Approved mental health professionals (AMHPs) have voiced concerns about the impact on their safety of a national police policy of not attending most mental health incidents.
In some areas, AMHPs are attending mental health callouts in pairs because of a lack of police involvement, in the light of the introduction of the right care, right person (RCRP) policy, but this is not always possible due to staffing constraints.
More broadly, health and social care services are struggling to manage the increased demands placed on them from RCRP, introduced last year under an agreement signed by the government and health and policing leaders.
Those were among the findings of an evaluation of RCRP published by the Home Office and Department of Health and Social Care (DHSC) this week.
The study was based on an analysis of the policy's impact in a sample of police areas, alongside surveys of NHS integrated care boards (ICB) and local authorities and research with health and social care staff, carried out by the University of York and the King's Fund.
What is Right Care, Right Person?
Under RCRP, which was trialled in Humberside from 2021 onwards, police should only attend mental health-related incidents:- to investigate a crime that has occurred or is occurring; or
- to protect people when there is a real and immediate risk to life or of serious harm.
RCRP is designed to be implemented by local partnerships of the police, NHS and local authorities, in four phases:
- Health services no longer calling the police to make welfare checks related to a person's mental health, for example, when a person does not attend an appointment and they have significant concerns about them. Such checks should be carried out by mental health staff instead.
- Officers not being called when a person leaves a healthcare facility without completing treatment or someone sectioned under the Mental Health Act 1983 (MHA) goes absent without leave, unless they are deemed to be an immediate threat to themselves or others.
- The police not being asked to convey patients to health facilities, with ambulances doing this instead. This includes people detained under section 136 of the MHA, which empowers the police to take someone to (or keep them at) a place of safety if the person appears to have a mental disorder and needs immediate "care or control".
- Timely handovers of people detained under section 136 from the police to healthcare staff.
Health and social care struggling to meet additional demand
A Home Office analysis of the impact of RCRP on five police forces from 2022-24 found monthly savings in officer time of between 1,030 hours in the Northamptonshire force to 18,910 hours in the Metropolitan Police, due to reduced attendance at mental health incidents.
However, health and social care services were struggling to deal with the resulting increase in demand, found a DHSC survey of 34 of the 42 NHS integrated care boards (ICBs) and 35 of the 153 councils in England.
Sixty two per cent of ICBs and 40% of councils said they had faced barriers to implementation. For NHS respondents, the most significant barrier by far was cost and funding pressures, which was cited by 21 of the 34 ICBs. Meanwhile, for councils, the most significant obstacle was a lack of infrastructure to implement RCRP, which was cited by 10 of the 35 authorities.
The Home Office and DHSC found that health and social care services were struggling to take on tasks previously carried out by the police, in the context of rising demand for mental healthcare. Referrals for adults increased by 3.3% a year, and those for children by 11.7% a year, from 2016-24, according to the recent Darzi review of the NHS in England.
Demand set to rise
No additional funding was provided to the NHS or councils to implement RCRP, which the DHSC/Home Office report said "will make it difficult for health and social care services to meet the demand that was being dealt with by the police, prior to RCRP".
Looking to the future, most ICBs and councils expected to see greater demand on their services as a result of RCRP.
Eighty seven per cent of councils expected to see moderately or significantly increased demand for AMHP services, with 74% saying the same of other adult social care services and 80% of community mental health teams (CMHTs).
Most ICBs (85%) also expected to see increased demand for CMHTs, with all of them anticipating growth in the requirements on mental health crisis teams.
Lack of workforce capacity and capability
Similar themes were reported in the King's Fund and University of York report, which was based on interviews with 29 staff from across mental health, social care, ambulance, acute trust and voluntary sector services.
Participants said a lack of staff was a particular constraint on being able to respond to mental health incidents, including because of high vacancy levels.
Having staff with the right capabilities was also an issue for some services. This was particularly true of ambulance services, who were being increasingly called upon to deal with welfare issues, despite lacking the police's legal powers to gain entry to premises or detain people should this prove necessary.
Ambulance staff raised concerns about police not staying with patients when they transported them to a place of safety, since they did not have training in restraint or appropriate safety protection.
Reduced use of police powers to detain
Use of the police's power to remove a person to, or keep them at, a place of safety under section 136 of the MHA fell by 10% in 2023-24, which police chiefs linked to the implementation of RCRP.
AMHPs interviewed by the King's Fund and University of York said the implementation of RCRP was reducing police attendance for the purpose of using section 136 powers in their areas.
In some cases, AMHPs had resorted to making increased use of section 135 of the MHA in order to guarantee police attendance. This empowers a magistrate to issue a warrant, on the application of an AMHP, enabling a police officer to remove a person with a mental disorder from a private place to a place of safety for assessment.
Some interviewees said it was easier to organise a section 135 than risking a need for a section 136, because the requirement to attend at a defined time gave services an opportunity to plan and ensured the attendance of all required professionals.
AMHP safety concerns
However, AMHPs also voiced concerns for their safety when undertaking Mental Health Act assessments in the community without police involvement.
In some areas, AMHPs were attending callouts in pairs, but this was not always possible due to capacity constraints.
Areas were also struggling to reduce handover times from the police to healthcare staff when a person had been removed to a place of safety under section 136.
According to the DHSC and Home Office report, ICBs said this was down to factors including a lack of health-based places of safety to remove people to and insufficient trained staff to manage people in a crisis.
A 'police-led initiative'
The King's Fund and University of York researchers said they heard "several examples of good practice, with strong multi-sector partnership working and communication, enhanced by open and, if necessary, robust feedback".
Practitioners also welcomed the intent of RCRP to enable a more health and social care-focused response to mental health issues, said their report.
However, it added: "Our interviewees generally felt that there has been insufficient focus on the impact of RCRP on health and social care service users, staff and systems, with a perception that it is a police-led initiative, and reports of its impact focusing on efficiency gains for the police."
