As long ago as 1780, John Howard noted that prisons were housing more “idiots and lunatics” and emphasised the detrimental effects that this had on the prison regime for both sets of prisoners.
But while there is now a significant body of academic research on prisons and mental health, the role of the police is often overlooked.
Deaths and police contact
The Independent Police Complaints Commission’s (IPCC’s) annual report into deaths after or during police contact highlights once again that mental health issues increase the risks that vulnerable people face while in custody.
Dame Anne Owers, Chair of the IPCC, introduced the report by saying:
The police are often called in to deal with acutely mentally ill people, who may be a danger to themselves or others or who may be behaving in a disturbing or strange way. It is clearly important that they are better trained in mental health awareness. But these figures also point to gaps and failings in the services that ought to support those with mental illness - before, instead of and after contact with the criminal justice system.
The number of deaths in police custody has thankfully fallen. But the report notes that almost half of those who died in custody either had a history of mental illness, or had others raise concerns about their mental health while in custody.
It is not just these figures that need to be examined. The report also found a rise in the number of apparent suicides in the two days following release from police custody; 64 individuals took their own lives in 2012-13 under such circumstances. Over two thirds of this group had some history of mental illness, including seven who been detained under the Mental Health Act.
These concerns raised add to those raised in the 2009 Bradley Review about the treatment of people with mental health problems across the criminal justice system.
The role of the police
The Sainsbury Centre’s 2008 study suggested that up to 15% of incidents dealt with by the police include some sort of mental health concern. They may well be the first emergency service contacted by the relatives of those in acute distress because they are putting themselves or others at risk, for example. If a person is acutely distressed in public, the likelihood of some form of police involvement increases significantly.
MIND, the mental health charity, has highlighted the negative impact of police involvement from the perspective of those using mental health services. We need to divert individuals with mental health problems from courts and jails into appropriate care on a consistent basis.
Policemen and women are vital to this process and the custody suite a key place for intervention. But at the moment, police are being forced into a complex and demanding role in mental health services that their training does not prepare them for.
Amendments to the Police and Criminal Evidence Act in 2004 gave key safeguards for the protection of vulnerable adults while in police custody - including those with mental health problems or learning disabilities. We should remember that the state has a legal and moral duty to ensure the safety of all those it detains for whatever reason.
The Guidance on the Safer Detention and Handling of Persons in Police Custody provides some advice on ensuring the safety of those with mental health problems. But the guidance is not comprehensive, and its success depends on police officers making appropriate assessments of individuals’ mental health needs.
My research has found that police officers are frustrated that they receive relatively little specific mental health training, but are called upon to deal with individuals experiencing acute distress. The current pressures on community mental health and A&E services mean that there will always be cases where people who should be receiving care will be in police custody.
More needs to be done to ensure that the time these people spend in custody is minimised. And police need to be better prepared for when the task of looking after civilians with mental health problems falls to them.