Mental health & policing

Penny Price, Frank Bruno & Lisa Hale

by guest authors Penny Price & Lisa Hale 

Penny is the Service Manager for Adult Mental Health Services in South Powys. In late September 2018 she and Lisa Hale, manager of Felindre Ward, the inpatient mental health ward at Bronllys Hospital, attended the third national conference on mental health and policing in Cardiff. The annual conference is jointly organised by The National Police Chiefs' Council, The College of Policing, and The Association of Police & Crime Commissioners.

The theme this year was “demand-data-diversity” as these were felt to be the challenges that mental health services would face in the coming years.

Demand:

It is recognised that the demand for policing services is on the increase rapidly where mental health is concerned. The police have raised concerns about responding to people experiencing a mental health crisis which could leave vulnerable people stigmatised and criminalised. They are attempting to ensure that the police services are not inappropriately and over-used as part of the wider mental health systems.

Data:

It is recognised that the day-to-day challenges of the police force are spent finding beds, places of safety and matters relating to patients AWOL (absent without leave) from inpatient services. The current IT systems are not built to harvest this information – they need to find ways of understanding the various kinds of demands being faced.

Diversity:

Those of us from diverse backgrounds are more likely to live with mental health problems because of issues relating to race, sexuality or other protected characteristics. Racial inequality in the application of the Mental Health Act (1983) was one of the main reasons the Prime Minister recommended changes to the Act itself. 

Highlights, day 1

Frank Bruno MBE

In 2003 Frank was diagnosed with bipolar. His well-documented profile put Frank in the public eye, and he used the media attention to help raise the standards of care and to reduce the stigma attached to those living with a mental illness.

In this Q&A session Frank spoke of his experience being detained under the MHA on 3 occasions. He believed the number of officers called to attend was excessive, and felt embarrassed when they turned up at his house with sirens blazing and neighbours’ curtains twitching.

Frank recalls the MHA assessment and feels that he was listened to more by the police than the doctors undertaking the assessment. Once detained and moved to the inpatient unit, Frank felt that he was not listened to and felt over-medicated on medication he felt he did not need. Frank felt that there was a need to improve communication by just spending time with people and talking.

Frank has now been free from all medication for the past 3 years and says that his only medication is attending the gym daily and having a steamer.

Mair Elliot

Mair is a 21 year old inspirational young woman from West Wales. She is a mental health and autism campaigner throughout Wales. Mair described herself as a young patient activist and spoke openly about her experience and the challenges of growing up as a child living with autism and mental illness.

Mair spoke of her disappointment with access to Child & Adolescent Mental Health Services (CAMHS) and found herself spending many nights in A&E in order to receive the support she and her family needed. On one occasion the police were called due to Mair experiencing a mental health crisis and they conveyed her to the local mental health hospital. Mair asked the police officers if she could stay in the police car rather than go on to the unit. Again, this was due to poor communication between staff and service users.

Neil Laybourn & Jonny Benjamin

Jonny Benjamin was a 20 year old man suffering with suicidal thoughts and poor mental health. He was admitted to a mental health unit and whilst there decided he was going to end his life the following day. Jonny asked to go outside for cigarette, left the hospital grounds and proceeded to Waterloo Bridge, where he sat on the edge contemplating jumping into the river.

Jonny's original #findmike flyer from 2014

Neil Laybourn – a passer-by on his way to work – noticed Jonny and stopped to talk to him. Neil spent 25 minutes talking to Jonny – reassuring him that life can get better. Neil asked Jonny to go for a coffee out of the cold and away from the bridge. Jonny agreed. However, as Jonny came from the bridge – the police attended with sirens blazing and Jonny was arrested, handcuffed and put in the back of the police car.

Jonny reports that the police contacted the inpatient unit and the staff on the unit were unaware that Jonny had been off the ward. He was returned to the unit – detained under MHA, and remained in the unit for the following 3 weeks.

6 years later – Jonny campaigned alongside Rethink the mental health charity to find the stranger on the bridge using the hashtag #findmike. Jonny had no idea who Mike was – it was just a name that came to him. The story went nationwide, with over 38 people coming forward claiming to be Mike, and saying that they had stopped someone from jumping off Waterloo Bridge in January 2008.

Since Jonny and Neil were reunited in 2014, they have campaigned together around suicide prevention and adverse mental health. Their campaign looks #beyondshamebeyondstigma.

Cambridgeshire first response crisis mental health service model

In Cambridgeshire people experiencing a mental health crisis can call NHS 111 Option 2 to seek support. This innovative model is totally reliant on strong and effective partnership, involving NHS services, the Third Sector (MIND) and the police. It is proven that this system reduces demand whilst aiming to provide the right care, at the right time, from the right agency.

The First Response Service in Cambridge provides assessment and support to people in mental health crisis out-of-hours. Working with existing teams, the team focuses on responding to urgent referrals from both the emergency services and NHS 111 Option 2. The team has clinical space based with GPs’ out-of-hours services to ensure co-ordination of care.

The dedicated phone line is staffed by a system-wide coordinator who triages the calls. 

Highlights, day 2: 

The value of joint working and early intervention – mental health emergency care

Yorkshire Ambulance Service has started a journey to make a difference in developing a quality approach for mental health patients. They are doing this by evaluating and measuring front line interventions that support mental health front-facing care.

A team of mental health nurses/practitioners is based in the ambulance crew control room where they triage emergencies. They class this as a single point of access. The mental health practitioner then follows up on the call and actions appropriately.

For example – a 25 year old woman contacted 999, requesting an ambulance due to experiencing suicidal thoughts. The call was triaged to the mental health practitioners who spoke to the woman and completed an initial assessment.

It became clear that there was no requirement for a blue light service as she was not in immediate danger. The mental health practitioner was able to gather information, give advice and have access to the person’s mental health notes. A taxi was then sent to collect the woman so that she was able to attend for assessment by the team.

This approach is successful in reducing unnecessary conveyance, avoidable 136 sections, and associated transport delays.

Improving care, reducing demand

Inspector Huw Griffiths, Mental Health Lead with Hampshire Constabulary, talked about the team he leads. This consists of three police officers who are embedded in the NHS mental health teams.

“Over policing is as bad as over caring, “ is a quote carried forward from the previous year’s conference. Nationally the police service is still seen as the default mental health emergency service in many areas and the first point of call for many people in crisis. Huw’s team has spent the past 5 years trying to change that, ensuring that through partnership working the police do not attempt to carry out the highly skilled role of another agency. This has led to locally to a 45% drop in police mental health deployments along with other areas of significant demand reduction.

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We both found the conference an excellent learning opportunity. We were able to see the point of view from different services of what it is like dealing with mental health crisis. We heard the opinions of the police on mental health services and the impact dealing with crisis has on a workforce that is not equipped to deal with the complexity of cases. It was so interesting to listen to the personal accounts of their involvement with services during a crisis.

The service users’ and relatives’ accounts of their experiences were the most powerful, however. And, finally, the discussion forums we attended inspired us to look at our own service to see how we can make improvements.

Community Connectors working with Dyfed Powys Police

R - L: PCSO Daryl McWatt, Community Connector Suzanne Iuppa,
 Mental Health Information Officer Jackie Newey, PCSO Geraldine Jones

Llanidloes is a small market town in Montgomeryshire, North Powys. What appear to be thriving voluntary sector groups provide activities for all ages and interests. Friendly faces greet you on the streets and in pubs and cafes. There is a revitalised Saturday market. It is a hub for people living in outlying villages and on even remoter hill farms. Not a place you would regularly associate with law enforcement! But, the local police are busy. Finding out more about their day-to-day work helps throw a light on some of the social problems and issues facing small rural communities in Mid Wales.

In May during Mental Health Awareness Week I met up with Suzanne Iuppa, PAVO’s Community Connector for Llanidloes and District, and two local police community support officers (PCSOs) – Geraldine Jones and Daryl Mcwatt. We wanted to promote sources of information and support around mental health, and decided to base ourselves in the popular Coffee Bean café in the town. At the same time, we also caught up ourselves on some of the recurring themes affecting people locally who are struggling to cope - for whatever reason.

Police working with Community Connectors

If Geraldine or Daryl meet someone who needs support they contact Suzanne and she meets them at Llanidloes Police Station – “she’s in before we know it!” They will have already gained the consent of the individual involved to pass over details. The Community Connectors (a Powys-wide team) help people (18+) and their families or carers, “to access community-level services and activities that will help them maintain independent lives and which help prevent their circumstances deteriorating to a point where they might need higher level health or social care services.”

Suzanne receives referrals from various agencies as well as families and people can also self-refer for support from a Community Connector. At the time we met she had ten clients on her caseload, having closed eight earlier in the week. “The numbers are usually sitting at around twenty. There is always a mix of different cases.”

The PCSOs and Suzanne have made joint visits in the past – “people OK it first.” Then it is up to the individual involved whether they take up offers of support or links with the wider community. “Some people are very isolated and lonely. It is quite sad.” 

Signposting to voluntary sector services

Suzanne liaises closely with staff at the mental health charity Ponthafren Association (there is a weekly outreach session in the town) to support some of her clients. People seeking talking therapies might face a long wait for statutory counselling sessions and even a few weeks to link up with a counsellor at Ponthafren. However, Suzanne explained, if they have a specific condition such as multiple sclerosis that is affecting their emotional wellbeing, she can then call in a specialist service. This works well as often the client does not have to wait. 

Loneliness and isolation in older life

In the Dyfed Powys Police Strategic Equality Plan 2016 – 2020 it states that additional support and collaborative working is vital in order to ensure that the necessary support is provided to “elderly service users”. Older residents are much more likely to be victims of telephone scamming and other crimes and may not be regular users of social media where frequent alerts are posted about such crime.

One of the planned actions in the Equality Plan is to “raise awareness of the ‘ageing population’ and the impact on individuals, families, carers, communities and the increased demand on public services.” So it was no surprise to find Daryl and Geraldine promoting Powys County Council’s Llanidloes pilot Home Support Scheme.

This scheme aims to “provide support and practical assistance an individual may need in their day-to-day life to stay living at home, safely and independently.” As well as offering practical support such as shopping and assistance with prescriptions, the service can help with emotional support, including accessing local community groups and supportive networks. It’s a free scheme, but people need to sign up as a member in order to be able to access support. There are also pilots running in Llandrindod Wells and East Radnor, and a long-running successful Rhayader operation.

The Llanidloes PCSOs and Suzanne recalled instances of how the Home Support scheme had recently supported people, some with physical impairments who use mobility aids, and others struggling with emotional wellbeing and agoraphobia. 

Other issues that came up - in brief

Neighbour disputes – as in all parts of the UK neighbourhood disputes are fairly common in Powys, and the police work with individuals concerned to try and resolve issues. Suzanne’s involvement includes finding distraction activities for people caught up in the disputes and ways to boost their emotional wellbeing.

Hoarding disorder – updates were exchanged so that all were aware that whilst Powys County Council provide a deep cleaning service some people are now being offered Cognitive Behavioural Therapy (CBT) to address the underlying issue.

Domestic abuse – Suzanne has referred clients to Montgomeryshire Family Crisis Centre and the churches locally. The police are also sometimes involved in these cases.

Cultural differences and language barriers – we all agreed how hard it can be to try and find speakers of foreign languages such as Bulgarian and Croatian to provide interpretation when working with some clients.

Dementia – Llanidloes is working towards becoming a dementia friendly community – volunteers meet regularly to move this forward as has happened in other parts of Powys. The police and Community Connectors also receive dementia friendly training through the Dementia Friends’ scheme.

Missing people – individuals may end up in Powys after going missing from a community many miles away where the culture and way of life is very different. Adapting to life in a rural area can be difficult.

And with that it was time for Daryl and Geraldine to return to patrolling the streets of Llanidloes. 

Suzanne, Daryl and Geraldine plan to meet up more regularly in community spaces in Llanidloes so that local people can easily get in touch and voice any concerns they have, or find out more about support services that are in place for them, their family and friends. We at the PAVO mental health team hope to join them on occasion too. If you would like to find out more you can contact Suzanne by emailing: community.connectors@pavo.org.uk or ring 01597 828649.

From Bermuda to Powys - Problem Oriented Policing

A couple of weeks ago I attended a training event at Dyfed Powys Police HQ in Carmarthen with Penny Price (Service Manager for Adult Mental Health Services in South Powys) and Lisa Hale (Acting Ward Manager, Felindre Ward, Bronllys Hospital). We were there to hear Criminologist Sylvia Chenery (right) speak about Problem Oriented Policing (POP).

“Problem Oriented Policing (POP) has a history of looking at those long term problems; those ‘it’s been there for years...nothing we can do about it’ occurrences. The best strategy for solving a problem depends largely on understanding the situation, learning everything you can about why it’s happening and then using factual knowledge, and sometimes creative use of partners to come up with effective, longer term solutions.” Sylvia Chenery.

I was possibly the only person attending from the voluntary sector (others had been invited), but numerous statutory partners came along, including: Mid & West Fire & Rescue, Trading Standards, Mid Wales Housing, Probation, Health and Mid & West Wales Ambulance. There were also many police officers and managers present, including Chief Inspector Rhiannon Ivens who leads on Partnerships in Powys for the force.

Penny Price, Lisa Hale (Powys Teaching Health Board) and Police Inspector Kathryn Griffiths

The invitation stated “we would really welcome attendance from partner agencies as a joint approach to (POP) will be vital. Problem solving must become everyday business; it needs to be robust and it must be consistent to get to the root causes….The (POP) techniques will assist with our engagement with each other and should not be confined to crime and disorder problems. We can utilise this approach to help manage demand for our services more generally…”

On her recent work with the Bermuda Police (yes, Bermuda the sub-tropical island which is also a British Overseas Territory!) Sylvia commented on the critical importance of partnership working: “The POP philosophy begins with taking problems and working with those who work and live in the area to deal with them. This is about how the police and their professional partners… work alongside the community. Problems are resolved from the group up, with the support of the government and legislation, but actually if you really want to have a sustainable solution, it has to come from within the community and your partners on the ground.”

So, what can Powys learn from the Bermuda experience…? Deputy Chief Constable Darren Davies informed us “all front line Dyfed Powys police officers have received awareness training and this will be followed up with practical application during the early part of 2018.” As partners, we had been invited “for a more localised practitioner approach.” The force, Darren explained, is keen to reduce harm for vulnerable people and stressed communities. The solutions do not rest with one agency. His ‘critical friend’ role allows people with a fresh pair of eyes to look at problems which have been ongoing for a while. Such problems could include anti-social behaviour, neighbourly disputes, or fly-tipping, for example.

Sylvia explained that POP started originally in the States, where police forces adopted the philosophy of Professor Herman Goldstein, a specialist in Criminal Law. Police forces the world over are often called out to situations where they do not actually have the necessary expertise to deal with the problem. In some cases that could be because someone is experiencing mental distress, for example.

Tools and models which Sylvia went on to describe in some detail will provide the police with a more strategic and scientific approach. The key, however, is for officers to ask the question: “How will this work on the person I’m trying to have an impact on?” “Knowing the people you work with – other agencies – that can help you manage that problem that you are working with.”

In this brief space I am just going to pick up on a few more of the key points that Sylvia made in her detailed presentation.

Why are we doing this here? To get the best out of partnership working. Colocation is the way forward.

What do you need to make it work? To have real buy-in – having senior officer support gives a breathing space to look at the problem differently or else otherwise we will always be dealing with it. The more confidence you give to communities, the more they will tell you.

Think creatively. In Dyfed Powys we have Crime Prevention Advisors. In Hertfordshire there are Call Ambassadors. In Northumbria – POP Stars!

Sylvia went on to describe a number of crime theories, available for the police to use to good effect in analysing crimes and offenders. These included the Problem Analysis Triangle, the Routine Activity Theory, the Journey to Crime and the Broken Windows Theory. This last theory also comes courtesy of the US, where former New York Mayor Giuliani postulated that if you don’t repair a broken window in a building then the next time you go back you will find two broken windows. Similarly, if graffiti and fly-tipping are ignored, this spreads the signal to the community that it is not a good place to live, and to offenders – come and do what you want because nothing will be done. “Zero tolerance is the way to solve crime”.

Sylvia pointed out that partners can have quite different remits and priorities. She highlighted Jonathan Shepherd, a surgeon from Cardiff, who introduced plastic containers for night-time drinking because he was forever stitching up faces slashed by broken glass.

“We need to deal with the low level stuff in the same way as a murder inquiry. Start with the victim and build up the facts around the victim to build a better picture of what’s causing the crime to happen.” We like to give labels to people – gangs, drug dealers, beggars… “But there could be a hundred different reasons why people are doing what they do. Break it down from the general to the specific.”

Sylvia spoke in detail about repeat offenders, and about the value of working with family members and friends in providing useful interventions. “Sometimes you need to be more like a doctor in diagnosing what is wrong, or like an engineer – very systematic.” She said that speaking to people who actually cause the problems, and their victims, would give a much greater understanding of why the behaviour is happening.

“The key to being more creative in approaching problems? Innovate. Do something different. Don’t do the same thing over and over again…”

Perhaps the key message I took away from the session was that we should all question ourselves, and others, to become more effective in what we do. As Sylvia says: “Be passionate about what you do and people will believe in you.”

What do you think about Problem Oriented Policing? Would you be willing to work more closely with the police in your area to try to resolve issues that crop up again and again? Let us know in the comments box below.

Pegasus – changing the way we talk to Dyfed-Powys Police

PCSO Aileen Stewart - 2nd from right, with colleagues from Dyfed Powys Police, PAVO and Mid & West Wales Fire Service

In May I met Police Community Support Officer Aileen Stewart at the Dementia Information Day in Newtown during Dementia Awareness Week. Aileen gave me an update about the Pegasus communication scheme used by police officers in the Dyfed Powys force area, and it seemed like a blog post would provide the ideal opportunity to share the information with a wider audience to further promote the scheme’s use.

First tell us a little about yourself and your role in Dyfed Powys Police

I am PCSO Aileen Stewart and I work within the Neighbourhood Policing team in Newtown. I have worked as a PCSO for five years.

As a PCSO we have various duties including high visibility patrols, public reassurance, safeguarding our community, gathering intelligence and dealing with anti-social behaviour. We also work closely with local agencies, for example housing, mental health services and voluntary services to deal with issues and solve problems, for example neighbourhood disputes.

What is the Pegasus scheme?

The Pegasus scheme is a service for people who live and/or work in the Dyfed Powys Police area aimed at those whose disability or illness makes it difficult for them to communicate when calling or speaking face to face to the Police.

It’s designed to make it easier to contact Dyfed Powys Police quickly and easily on both the 101 and 999 numbers.

How does Pegasus work?

Registering for the scheme is free. Once a person is registered and their selected password is approved the individual becomes a member of the scheme. The information will be stored securely.

Pegasus is really simple. The caller will only have to say ‘Pegasus’ and give their password to be identified by the call handlers.

The call handlers will then have access to details of the person calling – full name, home address, contact details for family member/support worker, and how best to communicate with the caller – this information will also be available to the incident handlers who can advise the officers on route to the call of the nature of the caller’s disabilities and how best to communicate with the caller.

Pegasus users will also be provided with a Pegasus key fob to carry. If they speak to Police Officers or PCSOs and find it difficult to communicate they can show this card, provide the officer with their password and they will be informed via radio of the person's details.

How would Pegasus work for people experiencing a mental health crisis?

The person calling would only have to concentrate on telling us what is happening once they have used their password and confirmed their details.

The call handler will have all the caller's personal information and be able to communicate with the caller in the way which they have said will help them or contact the family member/support worker that has been provided.

The attending officers will then be fully aware of the caller's need when dealing with them making it a more positive experience and aid in getting them the help they need as quickly as possible.

Where did the idea for the Pegasus scheme come from and when was it launched?

Pegasus was officially launched on 2nd April 2012 in Dyfed-Powys.

The idea originated in Nottinghamshire Police in 2008/9, from a member of the public who had suffered a stroke, and was also a victim of anti-social behaviour. When he called the police to report the anti-social behaviour he was told to phone back when he was sober. He then contacted the Chief Constable in Nottinghamshire and put forward an idea of having a PIN number which he could provide and they would have his details already.

After Nottinghamshire Police, City of London Police also adopted the scheme, and then ourselves, therefore we were the first force in Wales to adopt this kind of scheme.

How many people have signed up to Pegasus since then, and what kind of feedback do you get?

We currently have 440 members.

Some people that have signed up to the scheme have previously had a negative experience due to the officers dealing with them not having enough information about them before. They feel reassured about us having information about them that can make their experience with the Police a good one and also that we can deal with their needs should they need to contact us.

What is your personal experience of working with the Pegasus scheme out on the beat? 

There is a person that I speak to regularly that I signed up to the scheme. Due to knowing their needs I have been able to see when their mental health has begun to decline and get in touch with their mental health worker to begin the ball rolling for the person to have a psychiatric assessment.

And finally, why was the scheme named after a creature from Greek mythology?

The victim of the anti-social behaviour that prompted the creation of the scheme stated that in the worst times of the anti-social behaviour he used to imagine being whisked away by the Greek mythological flying horse “Pegasus” – hence the name.

Many thanks to Aileen for telling us all about the Pegasus communication scheme used by Dyfed Powys . What do you think of the scheme? We would love to hear from you - comment below or send us an email.

Ymddygiad gwrth-gymdeithasol a iechyd meddwl – beth mae gwasanaethau angen ei ystyried? Anti-social behaviour and mental health – what do services need to consider?

Meddyliau o brosiect ymchwil gan Philip Moisson

Thoughts from a research project by Philip Moisson

Gall ymddygiad a dargedir gan y ddeddfwriaeth ar ymddygiad gwrthgymdeithasol fod yn arwydd o broblemau iechyd meddwl (fel yr ysgrifennwyd amdano yma - efallai y bydd y cynnwys yn peri gofid i rai darllenwyr). Mae'r blog hwn yn ymwneud â phroject ymchwil yr ydym newydd ei gwblhau a oedd yn canolbwyntio ar 'bobl fregus ac ymddygiad gwrthgymdeithasol'. Bu i ni edrych sut yr oedd ymarfer cyfredol yn edrych i bobl â phroblemau iechyd meddwl y mae ymddygiad gwrthgymdeithasol yn effeithio arnynt, naill ai fel dioddefwyr, tramgwyddwyr neu dystion.

Behaviours targeted by the anti-social behaviour legislation can be a sign of mental health problems (as written about here - some readers may find the content upsetting). This blog is about a research project we have just completed that focused on ‘vulnerable people and anti-social behaviour’. We explored what current practice looked like for people with mental health issues who are affected by anti-social behaviour, either as victims, perpetrators or witnesses.

Roedd fy rhan fy hun yn y project hwn fel hwylusydd grŵp ffocws, ac roeddwn i'n un o'r bobl a hyfforddwyd gan academyddion o Brifysgol Bangor i wneud hyn ochr yn ochr â phobl eraill mewn cysylltiad â PAVO ac Unllais yng ngogledd Cymru. Mae'n hynod o bwysig i bobl â phrofiad o hyn fod yn rhan o'r broses o gasglu a mireinio gwybodaeth am y materion hyn, a chwarae rhan wrth ffurfio argymhellion ar gyfer arfer da.

My own involvement in this project was as a focus group facilitator, and I was one of the people trained by academics from Bangor University to do this alongside other people in contact with PAVO and Unllais in North Wales. It is incredibly important for people with lived experience to form part of the process of gathering and refining knowledge on these issues, and in playing a part in forming recommendations for good practice.

Yn ein cyfarfod cyntaf cawsom roi cynnig ar gymryd rhan mewn grŵp ffocws, lle bu i ni drafod un o'r senarios a baratowyd yn ofalus, a oedd yn troi adroddiadau heddlu go iawn ar ffurf hanes ffuglennol bywyd cymeriad. Ar ôl hyn, fe wnaeth ein hyfforddiant ein harwain at gyflwyno'r grwpiau ffocws a chawsom ein gwahodd yn ôl hefyd i drafod y canfyddiadau o'r ymchwil cyn cadarnhau a chyhoeddi pethau. I rywun fel fi sydd ag amser sbâr, mae bod yn rhan o broject fel hwn yn arbennig o ysgogol.

At our first meeting we had a go at taking part in a focus group, where we discussed one of the carefully prepared scenarios which turned real life police reports into the form of a fictional account of a character’s life. After this our training led us onto delivering the focus groups and we were also invited back to discuss the findings from the research before things were finalised and published. For a person like me who has spare time, being involved in a project like this is incredibly stimulating.

Yr hyn yr oeddem ni'n ei wybod o'r cychwyn yw bod yr heddlu'n aml yn cael eu rhoi mewn sefyllfaoedd amhosib wrth ddelio ag ymddygiad gwrthgymdeithasol yn y ffordd fwyaf effeithiol. Er enghraifft, efallai nad ydi'n briodol bob amser gorfodi sancsiynau sifil neu droseddol, a bydd llawer o sefyllfaoedd lle mae dyletswydd gofal yn bodoli yng nghyswllt unigolyn bregus. Hefyd, mae trefnu cydweithio rhwng amrywiaeth o wasanaethau yn aml yn anodd yn yr amgylchiadau hyn.

What we knew from the outset is that the police are often put in impossible situations in dealing with anti-social behaviour in the most effective way – for example it may not always be appropriate to enforce criminal or civil sanctions and there will be many situations in which a duty of care exists to a vulnerable person. Also, organising collaboration between a range of services is often difficult in these circumstances.

Prif amcanion y project yn gyffredinol yw deall y set o broblemau uchod o safbwynt gwasanaethau, ac o safbwyntiau defnyddwyr gwasanaeth a gofalwyr. Roedd y project hefyd yn ceisio tynnu sylw at ffyrdd y gall gwasanaethau gydweithio, a chydnabod yr hyn a allai fod yn rhwystro hyn ar hyn o bryd.

The main aims of the overall project were to understand the above set of problems from the perspectives of services, and from the perspectives of service users and carers. The project also sought to highlight the ways in which services can work together and to acknowledge what might be preventing this at present.

Drwy gyfweld ag amrywiaeth o weithwyr proffesiynol a sgwrsio efo defnyddwyr gwasanaethau a chynrychiolwyr gofalwyr yn ein grwpiau ffocws, mi gasglwyd llawer iawn o ddata i'w dadansoddi. Mae ymddygiad gwrthgymdeithasol ei hun wedi cael ei ddiffinio gan ddeddf seneddol 2014 fel “Ymddygiad sydd wedi achosi, neu sy'n debygol o achosi, aflonyddwch, braw neu ofid i unrhyw un.” 

By interviewing a range of professionals and talking to service user and carer representatives in our focus groups, a large amount of data was gathered for analysis. Anti-social behaviour itself has been defined by a 2014 act of parliament as “Conduct that has caused, or is likely to cause, harassment, alarm or distress to any person.”

Roedd gan lawer o'r rhai a gymerodd ran yn y project wahanol safbwyntiau ar hyn, ac roeddent yn pwysleisio nad oedd pethau bob amser mor glir wrth siarad am bobl fregus. Mae'r heddlu felly'n aml mewn sefyllfa annifyr wrth benderfynu sut i ymdrin efo pobl sy'n achosi problemau heb fod o'u gwirfodd.

Many participants in the project had different views to this, and emphasised that things were not always so clear cut when talking about vulnerable people. The police are therefore often in an awkward position in deciding how to deal with people who are not wilfully causing problems.

Daeth llawer o argymhellion gan ddefnyddwyr gwasanaeth a gofalwyr allan o'r project, a dyma rai ohonynt:

• Mae ar sefydliadau statudol angen gwybod mwy am waith da'r sector gwirfoddol.
• Mae ar asiantau angen cydweithio i helpu'r unigolyn mewn angen, yn hytrach na chael ateb wedi'i ddiffinio ymlaen llaw wedi'i seilio ar label, h.y. ‘sgitsoffrenig- angen meddyginiaeth.’
• Dylai'r heddlu a thimau iechyd meddwl gydweithio mewn timau blaenoriaethu (neu triage) a dysgu swyddogaethau'r naill a'r llall.
• Mae Eiriolaeth Iechyd Meddwl yn hanfodol.
• Mae angen cryfhau hyfforddiant i heddlu yng nghyswllt gofid a gwrando.
• Dylid defnyddio gofalwyr ac aelodau'r teulu bob amser gan fod ganddynt lawer o wybodaeth. Dylai defnyddwyr gwasanaeth a gofalwyr bob amser fod yn rhan o'r cynllunio a gwneud penderfyniadau.
• Mae cydymdeimlad, parch ac urddas wrth ddelio â phobl i gyd yn hollbwysig
• Mae tai a ffactorau cymdeithasol eraill yn bwysig iawn.
• Mae'r system cyfiawnder troseddol yn amhriodol i bobl mewn gofid difrifol
• Dylid ceisio cael atebion tymor hir yn hytrach na mesurau sy'n datrys pethau'n gyflym ond dros dro.

There were many recommendations from service users and carers that came out of the project, and here are some of them:

• Statutory organisations need to know more about the good work of the voluntary sector.
• Agencies need to work together to help the individual in need, rather than have a pre-defined solution based on a label, ie ‘schizophrenic- needs medication.’
• Police and mental health teams should work together in triage teams and learn one another’s roles.
• Mental Health Advocacy is crucial.
• General training for police around distress and listening needs to be bolstered.
• Carers and family members should always be utilised as they have a lot of knowledge. Service users and carers should always be involved in planning and decision making.
• Sympathy, respect and dignity in dealing with people are all paramount.
• Housing and other social factors are very important.
• The criminal justice system is inappropriate for people in severe distress.
• Long term solutions should be aimed at rather than quick-fix measures.

Mi wnes i helpu Anne Krayer wrth gyflwyno'r canfyddiadau hyn a chanfyddiadau eraill i grŵp yn cynnwys gweithwyr proffesiynol iechyd meddwl ac uwch swyddog yr heddlu'r wythnos ddiwethaf. I mi'n bersonol, os ewch chi â dim ond un peth o'r ymchwil hon, hynny fyddai ei bod yn hanfodol i'r holl bobl ac asiantau, yn cynnwys yr heddlu, grwpiau yn y sector iechyd, gofal cymdeithasol, tai a gwirfoddol, ddeall ei gilydd, a chyfathrebu'n gyson â'r naill a'r llall i ddatrys materion cymhleth iawn.

I assisted Anne Krayer in presenting these and other findings to a group consisting of mental health professionals and a senior police officer last week. For me personally, if you only take one thing from this research, it would be that it is vital for all of the people and agencies, including the police, health, social care, housing and voluntary sector groups to understand each other and to constantly communicate with one another to solve very complex issues.

Am fwy o wybodaeth, cysylltwch ag Anne Krayer ym Mhrifysgol Bangor: a.krayer@bangor.ac.uk

For further information please get in touch with Anne Krayer at Bangor University: a.krayer@bangor.ac.uk

Cyllidwyd yr ymchwil gan Lywodraeth Cymru trwy Ymchwil Iechyd a Gofal Cymru

The research was funded by the Welsh Government through Health and Care Research Wales

Dyfed-Powys Police - Mental Health: The Way Forward

Last Friday Laura and I attended a Dyfed-Powys Police conference at Police Headquarters in Carmarthen. We were there with our PAVO colleague Claire Powell, the Info Engine Officer, to promote the third sector in Powys. Laura also facilitated a session with two people from Powys who had experience of being arrested and detained by the police whilst mentally distressed.

Mental Health: The Way Forward, was promoted as an event which “will explore ways in which the police can work in partnership with statutory and third sector services in responding to people in mental distress.” Dyfed-Powys is obviously a vast chunk of Wales (Carmarthenshire, Ceredigion, Pembrokeshire & Powys), and we were able to network with colleagues from the statutory sector, including Bronllys Hospital and the Welsh Ambulance Service, as well as other voluntary groups and charities such as West Wales Action for Mental Health and Mind Llanelli. But our main role was to inform those police officers present of the mental health third sector groups in Powys, and the support these groups can provide to people experiencing any form of mental distress.

The event was kicked off by Temporary Deputy Chief Constable Carl Langley. He spoke about the recent joint review – “A criminal use of police cells? The use of police custody as a place of safety for people with mental health needs,” in which a police cell had been identified as the worst possible place for someone with mental health issues. Yet, as Carl admitted, cells are still used routinely as places of safety.

The average time taken to assess someone is 8 hours and 48 minutes. As a high percentage of people enter police cells having drunk alcohol, this time could be much longer. Carl then asked – “If that was my mother/daughter/sister who had experienced an episode which presents as mental health initially, how comfortable am I with that?” He went on to explain that as a police service “we don’t want these people in custody – we want to do the best for them… 9 hours is a long time.” Often the period of custody will exacerbate the level of anxiety experienced by someone already in distress. Recent TV programmes such as BBC’s Panorama and press articles have focussed on these issues.

Dyfed-Powys Police want to try things differently going forward. Carl asked if other statutory agencies present would be willing to share information, say from Care Treatment Plans, to help inform officers early on. Less than 10% of people who are detained in this way are sectioned, but what happens to the other 90%? Where do they receive support? Whilst Carl recognised that some people would benefit from support from the third sector, he said that the force currently underutilises these resources. And now is time to change that.

Temporary Chief Superintendent Andy John, the force Mental Health Lead, spoke with Helen Morgan-Howard, Equality & Diversity Manager, about Mental Health Street Triage (presentation available here). They began by describing “Section 136 of the Mental Health Act 1983 (which) allows a police officer to remove a person they think is mentally disordered and ‘in immediate need of care or control’ from a public place to a place of safety, in the interest of that person or for the protection of others.” Without access to a person’s records a Section 136 was described as “the only option”, despite it making people feel “I was locked up because I was ill.”

Dyfed-Powys Police are now asking:

• How do we provide better information to officers at the scene of an incident?
• Is there anywhere else we can take people to?
• Can we reduce the amount of time people wait to be assessed by mental health practitioners?
• Can we refer to support elsewhere, eg: third sector?
• Are there other crisis interventions out there that the police don’t know about? 

Andy described a real appetite to make a difference within the force, and pointed out key areas where change could be made, including staff training, and working more collaboratively with partners, including the third sector.

There was also talk of trialling mental health street triage. In nine force areas in England joint units comprising mental health practitioners and police officers, who have shared access to information, take to the streets together, resulting in better-informed decisions and better outcomes for people experiencing mental distress. There are already plans for a pilot scheme in Carmarthenshire in the lead-up to Christmas, and talks are imminent with Powys teaching Local Health Board about options for 2014. This approach, combined with the creation of new places of safety, away from a police cell, and local to an individual, look like a promising start.

Laura networking at the Dyfed-Powys Police mental health conference

Before leaving the conference for the day I asked someone who had been arrested on many occasions whilst mentally distressed, "where would your preferred place of safety be?" The answer, simply, was “anywhere but a police cell.”

Let’s hope it’s not that hard to arrange.

What do you think of mental health street triage? Let us know your thoughts on this, and any other aspects of policing in relation to mental distress, by commenting below.

Other speakers at the conference included:
Tim Burton, Deputy Police & Crime Commissioner, Dyfed-Powys Police
Tony Thomas, Criminal Justice Link Officer, Hafal
Gareth Coles, Public Services Delivery Officer, Wales Council for Voluntary Action

January 2014 BBC news update - Mental health units to be set up by Dyfed-Powys Police