Policing and mental health - Home Affairs Contents

5  Training

Mental health awareness and identifying vulnerabilities

65. We received a lot of support for improved mental health related training for police officers.[112] At the same time, we received views from a range of individuals and organisations that the police should not be trying to be mental health professionals.[113] The main subjects for improved training were general mental health awareness training, de-escalation techniques and the use of restraint. Calls for improved general training covered areas such as identifying indicators, the "tell-tale signs", of who might be vulnerable because of mental illness, and breaking down prejudices associated with mental illness.[114] There was a strong sense that the people working in the police control centre answering emergency calls should receive extra training in this area, so they can better inform the police attending and if necessary request a paramedic.[115]

66. Once a detained person is taken to a police station, it is more likely that the assessment will take place at the police station, rather than at a health-based place of safety. The custody sergeant will talk to the officer bringing in the person to understand what has led them to be in the custody suite, they will go through a formal risk assessment, including asking the person if they have previously attempted self-harm or suicide. Police records checked to see if they have passed through before.[116] Some people will present with obvious worrying behaviour, such as hitting themselves or banging their head against the wall of the van. Some will not present such obvious signs.[117]

67. The police can be trained to recognise some indicators, and the College of Policing current review of mental health training is moving toward an assessment of individual vulnerability rather than trying to identify specific mental ill health, learning disability or condition.[118] However, there is a clear need for police officers in the custody suite to be able to call upon trained professionals for advice. The presence of doctors and nurses in the custody suites are a clear way for the needs of those with mental health problems to be recognised early and enable quicker access to medical records.[119] The Government plans for NHS England to take over commissioning of health services in police stations by April 2015.[120] This should improve the minimum qualifications of those working in custody healthcare and the quality of the healthcare available.[121]

68. There is a need to improve training for police officers and civilian staff in identifying the signs that someone might be suffering from mental illness. This should be mandatory for all front line officers and include staff in the police control room. This is particularly important for custody sergeants, who must be adequately equipped with the skills to effectively deal with mental health patients who come into custody suites. Police staff then need to be able to get advice from a mental health professional—a social worker, doctor, or nurse—who is better placed to recognise medical conditions and illnesses, and is able to refer the person for further treatment. Such advice needs to be available to the police at all times, given that they operate 24 hours a day.

69. We are aware that mental health training varies across the country, particularly in the amount of time devoted to it—between four hours and one day—and the extent of online learning compared to face-to-face learning. British Transport Police (BTP) trains its recruits to deal with people with suicidal thoughts—there were over 4,000 suicidal incidents on the transport network in 2013-14, including 325 people who took their own lives on the railways. BTP officers get at least one day's training on mental health, including training in suicide prevention and 'softer' skills to help officers deal with somebody in crisis. About 1,000 BTP officers, out of as total of around 2,800, have been through the Samaritans' Managing Suicidal Contacts course—which is another full day.[122] Lord Adebowale commended the work being done in London on mental health and suicide prevention.[123] We heard of considerable support for joint training on mental health awareness, and that this should be part of a nationally-agreed programme of joint training with other agencies, such as paramedics, mental health nurses, and charities.[124]

De-escalation and restraint

70. The behaviour of someone having a mental-health crisis can be misunderstood and lead to them being treated in an inappropriate way, for example, their behaviour could be interpreted as dangerous and be met with inappropriate force. James Herbert was a young man who died after being detained by police in Bath in 2010. We took evidence from his parents, Tony Herbert and Barbara Montgomery, who both said James was subject to unnecessary force. Tony Herbert said:

    We know with our son that because of his temperament, had there been any attempt to de-escalate, to communicate with him rather than overpower him, his nature would have meant that he would have been peaceful. He did not do anything violent through all of his life until he struggled against the restraint, which is not, in my view, violence.[125]

71. There are real concerns that black and ethnic minority people are disproportionately detained under s. 136.[126] Matilda MacAttram of Black Mental Health UK said there was still a feeling in the black community that the young black men are presumed to be dangerous based on their physical appearance, and this perception determines how they are labelled and the treatment they receive.[127] At events organised by the Centre for Mental Health to hear views on experiences of detention under s. 136, black people more commonly reported the use of force and that force was used at an earlier stage during contact with the police.[128] Deborah Coles of INQUEST, agreed that there was a prevailing assumption that people with mental health illness would be dangerous, and that is doubled if the person is from the African Caribbean community. She said the answer was largely to do with training.[129]

72. The police are trained to use control and restraint when they find themselves in situations where there is potential for violence. This can include various physical holds, handcuffs or limb restraints. In London, Lord Adebowale found a disproportionate use of force and restraint,[130] and a risk that police will use restraint when they perceive the person to be potentially violent, even when they have not exhibited any violent behaviour.[131] Restraint was found to be a cause of death for 16 of the people who died in custody between 1998-99 and 2008-09. (These are all deaths not just those involving someone identified as having mental health illness.) Positional asphyxia was also given as the cause of death in four of the sixteen cases.[132]

73. In certain situations, the behaviour of someone going through a mental health crisis could be interpreted as potentially violent when they could be delusional and afraid. The police are not always aware that the person they are dealing with is suffering from something that is a medical emergency where restraint is "about the worst possible course of action to take".[133] Furthermore, being restrained may intensify that fear and lead them to struggle against the restraint. The parents of James Herbert said their son had not committed a crime nor had any history of violence, but because he was reported to be acting strangely he ended up being held down by several people—police officers and members of the public—restrained with his hands behind his back, and driven by police van, in a prone position, for over 40 minutes.[134] The parents of James Herbert were very clear that, in their view, James needed medical help and should have been transported in an ambulance.[135]

74. Mental health services train their staff in de-escalation, to try to create space for people who are at risk rather than trying to control them.[136] They are more likely to be restraining someone they know something about (their illness, level of medication, general physical health, etc.) and within a hospital setting. The medical approach is that anything more than a transitory restraint of somebody with a mental health problem should be dealt with as a medical emergency, and that if someone has to be restrained and it might last more than a minute or so, then there should be trained nurses available, defibrillators, drug trolleys, and the ability to call upon a doctor within 20 minutes. With reference to how the medical approach differs to the policing approach to restraint, Michael Brown said:

    If the medical guidelines to nurses and doctors are, "You must treat this as a medical emergency, have drugs, defibrillators and a doctor within 20 minutes", it paints a very fresh perspective on what the police should be thinking about doing when they are dealing with people in a community setting, in a street or in their own home.[137]

In the rare circumstance when the police are called to manage a person seen as disruptive in a healthcare setting, the mental health professionals should manage the situation and retain responsibility for the safety of the person. It should only really happen if the patient represents particular danger, such as if they are carrying a weapon.

75. Mental health is clearly a large and growing element of modern police work. The current amount of training for new recruits is not enough. Some forces have developed their own training to address perceived gaps. There needs to be a national strategy for mental health training for all police. It needs to be updated on a regular basis. As a minimum, it should include awareness of common mental health illnesses, techniques in de-escalation, safe restraint, and awareness of what mental health services are available locally. Mental health awareness training should include a component that addresses why some people who are ill might be perceived as violent, and how these perceptions impact upon the BME community.

76. This needs to include joint training with mental health nurses, paramedics and Approved Mental Health Professionals, and training involving mental health charities and people who have been detained under s. 136. We commend those police forces that already do this, including Greater Manchester, West Yorkshire and Leicestershire. Joint training should include de-escalation training, to make sure police officers are familiar with the techniques taught in mental health services.

77. Restraint should only be used in limited circumstances. Improved training should be given to correctly identify the range of behaviour of someone having a medical emergency rather than automatically presuming that behaviour means they are violent. The training should be aimed at reducing the presumption to use force and restraint on someone who is ill.

Deaths in police custody

78. IPCC statistics show that in 2013-14, 11 people died in or following police custody. Of those 11, four were identified as having mental health concerns, and of those four, two had been taken to a police custody suite under s. 136 of the MHA. Both were men had been restrained by the police, including handcuffs and leg restraints[138] Similarly, in 2012-13, nearly half (7 out 15) of those who died in or following police custody were identified as having mental health problems.[139] The number of deaths in or following custody has fallen since 2010-11.[140]
2007-08 2008-092009-10 2010-112011-12 2012-132013-14
Deaths in or following police custody 2215 1721 1515 11

79. The best way to reduce the number of people suffering from mental health issues and who then die in custody is to reduce the number of people with mental health problems entering custody. All that can be done, needs to be done, to ensure that people going through a medical emergency are treated like someone going through a medical emergency. This includes providing sufficient resources to ensure mental health crisis care is available 24 hours a day, seven days a week.

Suicide following custody

80. The number of apparent suicides following police custody—that is within two days of being in police custody—has risen from 39 in 2011-12 to 65 in 2012-13 and 68 in 2013-14. Of the 68 apparent suicides following police custody, thirty-two suicides occurred on the day of release.[141] There is a clear link between suicides shortly following police custody and mental health: 45 (about two thirds) of those who died were reported to have mental health concerns, and three had been detained under the Mental Health Act 1983 prior to their death. British Transport Police figures suggest 3% of suicides, or attempted suicides that result in injuries, on the railway were after police contact—often where the subject had recently been arrested or bailed for shameful offences.[142]
2007-08 2008-092009-10 2010-112011-12 2012-132013-14
Apparent suicides following custody 4556 5446 3965 68

81. Custody staff are responsible for carrying out a pre-release risk assessment of those who pass through their custody suite, assess if the person is vulnerable and if there is a credible risk that on release they may commit suicide.[143] The custody officer needs to be trained to identify signs that would represent a risk of suicide and to be able to call upon healthcare staff in the custody suite who can provide expertise when necessary, and refer them to the appropriate support.[144]

82. The recent increase in suicides following custody is highly alarming. The police must make sure that those who have been identified as vulnerable in custody are notified to medical staff. There must be a formal method by which this done and it must be followed. This will require additional training for custody staff but it also requires improvements in access to mental health nurses and doctors in the custody environment.

112   Q 125; Jonathan Owen (PMH0008); College of Paramedics (PMH0047). The College of Paramedics found large support among its members for mental health training for both police and paramedics  Back

113   For example, Alex Crisp (PMH0051) Back

114   Q 60; Q 317; Lord Adebowale (PMH0054); INQUEST (PMH0042) Back

115   Q 124; Independent Commission on Mental Health and Policing; College of Policing (PMH0024) Back

116   Qq 188-190 Back

117   Q 187 Back

118   College of Policing (PMH0024) Back

119   Faculty of Forensic and Legal Medicine of the Royal College of Physicians (PMH0035) Back

120   NHS England (PMH0055) Back

121   Q 292; Faculty of Forensic and Legal Medicine of the Royal College of Physicians (PMH0035) Back

122   Qq 234-245 Back

123   Lord Adebowale (PMH0054) Back

124   Q 153; Qq 244-245; MIND (PMH0027); Mark Standing (PMH0046); Police Federation of England and Wales (PMH0036); Mind and Victim Support, Police and mental health, How to get it right locally, 2013, pp 24-25; The Police Foundation (PMH0028) Back

125   Q 62 Back

126   Royal College of Psychiatrists (PMH0038) Back

127   Q 11; Black Mental Health UK (PMH0045) Back

128   Centre for Mental Health, Review of Sections 135 & 136 of the Mental Health Act, December 2014 Back

129   Q 53 Back

130   Q 124 Back

131   Independent Commission on Mental Health and Policing, pages 18-19 Back

132   IPCC Research and Statistics Series: Paper 27, Deaths during or following police contact: Statistics for England and Wales 2013-14. See also College of Paramedics (PMH0047) Back

133   Jonathan Owen (PMH0008) Back

134   Qq 70-76 Back

135   Q 49; Qq 63-64 Back

136   Q 107 Back

137   Q 112. See also Q 63 Back

138   IPCC Research and Statistics Series: Paper 27, Deaths during or following police contact: Statistics for England and Wales 2013-14 Back

139   INQUEST (PMH0042), para 9 Back

140   IPCC Research and Statistics Series: Paper 27, Deaths during or following police contact: Statistics for England and Wales 2013-14 Back

141   IPCC Research and Statistics Series: Paper 27, Deaths during or following police contact: Statistics for England and Wales 2013-14. Previous mental health concerns include previous suicide attempts, depression & long-term mental health disorders Back

142   British Transport Police (PMH0025) Back

143   Independent Commission on Mental Health and Policing, Report, May 2013, pages 18-19 Back

144   Q 161 Back

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© Parliamentary copyright 2015
Prepared 6 February 2015