 2013 a Health and Social Care Information Centre report revealed that in 2012/13 over three quarters of people were taken to a health-based place of safety by a police vehicle, rather than by ambulance or medical transport.
And in cases where Section 136 was used for children and young people under the age of 18, nearly half were taken to police stations, not health facilities or secure children’s homes.
Yesterday the Care Quality Commission’s report on health-based places of safety revealed much more besides.
The report outlines the poor situation in relation to detentions under the Mental Health Act 1983.
A quarter of health providers say that there are not enough health-based places of safety to meet the demand – which piles on the pressure on police cells.
And some providers are operating restrictions which exclude certain people from accessing a health-based place of safety, including young people, people who are intoxicated, and people exhibiting disturbed behaviour.
In addition, the review of Sections 135 and 136 – conducted by the Home Office and the Department of Health and which is due to report shortly – has exposed many of the same issues. Of the 1100 people who responded to an online survey: 67% of survey respondents thought that police cells were often used because of a lack of health-based places of safety, rather than the risks posed; 96% of respondents said that health-based places of safety should have 24-hour access and staffing available; and 92% said that there should always be an age-appropriate place of safety available for under-18s.
These findings make for worrying reading. As I have said, the police are not medics. We know that in an emergency they will often be the first to be called on to respond. But – as I know many police officers will agree – the police are not best placed to be dealing with vulnerable people suffering a mental health crisis. This is not just wasting police time, but it is often totally the wrong response for people who need care and support.
So let me be clear: when we say police cells should only be used as a last resort, we must never accept a situation when their use is anything other than just that.
Police vans and cars should only be used to transport vulnerable people – who have committed no crime – where there really is no alternative, and no excuse for there being no alternative.
We must recognise that alcohol or drug abuse may be a sign of vulnerability or mask a mental health problem or learning disability. It should never be a barrier to treatment.
And we should never accept a situation in which scared, confused children with mental health problems are routinely locked up in a police cell.
Black mental health
But we also know that the issues do not stop there.
Thanks to the work of Black Mental Health UK and organisations like it, we also know that some people are affected more than others.
Research shows that people from Black African and Caribbean communities are more likely to be referred to mental health services via the police and criminal justice system, with admission rates two to four times the national average.
African Caribbean people are also more likely to be treated under a section of the Mental Health Act, are more likely to receive medication, and more likely to be in high and medium secure units and prisons.
And evidence from the London Assembly suggests that not only are up to 30% of people who are Tasered by the Metropolitan Police emotionally or mentally distressed, but 50% of those Tasered are from black or ethnic minority backgrounds.
I am determined to ensure that all vulnerable people who come into contact with the police are treated appropriately, and get the right help at the right time.
And that is why this event is so important. And why I am pleased to see so many police officers, Police and Crime Commissioners, representatives from local authorities, professionals from the mental health sector, and those from charities and civil society organisations, gathered here today.
What we have done so far
So the issues are complex, and wide-ranging. We’re talking about people who might have carried out criminal offences and who also have mental health problems – and of course when a crime has been committed it should be dealt with in the usual way – but we’re also talking about innocent people reaching a crisis. How vulnerable people are treated at every point that they come into contact with the police and the criminal justice system is too important to ignore.
That is why the Home Office is working together with the Department of Health to ensure that the right help is being sought and given.
In 2013 I told the Police Federation Annual Conference about the programme of work that the Home Office was putting in place, with the support of the Department of Health and NHS England.
As I said then, I want to see more health professionals working alongside police officers during emergency call outs. That is why, right now – as part of a national pilot – police forces in nine areas are trialling street triage schemes. These ensure that a mental health practitioner – on the street, in a patrol car, in a call centre or over the phone – works closely with the police during incidents which might result in a detention under Section 136.
Police forces in approximately 17 other areas are setting up their own local approaches. I know that this is also an area where directly elected Police and Crime Commissioners are playing an important role. PCC Martyn Underhill in Dorset, and PCC Matthew Ellis in Staffordshire, have both put in place street triage schemes to help ensure that people in a mental health crisis get the support they need.
What’s more, early findings show that street triage pilots are working: the number of people being detained has fallen by an average of 25% across all pilot areas, and all areas are recording a reduction in the use of police stations for mental health detentions. In the West Midlands, Section 136 detentions have fallen by 44% on pre-triage levels, while in Leicestershire they have fallen by 33%.
I have also been clear that there must be much better access to health-based places of safety. We must ensure that – day or night, anywhere in the country – the police and medics have somewhere better than police cells to take people with mental health problems, and that those in need have access to a place that is appropriate to their medical needs. Jeremy Hunt and Norman Lamb are therefore leading work to improve the local mental health provision available. There is now – under this Government, for the first time – a health-based place of safety in every police force area.
We have launched a trial scheme to test a new model of liaison and diversion. This will help us better identify offenders with health issues and vulnerabilities at the first point of contact with the police and the criminal justice system. It is backed by £25 million of Government funding commissioned from NHS England, and it means there are mental health professionals in police stations and courts to assess and refer offenders, as well as provide support and advice to custody staff.
In February, the Government published the Mental Health Crisis Care Concordat, to ensure that all those involved in supporting someone in a crisis work together to improve the system of care. It is our ambition that all local areas will have signed local declarations by December.
And alongside the review of Sections 135 and 136 of the Mental Health Act, I have asked HMIC to undertake a specific thematic inspection on the welfare of vulnerable people in police custody, including, but not limited to, those with mental health problems and people from black and minority ethnic backgrounds. This inspection is on track to report at the end of March 2015.
What we will do
But even before these reviews have reported, there is more that we can do.
As I have said, it is vital that the police are able to take the right decisions at every point that they come into contact with vulnerable people. To help achieve this, the Home Office is today launching a guide for the police and their partners to ensure that their interactions with vulnerable people are consistent and appropriate at every stage.
But I want to go further.
So today, I am announcing a package of measures to improve the police response to people with mental health problems.
First, we need to bring proper transparency to the debate about mental health and policing. At present we only know how many people are detained under Sections 135 and 136 and where they are taken. The Home Office will therefore work with the police to pilot collection of data not just on the volumes of people detained under the Mental Health Act, but also their age, ethnicity and the circumstances in which they were detained.
Second – because this is not just about mental health – the use of physical restraint and the use of Taser deserve a similar level of scrutiny. Taser is an important operational tactic which can protect the public, but we are right to demand transparency. So I have asked the national policing lead and Home Office officials to conduct an in-depth review of the publication of Taser data and other use of force by police officers. This will present options for publishing data on how police officers are deploying these sensitive powers, who they are being used on and what the outcome was. Just as with stop and search, we need to bring proper transparency to these powers by improving data reporting.
Finally, to reduce the use of police cells as a place of safety we are investing in a three-month pilot scheme with Sussex Police, health partners and a local care home to trial an alternative place of safety to police custody. This will provide additional capacity, meaning a better experience for people who are detained pending a mental health assessment, and make the best use of police time and resources.
These measures will build on our existing work. They will continue our efforts to support vulnerable people and ensure that they are better served by health professionals. And let me be clear, if we get these measures right, they will save valuable police time and reduce unnecessary detentions, not add to police bureaucracy.
In addition to this, there is evidence to suggest that there are not enough Appropriate Adults to support vulnerable people who are in police custody. Appropriate Adults provide vital support and help to de-mystify what can be an intimidating and threatening experience. It is right that all vulnerable people can access this invaluable service. So the Home Office will commission the National Appropriate Adult Network to examine this situation and help us determine where the problems lie, and what can be done to ensure that that all vulnerable adults in police custody are able to receive the support they need from Appropriate Adults.
But I am clear that all this is not the whole answer.
The joint Home Office and Department of Health review of Sections 135 and 136 and HMIC’s inspection of vulnerable people in custody – both of which will be published in the coming months – will provide the impetus for the next stage of reform.
We must ensure we continue to reduce the use of police cells as places of safety for vulnerable people, and improve the support and care available to those taken into police custody where there really is no alternative.
Police powers of restraint and detention are some of the most sensitive and serious powers a police officer holds. So we must ensure that they are used appropriately. I do not underestimate the scale of the task ahead. Much work needs to be done, and it will require all of us in this room.
We cannot accept a situation where vulnerable people are kept in police stations for want of somewhere else to go.
We cannot accept a situation where people suffering a mental health crisis are attended to by police officers, with no support and advice from healthcare professionals.
And we cannot accept a situation where cycles of offending caused by underlying mental health issues are allowed to continue, without those issues being properly addressed.
The police cannot, and should not, do the job of healthcare professionals. People experiencing a mental health crisis deserve a proper healthcare setting. People with mental health issues who are arrested or held in custody deserve a proper assessment of their needs and the appropriate care and support.
I hope that the measures I have announced today, and the measures that the Government along with other partners, are working on, will ensure we can make this happen. So that the police spend less time dealing with people with mental health problems, and more time out on the streets catching criminals. And so the most vulnerable people in our society – at the moments when they are most in need – are not greeted by police officers, cells and handcuffs, but by medical experts, a bed and proper healthcare.
We’re a long way from realising that goal, but we have at least begun the journey. So let’s work together to ensure we can get there as quickly as we can.