In Part 1 of this series we discussed what the RCRP is and why the Met police are implementing it in London. Today, in Part 2, we will look at the responses of different stakeholders to this decision.
Despite the recent public cooperation between health partners and The Met, there are still great concerns that implementing RCRP by October 31st, 2023, will have negative consequences.
ITM talked first to Dinesh Bhugra CBE, professor at KCL, honorary consultant psychiatrist at South London and Maudsley (SLaM) NHS Foundation Trust and former president of the Royal College of Psychiatrists. Professor Bhugra responded by saying: “It is really disappointing that the Police have come to this decision”. He emphasised that not all patients require police involvement but that a “blanket ban” could put both staff and patients’ safety at risk in the rare cases where police support is needed. Furthermore, he eluded to the potential wider implications, stating: “Such an exclusion is also likely to increase stigma against mental illnesses and patients and families who are suffering”.
ITM also spoke with mental health and anti-racism campaigner and expert by lived experience, António Ferreira, who actively collaborates with The Government and Police forces to strengthen legislation, guidance, and training around policing within a mental health crisis. He is concerned that police call responders and officers require further training to be able to accurately “flag the matter as mental health related”, and that more “lived experience input remains the most critical change”. Lived experience input is particularly important to influence the police’s perception of people with mental health problems, which is coloured by the fact that they only meet them “when their symptoms are at their most severe”. Echoing Professor Bhugra’s concerns about increased stigma, Antonio highlighted research showing that the stigma levels of emergency services professionals are already significantly higher than that of the general public.
Dr Lade Smith CBE, president of the Royal College of Psychiatrists, responded to ITM by pointing to a statement online saying that, “for this agreement to be a positive step for patients” there is a need for “police and mental health services” to “come together in the spirit of collaboration”. Dr Smith highlighted the need for a “realistic timescales and planning” as well as “additional Government funding” to safely implement RCRP in London, and that this decision “should not be taken as a green light for a unilateral discontinuation of police presence in mental health emergencies”. Finally, she also worried that the consequences of RCRP for patients is unknown, as it has only been trialled in one region (Humberside) with “no evaluation of clinical outcomes or benefits and harms to the local population”.
This resonates with a comment from Kirsten Bingham, a mental health team leader at Humber Teaching NHS Foundation Trust. In a recent Channel 4 News segment, Kirsten said that it needs to be understood nationally that the implementation of RCRP in Humberside “isn’t something that has happened over night, it’s not been 3 months, 6 months, it’s been a journey of years and it’s been about phases.”
Indeed, The BMJ (The British Medical Journal) reported last month that, while giving evidence to the House of Commons health select committee on Tuesday 19th September, Dr Sarah Hughes, Chief Executive of Mind, warned that in some areas funding had been withdrawn and referred to a “postcode lottery” developing in terms of crisis response, with not everyone having the same planning in place as in Humberside. Responding to the initial announcement, she had previously said that “The way this decision has been framed is deeply worrying and sends completely the wrong message to the public and to local police forces (...) at the heart of any decision like this should be the people that the police serve, not the potential hours of work saved.”
Rachel Kelly, mental health speaker, author, and ambassador for SANE, also responded to ITM, saying that she recognises the “frustration of the police in substituting for mental health services”, while describing police as a “safety net” for people in crisis. “I fear for the many individuals and families for whom the police are the only people to respond when they feel they are reaching crisis point”, she added. Kelly also stated that many “distressed callers” contacting SANE struggle to get a response from NHS crisis lines and that without police these people “may have nowhere to turn for help”.
On the other hand, many have argued that without a firm deadline such a change would have taken years to implement. One health source spoke to The Guardian saying: “it is not malice, but the NHS is notoriously slow. If he [Rowley] did not give a deadline, we would have been here for 10 years.”
Dr A, a medic that ITM spoke with (but who wished to remain anonymous), voiced a similar opinion, saying that “the police are standing up for themselves”, and that, having worked in the NHS, only “a metaphorical knife hanging over its head” seems to get any real progress done. While Dr A is hopeful that this will lead to “better mental health care provision in the long term”, he said that “if their solution is to work, it will require an almost overhaul of the current system.” Disappointingly, other junior doctors we approached for this piece were either unaware of the changes or did not know how these changes would be affecting the medical field.
David Bradley, Chief Executive of SLaM NHS Foundation Trust, in a recent NHS blog indicated that misinformation may be misleading people. “Some recent media coverage has suggested RCRP will mean the police will no longer attend any health incidents. This is not the case.” He reiterated the central role of the threshold for police involvement in the RCRP model saying that when the threshold for police involvement is met, police will attend. As discussed in Part 1 of this piece, this is: 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.
However, Christina Cheney, a national lead in Adult Social Care Mental Health, expressed, in the aforementioned Channel 4 News segment, the concern that blanket refusals from the police to attend mental health callouts are happening: “We are hearing anecdotal reports from our members that there are already forces that either aren’t implementing or are part way through implementing, (and that) officers on the street and call handlers are saying the words “we don’t do mental health anymore“.
The Bottom Line
In response to the initial criticisms, Met Commissioner, Rowley, has maintained that allowing the “status quo to remain” ensures “we are collectively failing patients and are not setting officers up to succeed”. “My urgency”, he adds, “does not speak to a lack of compassion for those in mental health crisis, quite the opposite.”
Undeniably, such system-wide change will require significant funding and resources. Reassuringly, the “London Mental Health Crisis Care Concordat” presents the framework of how such changes will occur, including the establishment of the NHS 111 number for mental health and an increase in mental health joint response cars. However, whether sufficient resources and staff are available to deliver these new services does not seem clear.
As an academic-based magazine, ITM shares Dr Smith’s concerns that research on the clinical outcomes and on societal benefits and harms following such profound changes has not been conducted. Saving police hours or even A&E visits does not necessarily translate into better mental health in the community.
Yet, if these changes do work, they could benefit not only the police but also the community of people with mental health problems. Early access to trained mental health staff at the initial engagement and assessment phases could prevent unnecessary use of the Mental Health Act or of places of safety, as we discussed in Part 1 of this blog.
The devil will be, as usual, in the details: will the police be always able to assess if a mental health callout meets their threshold for attendance? And will this threshold, and the training required, be implemented consistently across all boroughs of London, or indeed nationally?
A continuous monitoring of the situation on the ground, especially early on in the implementation next month, will be the only way to discern if the public should be alarmed or reassured.