Right Care Right Person – Humberside Police

Police forces deal with a wide variety of incidents and calls for assistance. Some of these are policing matters, others are in relation to mental health, concern for welfare and social care issues.

Often, there is considerable overlap between the roles and activities of police, various parts of the NHS and other agencies. The police are often seen by the public as a ‘do all’ service.

Consequently, substantial demand is placed on police resources to deal with calls for service that may be better suited to other agencies. This demand diverts officers away from core policing functions and puts additional stress on forces.

The rise in demand was reflected in Policing and mental health: Picking up the pieces(opens an external website in the same tab) (His Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS), 2018).

Types of call for service

In 2018/19, Humberside Police received an increase of 14,120 (35%) in calls for service in relation to mental health. These calls accounted for 6% of all calls for service.

Similarly, welfare calls for service equated to more than 25,000 calls per year and accounted for 11% of overall demand. The force saw an increase of 27% in these calls over two years. Handling these calls severely hampered the force's ability to respond to other crime-related calls for service. 

Many of the calls for service were from other agencies who were unable to cope with demand. In 2018/19, the force received 4,577 calls from other agencies and attended 70% of them.

An analysis of the demand from other agencies identified the following types of calls for service that were being dealt with by the police.

Need for dedicated mental health resource

Funding for mental health locally meant that staffing of crisis suites did not provide for dedicated 24/7 resource. Police officers were found to be responding to incidents that should have been dealt with by dedicated mental health teams. This led to the following further issues.

• Once deployed to mental health incidents, officers were struggling to disengage and were spending a significant amount of time dealing with mental health incidents. An audit was conducted, which showed that Humberside Police spent 205 police hours dealing with just nine incidents.
• Police officers and police staff were making decisions with limited understanding of the complexities of mental health. Police officers were being sent to incidents where they had no powers and limited training (such as mental health calls). This was creating a significant risk to all involved. Those with the right skills were better placed to ensure a problem didn’t escalate into a crisis.
• Health and social care partners were routinely using the police service to manage clients where welfare checks were required. This passed legal responsibility for that task to the police and left them with the ongoing duty if it could not be achieved quickly or easily.
• Health calls for service, including mental health, were most often not people in crisis and immediate danger. Often they were people suffering from emotional distress or thinking of harming themselves.

How RCRP works in Humberside

RCRP is predicated on the right service providing support to people who call the police seeking a welfare check or for a mental health matter.

The role of the call taker in the force control room is to:

• assess the circumstances using the force control room toolkit, THRIVE and the NDM
• decide whether the police should attend the call for service or whether another agency is better trained, equipped and experienced to do so

Options available to the call taker

The current options available to the call taker under RCRP following an assessment of the circumstances are as follows. 

1. A police response required – log with system checks and staff deployed. (The police will take on responsibility for dealing with this call – a ‘yes’ response to the caller.)
2. Police may be required to attend, possibly with partners – system check and supervisor decision. (Further enquiries are required by the police. These will include system checks and consultation with other agencies to assess which partner has the right skills and experience to respond – a ‘maybe’ response to the caller.)
3. Not a police matter – no checks required, log closed, no deployment. (The request does not fall within the core roles of policing and no Article 2 or 3 Human Rights Act exists – a ‘no’ response to the caller.)

Threshold tests for police intervention

The force control room toolkit flowchart ensures that all calls for service are subject to the following threshold tests for police intervention.

• Is there a real and immediate risk to life or serious harm to an identified person?
• Is it a medical emergency?
• Is a child at risk of significant harm?
• Is the person suspected to have a mental health problem?
• Has a crime been committed?
• Is this a missing person report?

Guidance and a process map are available to support staff in identifying those calls that clearly meet the threshold for police intervention. They also highlight specialised processes depending on who the caller is – for example, a private individual or a partner agency.

As much information as possible should be gathered about incidents. This should all be logged regardless of whether the call is resourced or not. 

A full check of police information systems should also always be conducted where it seems likely that the police will attend the incident. This will ensure the risk level is correct and will help ascertain levels of vulnerability. This should be done in conjunction with standard THRIVE procedure. 

Where the call for a welfare check comes from a partner agency and the threshold for police attendance is not met, the partner agency must be notified. They must also be advised to call back immediately if more information become available, or the situation changes in a way that requires the police to re-evaluate their decision.

Calls from members of the public

When the call comes from a member of the public, the police will first:

• establish all the facts from the caller, so far as possible
• consider if another partner agency is better placed to give support and assistance

If so, the caller will be signposted to that partner agency and given sufficient information and contact details to do so themselves.

Due to circumstances beyond their control, the caller may be unable to gain support from a partner agency or do their own concern for welfare check. The police may take on the responsibility of a concern for welfare check in this situation. Whether the police do take this responsibility depends on the facts known at the time.

Where the call regards a welfare check on children and young people, logs will be created in the force control room. Where an immediate response is not required, these will be passed to the MASH team for their attention and consideration with partners.

Phases of the RCRP programme

Humberside Police implemented RCRP in four phases.

Activities

Phase one – concern for welfare

• Concern for welfare policy developed, making the new process transparent for all.
• Training delivered to all control room operatives, frontline patrol officers and control room supervisors.
• Tactical advisors and floor walkers in place, with the intent of providing intensive, live-time support for staff and intervention.
• Interactive toolkit developed for control room staff to aid decision-making.
• Escalation policy developed.
• Internal communications strategy and plan developed, to assist in embedding procedural changes and create the cultural change required.
• Partnership engagement plan developed, including stakeholder analysis.
• Significant legal advice commissioned.
• MOU developed with ambulance service – providing clarity of roles and responsibilities for attendance at health-related calls for service (which police may have attended previously).
• Extensive partnership engagement – influencing using a sound evidence base.
• Multi-agency workshop where partners were asked to assess whether they felt police should have been involved. Of the 48 mental health logs chosen at random, partners deemed that in 58% of occasions there was no role for police.

Phase two – AWOL and walk out of healthcare facilities

• Multi-agency policies developed.
• Legal advice obtained.
• New handover forms developed and agreed.

Phase three – Mental Health Act s136 and voluntary mental health patients

• Medical support policy developed to provide clarity on roles and responsibilities for medical matters.
• New handover form developed.
• Multi-agency MOU created.

Phase four – transportation

• MOU created

Legal and ethical considerations

Central to RCRP is the assurance that all policies and guidelines on practice: 

1. give clear guidance to officers and staff who use them
2. are reasonably comprehensive
3. are consistent with legal obligations
4. promote the best interests of the force and the public it serves

Extensive advice was given to Humberside Police on how RCRP fits with existing legal requirements on the police – including the duty of care on police in various circumstances and how this might vary with vulnerable callers (including children and young people).

Consideration was also given as to whether to conduct police system checks on calls where police did not have an obvious duty to respond. This took into account existing force operating models, Independent Office for Police Conduct (IOPC) investigations and law. The decision was made not to conduct intelligence checks where the decision was clearly a 'no', but to do so when the decision was 'yes' or 'maybe'.

Equality, diversity and inclusion

An equality impact assessment should be conducted by forces to ascertain whether the policy will disproportionately impact on any specific group within the community.

Children

The Humberside RCRP policy treats children as vulnerable. This vulnerability should form part of the assessment of any real and immediate risk under Articles 2 and 3 of the ECHR.

The policy may also adopt a different threshold of 'significant harm' (such as that enshrined in the Children Act 2004 s31(9)) that is arguably lower than that in Articles 2 and 3.

When children are involved, there is also an obligation to consider the best interests of the child. (This could involve making referrals to other agencies such as social services, even when there is deemed to be no immediate risk and thus no duty of care on the police.)

Enablers of implementation

Humberside Police is clear that several factors supported the successful implementation of RCRP. These included the following.

• Governance structure – the development of tight governance, providing staff with clear guidance regarding parameters, information sharing and briefing expectations with statutory partners. Humberside Police also embedded legal advice in every step of RCRP initiative. This supported buy-in when staff were anxious about not meeting their duty of care.
• Senior officer buy-in – having a chief officer lead who believed in RCRP and was prepared to drive it. Chief officer conversations are pivotal for gaining buy-in from other agencies and forming good partner relationships.
• Partnership working – RCRP benefits from close and effective partnerships with other agencies. Well-defined boundaries were created via MOUs, which also ensure all parties are updated about any intelligence that will be useful to them.
• Systems – Humberside Police and partner agencies already benefit from the use of standardised risk and need rating tools that are now employed alongside RCRP.

Barriers to implementation

The force also faced difficulties while designing and implementing RCRP and has since reflected on key learning to support future forces attempting to replicate it. 

• Internal culture – the force recognised a particular barrier to implementing RCRP was officers and staff who were cautious about declining to deploy support. The force prioritised clear and consistent communications, training, and support packages to reassure and upskill staff. This was seen to increase confidence and capability when making difficult decisions as to whether to deploy or refer calls.
• Partnership relations – another significant difficulty overcome by the force was the management of partnership relationships. An example of this was when mental health providers – despite agreeing with the principles of RCRP – pushed back against the programme. This was due to their lack of capacity and a perception that this would increase demand on their services. The force ensured they had both a clear shared vision with their partners (in this instance, providing the best possible service to the public) and a robust evidence base to support decision making. These two factors enabled the force to navigate more difficult periods of implementation and resulted in a stronger and more transparent relationship with relevant agencies.