Agenda item

Police and Mental Health Attendance at A&E


Detective Chief Inspector (DCI) Saj Hussein, Public Protection – Basic Command Unit (BCU) West Area at the Metropolitan Police Service (MPS), advised that he had been working with the North West London Integrated Care Board (NWL ICB) and involved in more meetings than he had previously.  The number of mental health referrals had continued to increase which had, in part, been affected by the cost-of-living crisis. 


The National Police Chiefs' Council (NPCC) had undertaken a review and identified that around one million police hours had been lost in relation to mental health detentions (which was around 10k hours per month for the MPS).  It was noted that, although approximately 20% of the calls to the MPS were mental health related, this figure was 30% in the West Area (which also had a higher level of Section 136 detentions).  Although there were still a lot of people going into A&E that were suffering and in mental health crisis, only 20% of those that attended A&E actually needed to be there. 


In 2022, 60% of mental health calls had been transported to a Health Based Place of Safety (HBPOS) or A&E.  This had reduced to 45% but was still too high so DCI Hussein had been working with Ms Vanessa Odlin, Managing Director – Goodall Division at Central and North West London NHS Foundation Trust (CNWL), to identify pinch points that could be addressed.  He noted that the handover to HBPOS usually took no more than two hours which was much quicker than the handover to A&E.  Whilst waiting in A&E, police officers were not doing policing work. 


Currently, when a mental health call was received, police officers were deployed.  Officers would arrive at the scene and determine whether or not the person was in crisis and could contact the Single Point of Access / Assessment (SPA) which was provided by CNWL and staffed by mental health nurses who could provide advice on what action needed to be taken.  However, police officers and the mental health nurses tended to be a little risk-averse and training was needed in relation to the alternatives that were available to s136s.  Action was being taken to provide training for the decision-making process and to reassure them that they were making the right decisions.  If the decision was not to detain an individual under s136, the police would not be required to take any further action.  The number of s136s in Hillingdon were amongst the highest in NWL and London which could be partly because of the Heathrow airport but it was unclear what else might be causing that disparity.  Mr Richard Ellis, the Joint Lead Borough Director at NWL ICB, suggested that this information be brought back to a future meeting of the Committee once more was known about the reasons for this high level of s136s in Hillingdon. 


Ms Odlin advised that CNWL's main responsibility was to look after patients within their remit.  It was important that the SPA nurses (trained mental health professionals) were provided with training to ensure that they felt that they were making the right decisions and further work was needed to improve relations with the police to ensure that the best decisions were being made.  These SPA nurses were located in the same building as the CAMHS SPA.  Although A&E had been made an HBPOS some time ago, it needed an appropriate place therein for patients to go.  Further work was needed to understand why patients were taken to A&E and include the local authority in this deeper dive to see what improvements could be made. 


Over the last year, progress had been made in setting up a Crisis Care Concordat (CCC) for the area as well as holding joint liaison meetings with partners that included the police.  The CCC meetings would continue to take place, overlapping with the West London NHS Trust where necessary.  Mr Ellis agreed to make arrangements for the Health and Social Care Select Committee's Chairman and Opposition Lead to attend a future CCC meeting. 


Although funding had not been received to introduce a mental health triage nurse, funding had been received for two additional HBPOS.  One of these would be put with two existing HBPOSs in Hillingdon that would be relocated and reformed as a suite.  The second would be opened in Kensington and Chelsea.  Ms Odlin advised that there was a need for more HBPOS, not fewer, as any individual could be taken to any HBPOS – they were not ringfenced to those that lived in a particular place.  She noted that, if funds were available, further work would be undertaken to identify the most appropriate number needed. 


Mr Ellis advised that there had been a focus on adult mental health pressures in Hillingdon, NWL and pan-London in recent months.  He noted that the data had been scrutinised, some myth-busting had been undertaken and a common interpretation had been identified to now build a way forward.  The Chief Executives from West London NHS Trust and CNWL had been in touch in relation to this work. 


The Committee was pleased to note that there had been improvements in collaborative working over the previous twelve months and that, although Hillingdon had the highest number of s136 detentions, it also had the lowest waiting times.  DCI Hussein advised that the new Right Care, Right Person (RCRP) model being introduced in London after 31 August 2023 had been lifted from the model used in Humberside.  Following its introduction in Humberside, there had been a significant reduction in the number of mental health calls (from 75% to 31%) with 508 fewer police officer deployments. 


The legal advice had been that the duty of care to protect individuals from harm was not just the responsibility of the police so, after this date, call handlers would have three options: 

1.    A police response was required to deal with the call.

2.    A police officer might be required to attend, possibly with partners.

3.    The call was not a police matter and no police response was required.


There would be a meeting with the Chief Executives, Trusts and NHS England on 7 July 2023.  Following this meeting, the MPS would be able to be more specific about the practical implications of the proposed changes – it was likely that the changes would be phased in.  A Memorandum of Understanding (MOU) and clearer understanding of RCRP would be needed.  Further information about the implications and way forward would be forwarded to the Democratic, Civic and Ceremonial Manager in due course. 


It was noted that there had been a negative spin on RCRP directed through the media but the proposals were still in the early stages with things yet to be worked out.  It was likely that there would be additional demands on the services of The London Ambulance Service NHS Trust (LAS) with the possibility of mental health cars needing to be used more widely (there was currently one being deployed in Wembley).  A central vulnerability hub was also being trialled in the West Area whereby a group of subject matter experts were available for the police to call for guidance about whether or not an individual needed to be detained under s136. 


From a health perspective, Ms Odlin advised that the RCRP model had been successful in Humberside because the partners had worked well together and implemented the new approach over a number of years.  CNWL was committed to engaging and working well with partners but it was noted that preventative work might need to take a back seat as it would be important to free up the police.


Mr Ellis advised that consideration had been given to the introduction of street triage in Westminster and that models could be investigated for implementation in Hillingdon.  There were issues around the potential risks in moving to this new model and action would need to be taken to make it work for individuals. 


It was suggested that the transition to RCRP was like moving mountains but that this was a positive move as police attendance to these calls felt like mental health was being criminalised.  A&E was not necessarily the right place for an individual in mental health crisis either so the provision on HBPOS was really important (as was the provision of mental health cars).  These changes were gong to provide partners with the opportunity to do things differently. 


Concern was expressed about RCRP working well when the SPA had not worked well.  DCI Hussein advised that the main difference between the two was that RCRP would be at the point of service and decisions would be about whether or not to attend a call rather than whether or not the individual needed to be detailed under s136.  Ms Jane Hainstock, Head of Joint Commissioning at NWL ICB, advised that the individuals for those calls that were not attended by the police could be directed elsewhere.  A lot of work had been undertaken in Hillingdon in relation to the crisis pathway.  The Crisis Café and Crisis House had been opened and consideration had been given to street triage but individuals needed to be helped to understand when these were the right options. 



1.    Mr Richard Ellis report back to a future meeting (after 7 July 2023) once more was known about the reasons for Hillingdon having amongst the highest level of s136s in NWL and London;

2.    Mr Richard Ellis make arrangements for the Health and Social Care Select Committee's Chairman and Opposition Lead to attend a future CCC meeting;

3.    DCI Hussein forward further information about the implications of RCRP and the way forward to the Democratic, Civic and Ceremonial Manager for circulation to Members of the Committee; and

4.    the discussion be noted. 

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