In recent months, police and health services across London have been involved in what The Guardian described as a ‘behind-the-scenes row’, as Met Commissioner Mark Rowley has pushed for London police officers to stop attending mental health callouts, in an attempt to free-up police time and resources.
The discourse was sparked on the 24th May 2023 when Rowley sent a letter to the Met’s health and social care partners, informing them that police would stop attending mental health callouts from 31st August 2023, as part of the implementation of the Right Care, Right Person model (RCRP) in London. This left health partners just 99 days to prepare for an overhaul of the current system in order to cover this workload.
A month ago, The Guardian reported that, after tense talks between The Met and Health Partners, and with the Met taking legal advice, an agreement has been made that the deadline will be pushed back by 2 months to October 31st, and changes will be introduced in phases. In return, the Guardian reports, health partners will not publicly criticise the police’s decision and will rush to accommodate the change.
Inspire The Mind wanted to understand the impact that this sudden decision could have on those suffering a mental health crisis, as well as the knock-on effect on NHS services. For this two-part feature, we investigated the reporting on this issue, and we talked (or tried to talk) to multiple stakeholders on both sides of the debate.
Here is what we found.
Why do the Police Want to Stop Attending Mental Health Callouts?
Police forces feel that they have become the first port of call for mental health-related concerns, rather than a service of last resort. Police curren
tly respond to mental health callouts when a person in crisis, concerned friend or family member, or member of the public, call for help. They also complete welfare checks and look for vulnerable/ missing persons. In 2018, the Metropolitan Police reported receiving a mental health call once every 4 minutes, and it is currently estimated that London Met officers spend >10,000 hrs each month responding to mental health concerns, which they consider to be health-related matters.
A report in 2017 said that, in half of these cases, due to ambulance shortages, police end up transporting patients to a ‘place of safety’, usually A&E departments, for further assessment or care; however, mental health patients, and the police accompanying them, can experience extensive waiting time. Indeed, in London, police report that it takes on average 14.2 hours from police arriving with a patient to medical staff taking over their care.
As a result of this, figures from the recent National Police Chiefs Council (NPCC) Productivity Review showed that police officers are spending ~1 million hours per year with mental health patients in hospitals whilst waiting for them to be assessed.
One case, that occurred last year and was described by police as “unlawful”, demonstrates how police are having to deal with overflow from oversubscribed psychiatric services, as a child detained under the Mental Health Act stayed in a police station for 2 days due to a national lack of psychiatric beds.
Police have been arguing for years that they are not best equipped to attend mental health callouts, given the need of people in crises for expert support. Indeed, an extensive 2018 report titled ‘Policing and Mental Health: Picking Up The Pieces’ expressed “grave concerns” over the level of police involvement for both staff and patient welfare, stating that “other services need to stop relying on the 24/7 availability of the police”. Police argue that, “health services must take primacy for caring for the mentally ill”.
The Right Care, Right Person model (RCRP) Model: A New Approach to Mental Health Callouts
Following the Met’s initiative in London, on 26th July 2023 a National Partnership Agreement between police and health partners was reached, stating that the RCRP will be implemented across the UK, at the discretion of local forces.
Based on the RCRP, in the case of 999 calls for a mental health crisis, police will no longer attend if the threshold for police involvement is not met. Police will conti
nue to attend calls to investigate a crime that has occurred or is occurring, or when there is a real and immediate risk to life or of serious harm. In Humberside, in place of police, a new dedicated response vehicle with mental health staff on board has been attending calls and providing support, alongside other community-based mental health services. A similar Mental Health Joint Response vehicle service has been implemented in Manchester in 2022, and staff subsequently reported 1,260 A&E visit avoidances and 1,014 section 136 avoidances. This success has been attributed to the ability of the onboard mental health specialist to provide immediate support and referral to specialist services, thus minimising patient admittance to A&E departments. This immediate response is not something police are equipped to do.
From a policing perspective, Humberside force found RCRP to be successful, with an internal evaluation showing that more than 46,000 officer hours were saved between May 2020 and December 2022 as a result of RCRP.
How Will RCRP be Implemented in London?
Many mental health organisations reacted with alarm to the May announcement, and there was uncertainty in the news about the timing and extent of police ‘banning’ any involvement with mental health calls. We at ITM shared these concerns and wanted to put together the facts, understanding the perspectives of key stakeholders in this decision.
At the onset of our investigation, we wanted to speak directly with Met Police representatives to further understand the practicalities of how RCRP will be implemented. Following our request to speak with a representative, ITM received a press release, and further involvement was declined. Indeed, despite extensive efforts to reach out to police officers, superintendents, and the press office at the Met, we were unable to speak directly with anyone; police officers and 999 handlers we approached also declined to respond.
Reflecting the decision between Police and London Health partners to cooperate, the press release came in the form of a joint statement. The statement referred to the 31st October as the “first key milestone” for RCRP in London, when 999 handlers answering calls will receive a new prompt to determine if police attendance is required. The plans to implement RCRP, from a police perspective, have been meticulously laid out in the RCRP toolkit.
We found some description of how London Health Partners are preparing for this change, but it is unclear what were already existing plans to improve mental health services that have been fast-tracked, as opposed to new initiatives, and also how the workload will be taken over, by whom, and with what funding.
What we do know, is that the plan includes the national launch of NHS 111 First for Mental Health. This scheme (which has been shown to reduce A&E visits and overdoses, and save millions of pounds in Peterborough and Cambridge) provides people phoning 111 with a specific ‘mental health help’ option to provide support and ensure that people have access to the best care for them. Secondly, there will be an increase in “joint response cars” (which have been operating across London since 2018 and combine mental health professionals’ skills with paramedics’) to redirect the workload.
The government have also previously committed to investing at least £2.3 billion of additional funding a year, by March 2024, to expand and transform NHS mental health services and support an additional 2 million people per year. £7 million of this funding will go towards mental health ambulances and other schemes, such as improved crisis lines. Whether this will be sufficient to cover the changes required for the RCRP, is up for debate.
So, is there cause for concern? In Part 2 of this piece, published tomorrow, we will discuss the responses of different stakeholders to present you with a balanced overview of this significant change.
In the meantime, you can also:
Read the recent BMJ News article: https://www.bmj.com/content/382/bmj.p2208.long
Watch the recent Channel 4 News segment: https://www.channel4.com/news/inside-the-police-scheme-helping-people-get-mental-health-support