Integrated care boards have been told that the “right care, right person” model might cause risks to people with mental health problems
“We agreed to implement the right care, right person approach for people at points of crisis, in partnership with the police, to ensure those needing mental health support can get the right help at the right time. We’re really clear that no unilateral withdrawal can possibly be safe or desirable, and what we can’t have is vulnerable people left to fall through the cracks." Claire Murdoch, mental health director, NHS England
NHS England has warned that the decision by police forces not to respond to most calls involving people in mental health crisis could pose risks to patients and to a service “already under enormous pressure”.
HSJ reports that Claire Murdoch, NHSE’s national mental health director, has written to the leaders of integrated care boards (ICBs) and the CEOs of mental health trusts about the impact of the new policing model, which is known as “right care, right person”.
The model, which involves police officers only attending mental health emergencies if there is a risk to life or of serious harm, was initially piloted in Humberside. In July, however, the policing minister, Chris Philp, told all forces in England that they could adopt the model.
In her letter, Murdoch warns that implementing all of the actions set out in the national partnership agreement may take time. She wrote: “I know you will all be doing your best to make this work, but I am so mindful of the risks to services and people with mental health problems, as I am sure you are too.”
The letter goes on to ask ICB chiefs and mental health CEOs to report any challenges to the safe and effective implementation of the model, including the need for additional resources or risks to patient safety, to the Department of Health and Social Care.
Integrated care systems (ICSs) are asked to provide a timescale for when they plan to implement different phases of the model. These include removing police involvement in responding to people going missing from health facilities in cases where there is no risk of serious harm or criminality.
Murdoch also asks how ICSs plan to mitigate risks to individuals experiencing a mental health crisis in their areas. The letter says it is “essential” that ICSs jointly agree phased plans setting out timescales as well as capital, workforce and revenue requirements. They must also carefully assess the impact of changes on the safety of individuals, and include clear escalation routes.
Mental health professionals have been raising concerns about the model in recent weeks, HSJ reports, citing instances where police officers have been instructed not to respond to any mental health calls – a policy known as “unilateral withdrawal”.
Murdoch told HSJ: “We agreed to implement the right care, right person approach for people at points of crisis, in partnership with the police, to ensure those needing mental health support can get the right help at the right time. We’re really clear that no unilateral withdrawal can possibly be safe or desirable, and what we can’t have is vulnerable people left to fall through the cracks. There’s good evidence of working in partnership [from Humberside] and so it should be possible for others to do so too.
“If there are problems of any kind that ICBs can’t work through constructively or if they think there’s a risk to people, we would expect them to escalate — regionally, in the first instance, but we do want to know nationally as well.”
NHSE would like ICBs to report problems such as these both to NHSE and to the government.
Although the Royal College of Psychiatrists supports reduced police involvement in mental health incidents, it has questioned the evidence base of RCRP and said it is concerned about the risk of unilateral withdrawal.
The National Police Chiefs’ Council, however, said that police forces in England increasingly receive complex calls about “significant mental health crises and vulnerabilities”, which has a “significant impact” on available resources.
Police forces have reported that officers spend 20-40% of their time on mental health call-outs. This is clearly undesirable, both because it is not the best use of police time, and because people in mental health crisis need to be attended and supported by mental health professionals. In the long term, the “right care, right person” model is a better approach. Claire Murdoch is right, however, to draw attention to the potential pressures put on the NHS by implementing the model too rapidly, particularly if trusts and integrated care systems lack the resources to deal with emergency mental health call-outs. Her request to ICBs to report problems with the policy at a national level offers an important opportunity for government to identify and address any difficulties, and to make sure that adoption of the new approach is ultimately successful.