Dyfed-Powys Police - mental health: a multi-agency approach

Over the last few months I seem to have read endless articles online (the latest just last week from the BBC here) about the increasing numbers of young people and adults being detained in police cells whilst experiencing mental distress. This is often because there are no suitable places of safety where people can be taken to be assessed, even though it is frequently accepted that a police custody suite is not usually an appropriate place in such circumstances.

In Powys, a multi-agency approach is now working to improve the police response to those with mental health needs. I first found out about this in November 2013 at a Dyfed Powys Police event called Mental Health: the Way Forward. Here we heard, amongst other things, some of the Force’s plans for change in the area of detention under Section 136 of the Mental Health Act.

Inspector Brian Jones

This week we found out more, from Inspector Brian Jones of Neighbourhood Development for Dyfed-Powys Police, about how plans had been progressing since the event. Brian started by addressing the issue of children and adults being placed in police cells due to the lack of mental health beds.

“In Powys, we have not found ourselves in this position during 2014”. The police are often called to assist with situations where someone has expressed concern for a family member, a friend or someone they have seen behaving in a manner which raises concern for their welfare. The police currently have minimal training on how best to deal with incidents where people have mental health needs, but will strive to treat everyone with dignity and respect. “Our first priority is to ensure that persons are safe and then to ensure that persons are cared for by specially trained experts at an agreed place of safety.”

Legislation

The legislation under the Mental Health Act, which is known as a Section 136, stipulates that “if a constable finds a person who appears to him/her to be suffering from mental disorder and to be in immediate need of care or control, in a place to which the public have access, the constable may, if he/she thinks it necessary, in the interest of that person or for the protection of other persons, remove that person to a place of safety.” No one will disagree that a police cell is not a suitable place or environment for someone with mental health needs. However, there are occasions when there is no other suitable alternative and this is when there are signs of violence, substance misuse or criminal offences for investigation with evidence to be preserved.

In order to make every effort to secure the correct and professional support for individuals, as well as avoiding police cells or any inappropriate use of police powers, a procedural pilot was introduced in Powys in March 2014. This pilot requires the Police’s Inspector’s authority before police mental health powers can be used. The Inspector will take an independent overview of the circumstances which have led to consideration being given to utilising the powers under the Mental Health Act.

Exceeding expectation

The pilot is exceeding expectation and the police cells have only been used on three occasions, which was justifiable in the circumstances and not due to having no suitable beds available. At no time have the police powers been inappropriately used and at no time during this period have any youths under the age of 18 been detained. There is a strong partnership approach between the police and health and social care partners, who are working together to raise awareness amongst colleagues, as it has been agreed that training is required for people who come into contact with people suffering from psychological problems.

Thank you to Inspector Brian Jones for his update. Let us know in the comments box below what you think about the new ways of working that the police are trialling in Powys - or elsewhere in the UK.

You can read a recently published report (6 February) from the House of Commons Home Affairs Committee on Policing & Mental Health here.

Volunteering while getting benefits

The title of this blog post is also the title of a UK government guide which can be downloaded from the internet here. Quite simply it lays down the rules around volunteering whilst on benefits:

"If you’re getting State benefits, you can be a volunteer and, in nearly all cases, your benefits will not be affected. However, there are some cases where your benefits can be affected, for example, if you get a subsistence allowance or if you’re doing what someone else would normally be paid for."

And yet people who are receiving benefits are sometimes made to feel – by society, by people they know, by workers at the Job Centres they attend - that if they are able to volunteer then of course, they should also be able to work.

Jan Rogers receives benefits and volunteers for the mental health charity Ponthafren Association at the organisation’s centre in Newtown. She is not in paid employment at this time. She wanted to share with a wider audience the value of volunteering to her.

Without going into detail of what, why and where, I will just say, when I first became unwell, I could see NO way out. Well, in fact, I did find a way out and that was to end “it”. To put a stop to the hassle and grief I was causing to my family.

Sometimes I think I functioned quite well in the sense that food was always on the table and the house and children were always clean, at least when they left the house. But I wasn’t living, it was existing - going through the motions. When my husband was in work I would quickly do housework and what I needed to do and then hide. Sometimes I would lie under the bed all day watching the clock so that I would be out in time to cook tea and pick the children up. This was harder when I had younger children so I used to draw the curtains and sit and interact with the children hoping that they would not pick up on how I was feeling. This worked for a few years but every time one of the children called me “Mum” I cringed.

One day Hell had just opened its doors. I went from a person who was out going and enjoyed life to almost becoming a recluse. Although I made sure the children and hubby were fed and looked after, I was sinking into a dark, dark world. I did not bathe or eat until I was so light headed I couldn’t function. My husband gave up his job and although he was amazing he was looking for answers to the complete change in a person, which to him had happened “moreorless overnight”.

I was regularly taken to hospital and sectioned and stays varied from one to three months in the early days. As time went on, with my husband’s and family’s support, and the help of the Community Mental Health Team, I was able to function slightly better, but each day was a struggle for us all. Sometimes I would leave the house and seem and feel okay, drop the children off at school but then, a dark cloud would surround me and I had no idea where I was or who I was. My husband would phone the police after looking, sometimes all night, and I would be back in hospital on a section.

I felt my life was over and although I was lucky in a sense that I had a great supporting family, this in one way was making me feel more guilty as I was letting them down and just causing more grief to the people that were at my side and holding me up. 

Jan in the garden at Ponthafren

All I kept thinking was why, why, why?

About six or seven years ago, I took my youngest sons to football practice. I was standing on my own, not really wanting to get into a conversation with people. There was a woman there, who I did not know, she seemed to be in charge of the football sessions. I remember the day well as it was windy, cold and raining, real football weather. The lady came across and introduced her self as Nicky Morris and explained that she was chair of the junior football club, Newtown Whitestars.

We got chatting and this was the first time I had really trusted anybody outside my family. I felt I could talk to her as if I had known her for a lifetime. Nicky went on to explain that she was Co-ordinator of Ponthafren Association , which was a registered charity for people with mental health problems. She suggested I pop in for a chat and see what Ponthafren had to offer for me. I was always very much into my sport, gym and running as well as a very keen gardener.

I went along to Ponthafren with my hubby and met up with Nicky and Jane and chatted. I said I would love to come along to the centre but needed a purpose. Nicky suggested volunteering for a couple of hours a week to go along with people to the gym. So, this is what I did. Mike was always outside at least half an hour before I was due to be picked up as he was very worried.

Over quite some time, I was volunteering more hours and even though some days I would not go in as I was feeling unwell, generally I felt a small sense of achievement. As time went on Mike was feeling more relaxed and able to take a step back. He too then became a volunteer at Pont. I think we sometimes forget about the person that has cared and carried someone with mental health illness for such a long time and almost expect them to pick up where they left off in a sense. This is not reality as when Mike gave up his job he gave up his “Life”, in the sense of friends, associates and a social life.

At Ponthafren I can be myself, I don’t have to pretend at all. If I want to smile I can, but at the same time if I don’t feel like smiling or putting on a face for people, then I don’t feel like I have to.

Some of the things I deal with every day and night:

• Sense of worthlessness.
• Scrounger to society/tax payers as I should be working.
• Sense of letting my family and friends down.
• Voices.
• Hallucinations, to the degree of bathing in shorts and tee shirt and dressing inside a large robe that is zipped up the front, from my neck to the floor. 
• Not sure if I’m having a conversation with real people or not.

Some of the things I feel and have partly gained by volunteering are:

• Self worth.
• Confidence.
• Self-belief.
• Passion for believing in my principles and beliefs and the fact that they do count.
• Helping my family understand my “illness”.
• Helping “ME” understand my “illness”.
• Being “Who” I am, and most of the time thinking, “others will have to accept me as is”.

I have been nominated and won awards but although I am very grateful for being put forward and gaining these awards I personally (it has taken me years to accept praise and to be honest, deep down, I still cringe even though I smile) feel that these awards I accept are on behalf of every volunteer I know. This, I feel, is how I am able to accept them.

Why do I volunteer?

At the moment I don’t think I would be able to cope with employment. I’m not sure it would be fair on an employer or me. I have never and never will be happy with myself drawing benefits but volunteering goes some way for me to prove my worth to Government, Job Centre, tax payers. I have received, and continue to do so, so much help from Ponthafren – and this is one thing I can do to part pay back for all I receive.

I volunteer in the garden because I am a keen gardener and others get so much out of the garden at Ponthafren. Some people have no garden or in fact a seating area. With volunteering, if somebody asks me to do something, I do not have a problem asking them to write it down if I’m not sure what they said and they don’t mind doing this. As an employee, this would not be okay.

Basically I volunteer because I can. I have failed so much over the years, in most aspects of my life. Volunteering, I feel I do not fail at all. Maybe I can make a difference to someone else!!!!

‘Volunteering’ = Coping , Living, Surviving, so really it is NOT Volunteering in my Mind or Heart !!!!!!

Thank you, Jan, for sharing your volunteering story with us. If you would like to find out more about volunteering, contact the Powys Volunteer Centre which is managed by Powys Association of Voluntary Organisations.

Are you on benefits? Do you volunteer? Tell us about your experiences in the comments box below.

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

Mental Health Patients in Wales Coerced

Healthcare Inspectorate Wales has criticised the support given to mental health patients in Wales, claiming some feel coerced into treatment. It also found outdated consent forms, security breaches and patients not being made aware of their rights. BBC News.

For full report, and interview with Ruth Coombs of Mind Cymru, see BBC website