Mental health street triage car

PC Mark Jenkins
Cheshire Police

Cheshire Police like a number of other Police forces nationally, have implemented a successful mental health street triage scheme.  This involves Police Officers and Mental Health Practitioners working together when responding to people in crisis.  Together, they have access to both Police and NHS data so both professionals can more accurately assess risk, make better informed decisions and achieve better outcomes for the individual. Both the local Police and NHS trusts benefit long term by being able to identify issues more effectively and intervene earlier to prevent a crisis developing.

There are different models of the scheme around the country but all are based on the benefits of mutually shared information.  What we learnt from the outset, was we were dealing differently with the same individuals and problems. Doing this in isolation was ineffective and detrimental to the individual, serving only to further complicate and exacerbate the issue.  Often an individual would self present to their GP, A&E or local Mental Health Services seeking help.  With increasing demand and reductions to services, inevitably, if their needs were not met, their situation would often escalate and result in a crisis and subsequent Police contact.  Often, a patient with health services at two in the afternoon ends up the high risk police subject on a motorway bridge at two in the morning. The volume of Police responding to mental health related incidents has significantly risen over the previous five years and accounts for a huge proportion of policing time and resources. That rising trend is set to continue as further cuts and reductions in services continue.

When the idea of the Street Triage concept was put to the Trust practitioners, most agreed it was a good idea and an exciting prospect – yet few nurses volunteered for the role. The reason being, they perceived working alongside the police as dangerous and they would be exposed to risk. However, the reality was in fact the reverse.  Whereas nurses, the majority being female would visit new patients in their homes, they would often go alone and as a new patient have little or no information on that person. Nurses would often be unwittingly unaware of the risks. Many patients had extensive forensic histories including violence towards women and sexual offences.  Nurses were attending their homes alone and often unaware.  By contrast, responding with police provides that vital information, in my nurses case, a big burley Constable to accompany her and immediate access to the back up of police resources.  She feels safer now than before. It is common practice now for nurses to ask me to do checks if they have any concerns before visiting a new patient. I have on numerous occasions advised additional precautions to ensure their own personal safety.

One of many examples that  illustrates the simple practicality and benefits all round was information being  passed to Police regarding  an Army Veteran suffering with post traumatic stress disorder, reported to have booby trapped his home address.  Police had very little information on the subject. This quickly led to assumptions that we had a delusional and paranoid, ex Special Forces Afghanistan veteran with a hand grenade wired to the front door handle. The limited information police had was that he was a conspiracy theorist, believing in a New World Order, the Illuminati, Government oppression and that Police were complicit in it. Police then had the difficult decision to make about what to do and how best to do it.  It was a potentially high risk threat but lacked the information to validate it. The sparse information Police had served only to support the delusional and paranoid angle. A firearms Operation was being considered. This would have led to an armed team containing and calling out occupants unknown, disrupting the local community and risking the potential for escalation or a siege situation. This would be every Commanders nightmare.

On accessing Health information, a very different picture emerged. We were able to make discrete enquiries resulting in de-escalating the potential threat he posed. Nothing in his medical notes from past contacts gave rise to any concern. On the contrary.

Rather than a full firearms containment to deal with a dangerous threat, Police instead deployed two officers who discretely knocked on his front door for a chat.  It turned out, days prior, he had a doorstep confrontation with bailiffs. On leaving the bailiffs stated, they would be back. In the heat of the moment, he flippantly commented that he would booby trap the house.  This was overheard by a bystander and later reported by a third party to police.  A simple every day example of how easily information can be misinterpreted and escalate.  Also an example of how simple information sharing can paint a true picture.

Two years in, I feel we have just scratched the surface to reveal the potential benefits of information sharing.  It is a simple concept that yields results. It has to be properly managed and used for a specific purpose as it develops. Information from different sources achieves better all round perspective and validation.  It also allows for mutual appreciation of organisational differences in culture, attitudes and language.  I am now use to information sharing.  It just makes my job easier and allows me to be more effective, doing it so much more efficiently. I was brought back down to earth with a bump only last week when I contacted another Government Agency for the most very basic piece information over the phone. The response was an automatic and instant activation of the barriers and an unequivocal NO. This was followed by a scripted, you have to do this and you have to do that, by which time I had lost interest having already decided the means didn’t justify the end. I realised just how far we had come. There was no reason why they couldn’t provide me with the information.  It was not sensitive. They simply wouldn’t and that was that.  There are few things more frustrating that needing to know something in order to do your job and there is no legitimate or rational reason not to comply with a reasonable and lawful request.  Of course sensitive and confidential information must be protected and subjected to the highest scrutiny and control, but in my experience, more often than not, the refusal is simply unnecessary and due to an organisational culture where it’s just easier to say NO.

With today’s technology, working closer together, better understanding and developing practicable agreements to share information, I hope mistrust and fear resulting in a NO will be the exception and not the norm.

In connection with PC Mark Jenkins the  issues surrounding information sharing between partners in the mental health crisis care system are being explored at a workshop with eight local places that  the Center of Excellence for Information Sharing are running next week in collaboration with Home Office, Dept. of Health, NHS England and the National Crisis Care Concordat.  Jim Symington from the National Crisis Care Concordat will be giving us his reflections from this event in a follow up blog so do check back to read about his thoughts from the day.

And finally remember next week is also Mental Health Awareness Week (16 – 22 May), which this year is focusing on relationships. This is doubly relevant as good relationships are essential for both good mental health and also effective information sharing . You can find out more by visiting the website.

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