Ask people to name the frontline mental health service in the UK and you’ll probably receive a few different answers. Some might say specialist mental health crisis teams, others the ambulance service, or even A&E doctors. But in fact, you can make a decent argument that it’s the police.
While no firm figures are available, between 15 and 25% of police incidents are estimated to relate to mental health, with responses to them occupying up to 40% of police time. This compares to around 10% of ambulance callouts and just over 1% of A&E attendances that are recorded as mental health-related.
Indeed, the oversized role played by the police in responding to such incidents is alarming given how little mental health training officers receive – usually a course lasting only 12 hours.
Policing the crisis.
Data on uses of section 136 of the Mental Health Act, under which an officer can detain someone who appears “to be suffering from mental disorder” for up to 36 hours, confirm the police’s disproportionate involvement in the UK’s mental health system.
In 2018/19, police in England and Wales sectioned people 33,238 times – a 12% increase on the previous year. Strikingly, the police detained people only slightly less frequently than mental health professionals – to compare, there were 49,988 detentions under the Mental Health Act across all of the psychiatric institutions in England in the same period.
In a rare moment of consensus, both police abolitionists and the Association of Chief Police Officers believe that this state of affairs is profoundly wrong. The public also agree, with 70% of people viewing mental health as the sole responsibility of health services, while only 2% see a role for the police.
Despite this, emergency mental health care remains a patchwork affair. Schemes to provide specialist mental health ambulances are in their infancy. Meanwhile, the most recent NHS mental health report revealed that access to one-third of specialist crisis teams is strictly limited – meaning you’d need a diagnosis and a referral to gain access to support. A similar number of these teams have limited operating hours, and consequently, the police, as a 24/7 service, fills in the gaps.
These shortcomings in crisis care – and the resulting reliance on police – are partly a result of a decade of government austerity, with record demands for mental health services coinciding with the longest funding squeeze since the foundation of the NHS.
Since at least the mid-2000s, police have carried out tens of thousands of detentions each year. In 2005/6, the first year in which figures were recorded, section 136s were used 16,995 times, rising to 23,036 by 2013/14.
It is of course no coincidence that the police is involved on such a large scale. The modern mental health system has always had a dual role: not only to provide care but to maintain order. The language of the Mental Health Act captures this dichotomy, authorising police to intervene whenever “a person believed to be suffering from mental disorder” is “being ill-treated, neglected or kept otherwise than under proper control”. Through this phrasing, it becomes clear that the prevention of abuse is weighed equally with the disciplining of perceived threats to social order.
Killing with kindness.
According to the Zoë Billingham, HM Inspector of Constabulary, “the police approach to people with mental health problems is generally supportive, considerate and compassionate”. Billingham’s words conjure an image of a friendly ‘bobby’ treating a distressed person with kindly patience, yet time and time again, British officers have responded to those in crisis with violence – with Black people being disproportionately targeted.
There is a long list of people who have died at the hands of UK police officers during a mental health crisis. Among them are Roger Sylvester, Sean Rigg, James Herbert, Terry Smith, Thomas Orchard, Leon Briggs, Mzee Mohammed, Darren Cumberbatch and Kevin Clarke, with violent physical restraint implicated in many of these deaths.
Research by the charity INQUEST reveals that people from racialised minorities who die in police custody are two times more likely to have experienced restraint or force than white people – and mental health is twice as likely to be implicated in their deaths.
Restraint techniques are disproportionately used against young Black men, whose distress and disorientation is stereotyped as aggression in calls to emergency services and the police responses that follow. In a vicious cycle, the brutal racism of the police, the state and public life fuel mental health issues, and then drive violent responses to Black people experiencing a mental health crisis.
The movement for police abolition is a response to such patterns of racist mistreatment. In the US, abolitionist commentators have called for social care professionals to attend callouts in the place of the police, whenever mental health is believed to be a factor.
The vivid evocation of a post-police Minneapolis produced by activist group MPD150 describes a future in which 911 call handlers “have mental health professionals, social workers, domestic violence advocates, and other responders who could be dispatched to the scene depending on the situation”.
In the UK, however, it is difficult to imagine how this model would work in practice. Not only are the police integral to mental health legislation, but many professionals rely on police coercion in the course of their duties.
A concerning collaboration.
UK police are heavily implicated in the process of performing mental health assessments, which must be completed before a person believed to be suffering from a mental disorder can be detained in a psychiatric hospital. These assessments are conducted by two doctors and an approved mental health professional – usually a social worker with specialist training. If, however, professionals are refused entry, they can apply to a magistrate for a section 135 warrant, which allows police to enter premises and forcibly remove that person. Incomplete statistics – released for the first time last year – record 2,640 uses of this section; 23% of those detained were Black.
But the most concerning collaboration between professionals and police takes place when officers attend mental health wards to assist staff in restraining patients. While there are no comprehensive figures on this, a Mind survey carried out in 2012 reported 361 incidents of restraint in the previous year across the half of NHS Trusts that responded. This is despite police having no specific authority to restrain patients for treatment.
Meanwhile, police use of force statistics – which have only been made available since 2018 – reported 4,209 “incidents” involving police in mental health settings during 2018-19. These numbers are likely to be an exaggeration: each officer who participates in an incident must file an individual report. This means that one event involving three police would be recorded three times. Nonetheless, these statistics are indicative of the main trends in police uses of force. It is worth exploring them in more detail.
In mental health settings the most frequently deployed “tactic” was restraint – in particular, “non-compliant handcuffing” (1,782 reports). “Unarmed skills” – a euphemism which includes arm and leg locks, and “distraction strikes” (a euphemism for punches and kicks) – were listed in 2,091 reports. Among the other tactics used by police officers in these settings were tasers (248 reports), pepper sprays (96 reports) and even police dogs (3 reports; 1 bite). Across all settings, police were significantly more likely to use force against Black people.
As well as being violent, the police’s presence in mental health settings has also, in some cases, proved fatal. Seni Lewis and Kingsley Burrell were both young Black men killed by police after being restrained for long periods by officers within psychiatric units.
In Lewis’s case, officers were called to the ward by staff when he became agitated and uncooperative. As his parents wrote in 2018: “To this day, we struggle to comprehend that our son died as he did, simply because those who were responsible for his care – police officers and medical staff alike – failed in their duty to treat him with the respect that he deserved as a human being.”
As their statement suggests, the violent, racist logics that underpin policing also operate in parts of the mental health system. Black people are three times more likely to be restrained by staff than white people; four times more likely to be placed under section; and eight times more likely to be subject to the much-criticised Community Treatment Orders. Dubbed a “Psychiatric Asbo” by its critics, the measure sees people being forced to take medication as a condition of not being sent back to hospital.
Dismantling the police would doubtless reduce the violent treatment faced by those experiencing a mental health crisis. But as abolitionist thinkers have stressed, this in itself is insufficient. It isn’t enough to get rid of the police: we need to abolish policing entirely by remaking all aspects of our institutions which enforce social control through violence.
Mental health activists have long been envisioning a more humane psychiatric system, which would include a reckoning with systemic racism and abuse; the reduction if not eradication of coercion; and a shift to a rights-based approach that emphasises dignity, agency and autonomy.
If we are going to build a less violent future, it is vital that we begin to reorient our social institutions in this way. But with the role of the police in mental health services expanding rather than shrinking, it seems that right now we’re travelling in the wrong direction.
Ed Kiely is a PhD candidate at the University of Cambridge studying the impacts of austerity on mental health service provision.