IPOC learning recommendation - response to investigation into complaints about treatment of patient PC-2334-19

IOPC Learning Recommendation Made Under Paragraph 28A of Schedule 3 to the Police Reform Act 2002.

Our Reference:  PC/2334/19

Author: Prevention and Learning Team, Directorate of Professional Standards, Metropolitan Police Service

This investigation follows a primary independent investigation into the complaints about the treatment of a patient detained under Section 3 of the Mental Health Act 1983 at a mental health centre. The patient was on escorted leave when they left their group and came to the attention of a member of the public and then police where force was used to detain the individual.

IOPC Recommendation

The IOPC recommends that the Metropolitan Police Service (MPS) create a Memorandum of Understanding (MOU) between all London-based Mental Health Trusts and the PAN London Mental Health Group. It is recommended that this MOU includes the following points: joint mental health training; establishing a mental health team with a liaison officer and regular liaison meetings and establishing a working relationship protocol in relation to police response to mental health incidents.

This is not an exhaustive list and it is recommended that relevant points highlighted in the Mental Health Authorised Professional Practice are considered when creating the MOU (specifically "local multi-agency protocol development" - section 6.5 at time of writing).

This recommendation follows an independent IOPC investigation conducted into an incident where a 17-year-old female with mental health issues was detained by police. During the course of the investigation, the IOPC learned that when the local BCU was created in late 2018, the Mental Health Liaison Officer (MHLO) was not retained and there was not a dedicated mental health team within the BCU. It is understood that the appointment of a new MHLO did not occur until over 12 months after the creation of the BCU.

MPS Response

The MPS has reviewed the recommendation by the IOPC and whilst it is not accepted as a whole, it is acknowledged that the recommendation is with considerable merit and has been achieved with partners through a number of elements that are already in existence.

The MPS is dedicated to improving external service delivery around mental health and strives to ensure that mentally unwell people in London get the right agency and the right intervention at the right time. Our objectives are to improve the user experience for those experiencing mental disorder who come into contact with policing services and to work collaboratively with our partners in health and social care.

Mental health services in London, including crisis care, are provided by nine Mental Health Trusts. The Trusts split into five Strategic Mental Health Partnerships to work on various projects and deliver cross Trust services. NHS England (London) and NHS Improvement are key partners and provide a co-ordinating and project service through Healthy London Partnership. London has a high number of Acute Emergency Department Trusts and the Emergency and Non-Emergency London Ambulance Service. There are 32 Local Authorities who warrant Approved Mental Health Practitioners (AMHPs) and provide social care. Non-profit and third party sector organisations also contribute to this complex and diverse delivery of mental health services.

The MPS works in collaboration with all of the aforementioned organisations to uphold the commitment to the ‘Crisis Care Concordat’, and there are a number of pan London agreements for services such as, ‘The Londoners’ Crisis Care Pathway’ for Section 136 Mental Health Act 1983, and the ‘National Memorandum of Understanding for Police Attendance and Use of Restraint in Mental Health and Learning Disability Settings’.

Each of the 12 BCU’s has a police Mental Health Team. The recommended resourcing of these teams is two police constables per Borough within their BCU, led by one sergeant. The resourcing and roles of the Mental Health Teams is being reviewed by the Head of Profession for Public Protection. The role of these teams is to develop and maintain local partnerships with Mental Health Trusts and other professionals to improve collaboration, provide interventions which safeguard service users and reduce demands and improve the confidence of service users that come into contact with the police.

The BCU Mental Health Team will have three key functional service deliverables; partnerships and crisis co-ordinators, mental health prevention officers and high intensity intervention officers. The teams will pro-actively identify repeat demand linked to mental health and work in collaboration with service users and our health partners to problem solve cases and utilise opportunities for early intervention and implement effective diversionary activities. Some of this work will be under high intensity user programmes. They will conduct co-ordinated tasking in a true multi-agency approach with police and partners to focus on intervention and prevention, as well as enforcement.

The principle statutes governing our response to individuals experiencing mental ill health are the Mental Health Act 1983 and the Mental Capacity Act 2005, with considerations given to the various codes of practice. In line with all operational policing, officers are encouraged to use the National Decision Model when attending mental health incidents. The MPS Mental Health Toolkit reflects guidance provided within the College of Policing Authorised Professional Practice and is updated when there are any changes to legislation and when national or pan London guidance is published, to which the MPS are a key stakeholder and/or signatory. The initial document was published in 2017 and there have been significant updates in 2018 and 2020.

Multi-agency training is addressed in our response to 2019/122222/002 (the next recommendation).

IOPC Recommendation

The IOPC recognise the protracted nature of drafting and agreeing MOUs, therefore the IOPC recommend that in any event the Metropolitan Police Service (MPS) should create and deliver joint mental health awareness training with London-based Mental Health trusts, including the input of mental health service users. This training could include topics such as: common mental health disorders; barriers for engagement; mental health in law and mental health street triage. This is not an exhaustive list.

This recommendation follows an independent IOPC investigation conducted into an incident where a 17-year-old female with mental health issues was detained by police. During the course of the investigation, the IOPC learned that when the local BCU was created in late 2018, the Mental Health Liaison Officer (MHLO) was not retained and there was not a dedicate mental health team within the BCU. It is understood that the appointment of a new MHLO did not occur until over 12 months after the creation of the BCU.

MPS Response

The MPS has reviewed this recommendation and it is accepted. The MPS has already completed a comprehensive training package for officers that included input from mental health professionals and mental health service users. Additionally, a fully funded project for a new and innovative multi-agency training initiative is in development. This initiative will commence when the extreme demand on health partners from the pandemic has eased. We are currently unable to provide a specific timescale for this.

In 2019, the MPS reviewed mental health training within the MPS and designed and developed a one-day training package which was delivered to 10,500 frontline staff through 2019/20.

This training focused on legislative amendments, policy and procedure, collaboration with partner agencies and providing a better understanding of mental ill-health. The package was co-produced with the College of Policing, mental health professionals as well as mental health service users. The content was based on the College of Policing Authorised Professional Practice (APP), the ‘London Crisis Care Pathway’ and the MPS Mental Health Toolkit. It included reviews of learning from previous high-profile mental health incidents, signs and symptoms of mental health crisis including a ‘voice of the service user’ film, de-escalation techniques and the importance of containing rather than restraining people in mental health crisis. There was a review of legislation including the application of Section 136 Mental Health Act 1983 (S136MHA) and incorporated specifics of the updated S136MHA pathway and the need for consultation with a mental health professional. The training refreshed officers’ knowledge of Section 135 Mental Health Act (S135MHA) and the Mental Capacity Act 2005 particularly Section 5 and Section 6. There was a short film about adverse childhood experiences and taking children into police protection, and an input on police attendance and restraint in mental health settings. This list was not exhaustive. This training, delivered by an external agency, reached the target of 10,000 frontline officers within the 2019/20 financial year.

A further initiative is being progressed to provide multi-agency training, bringing together all the key stakeholders involved in the provision of mental health services on the front line. This training was developed by Northumbria Police and their key partners and is called ‘Respond’. Respond strengthens relationships with partner agencies and improves officer knowledge through bespoke, multi-agency, role-playing exercises and scenarios. Respond training will be piloted in the MPS later in 2021 and is dependent on the demands of the pandemic on our wider partners.

A mental health input is included in police constables’ foundation training, albeit the content will have varied depending on the date of joining and the input is limited. A MH package has been developed for delivery to student police officers under PEQF and delivery will commence for cohorts joining the MPS from January 2021.

Bespoke local updates, professional development and awareness is delivered as required by BCU Mental Health Teams to their staff covering topics such as, a new local Health Based Places of Safety, triage schemes or other topics specific to local service delivery.

IOPC Recommendation

The IOPC recommend that the Metropolitan Police Service (MPS) draft and implement a new standard operating procedure (SOP), or amend any relevant existing SOP, to provide officers with clear guidance as to roles and responsibilities relating to incident management, outside of critical incidents and the types of incident specified in the general investigation policy.

A training package and/or briefing note, which can be delivered to both MPS Control Room staff as well as Emergency Response Policing Teams, could also be considered.

It is recommended that the following points are covered in the guidance. It is recognised that some of the points are covered in the MPS “General Investigation Policy”, and the “MPS Vulnerability and protection of adults at risk policy” but it is recommended that greater clarity and specificity is needed around how the policies relate to the dynamic phase of everyday incidents. This is not an exhaustive list.

• Who should assume responsibility at an incident? Should this be the first officer at a scene, the highest-ranking officer at the scene, or the first officer with free hands (i.e. not directly involved in the management of the incident or any persons involved)?
• What actions does the person in charge need to complete? What actions do they need to delegate (e.g. cordons, exhibit management, etc).
• Who is responsible for health and safety of officers at an incident?
• When should responsibility be handed over to someone else (e.g. if an Inspector attends, can they leave a Sergeant in charge as long as they record their decision-making rationale for why they are doing so and give the Sergeant guidance prior to leaving?)? How should this handover be completed?
• Officers involved in the incident should be removed from the scene as soon as practicable in order to check their welfare and for them to be able to report to their superior. This should include their decision-making process, any concerns they have (e.g. about the mental health of a member of the public/detainee), any actions that they took (e.g. any use of force) and so on.
• The guidance should include taking a graded approach to additional resource requests, starting with ‘on the hurry up’ and scaling up to activation of an emergency button.
• Consideration should be given to the need to deliver the support needed whilst managing blue light vehicle movements so as to reduce risks from RTIs and diminished resource availability in a geographical area. 
• Include what support the control room can give to officers, including guidance of assistance to officers (emergency ‘shout outs’)
• If a request for more resources is no longer required, this should be cancelled at the earliest opportunity. Any officers or other police resource that attend/are brought to an incident and are no longer needed should be dispersed to continue with their duties by the officer in charge.
• Who is responsible for dispersing units and cancelling any further attendance of units?
• All information available about the incident and its aftermath including police vehicle movements and availability should be fed back to control room to be recorded on the relevant documents (CAD/Crime report, etc).

This recommendation followed an independent IOPC investigation conducted into an incident where a 17-year-old female with mental health issues was detained by police. One of two officers in attendance pressed their emergency button and body-worn video footage shows approximately 26 officers attending the scene in multiple police vehicles.  The majority of these officers did not appear to be assisting with the incident. Not all of the 26 officers appear to have updated the control room for the CAD to be updated in a timely manner, either. This raised concerns about the efficient and effective use of police resources.

MPS Response

The MPS does not accept this recommendation in its current form. The operating model of the emergency response policing function and the limitations of the leadership model currently employed are not recognised within the recommendation and so adoption, as currently constructed, is not possible nor desirable.

The response to fast-time policing incidents in London rely upon a ‘collective command and control’ model, where the discretion available to those who hold the office of constable is wide-ranging. The majority of such incidents are self-led, indeed the presence of a supervising officer (sergeant) is not possible, due to multiple incidents taking place concurrently. Nor is a supervisory presence required (in person, or via radio communications) where the constable(s) on scene are making decisions based on the prevailing law/policy framework applicable in any given circumstance.

The language used in the recommendation, ‘everyday incidents’, usefully describes the nature of much of the policing activity in London but perhaps does not recognise the diversity of those incidents and the way in which they are managed. Whilst it is noted that the recommendation identifies a number of points that are not exhaustive, it may be helpful to further frame the MPS response around these areas:

• In response to who should assume responsibility of an incident, this is wholly dependent upon the dynamics of the given incident and in many circumstances, this will be a shared responsibility. It may be the first officer on scene, it may be the highest ranking officer – but not in all cases. Recommending any such defined approach would fail to recognise the shared leadership of any given incident.
• The person(s) who has assumed responsibility for the incident will undertake actions which are wholly dependent upon the dynamics of the given situation. Whilst not exhaustive, this may include activity in relation to securing evidence, supporting victims, arresting suspects and reassuring the local community. The act of delegation will sometimes be applicable, as will the act of working collaboratively with peers to achieve the desired outcomes.
• As per the corporate MPS Health and Safety Policy paragraph 26 – all officers and staff have a responsibility to comply with Health and Safety, to take care of themselves and colleagues. The MPS also has a duty to others (partners/public) who may be affected by our activity.
• With regard to when should responsibility be handed over to some else, again, this part of the recommendation is predicated on the assumption that a single individual is ‘in charge’ of the whole incident. By way of example: at a domestic disturbance incident at a residential address, one constable may be interacting downstairs with the aggressor, another may be interacting upstairs with the victim. They may, or may not, have the opportunity to converse before a decision to arrest is made. They are self-led and adopting shared command of the different aspects of the incident. The inspector who is leading the shift will retain overall accountability for the police response, but will not, in the vast majority of incidents, be overseeing actions at the scene.
• In response to your suggestion that officers involved in the incident should be removed from the scene as soon as practicable in order to check their welfare and for them to be able to report to their superior, this will depend on the incident, the impact it has had on the officers/community and the wider demand that the team on duty is currently faced with. A debrief, overseen by a supervising officer will be desirable in many (but not all) circumstances. On other occasions, a hot-debrief at the roadside, led by the first officer on scene, is the way that this would rightly progress.
• With regard to the IOPC’s suggestion that the guidance should include taking a graded approach to additional resource requests, this part of the recommendation does not recognise the differing perceptions of threat/harm that each officer will experience. Where one officer will see the need for an emergency button activation, others will simply ask for an additional resource to join them. This is a highly subjective exercise in risk perception and any attempt to reduce this down to a policy scale would see little added value.
• The core responsibility for control room staff is to support officers, including guidance or assistance to officers and already forms part of their training.
• It is standard practice that officers cancel further officers attending the incident when they are no longer required. Therefore, there is no requirement to change policy Resources will self-deploy to their next duty as appropriate and when safe to do so.
• Officers on scene will cancel additional resources once they conclude the risk / necessity has passed. However, attending officers who see a wider risk may still elect to continue to the scene, if they are in possession of more information than the officers already present. This is a classic example of the nuanced dynamic risk assessment at these kind of incidents.
• It is standard practice that all information available about the incident and its aftermath including police vehicle movements and availability is fed back to the control room and is recorded on the relevant documents (CAD/Crime report, etc).

n conclusion, whilst the recommendation is not accepted in its current form, the MPS does recognise and is grateful for the opportunity to improve resource management protocols to ensure the most efficient and effective use of resources . Rather than the Standard Operating Procedure, briefing notes or training interventions suggested, which do not demonstrate a clear appreciation of business-as-usual deployment in the MPS, there is an opportunity to consider more broadly how the lexicon of the organisation should evolve to more formally articulate its ‘collective command and control’ and its ‘self-led deployment and incident resolution’ operating model. Although this is common policing practice across England and Wales, there is value in more clearly defining and recognising this method of operation.

It should be noted that the MPS is currently working with NHS Improvement to develop a 111 Hub. The aim is to start pilots from the Q2 2021/22. If the ambitions of the Hub are realised the Hub will:

• Be the first point of contact for service users in crisis, (as an alternative to 999)
• Provide the opportunity for warm transfer from police control rooms into Health
• Provide 24/7 advice to police by MH Professionals with access to medical records
• Coordinate access to bed space across London