Amanda Keeling – Emergency Services as the ‘Safety Net’ in Mental Health

There is a programme running on Channel 4 at the moment called 999: What’s your emergency?   The programme follows calls through from when they are received at the call centre, to their resolution by one of the three (or a combination of all three) emergency services.  The programmes are themed around different issues, and this week’s episode focused on the use of 999 and the emergency services by people with mental health issues.

It was mentioned by several of the emergency services staff on the programme that they often felt that it was not really within their job description to attend to such issues related to mental health, and moreover that they were not the ‘right person’ for the job, and had neither the expertise or the training required to properly help the person who was asking for it, or needed it.  The programme itself showed that this was certainly the case in some situations, with police officers becoming increasingly frustrated with a ‘repeat caller’ who took overdoses ‘with no intention of killing himself’  (although, there were counters to this position, with a wonderful example of good practice from the paramedic who attended Alan Abbott when he relapsed into alcoholism and called 999 in fear of taking his own life).  Yet despite feeling that it was not strictly within their remit, and feeling inexperienced, they were concerned that there was no one else to do it.  They are, said one police constable, the ‘sticking plaster’ on society, trying to fill the gaps and provide one last safety net for people.

The police officers in particular clearly felt under equipped, under resourced, and lacking in the appropriate experience to perform the work that they felt was more within the brief of social services, but that there was simply no one else to do it and they did not feel they could just sit back and watch someone they perceived to be vulnerable harm themselves.  The programme only serves to highlight some of the issues the Chief Inspector of Prisons raised in his annual report published last week, concerning overuse of police cells as a place of safety under s.136 of the Mental Health Act.  Debate about section 136, and the appropriate place for people with a mental disorder found in a public place, has been on-going for many years, and concern over the excessive use of s. 136 in police stations is not new.  However, despite the academic research, and the opinions of officers themselves, use of the police force as a ‘stop gap’ does not seem to be diminishing.

It was suggested in the programme that the cause of the rise in this type of call to 999 was due to the diminishing number of psychiatric inpatient facilities, which is of course a deliberate scaling down with a view towards greater levels of community care, whether you believe the motivation for this to be an idealistic move towards community inclusion, or a more cynical cost cutting exercise.  However, reducing the inpatient facilities does not diminish the number of people with mental disorders who want or need help.  As one of the paramedics interviewed noted, the emergency services can provide short-term help – a police cell doubling as a place of safety, or a bed in A&E for the night – but this is no long-term solution.  One of the police constables noted that with the increasing cuts on the police force and their reducing numbers on the streets, there is going to be a growing need to define more clearly the parameters of ‘police work’, and they may have to start refusing to attend many of the types of incidents shown in the Channel 4 documentary.

This is not my particular area of expertise, but I was really struck by the issues this programme raised between the lines.  The police may not be the appropriate people to be dealing with mental health  issues, but the fact that they are doing so must raise the question ‘who should be?’.  As public sector cuts only look set to continue, we must start asking this question more pressingly, because if the emergency services ‘safety net’ is taken away, what will replace it?  I know there are those of you out there reading this blog for whom this is your area of research, and I would welcome discussion of the issue in the comments section below.

Amanda Keeling
PhD Student
School of Law, University of Nottingham

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