Episode 4 - A joint approach to mental health

Speaker 1

[Music] Welcome to Cambs Cops Our Stories, the podcast series that delves into the Unseen World of policing. In this episode we're joined by inspector Karl Secker who talks about the force's work to support those in Mental Health crisis through the use of a mental health car. Historically police were heavily reliant on the use of emergency powers through the Section 136 of mental health act to provide support to those in Mental Health crisis. Now, thanks to the force's mental health car, those in crisis are getting the expert care they need thanks to joint working with health colleagues. [Music]

Speaker 2

So first of all, hello Karl how are you doing?

 

Speaker 3

Good morning, I'm good thank you very much.

 

Speaker 2

Thanks for joining us today.

 

Speaker 3

Thanks for having me.

 

Speaker 2

First of all maybe you could just give us a bit of a background about why we set the project up, a bit about maybe how we were dealing with incidents of involving  mental health before the car?

 

Speaker 3

So the car was set up jointly between us and our NHS colleagues in mental health because it recognized both in their world and ours that we weren't maybe providing the best care or best practice approach to managing people in Mental Health crisis in a policing context. So that could be that maybe we were section 136 too many people or people that didn't actually require it but based on our risk assessment process that we weren't dealing with people and giving them the right response because we don't have medical training we're purely police officers there to basically prevent crime you know preserve life prevent crime and prevent damage to property. So there's coming together of you know people above and saying we need a joint response to this and the car has been used in other areas successfully and has reduced section 136 and given that best care to people and that's why we did. Policing is a is fast becoming a kind of not a joint role but there is more mental health issues that are coming into everyday work in when it was just purely concerns of personal stuff a while back, whereas now an element there's an element of mental health nearly every job we go to. It's not may not be purely it may be like a shoplift or something like that which has connotations or um links to mental health but so therefore our officers have to be better prepared better trained and have a better understanding to give provide the best care that we can do because it's we are going to do this we're gonna we're going to have to become better at it.

 

Speaker 2

Okay some people might ask kind of why police are involved in in incidence of mental health people maybe in Mental Health crisis in in the first place what would you say if it's primarily a health issue people may argue what would you say to that?

 

Speaker 3

Well as part of the police we're supposed to as I said preserve life prevent further injury you know prevent harm coming to property and prevent crime they're kind of the key things that we're supposed to do. People will reach out in a crisis to whoever they see fit, whoever they think is going to get the best care from and sometimes say ring 999 I'm going to kill myself or I've got a weapon I'm going to harm myself and it will naturally come to us because we can get there quicker and we can take the initial steps that then hand off to medical if they require. In terms of why, so the jobs that come in can be a concern for person which is where someone's called in and said I believe someone is causing harm to themselves or others or maybe some are ringing up because they're in crisis themselves and it gets diverted to us and then we are there as a blue light response team as in partnership with fire and ambulance to preserve life. The reason why it comes to us a lot is as I said because of the weapons involved sometimes or the fact that we have the necessary ability to be able to break into get entry or that we have the necessary powers to deal with it so there section 136 where we can take control of someone if they're in immediate danger or they or rather in immediate need control or care. So therefore sometimes we are the best agency to deal with that it's not always the case and this is why we work in partnership with ambulance NHS mental health CPFT crisis car that stuff to ensure they get the best care they can do. However, there is police are and it's been well documented both in and around Humberside police are almost stepping our toe into the mental health arena at the minute because we are being relied upon to maybe do more than what we should be because everyone is stretched. So, we are the last port of call for any sort of emergency call that comes in. So if there's a say that someone's gone to 999 the ambulance says no we can't get the 5 hours they're going to refer to us say can you get there quicker because this person is in crisis but we don't have the capability or ability to get there at this time.

 

Speaker 2

Okay and can you tell us a bit about this new project and the idea behind it, kind of how it works?

 

Speaker 3

So we have a mental health nurse who comes in uh and works with our blue light responders on front line. At the minute they're only on late turns and they come in, they then partner up with some of our PCs and it's not just one or two, it's we're trying to get the knowledge all around the team so trying to rotate as best possible. And they come in and basically go to the concerns the jobs that are tagged for mental health or it could be just that if it's a misper that we need someone to go, a missing from home person, that needs that slight bit of extra care or someone that's not in uniform because sometimes the uniform is a barrier to people opening up to us and telling us what help they need and how we can get it. So it was created to basically reduce the number of people of that being section 136 so taken into police care and then taken to the mental, to the crisis sort of Care Centre the 136 Suite in Fulbourn or to another place of safety, then being assessed and then maybe being released which is what was happening quite a lot because we were dealing with people of more behavioural rather than mental health issue. So the mental health nurse is there to primarily provide the best care we can try and reduce the number of 136s that are that are occurring, but provide that immediate best practice approach to that person. They've also got access to things like the mental health records, they have a better understanding of care plans and future planning and also they have a better decision-making ability around things like future planning and so if someone says to me as a police officer I'm going to kill myself alarm bells right what do we need to do to help them and stop them prevent them doing that. Now the mental health nurse comes through from a different angle where it's saying things like well okay so what are you doing tomorrow or can we see tomorrow, yeah yeah that’s fine and then it's a future plan and to them that's concrete enough to them to say right we can leave you you're happy are you safe now, can we leave you now and it's fine. Whereas police, because of our lack of experience and training in this sort of area, we're a lot more risk averse to this sort of thing, so it's having that professional there to one confirm our thinking two provide that almost safety blanket in three provide the best care to the person in front of us.

 

Speaker 2

Fantastic

 

Speaker 3

Does that answer your question?

 

Speaker 2

Yeah more than, um now you've kind of touched on a bit already really but  what do you see the real benefits are for? I mean there's three groups really here I suppose it's the person in crisis, it's police, and then it's the NHS as well, what the benefits do you think for this project?

 

Speaker 3

I'd probably add the community to that as well.

 

Speaker 2

Community okay that's fine that's four!

 

Speaker 3

Um so the person the person they're going to be in crisis, they're going they're going to be reaching out it could be that they are absolutely at the last point of their life of like I'm going to kill myself I need someone to help me through this or maybe that they're going through a difficult process or mental health issue and they just they could they're asking for help. And police, we're not trained to deal with it so therefore we're with the nurses providing that best care with the ability to search for the records and understand that person better than we ever will be able to. We also have nurses in our control room which called the IMHT nurses who are able to access different areas as well provide that nurse with information on the ground that they can then deal with it, maybe that for instance and this is really sort of hypothetical person's mother died recently but died due to an overdose or car crash it maybe that on the care plan, it says don't put them into a back at van because of ABCDE. The nurse then can provide that information to help us better provide care for that person also the nurse is better at uh deciding what care plan we need to go down so it could be that we would then instantly go I think they're going to kill themselves they need immediate control or care to prevent harm to themselves or others I'm going to put hands them going to 136 them. Whereas the nurse could say right well actually I'm not as concerned about what they're doing now they're not showing any behaviours that that may cause this or maybe are concerning to me so maybe we need to put a referral into The Crisis Care Unit or to First Response and say right tomorrow we're going to call you or someone can call you in the next four hours from the First Response Team and then we can go along with that and it's about providing the almost the a round peg for a round hole instead of police coming there using the only tool that we really have an understanding of and that we should only really have understanding of. It provides a sounding board and a learning opportunity from the mental health nurse so people are working with them and some of the feedback I've had is that the police finding it easier to work with the person in front of them, to make decisions based on what they've being presented with and decide on care plans and know who to go to when the mental health nurses are on. So like 136 detentions are reducing because people are becoming more understanding and knowledgeable about the powers that we have the reason why they're there. Also as part of the police is that that it upskills them, but it also gives them more confidence it allows people to have a better understanding of what when someone's in crisis, when someone hasn't got mental capacity, what ambulance should be doing, what the mental health team should be doing, what we should be doing, and then so they're a better more rounded person in terms of police officer. Then also it enables other people to deal with blue light jobs and you know article 2 you know death serious injury jobs instead of being at Edith Cavell or um PCH or Addenbrooke's for four five six hours looking after this person when a mental health nurse could just made a care plan about seeing them tomorrow. Everything comes at a cost and every time the police use the our powers under 136 to detain someone, it cost the NHS time money management people all that sort stuff when we take them to the 136 week and especially if we take them to the place of safety like the emergency departments in Hinchingbrooke or PCH. So one of the main things is that we they're not getting the 136s now which they used to which is someone's assessed, they're regularly there because of the mental health issues that they have and they're released three or four hours later or six hours later depending if they alcohol dependent. That 136 or the ED Suite that they've got is been taken up when someone else requires it. And is it all comes at cost so the NHS the mental health teams that create this are putting money into prevent rather than the cure, so if we can prevent these 136s before they occur, one some someone's getting better help in the community or in the house where they're safer, and two we're not then taking up the 136 because, we only have one 136 Suite in the county, it's not being taken up with someone who doesn't necessarily need it through the choice of a police officer. It's, as I say, it's kind of links into the policing and the NHS one is that there are more officers and more nurses now that are able to be dealing with the people that are most vulnerable and most need the most help. Because if you pick up that phone, you'll say I need someone someone's at my door with a machete and you want someone there as quickly as possible and you want the best trained officer to deal with that. But however there is always a balancing act of demand versus you know resources that we have in policing we have to manage that and it's sometimes it's a real sort of tight rope of demand you know of balancing that we have. And this having the mental health car it's shown at the minute that like 1 hour of this mental health car saves around two to two and a half hours of police time and saves I think well several hundred 136s so far over the past sort of year or so that's been working so it's saving both time effort and resource that can be better used in the community to you know manage these high-risk calls or manage these high-risk persons rather than dealing with something that could be dealt with quite easily on the night. So it's the community getting a better service they should have more trust and confidence in what we're dealing because we've better resources for it but I just don't think they know about it. There have been occasions when there have been mental health nurse because they have mental health nurse on the back of the  jumpers and on the coats and that sort of stuff where people said oh that's fantastic you got them out they why haven't you done this before? So the word starts to get out and it's been on Look East and that stuff so people starting to understand it and know it.

 

Speaker 2

Just briefly are there any kind of actual examples you can that you can think of that might demonstrate the work that's happened? I mean obviously there's dozens really but is there anything that particularly springs to mind that might demonstrate?

 

Speaker 3

So there's a few so the there's several examples but a couple of key ones. Like um where a person may be on a bridge, there's a couple where there's been people over on bridges over like the A1 or the A14 in Cambridgeshire where we may have got hands on and stopped them and been 136s person when we didn't need to when the mental health nurse come and said oh I know you, right what's going on, what's your problem, right we can work through that, oh it's a bill, it's this, it’s that, right come off the bridge and do and we haven't had to put cops or anyone in danger because the mental health nurse has dealt with that. Or a key one was in Peterborough recently was a female who was in crisis at home and the police didn't really know how to manage it, what to do because every avenue we went down the mental capacity, she was proved to have capacity by ambulance, went down the 136 route but we couldn't 136 the person because she was in her house and we can't do that. Right so what else can we do and the mental health nurse was able to come in and say right we need to make her safe tonight we need to ensure that there's one to one work with her care workers and then this is the person and then was able to categorically say to her you are going to be talking to this person tomorrow at this time around this are you happy with that, yes, the mental health was able the mental health nurse was able to make a clear decision around we have gone through every legislative and every best practice possibility here around dealing with this person, this lady. There is nothing else we can do but 136 and the police had seen the process, had heard the questions, knew them, knew everything, and were like fantastic, and although that was a long incident that they dealt with, it was proof that incidents change as you as time goes on and we had the correct tools to deal with that and the police then made a correct 136 detention which she was then detained and taken away and you know it wasn't forceful or anything but it's like right we're on 136 you you're now under our care, here's an ambulance can you go in the ambulance, someone's going to go with you, then they go to the 136 suite and it was correct, and that person got the correct care they needed. But without the mental health nurse there it could have gone very wrong because the police don't, force may have been used or you know when it wasn't needed or incorrect terminology or stuff it could have escalated to them getting hurt or the police getting hurt or the care givers have to come in care providers have to come in and help with you know preventing them harming herself whatever but because we had the right the mental health nurse with the right understanding it wasn't and the right the correct calls made in the end.

 

Speaker 2

Okay that's really interesting to hear those actual you know examples and as you say there are dozens dozens more since the car's been in operation and in a moment we're going to show some footage of going kind of out and with the officers and the mental health nurses and get some um kind of information them we're going to speak to them so that'll be that'll be great and before we do that though is there anything else you want to add in relation to the project or the scheme?

 

Speaker 3

I've got I've got a dream of this moving forward and how it's going to develop and that we have cops that are almost they apply to come on the car so they although now we're trying to build a sort of a knowledge base up around all of the response ideally in the future I'd like to um investigate whether it's worth having specific cops that apply and get on it and then have extra training in mental health and go on  like the Mental Health First Aid course could then work with the nurses long more long term and then  manage sort of what we would class as people that need that extra level of care or that may provide a bit more demand on us or provide the demand on us and need it but need that policing and in sort  of engagement to try and prevent them coming into crisis. So therefore I want it to go long term I want to work with our partners and Carolyn Leddy in in CPFT have been fantastic and I really I see it as almost becoming a department in itself, and working with the ambulance car it's just I think you know 10% of our jobs are specifically around mental health concerns someone is going to hurt themselves or harm someone else because this. But there's a while back I did a study around it was around 47% of jobs had some form of mental health qualifier in terms of a person that was involved in it may not be a mental health job as I said earlier like shoplifting all that sort  of stuff had I've had mental health issues in the past and people may not know that and it's  the it's the knowledge that we need to build to better deal with those jobs as well. And so if you think 10% of our jobs are purely mental health, we therefore need the, how would you say, the knowledge understanding and the expertise to deal with it because these are people's lives and we need to make sure that we're providing the best care that we can. It's the jobs aren't going away so therefore we need to change and get better at dealing with them and that's what I think.

 

Speaker 2

Fantastic yeah, I mean obviously this is a fantastic project a fantastic start to it but it's really interesting to hear how it could just be the start and now that could develop and how we can continue to learn and continue to provide a better service for the public so thank you so much for your time today Karl, really appreciate you 

coming and speaking to us.

 

Speaker 1

Thank you for listening to Cambs Cops our stories. If you or someone you know has been affected by the issues raised in this episode help and support is available for more information visit the force's website www.cambs.police.uk

 

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