Police contact deaths for those with poor mental health

The role played by the police in our wider mental health system has never been truly resolved. In both Australia and the United Kingdom, as across the world, discussion is at its most intense when considering police contact deaths involving those of us affected by our mental health. In this blog, Michael Brown explores the complex issues behind tragic outcomes and starts to think about how to embed “lessons learned” into policy.

Fatal police contact raises questions amongst others about: the legitimacy of the police; the state of mental health care; and the consent we give for officers use of force upon us when we have broken no laws. We do not have to look hard to find controversial examples where vulnerable people have been subject to lethal force, and we know police officers in both contexts have been convicted of manslaughter for their responses to vulnerable people.

New South Wales police (AU) and the Metropolitan Police (UK) have both commissioned reports in recent years to examine lessons after mental health police contact deaths (MH-PCDs). Other inquiries and research projects have examined similar questions, and Coroners in both jurisdictions have undertaken incident-specific inquiries.

Current academic and professional discourse includes discussion about how to remove the police from responses - as far as we can - and examines alternatives. For example, the National Justice Project in Australia is backing calls for alternatives to police responses, but deciding on alternative responses raises other complex questions including: situations where vulnerable people have had weapons and either represented a risk to the public or to healthcare and other professionals; or who might be best placed to respond instead.

LEARNING FROM PAST CASES

My PhD research on MH-PCDs in the UK has so far identified more than 200 incidents since 2000, which allow insight into the claims about “lessons learned”.

They cover the breadth of adversity including as a result of restraint (Michael Powell; James Herbert), failures to respond to vulnerable people at risk (Martin Waite; Sophie Cotton) and incidents within psychiatric units after threats towards healthcare professionals (Seni Lewis; Kingsley Burrell). In addition “lessons learned” have included cases involving fatal police shootings (Terry Smith, David Joyce), inadequate supervision of those detained in cells (Lloyd Butler, Martine Brandon), and wider issues in policing (Nigel Abbott; David Stacey).

We know of equivalent deaths in Australia (Jack Kokaua, Courtney Topic) and a very recent incident involving a man yet to be named in Western Australia where the police were called to Newman Hospital following a disturbance. There is a higher prevalence of fatal police shootings in Australian PCDs from officers who are routinely armed. We know from the 2017 inquest for Courtney Topic, the UK police would have been unlikely to deploy armed officers to such an incident – and these sorts of nuances add complexity and sensitivity to interpreting across contexts or trying to identify comparative “lessons learned” between the Australian and UK contexts.

“LESSONS LEARNED” SO FAR

It is common practice following an inquest to identify “lessons learned”. Families want to understand how things will change to avoid repetition of tragic incidents, and senior officers frequently promise it in press releases to move beyond the failures, omissions and errors. We do not understand the appetite to adopt “lessons learned” within complex systems and this needs further research and understanding. However, “lessons learned” are in and of themselves worth scrutinising.

In 2016, Deborah Coles, the Director of UK charity Inquest spoke at a national conference on policing and mental health in Oxford. After detailing many themes and similarities across deaths in a lifetime of work she said –

“The police are not just guilty of failing to learn lessons, but of repeatedly failing to learn repeated lessons.”

In my (UK) database of 208 MH-PCDs, just under 50% of them (103) have seen Coroners issue Preventing Future Death (PFD) reports, outlining specific “matters of concern” to be addressed to prevent loss of life (and seventeen inquests for more recent deaths are yet to conclude – we will likely see more PFDs).

These are a treasure trove of very hard-learned “lessons learned”, predicated on tragedy and many saying the same things for example: use of restraint was excessive and sat outside policy and training; under-responsiveness to life-threatening situations; strategic failures of senior police and healthcare professionals to agree; poor oversight of joint protocols about how to manage the gaps and the overlaps in responsibilities between professions; and failures to communicate within and between organisations.

There is also, however, a healthcare dimension that needs to be considered in parallel to get a rounded picture of the problems. Many PCDs identify engagement in healthcare contexts prior to someone ringing an emergency number for the police. Neglect findings for healthcare bodies are not uncommon (Leon Briggs; Sean Rigg) and often frame police actions in a way that requires acknowledgement of “lessons learned”.

POLICY CHANGE ON THE HORIZON

The National Justice Project call is for Australia to consider the “Right Care, Right Person” approach from the UK. RCRP creates a “threshold” for police involvement in mental health and calls received which fail to reach this threshold are directed to healthcare agencies.

There are two potential issues with this, however, and first amongst them is the fifteen inquests in the UK so far (and there are at least five more inquests pending), where RCRP is relevant either to the outcome or to the learning to be taken. If we think again of “lessons learned” we see RCRP patterns emerging – especially under-responsiveness or indifference to highlighted risks to life (Martin Waite; Sophie Cotton).

The second potential issue is the reality of whether healthcare agencies can actually fill that void as this has significant resource implications. We know the UK ambulance service has seen an upsurge in demand since RCRP, most of it for people a paramedic might struggle to help because the person doesn’t need an ambulance or acute medical care. They need mental health care.

My research is untangling the factors that drive PCD events, but also importantly looks at why such valuable, “lessons” are just not learned, something which subsequent copycat incidents make obvious.

In the end, what is exposed by Coroners in their outcomes and statutory notices – is that we ignore this detail at the peril of others and that this learning is a lost opportunity to make meaningful change.

Michael Brown OBE is PhD student at the University of Birmingham, researching mental health police contact deaths. He is a former police officer with significant policy and practice experience in mental health and the author of the “MentalHealthCop” blog. He is the only police officer to have been awarded the President’s Medal by the UK’s Royal College of Psychiatrists.

Contact: mtb639@student.bham.ac.uk