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In his recent report, Lord Adebowale (2013) described mental health issues as “core police business”. The recent retrenchment in mental health and wider public services mean that the demands on the police in this area are likely to increase. Mental health triage is a concept that has been adapted from general and mental health nursing for use in a policing context. The overall aim of triage is to ensure more effective health outcomes and the more effective use of resources. The purpose of this paper is to examine the current policy and practice in this area. It then goes on to explore the models of mental health triage that have been developed to try and improve working between mental health services and the police.

The paper outlines the main themes in the research literature regarding mental illness and policing, including a brief overview of section 136 MHA. It then examines recently developed models of triage as applied in these settings.

The models of triage that have been examined here have developed in response to local organisational, demographic and other factors. The approaches have two key features – the improved training for officers and improved liaison with mental health services.

Wider mental health training for officers and improved liaison with community-based services are the key to improving police contacts.

The current pressure on mental health services has increased the role that the police have in responding to these sorts of emergencies. This situation is unlikely to change in the short term.

This paper contributes to the wider debate about policing and mental illness. It highlights the fact that section 136 MHA use has tended to dominate debates in this area to the detriment of a broader discussion of the police role.

South Wales Police Mental Health (MH) Triage service was initiated to meet the Welsh Government MH priority of early intervention to prevent MH crisis. Community Psychiatric Nurses, based in the control-room, provide advice to police and control room staff on the management of MH-related incidents. The purpose of this paper is to evaluate the first 12 months of operation (January-December 2019).

Service evaluation of the first 12 months of operation (January–December 2019). Data were analysed in relation to: MH incidents; repeat callers; Section (S)136 use/assessment outcomes. Police, health staff and triage service users were interviewed and surveyed to capture their opinions of the service.

Policing areas with high engagement in triage saw reductions in S136 use and estimated opportunity costs saving. Triage was considered a valuable service that promoted cross agency collaborations. De-escalation in cases of mental distress was considered a strength. Access to follow-on services was identified as a challenge.

Triage enables a multi-agency response in the management of MH-related incidents. Improving trust between services, with skilled health professionals supporting police decision-making in real time.

There is a gap in the research on the impact of police-related MH triage models beyond the use of S136. This project evaluated the quality of the service, its design and the relationship between health, police and partner agencies during the triage process. Multi-agency assessment of follow-up is needed to measure the long-term impact on services and users.

Interactions between individuals experiencing mental health (MH) problems and the police are complex and may affect the way in which both parties react to and experience the interactions. The purpose of this paper is to examine three commonly used interventions to improve these interactions.

Mixed methods were used to examine embedded MH professionals in command and control rooms, Liaison and Diversion Teams and Street Triage. The authors also reviewed the use of Section 136 (s136) of the Mental Health Act 1983 (2007) during the period these interventions were deployed.

There was strong support for these interventions but also gaps, resource and operational issues that need to be addressed if they are to have optimal effect on delivering appropriate diversion from the justice system, reduce reoffending and improve MH outcomes for individuals. The use of s136 remained relatively constant.

Despite a recent increase in the level of investment related to these interventions the evidence base remains limited. This study provides baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system.

The purpose of this paper is to describe the design, implementation and evaluation of a small UK case study of a mentoring style pilot intervention integrating a specially trained police officer alongside mental health professionals to support highly intensive service users of emergency services.

The development of the conceptual framework informing the mentoring intervention is described and its implementation evaluated using a range of qualitative and quantitative outcome measures.

The four high intensity service users involved in the pilot had internalised the need to participate in recommended recovery pathways. Mental health nurses reported improved compliance with treatment. Although the sample was small, the number of police mental health crisis detentions was reduced by 66 per cent after one year and by 100 per cent after 18 months. Usage of other emergency public services had also drastically reduced, or been eliminated altogether.

Limited time and resources and the need for a solution that could be implemented as soon as possible meant a pragmatic design, implementation and evaluation.

The study indicated that a wider roll out of the new multi-agency mentoring model would be beneficial.

This is the first intervention to integrate mental health professionals and a trained police officer directly into the care pathway of repeated users of emergency public services with complex mental health needs.

The issue of mental health and policing is a subject that has been debated from a number of different perspectives. The purpose of this paper is to report on the findings of a case study that explored mental health difficulties and vulnerability within police custody.

The design of the study was qualitative, and it utilised telephone, semi-structured interviews with all levels of the custody staff. This approach was taken because the aim of the study was to explore how people in different roles within the organisation worked to safeguard vulnerable people in custody.

The findings from this study identified a number of interesting themes that could be explored further in later studies. Overall, the respondents expressed frustration that vulnerable people find themselves in police custody for low-level crime, when it could have been avoided with improved mental health services in the community. Additionally, the findings demonstrated that despite the processes that are designed to safeguard the detainee, tensions still exist including, timely access to mental health assessments, appropriate training and support for staff and the use of appropriate adults.

Although the study was small in scale, the custody facility delivered detainee facilities for about 5,000 individuals per year. The research and information obtained supported the police lead for mental health to identify opportunities for improving the customer journey, as well as recognising the need for further research to identify how officers and staff relate to vulnerable individuals in contact with the police service.

Despite the limitations of the study, the findings have captured interesting data from a range of professionals working in one police custody suite, and therefore it presents a holistic overview of some key issues around mental health, vulnerability and safeguarding within the context of police custody.

The Policy Watch series reflects on recent forthcoming developments in mental health policy across the UK. The purpose of this paper is to consider the use of the Mental Health Act to detain people in police custody and the use of physical restraint, and in particular face down restraint, in mental health settings in England.

The paper reviews findings of recent reports into policing and mental health and a Mind report on the use of restraint in mental health settings.

The paper suggests that people with mental health problems are being held in police custody more often than they should be, and that this is partly due to the unavailability of good care at an earlier stage for people approaching crisis. It also suggests that people are being physically restrained in inpatient settings too often in some areas although face down restraint has been phased out altogether elsewhere. These practices threaten human rights.

The paper discusses recent evidence from Her Majesty's Inspectorate of Constabulary and others, the Indepedent Commission on Mental Health and Policing and from Mind.

Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis.

This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019.

There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service.

Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team.

This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.

In their 1999 classic, Crime is Not the Problem, Zimring and Hawkins changed the way criminologists thought about crime and violence simply by forcing us to distinguish between them. In so doing, they advanced an agenda for a more effective response to the real “crime” problem in America – violence. In this short commentary, the authors apply this logic to gang research and responses. The authors argue police fall short in responding to “gangs” because researchers and policymakers have defined them in terms of criminal behaviour writ large, not the problem that really needs policing – the precise social and spatial dynamics of gang violence. The purpose of this paper is to stand on the shoulders of others who have stated violence trumps gangs when it comes to policy and practice and provide a conceptual review of the literature that captures mainstream and critical perspectives on gangs and offers both sides some common ground to start from as they contemplate “policing” gangs with or without police.

A review of the extant literature.

The authors stand on the shoulders of others who have stated violence trumps gangs when it comes to policy and practice, to provide a conceptual review of the literature that captures mainstream and critical perspectives on gangs, in North American and European contexts, and offers both sides some common ground to start from as they contemplate “policing” gangs with or without police.

The paper is a conceptual piece looking at policing gang violence versus gang crime. The paper aims to restart the debate around the role of crime in gangs and gangs in crime. This debate centres around whether gangs should be understood as primarily criminal groups, whether “the gang” is to blame for the crime and violence of its members and what feature of collective crime and violence designate “gangness”. We use that debate to reflect past and current police practices towards gangs.

There is a proportion of psychiatric service users whose needs are not met by existing models of care. This can lead to a reliance on acute and crisis services. These service users may be considered high intensity users (HIUs). The purpose of this research is to evaluate the Crisis Plus model, an intervention designed to better support HIUs in the community and reduce dependency on acute and crisis services.

Forty-seven HIUs were involved in Crisis Plus. The core intervention of Crisis Plus was an Anticipatory Management Plan (AMP), produced in collaboration with service users, their families and their care coordinators. AMPs were shared with relevant services and attached to electronic patient notes to ensure a uniform, psychologically informed approach to care.

HIU service use was compared pre and post-AMP. On average, number of inpatient admissions, number of days spent on the ward, accepted psychiatric liaison referrals and accepted home treatment team (HTT) referrals decreased significantly.

Crisis Plus has taken a collaborative, proactive approach to engage HIUs, their families and the services that care for them. Crisis interventions that emphasise collaborative working and service user agency are key.

The provision of dedicated psychological support to HIUs and their professional and personal network is crucial to reduce reliance on acute and crisis care. Crisis Plus is unique in that it instigates co-production and active consultation with HIUs and services to improve clinical outcomes, in addition to reducing NHS expenditure.