Taboo subjects are increasingly rare in society, where the most intimate topics can now be exposed and examined at whirlwind pace via social media. However, outside its practitioners and their patients, mental health still largely remains a subject cloaked in secrecy, as it has been for centuries.
Progress is rarely made in any sector without the spotlight of public debate, so it’s pleasing and refreshing to hear about the remarkable achievements of Birmingham and Solihull Mental Health NHS Foundation Trust and West Midlands Police. Together, they have evolved a new way of dealing with individuals whose mental health issues bring them into contact with the front-line of our emergency services.
Detective Chief Inspector Sean Russell, who leads Birmingham and Solihull’s mental health work for the regional force, explains the origins of the Street Triage project. “For many years, when people suffered a mental health crisis on the street, they were typically detained by the police, and taken to what the 1983 Mental Health Act calls a ‘place of safety’. The relevant legislation is Section 136, so you will still hear of a Section 136 referral,” he says.
“These unfortunate individuals were often taken to police cells, not because they had committed crimes, but simply because there wasn’t a system in place for them to be taken anywhere else. Police officers didn’t have the appropriate skills to deal with them, so it was frustrating for all concerned.
“It was clear that a new approach was needed, and one of the significant drivers for change was the tragic death in 2011 of a young black man, Kingsley Burrell. He was detained in Birmingham under the Mental Health Act, and died following a prolonged period of restraint by officers and health service staff.
“We began using specialist hospital units as ‘places of safety’, but it wasn’t always possible to find space in those units, and we were still seeing between 25 and 50 individuals detained in police cells every year, often because they were in a public area, and their behaviour was seen as violent.”
DCI Russell’s ‘day job’ is heading the unit which tackles violent crime in Birmingham and Solihull, but before joining the force 20 years ago he worked in the health service. “I wanted a more thoughtful approach and a multi-agency approach,” he says. “I’d been a medic, and had a wide range of experience on the streets with the police, so it seemed logical to bring the police and the NHS together, to provide a more sophisticated and effective response.
“Birmingham and Solihull Mental Health NHS Foundation Trust really embraced the idea, and we evolved the concept of ‘Street Triage’ response teams, where police officers, paramedics and mental health nurses were sent to incidents in teams of three.
“The individuals, often young men, could be assessed and treated on the spot, then taken to places of safety. As a result, there was a dramatic fall in the number being detained under section 135, from 650 when we introduced the new approach to 333 in the 2014-2015 financial year.
“The resultant savings in police time meant officers could spend more time preventing crime, and serving their communities. The presence of paramedics at each incident meant 650 fewer people were taken to A&E units, a significant benefit to the NHS, particularly at a time when its services are under so much pressure.”
The new model was first extended in the Black Country, and then to Coventry, and further afield as recognition of its success became more widely known. “Our strategy is constantly evolving, and as community engagement deepens, and police officers and paramedics learn more about how mental health issues can manifest themselves, I am sure we will see the number of individuals detained continue to fall,” says DCI Russell.
“It’s also very pleasing to hear that other towns and cities, and other NHS trusts, are learning from our experiences, and looking to adopt similar mental health strategies, for the benefit of everyone.”
John Short, the CEO of Birmingham and Solihull Mental Health NHS Foundation Trust, says the triage approach continues to win approval from forces and NHS trusts across the country, and reports that it has recently been adopted in Dorset. “They have called it ‘Street Triage’, even though it’s a largely rural area, but because it would really stretch their resources, the nurse stays in the control-room when the teams attend incidents,” he says.
“In major urban areas, these teams might receive three, four or five calls every day, but in less populated areas, the demands are much less. The number of people detained in Birmingham and Solihull continues to fall, and so far in the 2015-2016 year, no-one has ended up in police custody via s136, which is very gratifying.” The success of the Street Triage concept has even reached Downing Street, and Short met both David Cameron, and the chief executive of NHS England, Simon Stevens, to discuss how other innovations might be adopted within the mental health community.
“I think they were surprised to hear that the old system could involve a van full of police officers being dispatched to look after an incident involving just a single person,” admits Short. “However, it is still vital to have an officer there; to provide an element of safety for the public, and to help divert these unfortunate individuals away from the criminal justice system. It’s a far more efficient use of resources, and the head of the ambulance service in the West Midlands is a great believer in this approach.
“Now, just in this one area, hundreds of people who would previously have ended up in police custody are being treated in a compassionate and effective manner, and all the agencies concerned have a much sharper focus on issues around vulnerability.
“In the past, it was always considered that the agency which was best at recognising vulnerability was the fire brigade, not least because no-one ever turns away a fire officer who knocks at their door.
“Now we’re seeing the West Midlands Fire Service doing excellent work with housing associations, to make sure that as many people as possible understand the issues involved. The Street Triage teams are the most visible sign of the new strategy, but there’s a great deal of work going on out of public sight.
“The next step, which we’re already working on, will be to engage with people more via their smart phones. If individuals suddenly experience a mental health crisis, it would be a massive boon if they had a number to ring, which had someone with a medical background there who understood their personal issues.
“We’ve received funding for a project to look at developing a more tailored response, and we’re the only mental health trust in the country to have that funding, which is a great compliment to the work we’ve all been doing here.”