Perspectives
Ellen Kirk, Analyst | Greg O'Meara, Analyst
Wednesday 23 August 2023
In July a national partnership agreement was announced to improve the way emergency calls relating to mental health incidents are dealt with. The new approach, known as ‘Right Care, Right Person’ (RCRP), aims to “end the inappropriate and avoidable involvement of police” in responding to such incidents across England and Wales. Announcing the agreement, the National Police Chiefs’ Council (NPCC) cited evidence that RCRP “could save around one million hours of police officer time per year”. Crest Advisory Analysts Greg O’Meara and Ellen Kirk examine that claim - and consider if the new approach will be a success.
There’s widespread agreement that, in principle at least, RCRP is the right way forward to deal with mental health incidents. The main objective is to reduce police involvement in mental health emergency calls when another response would be more appropriate. Under RCRP there will be:
A new operating model for handling and responding to emergency calls relating to a person with mental health needs
A College of Policing ‘toolkit’ for police forces
NHS England guidance produced by experts and people with lived experience
The RCRP approach does not mean that police should never respond to an emergency involving someone with a mental health need, but there is a threshold for determining whether they should be involved. The threshold is reached when police need to:
investigate a crime that has occurred or is occurring, or
protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to, or at risk of, serious harm
There are two key reasons why RCRP is being introduced.
First, a police response to a mental health incident may be harmful to the person in need. Those who have experienced such a response have described it as “degrading and stigmatising”, while police officers say they lack the training and skills required. Although Section 136 of the 1983 Mental Health Act gives police the power to detain someone if they are experiencing a mental health crisis, research suggests that people who research suggests that people who are detained often are left worse off.
Second, mental health call-outs place a considerable burden on police resources. A report in 2017 from His Majesty’s Inspectorate of Constabulary, Fire and Rescue Services (HMICFRS), Picking up the pieces, warned that police had been left to deal with the consequences of a collapse in mental health care for which they were ill prepared. As pressure on police to improve performance has increased, forces have tried to find ways to focus on what they see as their core roles - preventing and detecting crimes. That has led some constabularies, such as Humberside, to reduce the number of mental health call-outs attended in order to free up resources.
The Humberside approach
A HMICFRS inspection in 2015 concluded that Humberside Police was “inadequate” at keeping people safe and cutting crime - the only force to be given such a low rating that year. Humberside was placed in ‘special measures’, which meant that its performance was closely monitored in order to bring about improvements. By 2022 it had turned things around and received the highest grades ever recorded by the inspectorate, a change widely attributed to its pioneering RCRP approach to mental health incidents.
In 2018/19 the force had identified that it was devoting an increasing amount of officer time to calls for mental health incidents, up 35 per cent on the previous year. Many of the incidents were not life threatening and didn’t involve a crime. They included:
Concerns for welfare
Sectioned (detained) patients who were missing
Calls for transport
Section 136 detentions
To curb the increasing drain on officers’ time, Humberside engaged proactively with partner agencies, telling them they intended to withdraw from responding to mental health calls where a police response was not appropriate. The Chief Constable at the time, Lee Freeman, set a deadline of 12 months, after which the force would phase out responses to certain calls. During that period mental health services prepared to take responsibility for managing such incidents while the force developed a process flowchart and toolkit for call handlers to help them adjust to the new protocol.
In its 2022 inspection report for Humberside, HMICFRS congratulated the force on its “excellent performance” and highlighted the innovative RCRP approach as an area of good practice. The report cited an internal evaluation which found that “along with the public receiving more timely care from the most appropriate care provider, the programme has led to efficiency savings of 1,100 police hours per month”. Asked about the role of RCRP in his force’s turnaround in performance, former Chief Constable Freeman said it had allowed officers “to get back to basics”. The success of the Humberside model has been the subject of significant interest from other forces - with the NPCC claiming a national roll-out would save one million police hours a year.
One million hours
The NPCC website says the figure comes from extrapolating Humberside’s reported time savings onto a national scale. It uses the population served by Humberside Police, 935,875, and the amount of officer time saved through RCRP, 1,441 hours per month, to get to a figure of 0.0185 hours saved per year, per person. Nationally, that works out at 1,043,756 hours saved per year. According to these calculations, the Metropolitan Police, the largest force in the country, would save 13,536 hours a month - more than the 10,000 hours Mark Rowley estimates the Met currently spends on mental health-related incidents.
However, scaling up the time savings observed in Humberside for the population of England and Wales involves two big assumptions. The first is that RCRP will have the same impact everywhere, relative to population size. But that doesn’t take into account local differences in mental health needs and access to services - differences which would significantly affect the extent and type of mental health demands on the police and how much other services can absorb.
The second assumption is that the reduction in hours recorded by Humberside Police was solely due to the introduction of RCRP. But it’s not possible to know how many hours officers would have spent on mental health incidents without the introduction of the new approach because the figures do not remain constant every year. For example, the number of detentions under the Mental Health Act varied considerably between 2020/21 and 2021/22. In the West Midlands, it went up 55 per cent, while in Warwickshire the number of detentions fell by 44 per cent. In Humberside detentions also dropped - by 13 per cent - which may have had some impact on time savings.
That’s not to say that RCRP won’t result in time savings for the police - the approach clearly has the potential to deliver significant benefits for the public and local partnerships. But given the limitations of the data the figure of one million hours should be seen as a rough estimate rather than a precise prediction. The success of the new approach, in terms of quality of service and officer hours saved, will come down to how it is implemented.
RCRP success factors
If the RCRP approach is to be successful on a national scale, police forces will need to address three factors:
1. Call handler training and culture
Humberside’s internal evaluation of RCRP found that a key challenge was an internal culture of responding to all mental health calls. Call handlers in Humberside were initially reluctant to deny deployment to someone who was feared to be at risk, so training and tailored support were offered to ensure call handlers felt confident about passing calls to other services when appropriate. They began working alongside experts from the mental health charity, Mind, to help their decision making. Other areas will need to make similar support available if they are to see the benefits of RCRP.
2. Buy-in from other agencies
The Met’s announcement that it would stop responding to certain mental health incidents from the end of August, as part of a move towards RCRP, was heavily criticised by the health and social services sector. The author of HMICFRS’s ‘Picking up the pieces’ report said that due to the state of mental health services in London there wasn’t another agency to step in and fill the vacuum. The deadline was later pushed back to the end of October, but the row highlighted the risk that people will fall through the cracks if services do not work together to deliver RCRP.
A coroner's report into the death of a woman who had fled from a mental health facility raised similar concerns. It heard evidence which indicated that RCRP “allows each agency to regard such a situation as the other’s responsibility, whilst nobody is on the ground attempting to retrieve a seriously ill patient”. Humberside’s internal evaluation emphasised that a shared vision with other agencies to provide a better service to the public, plus a strong evidence base for decision making, “enabled the force to navigate more difficult periods of implementation.”
3. Dealing with demand
The success of RCRP depends on demand currently met by police being picked up by other agencies. In areas where RCRP has been implemented, resources have been made available to health and welfare services to deal with that demand, but it’s unclear if they were extra resources or taken from another part of the system. Lee Freeman said that after engaging with local clinical commissioning groups in Humberside they “found” an additional £1 million to fund mental health suites and assessment beds. But given the current workforce crisis in the NHS, there are legitimate concerns about the ability of partner agencies in some areas to meet the extra demand they will face.
Making RCRP work
If the potential dividends of the RCRP approach are to be realised, police forces must assess how prepared they and their partner agencies are and take steps to resolve any issues that might arise. It will be equally as important to evaluate the impact of RCRP, once it is operational, to understand what has worked and why.
Above all, the focus of the new model should be on the provision of high quality care to vulnerable people.