This week’s Panorama on the use of police custody in mental health emergencies painted a disturbing and distressing picture. It provided a graphic reminder of the risks of using police stations as “places of safety” under the Mental Health Act while illustrating the dilemmas police officers and mental health services face in being able to respond to the needs of people in a crisis.
During the programme, care services minister Norman Lamb described the picture it presented as a “national scandal” and it is hard to disagree. Despite the best efforts of both the police and mental health services, it is clear that, as a nation, our ability to respond to urgent care needs is inadequate.
Much effort is already being put into trying to resolve this situation. Spurred by previous reports of shortcomings in the system, the Home Office and Department of Health have already made clear their determination to see the NHS and police put better systems in place and to try out new approaches like street triage.
Separately, NHS England is now carrying out its own review of urgent care and the Department of Health is investing extra funding in A&E services. It is not, however, clear if these developments will be joined up and include the whole system of mental health crisis care. Yet this must now be regarded as a litmus test for parity between physical and mental health care.
While Panorama made clear that there are no easy solutions to the problems it laid bare, it was also plain to see that continued under-investment in mental health care is making it harder for anyone to improve the situation.
We also know some of the ways in which we could begin to do better. Completing the job of making a liaison and diversion service available, 24/7, to every police station in England is crucial. Recommended in the Bradley Report and committed to by the government, liaison and diversion can no longer be seen as an optional extra but a core role of all mental health services. Timely access to crisis resolution and home treatment services, appropriate places of safety and of course hospital places (or alternatives to admission) for adults and children are also key to building a whole system of mental health crisis care.
In general hospitals, meanwhile, there is growing evidence about the importance and the benefits of investing in liaison psychiatry services, again available 24/7, for people of all ages to ensure that those who seek help through A&E get effective mental health support alongside any physical health care they require.
Responding quickly, humanely and effectively to crises is fundamental to the mission of the NHS, and indeed of the police. Nobody can ignore the need to offer better care to people experiencing a mental health crisis: and not just the police and mental health services but general practice, ambulance services and A&E all need to be ready to respond.
Looking more broadly, while not all crises can be averted we need to keep focusing on prevention, early intervention and recovery: to ensure we are doing all we can to stop crises from happening at all and enable people with mental health problems to live without the fear that if they become unwell they will have nowhere safe to turn.