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Last year I became very unwell and made a hoax call to the police. I told them I was ill and in need of help. However, I was locked in a cell, stripped naked and forced to put on a forensic suit. I have physical problems as well in that I have bladder weakness – I became soaking wet and had to take the suit off. Nobody came near me for over three hours. The only thing they did was get a doctor to examine me who had no knowledge of my medical history. The care was non-existent. I should really have been admitted to hospital. The police just don’t know what it feels like. They treat you as if you are bad and a criminal."

This anonymous account from a woman with mental health problems makes for shocking reading. Yet it is neither exceptional nor surprising.

With the closure of long-stay hospitals and increasing emphasis on care in the community, the police have become more involved in the lives of people with mental illness. This is partly because the police are on hand 24 hours a day and are often the first to be called to a situation. It might be that they are called by somebody who wants to report a person acting strangely. Or it could be that, with conventional mental health services closed after office hours, a person who feels suicidal or who is self-harming has nowhere else to turn.

The police are ill-equipped to deal with such people. During their basic 15 to 18 week training, recruits receive minimal information about mental illness and what they do learn tends to be based on their powers under the Mental Health Act 1983.

"Mental health is included in a number of modules but it is not concentrated on," says Linda Van Den Hende, who works for the Metropolitan Police and is the disability and mental health lead for the Association of Chief Police Officers.

"There is no set number of hours and it is not about how to recognise mental health issues and deal with them sensitively. They don’t have what I might call a general awareness training."

Custody sergeants, who are responsible for detainees in police cells, are given more training, but not much more. Those in the Met receive an additional two hours – hardly enough given that it is they who decide whether someone is fit to be interviewed and detained.

Given the frequency with which officers come across people with mental health problems, their lack of training is somewhat alarming. Can they really be prepared for what becomes a significant part of their job?

One survey found that in six police force areas there were 200 incidents involving people with mental health problems every day.(1)  Many of these incidents – exact figures are unknown due to lack of adequate recording – will be "section 136s". Under section 136 of the Mental Health Act, a police officer can remove someone from a public place to a "place of safety" (usually a hospital or police station) for assessment by a doctor.

Considering the number – and sensitive nature – of the incidents, it stands to reason that at times the police will make mistakes. This can mean mishandling that will only add to the individual’s distress and occasionally has tragic consequences.

According to the Independent Police Complaints Commission (IPCC), the body responsible for investigating police complaints in England and Wales, about half of deaths in custody involve people with mental illness – a disturbing figure given that 38 people died in custody in England and Wales in the year to March 2004.

The IPCC’s findings during its first year of operation have led it to consider mental health as its single most important area of concern.

But John Crawley, the IPCC commissioner with lead responsibility for mental health, says that it is not just the police who are at fault.

"Sometimes it is to do with statutory services not working together," he says. "The police do get it wrong but often they are caught as a key actor in a complex system where they have insufficient power to deliver what the person needs.

"Community mental health teams are not sufficiently resourced. The police are often called because they are available and will turn up. But sometimes it’s only the police who turn up. They can be the first, and only, response."

It is paramount then that the police are trained to deal with incidents involving people with mental health problems. But what sort of training should this be?

The Social Exclusion Unit’s 2004 report into mental health highlights an

awareness course run by Northumbria police in response to officers’ needs. Sessions were delivered by mental health professionals and user groups who gave information on conditions including psychosis, personality disorder and self-harm. Independent evaluation found that the training resulted in quicker and more appropriate responses to incidents – and improved attitudes from officers.

Elsewhere, other forces have introduced a system whereby people with mental health problems give talks to officers about their experiences. While this is better than nothing, it is no substitute for evidence-based, standardised training.

However, this is an area being developed. The government has made £155,000 available to strengthen police training in mental health and work is under way to establish what officers need to know. By June 2007, the Central Police Training and Development Authority (Centrex) is expected to be in a position to roll out this training.

Better police awareness about mental illness is long overdue. Those in the midst of a mental health crisis are often frightened and distressed, and the way they are treated by a police officer can be their make or break. Being spoken to like a criminal and thrown in a police cell to "cool off" is, without doubt, the last thing they need. 

1. Mental Health and Social Exclusion, Social Exclusion Unit, 2004

Screaming sirens and flashing lights add to the trauma

"I have mental health problems and, because of the behaviour of the police, I am now denied emergency treatment when I need it.

"I suffer very severe long-term anxiety and one of my symptoms is that I self-harm. When I have injured myself and called an ambulance the police always come too, yet they know very well that I am not a danger to anyone except myself.

"Despite this the police come, with sirens screaming and lights flashing, and cause a great hoo-ha. Sometimes more than one police car comes and they park all over the road. Before, when they came into my flat, they left the police car lights flashing. It was as if they had come to arrest a dangerous criminal. All my neighbours were out and watching – it was awful. Goodness knows what sort of total nutter they must think I am. And all because I had injured myself superficially.

"The police also made a lot of noise with their radios going and their loud voices. They had no intention of sparing me the embarrassment. I think it’s quite likely they may have even done it on purpose as the police hate people with mental health problems.

"The police presence causes me massive trauma on top of the trauma I already suffer from the illness. Because of the police I have stopped calling ambulances and in effect have been denied treatment."

The right approach

"When the police came to collect me I told them that I didn’t want their radio on as it was a Saturday afternoon in the summer and everyone was in their gardens. So they turned their radios off. When they got information they explained to me what was happening. From what could have been a confusing and frightening situation they did their best to explain things and reassure me."

"My brother has schizophrenia. Every time we saw the police in action we saw calming, non-assertive, non-aggressive behaviour that worked. The police referred my brother to the GP, and that led him to being sectioned. The actions of the police led to him being supported and getting treatment in the mental health system."

"I work in a hostel. I’ve found that on the whole the police react well when they’re experienced or have a superior officer present. I have always found the police to be attentive, co-operative and ready to do whatever is decided in the best interests of the patient. I have never seen a single incident of the police being heavy-handed or using any physical methods. This may be a fluke. It could be that when they hear the incident on the radio the only officers who attend are those who want to deal with it."

The wrong approach

"I was head-butting a police cell wall for three hours and they didn’t know how to deal with me. They came in and put a cup of coffee on the floor and walked out even though I had a bruise the size of a tennis ball on my head. Another time I was at a tube station, behaving oddly. The police saw me as a public nuisance. They told me to go home but I said I couldn’t. They said ‘either go home or we will arrest you’. My flatmate wouldn’t let me in and so I wandered around London and was lost for 12 hours."

"I live in a good bit of town. When I say I have a son who has schizophrenia who has gone missing they send people round who couldn’t be better. But they make assumptions based on how people talk and where they live. I was once helping a mum who needed to go to the police station where her son was being held as he needed his medication. The custody sergeant wouldn’t let us in. This family lived on a bad council estate and the police made the assumption that the lad was criminal and not mentally ill. It took us nearly three hours to get into the police station."

"The police should be made fully aware of people with mental health problems, perhaps with a department that specialises in this field. Where I live the police can’t be bothered or don’t have the knowledge to deal with people with mental health problems."