Working in Partnership: Police Mental Health Triage

Police Mental Health Triage (PMHT) initiatives emerged in England and Wales (E&W) in 2012 and are partnerships between the police, and health and social care services. Within them, mental health professionals can provide advice and support to police constables attending incidents where an individual appears to be experiencing a mental health crisis. In E&W, the partnerships have predominantly adopted co-response (at the scene) or virtual (control room/telephone) models. The overarching objective of this study was to provide a rich, contextualised account of PMHT, undertaken through the application of a critical lens, to plug a gap in the hitherto largely evaluative literature. Through not only the methodological stance, but also by situating PMHT within a socio-historical context, engaging with wider debates about police partnership work, and including the previously omitted perspectives of those with lived experience of PMHT, this research is an original contribution to the existing field. A qualitatively led mixed methods research design was adopted, with fieldwork conducted across three sites. The methodology included 214 hours of observation; 64 in-depth semi-structured interviews with stakeholders, practitioners, and service users; and a service user postal survey. A hybrid approach was taken to data analysis, with findings that drew upon the practice-orientated theory of collaborative advantage (Huxham and Vangen, 2005) and risk society theory (Ericson and Haggerty, 1997; Gale et al, 2016), through a framework of law enforcement and public health (LEPH). The research approach adopted, and methodology undertaken, have produced empirically informed findings that have encompassed both the anticipated and unintended consequences of PMHT partnerships. The research shows the localised drivers behind PMHT included key individuals, partnership informality, and local governance structures, all of which emerged under the broader socio-political umbrella of austerity. It shows that whilst prima facie, PMHT partnerships were operating with a shared sense of purpose (reducing demand on police and health agencies), this was underpinned by irreconcilable interpretations of this purpose and incompatible working assumptions, particularly about risk management. Co-response models were found to have developed a purpose far beyond that for which they were intended, acting in some instances as a first responding emergency MH service in the community. Though service user perspectives showed optimism about the prospect of any novel addition to the crisis care landscape, this had arisen out of the flames of a profound sense of injustice about broader systematic failures of extant crisis care provision. The research provides a much-needed insight into the impact that the introduction of PMHT has had on the existing policing and crisis care landscape, depicting the rhetoric versus the reality of the partnership practice and procedures. The findings from this study would suggest there is a clear need to focus on actually removing the mental health demand burden on the police, rather than continuing to provide a ‘sticking plaster’ over it, in the form of PMHT. The thesis includes twelve research recommendations for policy and practice. Included within these is the need for PMHT managers to avoid the temptation to continue to base the effectiveness of their partnership initiatives on singular measures, particularly s.136 data, as well as ensuring there is meaningful co-production with mental health service users in all aspects of the continued operation of any PMHT partnership arrangements.