Mental Health (Police Procedures)

Paul Burstow Excerpts

Thursday 28th November 2013 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

I will keep that in mind, Mr Brady. I thank the Backbench Business Committee for enabling us to have this debate and for rescheduling it so quickly. I congratulate both the hon. Member for Bridgend (Mrs Moon) on starting the debate and setting out many of the issues so well and my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on outlining so much of the important ground in this area.

My hon. Friend referred to the blogger Michael Brown, who tweets under the name MentalHealthCop and rightly won the Mind digital media award last year. He probably deserved to win it again this year as he continues through his blog to inform and educate not only the public, but many of his fellow officers. More power to his elbow for that.

When I was preparing for this debate, the stand-out fact that jarred with me was that 36% of all people subject to place-of-safety orders find themselves in a police cell rather than a hospital. On the most recent figures, that is 7,761 place-of-safety orders. According to Her Majesty’s inspectorate of constabulary, the average length of stay in a police cell is over 10 hours and 32 minutes —more than 10 hours!

Such people have not committed any crime, but have been judged under section 136 of the Mental Health Act 1983. They are not criminals; they are experiencing a mental health emergency and are being let down by a health service that institutionally discriminates against those with mental health problems. There are many ways of measuring whether we have achieved parity of esteem between physical and mental health, and the numbers we lock up in police cells must be among the starkest measures of progress. Today’s debate is about the role of the police service in addressing the needs of people with mental health problems. The police cannot completely be removed from the equation and do have a role to play.

One in four of us will experience a mental health problem at any one time. We are talking about something commonplace, but often hidden in plain sight in our society. That is why Victor Adebowale, in his report for the Metropolitan Police Commissioner, Sir Bernard Hogan-Howe, was right to say that mental health issues are a part of the core business of policing. The current situation is not properly serving that purpose.

The issue is not peripheral. Rates of mental health conditions among offenders range from 50% to 90%. There is no escaping the fact that the police, often as first responders, are and will continue to deal with people suffering from mental health problems. In London, according to estimates by the mental health unit of the Metropolitan police, 15% to 25% of police activity is related to mental health issues. Some estimates put the level much higher—40% has been cited in the debate already. Either way, that amounts, in London alone, to more than 600,000 calls a year related to mental health difficulties.

It is important to stress that people with mental health problems are much more likely to be the victims, rather than the perpetrators, of crime. That fact all too often gets glossed over in how our media report such things. The impact of crime on people with mental health problems can be far more profound, with deeper consequences, than for those with greater resilience. That is often not reflected fairly or appropriately in how such matters are reported.

In October, Victim Support and the mental health charity Mind published their study of the victimisation of people with mental health problems—“At risk, yet dismissed”—and it challenges many of the popular misconceptions. Some of the facts from that report have already been referred to, but the ones that stand out for me are that women with severe mental illness are 10 times more likely to be assaulted and that almost half of people suffering from a severe mental illness were victims of a crime in the past year. The impact of such crimes on the victim is huge.

As the Chair of the Select Committee on Home Affairs, the right hon. Member for Leicester East (Keith Vaz), pointed out in his intervention on the hon. Member for Bridgend, it is also right to recognise that the police themselves are in a stressful occupation, which is often distressing and a cause of real difficulties for them. Estimates suggest that in London alone the mental illness costs to the Metropolitan Police Service are equivalent to £1,000 per employee—a huge, unmanaged cost.

The nature and role of police work, however, also require the police to be in control and psychologically robust. All police services, and the MPS especially, are therefore in a unique situation, in which the mental health and well-being of staff require particular attention. The statistic we were given earlier—the 56% of staff working in custody suites who are themselves reporting anxiety and depression—is a stark reminder that our debate is not only about them out there, but about all of us experiencing mental health problems in our lives.

Lord Adebowale’s report included 12 recommendations. Incidentally, although the report was commissioned by the Metropolitan Police Commissioner, my understanding is that he has not yet responded to it. When is he likely to do so?

I will pick up six stand-out common themes from the report: first, the lack of mental health awareness, touched on in earlier contributions; secondly, the lack of guidance and training on suicide prevention, which is an important element; thirdly, the lack of adequate care for vulnerable people in custody, which goes to the heart of the debate; fourthly, poor inter-agency working—without doubt one of the keys to unlocking so much of what does not work; fifthly, the disproportionate use of force and restraint; and finally, the failure to communicate with families, which all too often sits at the heart of failure on these issues.

Much of that is echoed in the report “A Criminal Use of Police Cells?” by Her Majesty’s inspectorate of constabulary, which found that the use of police custody as a place of safety varies from 6% to 76% of the total number of people detained under section 136. As a result of a shortage of the right staff in the right places at the right times, people who have not committed a crime are often treated as if they were criminals. HMIC put it this way in its report:

“those detained under section 136 who were taken to a police station were generally treated like any other person in respect of the booking-in procedure; risk assessment; and, ultimately, being locked in a cell (rather than being taken to another part of the station).”

The report also found multi-agency working to be patchy, as was awareness of training resources and activity—they are clearly the areas where relatively small changes could lead to big differences in operation.

The recently published experimental analysis of police data offers some important insights. It bears out the HMIC finding that there is huge variation in the use of police cells as a place of safety. The Sussex, Devon and Cornwall, West Yorkshire, Avon and Somerset, and Hampshire forces all recorded more than 500 uses of section 136, while Lancashire, Merseyside, Hertfordshire and City of London recorded 10 or fewer uses.

Drilling down into those figures and using them to understand why things are so different and what best practice might look like, and to ensure its better spread, we can see why the Government should be commended for having the statistics collected and such analysis done. Buried a little deeper in the experimental data, however, is something else. For the first time, there are estimates for the number of under-18s held in police cells under section 136.

In the past year, according to the most recently published statistics, 263 children and young people were held in police custody. The report urges caution about that figure, because of the experimental nature of the data, and I can understand that caution. It should still be a source of shame and a spur to act, however, that we are locking up children at a time of deep and acute mental health crisis. The hon. Member for Totnes (Dr Wollaston) has rightly challenged on that issue—she raised it in Health questions—and I hope that she will be speaking in the debate.

I hope that the soon-to-be-published concordat on emergency mental health care will do something—more than something—to stop the barbaric practice of children being held in police cells when they are having a mental health crisis. Indeed, next year the Care Quality Commission will be conducting a themed inspection, looking at the whole pathway of crisis care—the role of the police service and of various aspects of the health service—and I hope that it will also cast light on this issue.

I have some questions for the Minister. There has been good progress on rolling out the liaison and diversion services in custody suites. That early identification, assessment and referral can result in much better outcomes. Will the Minister give some indication of when the Treasury will sign off the outline business case for national roll-out of the service? Given the numbers of young people in the criminal justice system with mental health needs, does the liaison and diversion service cover them as well? Will it ensure that they are always included?

Street triage is being piloted by the Home Office and the Department of Health, and we have heard how that can make a significant difference by bringing health professionals into the equation. How will the street triage model fit with liaison and diversion? Also, to repeat a rightly put question, how is that model being evaluated, and what are the time scales for a rapid roll-out should the evaluation show that street triage is working well, which I understand it is showing? How quickly therefore can we get it out throughout the country?

In the report on police custody as a place of safety, HMIC recommends that if there is not significant reduction in the inappropriate use of police custody by April 2016, the Mental Health Act should be amended to remove police stations as a place of safety, except on an exceptional basis. HMIC goes on to state that “exceptional basis” should be written into the law and defined. Will the Minister set out the Government view of that recommendation? If that was signalled as an intention of the Government, would it serve as a further spur to action throughout government, the NHS, social care and police services?

Finally, sitting at the heart of the disparity between mental and physical health and of the institutional bias and discrimination that people with mental illness suffer is deep-seated stigma. The Government deserve much credit for funding the Time to Change anti-stigma campaign—a global leader in such campaigning that is making a real difference in this country. So far, a number of Departments have signed up to play their own part in the Time to Change campaign. I understand that there are discussions with the Home Office, and it would be good to know from the Minister today when the Home Office will be signing up to Time to Change. Furthermore, the attitude to and awareness of mental health problems remain an issue in the police service. One way in which forces could address that is by working together to sign up to Time to Change. Will the Minister use his good offices to promote Time to Change to chief constables and police and crime commissioners?

In conclusion, I want to cite the HMIC report and give two quotes from it from people detained under section 136. The first is:

“I was discharged by the mental health crisis team as a low risk to myself and others and not requiring follow-up. I am concerned that my section 136 detention [in police custody] will show up on…enhanced criminal record checks…in the future.”

Perhaps the Minister will say whether we can ensure that that does not happen.

The second is:

“What have I done to deserve this? I was ill; I was locked up because I was ill.”

Surely that is not what the police service is there for; that is what the health service is there for.