By Matt Bee
You’re a young police officer and it’s late at night. You’re called out to attend to a man in the street. He’s incoherent, crying, wandering, and passers-by have twice seen him almost run over. What do you do?
Until recently you’d have more than likely whisked him off to the nearest psychiatric unit under section 136 of the Mental Health Act for further assessment. He would have been assessed by someone like me, who, until recently, was a mental health social worker who spent his days waiting for his mobile to ring before springing into action along with an approved mental health professional (AMHP), a doctor and handfuls of paperwork.
Alternative to detention
But now there’s another choice. In most constabularies, at least, a police officer can call for the street triage team – a small group of mental health professionals who will come and attend right there and then. These nurses will have an informal chat with the person, make a decision on whether detention is absolutely necessary, and help them on their way if it isn’t.
What difference does that make? To the person in distress, probably a lot. It must be harrowing to find yourself caught in the crosshairs of psychiatrists and AMHPs. You just nipped out for a few drinks and now here you are, about to be locked up and certified. I’ve seen plenty of people in this situation and, yes, they may be mentally unwell, but they know only too well the significance of the questions being asked, the forms being completed, and their future being quietly decided for them.
So I’m happy to report that when the first street triage team, comprising three mental health nurses and a support worker, came into being in Cleveland in August 2012, it was an unequivocal success. The difference this team has made is hard to overstate. Within a year, section 136 detentions fell dramatically. Of the 371 people the team attended, almost all of them were helped right there in the street. Only 12 ever saw the inside of a psychiatric unit.
That really is incredible! And the benefits don’t stop there. In 2009, the Centre for Mental Health estimated that it cost £1,780 to detain and assess someone in custody. If, say, a further 300 of that 371 would have been detained but for the existence of the team, that represents a saving of some £500,000. With a team budget of £170,000 a year, by my rough calculations, then, for every £1 spent on the team, £3 was saved. Pilot schemes elsewhere were soon reporting similar successes.
Home secretary Theresa May was so impressed that in 2013 she announced a further nine pilot sites, and the idea has grown from there. These days most constabularies are now either operating a street triage service or seriously considering putting one in place.
Where it all started
But where did it all start? Quite simply it was the brainchild of PC Rob King, now retired but previously a mental health coordinator for Cleveland Police with a dual role at Tees, Esk and Wear Valleys NHS Foundation Trust. He explained to me that he’d seen similar models operating in America but over there the idea was to train officers themselves in mental health needs. PC King reasoned: why not just have the police work alongside people who are experts already? Why not have them working with nurses right there in the street?
He put the idea to the Department of Health, got the green light, and three years later here we are.
But where we’re at now is some sort of crossroads. Because although everyone seems to agree the street triage service works, no-one can decide on the best model for running it. Some teams operate out of hospitals, others from police stations, one has a purpose-built vehicle with an assessment room inside it, another can only provide support by telephone.
And who pays for the service is also up for debate.
Hospitals, the police and social services all stand to gain but how best to pool their budgets is proving tough. In June, the BBC reported that this year the street triage service in Kent, a partnership between the police and the local mental health trust was being axed, a move blamed on a lack of police resources to fund it. This was despite figures obtained by Radio Kent showing a 30% reduction in detentions under the Mental Health Act. Kent Police said it was operating a call system where police officers could seek the advice of a mental health expert on a 24/7 basis, instead.
This does seem something of a tragedy. Running a street triage team, in the view of Gemma Handley, operational support manager for the Cleveland service these days, is a ‘no brainer.’ The benefits are clear – both to local services and the man in the street.
But will these teams still be here in ten years’ time? I put this to Gemma and she thinks awhile. ‘Yes,’ she replies, ‘but there needs to be a national model established. It’s all a bit piecemeal at the moment.’
And this is the key issue: turning all these local successes into some sort of single cohesive national strategy. Let’s hope someone takes a lead with this soon. Because, as a mental health professional myself, to me the benefits of this service couldn’t be clearer.
Matt Bee is a social worker based in the north east of England