Putting nurses in 999 control rooms can end culture of detaining vulnerable people in police cells

The number of people with mental health issues being held in police cells inappropriately has significantly fallen in Bradford since our nurses, trained as police specials, started going ‘out on the beat’ in January.

“Nurses in police control rooms, where 999 calls are answered, sit with the hub commanders monitoring calls and offering advice. They make real-time decisions and signpost people, who ring up where mental health is a factor, to the right support at an earlier stage. People are given safe and appropriate care, instead of being taken into custody and detained in police cells.”

Many incidents the police are called out to have some sort of mental health related issue; people in distress often call 999 when it may not be a police matter. Our scheme aims to ensure people get the right help at the first point of contact and it has achieved a significant reduction in Section 136 Mental Health Act police detentions [sectioning].

The project is the first of its kind in the country. It gives nursing staff the same powers as regular officers to work on a variety of police duties following police training in July 2016 and has been actively supported by Bradford District Care NHS Foundation Trust. The work is part of the West Yorkshire mental health collaborative. Six nurses have been through the programme since it launched, with staff receiving their warrant cards in December 2016.

Dignity and help

We embarked on the initiative with West Yorkshire Police last year to see how we could make better use of our combined skillsets, to enable police and nurses to work collaboratively in the community. Officers don’t want to treat people with mental health problems as criminals; they want to refer them to the right people for help. We came up with the idea of training nurses as police specials to go out on patrol, working alongside officers on the frontline, to ensure that people are given safe and appropriate care, instead of being taken into custody and detained in police cells.

"Individuals may be directed to one of our three homely safer spaces for adults and young people to go to in emotional distress. They give a realistic alternative to hospital or police admissions that are run in collaboration with the voluntary sector."

Our staff have been able to combine their mental health expertise and policing skills to look after vulnerable people in the most dignified way. These people may be experiencing a mental health crisis and are confused and upset so this has helped to prevent unnecessary arrests and has reduced demand on the police.

Stationed in various areas, nurses are involved in street triage, hospital liaison and attend calls in the community linked to mental health as part of our 24-hour First Response mental health crisis service. Nurses in police control rooms, where 999 calls are answered, sit with the hub commanders monitoring calls and offering advice. They make real-time decisions and signpost people, who ring up where mental health is a factor, to the right support at an earlier stage.

Homely safer spaces

By having access to both clinical records and police systems, nurses are able to make accurate assessments of where people are best supported during a crisis. This has been very successful. For example, individuals may be directed to one of our three homely safer spaces for adults and young people to go to in emotional distress. They give a realistic alternative to hospital or police admissions that are run in collaboration with the voluntary sector.

The police receive all sorts of calls where mental health plays a part. We had a call from a member of the public regarding a gentleman who was climbing a building and threating to kill himself. A nurse attended the incident who was on duty as a police special at the time. She recognised him instantly, as she knew him from a previous hospital admission, and was able to carry out an on-the-scene assessment. This resulted in him getting the help and support he needed in the community without being sectioned.

We also had a concerned family member ring up about a loved one, who was suffering from depression, and was threating to take an overdose and kill herself. Within five minutes of the call coming in, our nurse, working as a police special, was deployed to the scene with a regular officer.

An assessment of the individual’s current mental health and risk was carried out, including reviewing the patient’s records. They were referred to our First Response service and were offered support from our intensive home treatment team. They were able to stay at home with the right support, rather than being taken to a place of safety under 136 of the Mental Health Act.

Weekend focus

Police and nurses also mobilise, a double crew, known as a ‘mental health1’ which involves nurses, working as special constables, and police officers attending callouts where it’s believed that people need immediate mental health support. Nurses can provide mental health assessments and have access to medical records at the scene.

Our nurses try to work shift patterns that match days of the week that have the highest number of incidents related to mental health. These shifts typically tend to be on weekends. Going out on patrol with regular officers, they respond to calls with a mental health component; this could be related to an overdose, call for safety or a potential 136.

"Our proactive interventions have led to a 90 per cent reduction in the number of people being detained in police cells where more appropriate signposting and support are available. The scheme avoids criminalising people in the community that are in crisis and need clinical intervention and social support, rather than police intervention."

Officers, working together with nurses, are learning and observing clinical interventions and how we work with people in crisis, rather than going down a criminal route. This has enabled us to teach officers how to communicate with vulnerable people, what language to use, what body language to look for - the nursing skills that police have not traditionally been trained to spot.

Our proactive interventions have led to a 90 per cent reduction in the number of people being detained in police cells where more appropriate signposting and support are available. The scheme avoids criminalising people in the community that are in crisis and need clinical intervention and social support, rather than police intervention. The programme is about supporting people at the earliest opportunity to prevent problems, rather than allowing them to escalate.

Our partnership work has supported officers to better understand mental health and how to approach people in mental health crisis, whilst our understanding of how police have to manage people in crisis has also increased. By working in partnership, fewer people are unnecessarily detained. It’s been a good development for both organisations and most importantly for the person in crisis, supporting them to get the right care, at the right time, with the right professional.