120.A prominent theme emerging throughout this inquiry was the increasing volume of police work arising from identifying and managing various forms of vulnerability, including safeguarding vulnerable adults who cross their path, being first-on-scene during a mental health crisis, undertaking child protection work on a multi-agency basis, and dealing with repeat missing person incidents, including looked-after children. These trends were attributed to a multitude of factors, including growing awareness of various forms of vulnerability and the need to protect marginalised individuals from harm, a culture of risk aversion, and the impact of funding pressures experienced by other public services (some of which do not operate a 24/7 service), including local authorities and NHS mental health services.
121.Dee Collins, Chief Constable of West Yorkshire Police, told us last year that “83% of my time in terms of delivering services is not about crime”, and referred to “real pressures around mental health, real pressures around [people] missing from homes, children and adults”. Her force had seen “almost a 300% increase in the number of missing [ … ] people over the last three years”. Similarly, Chief Inspector Michael Brown, Mental Health Coordinator for the NPCC and the College of Policing, told us that the “vast majority” of what the police spend their time managing is “vulnerability, mental health, missing children, CSE [child sexual exploitation] and other concerns for welfare from accident and emergency departments, social services and so on”. Chief Constable Mike Veale, the NPCC’s Lead for missing persons, said that “the responsibility for filling that gap” in services to vulnerable people sometimes becomes “suffocating and difficult to manage”.
122.Despite the wide scope of this inquiry, we were unable to examine every area of growing demand and vulnerability in detail. This chapter focuses on mental health work, missing people (particularly missing children), and multi-agency child protection work. In July, we launched a separate inquiry into Modern Slavery, including the role of ‘county lines’ drug distribution networks, after several reports criticised the response of the police and other agencies since the Modern Slavery Act 2015 came into force. Our Serious Violence inquiry is also examining the involvement of vulnerable people in gangs and organised criminal groups.
123.Faced with limited statistics on the level of demand on policing arising from vulnerability and mental health, with vast variations in estimates, we asked forces how many command and control (C&C) calls handled locally resulted in (a) a crime report, (b) a police intervention involving the safeguarding of vulnerable people, and (c) a case involving someone experiencing a mental health crisis. On average, only 14% of calls and 24% of incidents resulted in a crime report, 3% of calls included flags to suggest they involved safeguarding a vulnerable person, and 1% of calls included flags to suggest that they involved a mental health issue. These figures should be treated with caution, as forces used varying methods of identification. The College of Policing made similar estimates in 2015: it revealed that 83% of all “command and control” (C&C) calls during 2012/13 concerned non-crime related incidents, and approximately 2% of incidents reported to the police over the course of a year were linked to mental health.
124.In both sets of data, mental health incidents were far less common than the volume estimated in written evidence. The Met’s submission said that approximately 40% of its work has a “mental health element”, and Kent Police estimated more recently that a third of its time is spent dealing with individuals and cases involving mental health. Chief Inspector Brown told us that data provided to the Home Office by forces had demonstrated that “not every police force fully understands its demand”, in part because “the data does not lead easily from police systems that were built for purposes such as crime recording”.
125.Despite the figures outlined above, there is very strong evidence that mental ill health is placing increasingly high demands on the police service. The results of an FOI reported by the press last October showed that 23 police forces in England and Wales dealt with 215,000 mental health cases in 2016–17—a 39% increase on the year before. Some forces saw the number of incidents more than double during that period. The use of section 136 of the Mental Health Act, which enables the police to remove an individual to a place of safety if they are suffering from mental disorder and are in immediate need of care or control, reportedly increased by 50% between 2005/06 and 2015/16.
126.There is evidence that NHS mental health services are under significant strain, particularly in crisis care: the Royal College of Psychiatrists warned last year of a ‘national crisis’ in inpatient psychiatric treatment, resulting in more patients needing to be sent out of their area for care. Figures obtained by the BBC last year from 39 mental health trusts showed that 70% reported a workload increase in the previous year, and one trust (East London NHS Foundation Trust) had seen a 60% rise in crisis referrals. In August 2017, it was reported that the amount of paramedics’ time spent supporting people with their mental health rose by 32% nationally and by 45% in London.
127.Sir Thomas Winsor said last year that these pressures were “too often making the police the service of first resort, long after the chances of effective prevention have been lost”. He declared this “a profoundly improper way to treat vulnerable people who need care and help”, and said: “Until mental health is given the same priority as physical health, in resources including funding, the police will continue to play too large a role dealing with people with mental health problems”. This year’s annual report called for public services to work together to prevent mental health problems in children, and said that there are “many people in the criminal justice system who should not be there”.
128.Dame Vera Baird, PCC for Northumbria and APCC Lead for Victims, highlighted to us that “there isn’t an obvious place to go if you, as a member of the public, see somebody behaving in an odd way, which might trigger your concerns that they have mental health issues”, so people “tend to go to the police”. Sophie Corlett, Director of External Relations at Mind, suggested that there should be “an open number that everybody could call [ … ] and then be able to get a mental health appropriate response”. She noted that the health service has an “aspiration” to “move towards” better crisis care, but that “funding it and putting it in place is slow work”.
129.The deaths of a number of vulnerable individuals in police custody prompted the previous Government to appoint Dame Eilish Angiolini to carry out a review on the subject, resulting in a report published in October 2017. She recommended that plans to introduce NHS commissioning of healthcare in police custody should be reinstated and implemented; that the viability of “drying-out centres” as an alternative to police custody or A&E for those under the influence of drugs and alcohol should be “reconsidered”; and that local authorities should ensure that they have “reasonable systems in place” to guarantee that all police requests for accommodation, whether secure or non-secure, are accepted. In response, the Government said that Dame Elish’s report would be “used to further improve training, guidance and standards in relation to detention and custody”, including through the NPCC’s National Strategy for Police Custody. £30m was made available to local clinical commissioning group areas to ensure sufficient provision of community and health-based places of safety for children.
130.Despite these efforts, campaigners criticised the Government’s approach in this area in July, after official figures revealed that 23 people had died in or after police detention in 2017–18, the highest in a decade. Over half had “mental health concerns”, and 18 had “links to drug and/or alcohol”. Deborah Coles, Director of INQUEST, said that “this has been a year of widespread promises of change and learning lessons”, following the Angiolini review, but that “real systemic change remains to be seen”. Chief Inspector Brown has also voiced concern about the extent to which forces and NHS organisations are learning lessons from deaths in police custody. In a blogpost published in July, he said: “this could happen again tomorrow because the learning is usually just done by the force affected”.
131.After reforms to the Mental Health Act to reduce the use of police cells for s136 detentions, this practice fell dramatically (by 56%) between 2014/15 and 2015/16, with a particularly marked reduction (by 73%) for children and young people. Nevertheless, last December the NPCC estimated that around 2,000 people per year were being detained unlawfully in police custody beyond the 24-hour limit. Although health-based places of safety are more appropriate for people experiencing a mental health crisis, Chief Inspector Brown told us that it “actually costs more in officer hours to work with the NHS by taking people to healthcare settings than it does to put someone in custody”. He elaborated: “If you have a health-based place of safety process in an area where the NHS do not staff the safe room”, then “two officers frequently remain there for six or seven hours or more—for the whole period of time that it takes to arrange an assessment”. He added: “If the person needs an inpatient bed, which may not be available for hours or indeed days, the officers may have to remain there for that period, too.” Sophie Corlett said that, in London, the police are “doing a lot of phoning around to find out where the empty space is—the police are doing that labour, not the health services”.
132.The interim report of the independent review of the Mental Health Act observed that the principle of treating an unwell individual in hospital, rather than a police cell, should extend to the method of transportation used to take them to hospital. The latest figures show that, in the year ending March 2017, a police vehicle was used to transport the person to a place of safety in over half of cases. In over a third of cases in which a police vehicle was used, this was because an ambulance was not available within a reasonable amount of time.
133.We welcome the reduction in the use of police custody for individuals detained under section 136 of the Mental Health Act. We remain concerned, however, that lessons are not being learned by all forces about the use of these powers in a lawful and appropriate way, including the use of restraint against individuals experiencing acute mental distress, and we are very troubled by the increase in the number of deaths in police custody. The Government should provide us with an annual update regarding progress against Dame Eilish Angiolini’s recommendations, and explain why the number of deaths in police custody have increased in the last recorded year.
134.If an individual requires a health-based place of safety for a mental health crisis, the police service’s involvement in their care should end at the point at which they are sectioned. It is unacceptable that the majority of section 136 cases involve police transport to a health facility, frequently because an ambulance is not available in time. This is an inappropriate way to care for patients, and leaves police forces overstretched. We have also heard evidence of the police spending hours trying to find a treatment provider, and remaining in hospital with a mental health patient while an inpatient bed is found for them. These are risks which the NHS should be responsible for managing, and has the expertise to manage—it is completely inappropriate to leave the police to pick up the pieces in this way. The NHS is currently advancing Integrated Care Systems as an attempt to integrate local health and social care services more effectively. These should take into account the effects of local health needs on the police.
135.Dame Eilish’s report criticised progress on police mental health training, stating that it had “tended to be slow, not sustained, fragmented and with little national coordination”. She said that “there appears to be a pressing need for a national mechanism that can monitor if and when police forces are carrying out training recommended by the College of Policing”, and recommended that “national, comprehensive, quality assured mental health training” should be provided to all officers in front-line or custody roles, covering all new recruits, and with the provision of regular refresher training.
136.In October 2016, the College of Policing published new authorised professional practice (APP) materials for officers on responding to calls involving mental ill health, mental vulnerabilities and learning disabilities. Chief Inspector Brown told us that the College suggested that all officers should have a two-day training package on mental health, which he described as the “absolute minimum”, with an option for a third day. The training is not mandatory—“unfortunately in my opinion”—and there is a “mixed picture across the country”.
137.As part of our data collection exercise, we asked forces how many of their officers, PCSOs and staff members had received mental health training, and what form that training had taken. Of the 32 forces that returned data on proportion of headcount, rather than attendance numbers for the training, we found that an average of 53% of officers and 23% of staff had received some form of training. In most cases, this was reported to be a mix of online and classroom training, although twelve forces provided no details. Figures varied significantly between forces, from 5% of staff and 7% of officers/PCSOs in Derbyshire to 100% of officers/PCSOs and staff in Cambridgeshire.
138.Chief Constable Veale said that training on mental health and vulnerability in his force (Cleveland) is “embedded into one day of wider training”. He told us that demands on policing “often outstrip resources”, with the result that “There is no longer the ability to just take officers and staff from the frontline and spend two days training them in some of those incredibly important areas of our business”. In a blog post last year, Chief Inspector Brown contrasted the amount of mental health training for officers with the three-week course on driving police vehicles, with longer training courses for advanced drivers. He said: “I would argue the strategic risk to policing that is represented by mental health related demands means we should be giving more than two days, if the risk represented by driving standards means a three week course”. He later told us that there is significant appetite for mental health awareness among the officers to whom he speaks, and he described the advantages for chief constables of investing in training, stating that they get “an awful lot back in terms of reductions in crime and reductions in demand”.
139.From the evidence we received, it appears that some police forces see mental health training as a ‘nice-to-have’, rather than an essential part of their officers’ knowledge base and skillset. We appreciate that it is extremely challenging to remove officers and PCSOs from the frontline in order to train them for two days, as per the College of Policing’s guidance. But we urge forces to consider the cost of a single death in police custody of an individual experiencing a mental health crisis—not just in monetary terms, but to that individual’s loved ones, and to society as a whole. It is ludicrous that officers receive a three-week course in police driving, while dealing regularly with acute mental health crises with just a few hours of training. The College of Policing should take immediate steps to mandate a minimum two-day mental health course for all officers and PCSOs. We urge chief constables to regard this as an investment rather than a chore.
140.An increasing number of forces are working in closer partnership with the NHS and other local agencies to improve their response to individuals experiencing mental health crises, including through street triage services, in which mental health workers or paramedics work with the police to respond to mental health incidents. In 2016, researchers at University College London (UCL) published an evaluation of triage services in nine pilot areas across England and Wales. The researchers recommended that the schemes should be made available 24/7, and that a national curriculum and associated training materials for street triage staff should be developed, along with enhanced mental health training for all police officers. Sophie Corlett told us that there are about 17 schemes operating across the country, but “we would like to see them everywhere”, and later highlighted that they can enable the police to access information from other services “about people they are coming across on the street”.
141.Chief Inspector Brown had less praise for these schemes. He criticised the UCL study and told us that Kent’s street triage scheme was disbanded, partly because they “couldn’t physically get to everything that they were trying to respond to”—unlike in urban areas with more condensed populations. He also questioned their value: in the street triage schemes he had witnessed around the country, he had observed that the majority of incidents “didn’t require the police service”, and “a good proportion of them, if not a clear majority of them, are patients who are currently known to their local mental health trust as having existing mental health problems”. Warning that such schemes might be having unintended consequences, by increasing demand on the police, he said: “We know that in some areas, the existence of street triage means other professionals now see the police as an easy-to-access nurse-led service, even when the interaction itself does not require the police”.
142.Joint triage schemes between the NHS and the police have been spoken of positively by many witnesses, and efforts to encourage data-sharing and cooperation between the police and local health providers are to be encouraged. We are concerned, however, that they are promoting further reliance on the police as the first-point-of-call for individuals who witness or experience a mental health crisis. People who require mental health treatment in a crisis need an urgent, NHS-led response, not a police car.
143.In too many areas, the police are the only emergency service for those in crisis, and they are being used as a gateway to healthcare for those in desperate need of help. This is an extremely poor use of public funds and one of the worse examples of cost-shunting between public services. The NHS is expected to receive a £20bn funding uplift in the upcoming Budget. This should take into account the significant disparity in funding for mental health, relative to physical health, so that the NHS is better able to support those with mental health needs, rather than relying on the police.
144.Reports of missing people, including children, are another frequently-cited area of growing demand on the police, and can involve complex vulnerabilities and associated safeguarding activity. NCA figures released in December 2017 showed that police forces in England and Wales received 337,650 calls regarding missing people in 2015/16—an increase of a fifth compared with the year before. Included in those figures were 124,507 reports of missing children made to the police, accounting for 60% of incidents (the vast majority of which related to teenagers). A large amount of demand is generated by the same individuals going missing repeatedly: 59% of missing person incidents involving children are repeat missing episodes involving the same child, and 20% of adult incidents are repeat episodes.
145.Children in the care of local authorities are much more likely to go missing than those living with their parents, with demand generated from care homes housing children from other areas, as well as those who grew up locally. Figures obtained by the Labour MP Ann Coffey, published on her website, indicated that the number of looked-after children placed in residential care outside their local area had increased by nearly two-thirds between 2012 and 2017. Separate figures provided to us by police in Rochdale showed that, between November 2017 and April 2018 alone, there were 227 local incidents of children going missing from care homes that involved children in the care of the local authority, but an additional 101 incidents involving children in the care of another local authority.
146.The latest HMICFRS thematic inspection of the police response to missing people was published in March 2016, focusing on missing children. The inspection found “unacceptable inconsistencies between and within forces, across all aspects of the approach to missing children, whether in respect of assessing risks, investigating or supporting children”. It called for “both operational and cultural changes in the police service”, and made a series of recommendations, including for the Home Office to work with the Department for Education to review the placement of looked-after children in other local authority areas; for the national policing lead to work with the Association of Independent Local Safeguarding Children’s Board Chairs to improve oversight within local authority areas, to ensure that agencies are fulfilling their responsibilities; and for chief constables to ensure that information management processes are in place which focus on outcomes for children who go missing, and to provide better analysis of the effectiveness of the police and multi-agency responses.
147.A further HMICFRS inspection in September 2016 examined the multi-agency response to child sexual exploitation and missing children. It found that a better understanding was needed of why children go missing, at both an individual and strategic level; that the requirement for every child who has been missing to receive a return home interview was “not working well enough”; that police risk assessments of missing children are “inconsistent”; and that their effectiveness is “limited” for some children, because “episodes of children going missing are sometimes seen in isolation without considering wider vulnerability”. Chief Constable Veale told us that there needs to be “more emphasis” on a “seamless partnership approach between residential care homes and local authorities”, adding that the police have “made great strides in improving” multi-agency working in this area, “but we’re not anywhere near where we should be”. Overall, he painted a picture of inconsistency and a lack of leverage at a national level. For example, he told us that, “unfortunately [ … ] despite my desire and the guidance for local authorities”, return-home interviews for missing children are still administered in different ways across the country, “with different standards, different questions being asked and different professionals involved”.
148.Data-sharing between agencies was highlighted as a key barrier to progress in this area. In written evidence, the Children’s Society highlighted that risk assessments undertaken by the police when children go missing are mostly informed by “limited information communicated to the police call taker by a person reporting a child missing”. The information that might be available from children’s services and voluntary sector organisations is “often not taken into consideration” during risk assessments, and there is “a lack of proper information sharing between the police and local safeguarding service”. It attributed this partly to “the variety of IT systems used, and a lack of clarity around what data can be shared without breaking data protection laws”.
149.Chief Constable Veale also referred to data protection concerns as a barrier to information-sharing about vulnerable individuals. He suggested that concern about personal data “impairs and inhibits conversations between agencies”—sometimes due to “misinterpretation of some of the legislation”. He admitted that there are occasions when the police are “risk averse” and “not lawfully audacious”, the latter of which “we should be”. Chief Constable Simon Bailey’s follow-up written evidence called for better sharing among agencies of information about children at risk, or those identified to have had adverse childhood experiences. He said that “Creating more innovative and effective ways for the public to submit concerns and intelligence to law enforcement and partners would provide further sources of intelligence”, as would “bringing together the large datasets held by individual public services”. He called for a cross-government strategy on CSA, and a public health approach to tackling abuse and its causes, to “clarify responsibilities for all agencies” and enable the third sector to work with the public sector.
150.The demand on policing arising from cases involving missing people—particularly children—appears to be the result of a perfect storm generated by funding reductions to other public services, the extensive use of out-of-area placements for looked-after children, a lack of data and intelligence-sharing between the police and other public agencies, and an excessive dependence on the police as a service-of-last-resort for vulnerable individuals, including the safeguarding of children at risk of sexual exploitation and abuse. We do not lament the police’s involvement in this important area of work, but their increasing workload appears to be the result of failures in other services and in partnership working, rather than a political or strategic decision. We are also concerned that there appears to have been little progress since HMICFRS published its 2016 report on this subject. This is one of many areas in which the national policing lead seems to have insufficient leverage to enact fundamental change at a local level.
151.We are concerned that there has been a serious lack of Ministerial leadership in relation to the threat of child sexual abuse in England and Wales, including the response to missing children, the proliferation of child abuse images, and the join-up between agencies on child protection work. Police activity is fragmented, under-resourced and subject to competing demands; information-sharing between agencies is woeful; rehabilitation for CSA offenders is virtually non-existent; and there is nowhere near enough proactive activity taking place to stem the tide of child abuse images online, and the associated growth in known paedophiles. We welcome the Home Secretary’s personal commitment to driving progress in this area. The Government should appoint a Commissioner for the Prevention of Child Sexual Abuse to work across departments and agencies, work closely with private and non-profit organisations, and produce a bold and comprehensive cross-Government strategy on child protection and the prevention of child sexual abuse.
152.Even if our recommendations are implemented effectively, the police will still have an important role to play in protecting vulnerable people from harm, including managing the risk from sex offenders, referring vulnerable offenders to other agencies, and tracking down missing people. However, our findings strongly point to the need for agencies to be much more joined-up in their approach, with more pooling of resources and a less risk-averse approach to data-sharing. We return to this issue in the next chapter.
174 Home Affairs Committee news item, , 18 July 2018
175 They may relate to calls (999 and 101), or to the creation of incident reports. Further information is provided in the Annex to this report.
176 College of Policing analysis: , 2015
177 Kent PCC, 9 March 2018
179 BBC News, , 28 October 2017
180 The Guardian, , 9 October 2016
181 HSJ, , 11 July 2017
182 BBC News, , 27 July 2017
183 The Guardian, , 13 August 2017
184 HMICFRS, , 20 April 2017
185 HMICFRS, , 12 June 2018
188 Rt. Hon. Dame Elish Angiolini DBE QC, , January 2017
189 Home Office press release, , 30 October 2017
190 IOPC news item, , 25 July 2018
191 INQUEST press release, , 25 July 2018
192 Mental Health Cop blog, , 5 July 2018
194 NPCC, , 9 September 2016
195 BBC News, , 8 December 2017
198 The independent review of the Mental Health Act: , 1 May 2018
199 Home Office, Police powers and procedures, England and Wales, year ending 31 March 2017 (), 26 October 2017
200 Rt. Hon. Dame Elish Angiolini DBE QC, , January 2017
201 As outlined in Chapter 6, Police officers and staff are expected to “have regard to APP [guidance] in discharging their responsibilities”.
202 College of Policing, , accessed 6 September 2018
205 Mental Health Cop blog, , 30 October 2017
207 UCL, , March 2016
208 UCL, , March 2016
213 NCA, , December 2017
214 NCA, , December 2017
215 NCA, , December 2017
216 Ann Coffey MP website (anncoffymp.com), news item: , 8 May 2018
217 Greater Manchester Police, Rochdale District ()
218 HMIC, , March 2016
219 HMIC and others, , September 2016
222 The Children’s Society ()
224 National Police Chiefs’ Council ()
225 National Police Chiefs’ Council ()
Published: 25 October 2018