Crime and mental illness

7 Jun 2019 Nick Garbutt    Last updated: 7 Jun 2019

Pic: Unsplash

The announcement that all police custody suites are to get full-time nurses is an important and welcome development.

It should also cast new light on an often-neglected issue – the correlation between offending and poor health, especially mental health.

The fact is the PSNI is bearing the brunt of Northern Ireland’s growing mental health crisis. Time and again officers are effectively first responders and there is a need for a deepening of the partnership between police and health services to deal with the problem.

Just one example. The police receive 1.8 million 999 calls every year. An increasing number of them – between 45 and 60 calls per day are either from people with mental ill health or concern people exhibiting signs of it.  That’s 25,000 every year. Some of these calls are from people who are feeling desperate and need someone to talk to. There have also been times when police have been called out to an incident, only to discover that the caller was imagining it or hallucinating.

But people with mental health problems are often also involved in very real and dangerous situations – mental ill health is at the centre of the vast majority of incidents so serious that they require the Armed Response Unit. 

Many of these cases involve people who have taken drink or drugs or both and have weapons. They may be threatening self-harm or members of their own families. Quite often this kind of incident happens in their own home.This is the reality of policing today. And that is even before you start to count offenders who subsequently turn out to have mental health problems.  

Two years ago the police carried out an assessment with the Public Health Agency of the needs of people in custody.  Every year around 27,000 people are detained. Of them:

• 18.6% had a self-harm warning;

• 6.2% had a suicide warning;

• 70.7% had additional risk factors for suicide as defined by the College of Policing.

This statistics in themselves are clear evidence for the need for specially trained nurses in custody suites.

Where people have mental health issues they need to be assessed and referred to the appropriate services for treatment. Effective interventions reduce the risk of re-offending, make Northern Ireland safer and reduce pressures on the police.

For example it is estimated that 64% of male prisoners have personality disorder with anti-social personality disorder especially common. According to guidelines produced for prison staff by the charity Mindwise typical characteristics are: “Previous experience of coming into contact with the Criminal Justice System or being involved in offending; being impulsive without considering the consequences or impact on others; lacking empathy and sounding ‘scripted’ when discussing emotions; being physically violent getting into a lot of fights; having difficulty holding down a job or staying in education or training; lying frequently and without difficulty; enjoying doing risky things; dependency on alcohol and drugs.”

This sounds like exactly the sort of person you might expect to be involved in crime. Yet this is a disorder that people can be helped to manage. It does not mean that the person suffering from it is  “bad”, per se.

No wonder that people with this type of personality disorder are first diagnosed after contact with police, probation and prison officers, rather than medical professions.

This is not to argue that we should not be protected from people who behave dangerously, but it does beg the question whether prisons as currently operated are the best environment for treatment.

Police have always had a responsibility for the health of people in their custody. Traditionally in Northern Ireland this is dealt with in two ways. Forensic Medical Officers (FMOs) can be called in to assess detainees and they can also be brought directly to A&E. The problem with the first solution is that there is no formal line of communication with the patients’ GPs and the latter can tie up officers for many hours in an environment which is not best suited to people in highly agitated states who can be a danger both to themselves and to others.

Last month the Northern Ireland Audit Office published an important report on mental health in the criminal justice system. It cites the high frequency of repeat offenders  who live chaotic lives which include mental health, alcohol, substance abuse and homelessness.

It observes that many people with complex health and social needs come into contact with the justice system before getting help and support within the community. This, by any measure, is shameful. As the report says the justice system “has become the service of last resort.”

Providing better mental health services to the public will be expensive but currently the cost is just being passed on: on policing, where a hard pressed service is dealing with people who are ill at the expense of chasing criminals; on the prison service where beds are far more expensive than interventions in the community; on the lost, broken and unproductive lives of the individuals concerned and their families and, of course, on the victims of crime.

There is another issue which some might find still more troubling. Most people recognise that there is an unwarranted stigma attached to mental ill health and there have been great strides made in lifting it. Yet at the same time we are collectively criminalising the mentally ill – people who deserve our help and support.

Society needs to be protected from people who commit crime, especially violent crime regardless of their mental state. That’s why we have a criminal justice system in the first place. But it is not geared up to deal with people who are ill. There is an urgent need for yet greater co-ordination between health services and the justice system and a real focus on treating mental illness within the community before it manifests itself in crime.

Embedding nurses in custody suites is a good first step on what will be a long journey. 

 

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