The Guardian: ‘Just putting out fires’: how police remain the default frontline in mental health crisis

A broken health system means people with mental illness are overrepresented in the criminal justice system and the first responders are often police.

https://www.theguardian.com/australia-news/2021/may/01/just-putting-out-fires-how-police-remain-the-default-frontline-in-mental-health-crisis + SEE ALSO https://www.theguardian.com/australia-news/2021/may/02/navigating-a-confusing-and-complex-mental-health-system-a-guide-to-care

A paper published in Social Sciences found ‘police responding to people with mental illness provide transport in anywhere between 20% and 50% of cases’.
A paper published in Social Sciences found ‘police responding to people with mental illness provide transport in anywhere between 20% and 50% of cases’. Illustration: Greedy Hen/The Guardian

Kate* says she still has nightmares about the way she was forcefully committed to a mental health unit by police while suffering from acute mental illness that began after she was raped.

“Two policemen ambushed me as I walked home from buying milk, screamed at me that I had been scheduled, threw me violently in the back of a [police care] and drove at breakneck pace to the local psychiatric ward,” she told Guardian Australia.

“I was terrified and crying in the back. Only people with a mental illness are treated like this. Everyone else gets an ambulance.”

The incident occurred in 1997 in New South Wales, but Kate has been forcibly admitted to hospital half a dozen times since then. What she required each time was a compassionate and specialist health professional response, but, too often, Kate says, she was “humiliated”, starting with the first time she was sectioned by police.

“Until I was raped I had no problems with my mental health,” she said.

“I was never any threat to myself or others. It happened to me a second time, when my GP in Newcastle scheduled me without examining me or seeing me in person and police turned up at my address. I had been renting a granny flat in Willoughby. Because police turned up to ‘take me away’, when I came out of hospital I had no home. My landlords evicted me because I was obviously a ‘dangerous person’.

“I think things have improved somewhat since – but police are still involved often when it is completely unnecessary.”

In March, the ABC reported that an Aboriginal woman, a teenager, suffering an anxiety attack in Sydney was arrested by two policemen after she and her partner pulled their car over on the side of the road so she could get out and get some air. Aboriginal people, often suffering high levels of mental health distress, are overrepresented in the justice system, where they have even further reduced access to mental health services.Advertisementhttps://68aef0a202b7fd21a49c1ab1e169ed19.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

In September, Victoria’s anti-corruption agency launched an investigation into two officers involved in the arrest of a man who had reportedly been seeking treatment at the Northern hospital while undergoing a mental health episode. The man was left in an induced coma after video footage of the arrest appeared to show police running him over near the hospital, before getting out of their vehicle and kicking him and stomping on his head.

Numerous investigations, inquiries, studies and reviews over the decades have made similar findings; that most people with a mental illness, including those with major illnesses, do not commit crimes. But people with mental illness nevertheless are overrepresented in the criminal justice system, as a 2006 Senate inquiry found.

Victoria’s mental health royal commission, which delivered its findings in February 2020, found a future mental health and wellbeing system must be “fundamentally restructured around a community-based model of care, where people access treatment, care and support close to their homes and in their communities”.

“For those in crisis, police and ambulance callouts and visits to emergency departments will no longer be the only options,” the report found.

“A range of new consumer-led safe spaces will be available for people experiencing different levels of distress or crisis. These will be provided in compassionate settings where people can stay safe and access support.”

To achieve this, a new agency must be established, led by people with lived experience of mental illness or psychological distress, to support and design these new services, the commission said.

An paper published in January in the academic journal Social Sciences, by Matthew Morgan from the Queensland University of Technology’s school of justice, describes how the Queensland police operating manual “recognises that using police cars to transport people with mental illness is a stressful and undignified mode of transport, and therefore provides instructions for police officers to contact ambulance officers to fulfil this transportation role”.

Despite this explicitness that police cars are not ideal, “research across Australia demonstrates that police responding to people with mental illness provide transport in anywhere between 20% and 50% of cases”, the paper said. “Due to a dearth of ambulances (especially in rural areas in Australia), and a prioritisation of physical health over mental health by the ambulance service, ambulances may be an unavailable resource for police to utilise during mental health crises.”

A lecturer in criminology and policing at the University of Western Sydney, Dr Erin Kruger, co-authored a book in 2020 called Australian Policing; Critical Issues in 21st Century Police Practice, writing a chapter dedicated to mental health. Her research has mostly examined NSW police, and she believes responses are improving due to training programs such as the NSW Police Force Mental Health Intervention Team, where frontline police officers are trained to become accredited specialist mental health intervention officers.

The training helps police identify behaviours indicative of mental illness, and provides them with tools and crisis intervention techniques to manage them, as well as understanding of the current Mental Health Act.

“However, high profile cases, such as police fatal shootings of mentally ill individuals, tend to receive media attention and, thus, skew public perception that the police are not handling these cases well,” Kruger told Guardian Australia.

“Such cases also lead to the perception of mental illness as ‘criminal’ or ‘dangerous’, which is rarely the case. Research has also found that, in general, police are ‘gatekeepers’ or a ‘one stop shop’ for complicated social issues, including mental health.”

Unfortunately, police remain the default front line in managing people in crisis. In the case of mental health, these are often situations of medical emergency as opposed to criminal activity, Kruger said, and police are often facilitating access to medical care in such instances.

“Increasing access to mental health services and social supports for those with mental health issues may reduce police involvement in these cases,” Kruger said. “The risk in police responses to mental health, I would argue, is in potentially criminalising those who are in a health crisis.

“At the same time, police are sometimes essential to responding to mental health call-outs, as they provide security functions that may be required.”Advertisementhttps://68aef0a202b7fd21a49c1ab1e169ed19.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

This was the case for Anna, the carer for her 27-year-old son, Harold*. She shared her experience with Victoria’s mental health royal commission, saying her son was diagnosed with schizophrenia, post-traumatic stress disorder and alcohol dependency. Over the nine years she tried to get treatment for Harold, his condition worsened.

“I have been forced to watch my beautiful boy’s life deteriorate in front of my eyes,” she told the commission. “I have felt so disempowered and exhausted from constantly battling to get my son the support and care he needs. Mental health workers have said to me ‘I can’t talk now’ or ‘I’ll let you go now’.

“There have been thousands of phone calls, between 20 to 50 calls on some days, yet I have been unable to get my son the help he needs. Sometimes, the situation has to be really drastic before you are taken seriously, and help is provided.”

It was a police officer who she said managed one of Harold’s crises best, she told the commission. Police attended her home after a neighbour reported a disturbance when her son was having a mental health crisis.

“Although the policeman was assertive, he was also compassionate, empathetic and listened to Harold,” Anna told the commission.

“Harold really opened up his heart to him. He showed the policeman all the scars on his arms and the cuts he’d made a couple of days earlier, talked about … how his cat was missing. One of the policeman said to Harold ‘I know, I’ve lost a cat too, it’s really hard’ … The police and some public service officers have been fantastic … and in my experience far more supportive and responsive than the [crisis assessment and treatment] team.”

Nonetheless, Anna said improved crisis services were needed so that police are not the main contact for people who need specialised treatment, but this meant more mental health staff and improved waiting lists, she said. As Guardian Australia has previously reported, responses to mental health crises by the health system are not always compassionate or helpful either.

In response, there are programs being piloted to integrate mental health professionals and lawyers with police emergency responders in order to better facilitate a more compassionate and health-focused response. A senior lawyer with the Inner Melbourne Community Legal Centre, Molly Williams, leads the centre’s involvement with the Mental Health and Police Response program.

The pilot program recognises that people experiencing mental illness are vulnerable to legal problems that can cause or exacerbate mental ill-health, and that integrating lawyers in other non-legal settings works to reach people who would otherwise not seek legal help. They key partners in the program are Victoria police and the emergency mental health team at Royal Melbourne hospital.

“We see the opportunity in preventing legal problems from escalating, so that might be getting in before the police decide to charge someone, and often times they can use their discretion not to not to proceed in that way,” Williams said. “Sometimes it’s the clinicians who help to do this, identifying that the precursor to the crisis is the person being, for example, on the brink of losing their housing.”

While she said “it certainly depends on the police officer” and their training as to the impact the specialists involved in the program could have, it had no doubt helped many people avoid jail or charges at their time of mental health crisis.

But she added; “I think the biggest challenge we keep coming up against is that we’re working in a broken mental health system.

“The mental health royal commission in Victoria very clearly said we need to really start again in terms of how this system works for people. And it’s great to have these initiatives, but until you fix all the other parts of the system, it is sometimes very difficult to not just feel like you’re putting out fires.”

The Mental Health and Police Response pilot identified a number of system failures beyond a lack of adequate training for police. There was also high clinical staff turnover, insufficient funding and services not prioritising the role of prevention, including through early access legal services. Securing ongoing funding for such pilots to continue is also key.

Georgie Harman is the chief executive of Beyond Blue, the national mental health and wellbeing support organisation, and said she does not understand why such pilots aren’t funded longterm and rolled out more widely.

“There have been many, many trials that have police accompanied by mental health professionals or peer workers who can help to deescalate a situation, and these programs have been shown to be incredibly successful, both in terms of reducing police time, but also in reducing stigma for the person in distress and ensuring that that person gets connected to mental health supports more quickly,” Harman said.

“It can also help to avoid an unnecessary admission to an emergency department.

“But we suffer from ‘pilotitis’ in Australia. There are many many different examples of these pilots proving their value, both in terms of cost, but more importantly in terms of better outcomes for people. And what we need to see is them systematically rolled out, committed to long term and funded.”

* Names have been changed

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