Mental Health Street Triage and the Police (part 1): Addressing Demand

By Dan Moloney, Research Assistant

In 2013, nine police forces in England and Wales piloted mental health triage schemes in order to create better outcomes for members of the public encountered by police who are experiencing mental health distress. Since then, many more forces have implemented their own localised policies, providing valuable insight into these operations.

So, what are the local factors that drive differing levels of demand for these services?

In its role of protecting the public, the police often deal with incidents involving people experiencing distress and crisis related to mental health issues. These incidents vary significantly, but often involve verbal abuse, threatening behaviour, becoming a ‘missing’ person and acts of physical violence.  Clinical Commissioning Groups (CCGs) are responsible for providing funding for community mental health services at a local level and this means services look very different across England and Wales. Mental health triage schemes have been designed to interact with these services in the most effective and efficient way, which varies considerably across force areas.

Some forces are operating in areas where these services receive considerably less funding than the national average, and therefore individuals with mental health issues might not receive the support they require to prevent them reaching the point of mental health distress and crisis.

Lack of funding for local mental health services also leads to repeat demand, where the same individuals are seen continually by the police. This often leads to detainment in hospitals under Section 136, because of a lack of support and intervention at the community level post-police intervention. It’s important to bear this in mind while evaluating the impact of mental health triage initiatives on managing and reducing demand; the purpose of mental health street triage is to divert people in mental health distress to appropriate services (whether through Section 136 powers or otherwise) enabling provision of treatment that improves their mental health and decreases the likelihood of interaction with the police and criminal justice services going forward. However, without adequately funded and resourced community services, the potential for the triage initiatives to reduce demand on policing services and the presentation of individuals with mental health needs in the criminal justice system is significantly hindered.

Looking at the demographics of those interacting with police mental health triage initiatives, we found that whilst the national average suggests those in their 30s and 40s are most likely to present with mental health distress, in some areas, the younger demographic create much higher demand. This could be linked to lack of access to mental health services in particular localities, as well as cuts to local government funding impacting on social services’ ability to identify risk at an early stage and put safeguards in place.

The Guardian recently set out the stark challenges faced by the millennial generation in terms of poor home-ownership prospects and reliance on insecure zero hours employment. These issues provide many millennials with poor prospects for the future and are likely to be more pronounced in different areas of the country. Moreover, with these issues becoming more prevalent, the impact on policing may be an increase in demand from those with mental health issues.

Not investing in services to address early signs and symptoms of problems can lead to issues being passed on through generations within families and becoming entrenched. Exposure to drugs and intoxication at a young age requires interventions from local health care and social services in order to be addressed and prevent the development of mental ill health. If those services are not available in particular localities, then issues around intoxication often escalate and create further mental health demand.

The physical geography of a county is also relevant to the way in which the police experience mental health issues. While it doesn’t necessarily affect the volume of demand, it will certainly affect where demand is and how it might be addressed. It might also affect the ability of the police and other services to respond to emergent issues in the community while navigating larger rural areas. Moreover, the proximity of services that are available to people suffering with mental health distress can be a significant factor in the decision-making process for police officers and may impact the course of action taken.

From a wider perspective, the mental health demand experienced by police is linked to the issues around funding of local mental health services. Unless those services are resourced in a way that reduces instances of acute mental health distress and crisis, police are likely to experience sustained demand. Whilst Clinical Commissioning Groups work strategically to design and commission services to address mental health, police response officers on the ground are dealing with the immediate safety, vulnerability and risk of the individual in front of them. It is important therefore to bring both the strategic and the operational perspectives to the design and implementation of triage operations. Some triage models may be perceived to work more effectively than others, however this could be influenced by the efficacy and availability of mental health services in those areas.