‘It’s not getting them the support they need’: Exploratory research of police officers’ experiences of community mental health

Abstract

Police officers are first responders in a role which not only encompasses crime, but also increasing welfare issues. Issues have been highlighted with officers ‘detaining’ those with mental health difficulties and the impact that this process can have upon all involved. However, there appears to be a shift towards a police-health nexus. An exploratory study interviewed ten UK police officers with a view to understanding officers’ experiences of working with people with mental health difficulties and the availability of training for this role. With increasing demands to support people with mental health concerns, alongside a reduction in officer numbers, thematic analysis highlighted three themes: Support, Impact on the Officer and Understanding Mental Health. Increasing demands, a lack of training and limited multi-agency working were experienced by officers. However, officer-to-officer support was strong. Recommendations are made to increase collaborative multi-agency working and review the role of police officers as first responders in mental health crises.

Keywords

Community policing mental health section 136 officers’ experiences

Introduction

This study aims to explore police officers’ experiences of working with people with mental health difficulties and the availability of training for this role. The UK’s policing role is defined in the police service’s Statement of Common Purpose (Newburn, 2003):

The purpose of the police service is to uphold the law fairly and firmly; to prevent crime; to pursue and bring to justice those who break the law; to keep the Queen’s peace; to protect, help and reassure the community; and to be seen to do this with integrity, common sense and sound judgement.

Whilst this definition remains, police roles have evolved over the years, from the traditional models of policing in the past, where concerns were raised about outdated practice, equipment and organisational structure, to policy-led modernisation and extensive cost improvements following the financial crisis of 2007–2008 (Hall, 2015). 2011 saw a 20% reduction in UK police forces’ finances (Shaw, 2015), meaning a decrease in officer numbers by 14% (35,000) in 2010–2014 (College of Policing, CoP, 2015). In the meantime, reports (CoP, 2015) indicate that police incidents involving mental health concerns are increasing. One example comes from the Metropolitan Police Service, who reported a 2% increase in calls ‘flagged’ as involving mental health concerns (2011–2012; CoP, 2015). Furthermore, estimated figures suggest 15–25% of police work links to mental health concerns; work which is estimated to take around 20% of police time (Adebowale, 2013). This highlights a concern about reducing officer numbers and increasing welfare issues. Furthermore, there appears to be a slight shift in police practice from the definition highlighted in the police service’s Statement of Common Purpose, now with a focus on welfare, alongside crime. This change in police practice, alongside a reduction in officer numbers, may increase demands placed on officers, which may affect the officers’ experience of their roles. There is limited research into officers’ experiences working with people in mental distress. However, this has been widely researched for health professionals working with this population. Edwards et al.’s (2000) review of the literature indicated that health professionals working as part of community mental health teams are experiencing increasing levels of stress and burnout as a result of increasing workloads, increasing administration and a lack of resources.

One area where police work has increased is the number of section 136 (s. 136) cases they work with, with an increase in detentions under s. 136 from 14,902 to 22,965 since 2011/12 to 2015/16 (Health and Social Care Information Centre, HSCIC, 2016). Under s. 136 of the Mental Health Act 1983 UK, if a person is deemed to be at serious risk of harm to themselves or others, police officers have the power to detain them in a public place and take them to a place of safety (PoS), i.e. a hospital or police station. Concerns have been raised about the experiences of patients being detained in police stations, with police being criticised for lacking awareness of mental illness and lacking the skills required to support these individuals, resulting in patients feeling ‘criminalised’ (Bradley, 2009; Riley et al., 2011; Wright, 2014). In addition, research indicates a general dissatisfaction with the way both healthcare professionals and police treated patients detained under s. 136, with patients describing their experience as ‘frightening’ (Riley et al., 2011), alongside lacking good communication and trust (Gilburt et al., 2008).

As a result of the Bradley Report, PoS schemes were introduced; these are specific units (usually in a psychiatric hospital) run by healthcare professionals to care for those detained under s. 136 (Bradley, 2009; Mind, 2010). This led to positive results in terms of reductions in detentions in custody, from 8,667 (2011/12) to 1,764 (2015/16). However, high numbers of patients were still being taken to police stations and held in custody as a default location (Durcan et al., 2014; Wise, 2013) rather than hospital; arguably a potential breach of their human rights (Scott, 2014).

Research (Bradley, 2009) shows that patients experience difficulties when detained under s. 136; one possible explanation for this may be the inconsistencies in mental health awareness training across police forces in the UK. Some forces received annual training days or placements in mental health units and others received little to no training (Bradley, 2009). Therefore, police training to assess capacity of the individual, in accordance with the Mental Capacity Act 2005, (Department of Health, DoH, 2007) may be lacking. Some forces have made improvements, such as introducing training initiatives, including officers having more exposure to mental health professionals (Durcan et al., 2014). This has resulted in increased recognition of mental health concerns, alongside increased officer confidence in this area (Durcan et al., 2014). However, officers still reported feeling under-prepared for the task (Durcan et al., 2014).

A recent UK government scheme, the Street Triage Project, where mental health teams respond to mental health concerns alongside police officers, has been found to be successful in reducing the number of s. 136 detentions (Durcan et al., 2014; Dyer, Steer and Biddle, 2015; Reveruzzi and Pilling, 2016). Furthermore, this police-health nexus is deemed to alleviate human rights concerns, which have been associated with s. 136 concerns (Morgan and Paterson, 2017). Whilst this suggests officer recognition of mental illness has improved (due to them raising concerns and contacting the street triage teams in the first instance) and the two services work well together, there is a lack of qualitative research exploring police officers’ general experiences of s. 136 cases (Borschmann et al., 2010). Furthermore, Street Triage is not a national or 24/7 service; therefore s. 136 issues around police recognition and training in mental health are likely to persist outside of Street Triage hours and in areas where the service is not available. As a result, it is unclear how useful this ‘new service’ and potentially shared workload has been upon officers’ experiences of working with persons with mental health difficulties.

Aims of the research

In a climate of reducing police numbers and inconsistent training in mental health concerns, it is unclear how police officers in the UK are experiencing these changes with Place of Safety and Street Triage schemes, in relation to working with people with mental health difficulties. A qualitative design using semi-structured interviews was deemed the most appropriate method in order to facilitate an in-depth understanding of the police officers’ perceptions of working with people with mental health difficulties. Thematic analysis (Braun and Clarke, 2006) was used to identify coherent themes within the data.

Research question

How do UK police officers view their experience of working with people with mental health difficulties and their experience of training to equip them for this?

Method

Design

This research derives from a social constructionist perspective, suggesting that the world and events within it are constructed through social interaction, which aids human knowledge (Burr, 2015). Due to the nature of the research focusing upon police officers’ personal experiences, the epistemological viewpoint takes a relativist ontological position, which explains people’s understandings and experiences as being relative to their specific cultural and social frames of reference (King and Horrocks, 2010), describing society as a product of people engaging with one another. An interpretivist rationale in the form of qualitative interviews was likely to generate appropriate data from the officers, as the research questions concerned their experiences. Furthermore, interpretivism allows for multiple versions of reality (King and Horrocks, 2010), rather than limiting to one version of reality, such as with quantitative research. Therefore, a thematic analysis technique was the most appropriate method, in order to gain rich and detailed data through a flexible analysis technique (Braun and Clarke, 2006).

Participants

A purposive sample (Mack et al., 2005) of ten officers from a police force in the north of England was used, due to the need for the research to focus upon the experiences of a specific group of people. This police force was chosen due to the recent introduction of a local Street Triage Team and their access to a 136 suite (staffed mental health hospital with beds available for people detained under s. 136). The officers were selected by an Inspector and access to these officers was granted through the Chief Inspector and the Force Lead for Mental Health at the police force. Participants were required to be fully trained police officers, namely those with ongoing contact with the public, and selection was based around officer availability at the time of the research. All those selected participated, and full details of officers can be found in Table 1, alongside explanations of their job roles in Appendix 1.

Table 1.

Demographic information of officers.

Pseudonym	Job Role	Gender	Ethnicity	Length of Time in Service	Length of Interview (minutes: seconds)	Location of Data Collection
Ben	Police Constable	Male	White British	<2 years	23:51	Interview room at police station
Abby	Police Constable	Female	White British	2 years	31:20	Interview room at police station
Dave	Custody Sergeant	Male	White British	18 years	36:48	Officer’s home
Leo	Police Constable	Male	White British	<1 year	34:28	Interview room at police station
Terry	Response Sergeant	Male	White British	23 years	22:29	Office at police station
John	Police Constable	Male	White British	9 years	25:25	Interview room at police station
Lee	Police Constable	Male	White British	15 years	37:24	Office at police station
Fred	Police Constable	Male	White British	25 years	27:29	Interview room at police station
Elliot	Police Constable	Male	White British	6 years	53:32	Office at police station
Bert	Police Constable	Male	White Irish	11 years	52:29	Interview room at police station

Researcher

The researcher (first author) who conducted the interviews was a 24-year-old female MSc Forensic Psychology student. Her background in working with adults and young people with mental health difficulties gave some understanding of the topic but not enough that it impeded her view or biased the interview questions. The researcher’s experience with the police stemmed from her time volunteering as an appropriate adult, a role which involved supporting vulnerable adults in custody during their police interviews.

Materials

An audio digital recorder (dictaphone) was used to record the interviews with the officers. Officers were given an information sheet detailing the background to the research, what to expect and who to contact for any concerns. Officers signed a consent form to say they agreed with the aims and content of the research and were debriefed afterwards, informing them of their right to withdraw and contact details for the researcher.

Interviews were based on a set of questions informed and amended by the pilot study. This included asking officers about their experiences of working with people with mental health. This was followed by questions about their experience of training to enable them to fulfil this part of their role. The interview schedule was loosely based on Berry’s (1999) questioning techniques in order to elicit the most information and allow for questions to be topical and adaptive. The list of interview questions can be found in Appendix 2.

Procedure

The interviews were arranged by an Inspector in accordance with officer availability and conducted at the police station. Interviews took place in either interview rooms or offices. This excludes the pilot study, which was conducted at the officer’s home. Officers were introduced to the researcher (first author) and given an information sheet and consent form before picking a pseudonym. These interviews were semi-structured to allow for diversion and unanticipated directions (King and Horrocks, 2010). The interview structure included a warm-up question querying experience, length of service, time in role and responsibilities. This was followed by a number of questions linked to their experiences of working with people with mental health difficulties, the process, the impact this has upon them and their role, and training they receive to equip them for this. Following the semi-structured interviews, officers were debriefed verbally and given a debrief form to reflect this.

The pilot interview highlighted that some of the questions required clarification. Furthermore, questions related to supporting those with learning disabilities were removed, due to the differences in police protocol between learning disabilities and mental health concerns. Due to the similarity in responses elicited across the interviews, the responses regarding mental health concerns from the pilot study were utilised in the results of the research.

Data analysis

All interviews, including the pilot study, were used in the analysis. Audio recordings varied from 22 minutes 29 seconds to 53 minutes 32 seconds, with an average of 34 minutes 29 seconds. Interviews were transcribed verbatim by the researcher and analysed using Braun and Clarke’s (2013) six-stage thematic analysis technique. The interviews were transcribed by the first author in order for the researcher to become familiar with the data (Riessman, 1993), including slang, colloquialism and anecdotes in order to maintain context and reliability. Subsequently, an initial list of codes relevant to the dataset was created, prior to coding each interview. Following this, codes were laid out on cards in an attempt to search for themes using visual representations (Braun and Clarke, 2006). An inductive approach was used in contrast to a theoretical one, to ensure that the themes strongly linked to the dataset (Patton, 1990). Furthermore, themes were identified at the latent, interpretive level in order to fulfil the constructionist paradigm (Braun and Clarke, 2006). Quotes from each transcript were then copied and collated under the relevant sub-themes.

Interviews were revisited in order to reduce subjectivity and ensure the themes and quotes represented the whole dataset. During this time, some quotes were moved to other sub-themes, to ensure that they remained in context (Bryman, 2001) and adequately captured the outline of the coded data. Consequently, a thematic map was produced (see Figure 1) and data were revisited to ensure validity, prior to defining and refining themes. At this stage, the theme named ‘Emotional Impact’ was renamed ‘Impact on the Officer’, as it was felt that emotional impact was better identified as a sub-theme. The literature base was then consulted once more to give the first author a better understanding of these themes within the current climate. The final thematic structure consisted of three main themes and sub-themes within them, which was subsequently agreed by both authors.

Figure 1.

Map of themes and sub-themes derived from the thematic analysis.

Results

Three key themes emerged (see Figure 1) from the interviews with the officers regarding their experiences of working with people with mental health difficulties: Support, Impact on the Officer and Understanding Mental Health. These themes are not entirely independent from one another, with links between Impact on the Officer and Understanding Mental Health, through two sub-themes, Resources and Training, which relate to the impact that limited resources are having upon officers’ training in mental health. Officers’ quotes are identified through their pseudonyms in circle brackets at the end of each quote for transparency and evidence of the consistency between officers’ responses.

Theme one: Support

Theme one encompasses the support officers receive within their role when working with people with mental health difficulties. This is achieved through the following four sub-themes: Working Alongside Other Agencies, Resources, The Person Concerned and Colleagues.

Sub-theme one: Working Alongside Other Agencies

Officers spoke about other agencies during the interviews. These agencies included the Crisis Team (a service to support people in mental health crisis), the Street Triage Team (a team of mental health professionals implemented to support police officers when attending mental health concerns), the ambulance service, alongside general and psychiatric hospitals, including the 136 suite. Some officers highlighted timeliness and level of support from other agencies as problematic when working with people with mental health concerns: ‘I’ve said to th-, the Crisis Team before, because the sys-, the system takes so long, and it’s, I’ve voiced my, my frustrations, basically it’s the time delay’ (Dave); ‘I’ve, dealt with a lot of situations where I think the person’s been let down by, erm mental health services locally round here erm, the we have a 136 suite at [name omitted] hospital and I don’t think it works very well and I think, I’ll be honest I think the staff there have got some issues about their role’ (Terry). However, appreciation for the support from the Street Triage Team was seen across a number of interviews, ‘they just made the su-, situation so much easier to deal with’ (Abby); ‘Street Triage are brilliant and they will come out to us they will do assessments there, they will work with us’ (Elliot).

Sub-theme two: Resources

Resources were a topical matter for all of the officers interviewed. Ben highlighted the impact of cuts to resources: ‘in terms of cut backs, I don’t, I don’t know what its gonna leave, like our Street Triage used to work from I think it was 3 pm until 1 am everyday of week, and now they just work daytimes Thursday to Sunday or Wednesday to Sunday, so we’ve already lost a, a chunk’. Lee recognised the impact this is having day to day: ‘we always have to adopt the way we do our role based on er officer numbers rather than necessarily the needs of the victim or the needs of the like in this case like, the person who’s suffering’. Bert summarised the impact of cuts and low resources: ‘From our point of view as a police officer there isn’t enough resources to deal with people with mental health’.

Sub-theme three: The Person Concerned

It appeared all officers discussed the topics above (Working Alongside Other Agencies and Resources) in a bid to emphasise the impact a lack of resources and coordination between services had on the person concerned: ‘it’s putting the person at even more distress ‘cause rather than getting the help that they need from the mental health team they’re then sat in A&E, just waiting around because they’re so busy, it’s not, it’s not getting them the support they need’ (Elliot); ‘that’s a hell of a long time for somebody, you know who’s not feeling particularly great, to be sat up at hospital, you know potentially looking at twelve, fourteen hours worth of time sat there’ (John).

Sub-theme four: Colleagues

Experienced officers leading by example and providing background support was a common theme highlighted by officers: ‘I was very pleased I was with somebody else, ‘cause he’s an experienced officer and he sort of knew he recognised straight away and knew how to deal with the situation’ (Leo); ‘having another person there just in case anything did go wrong, that does help, and also you get two opinions and y-you know, you’re definitely doing the right thing’ (Ben).

Theme one, Support, highlights a perception of inconsistent coordination and support between agencies, including staff from a variety of services and the UK police force. As a result, officers are concerned about the impact this is having upon the person concerned. However, officers appear to feel supported by their colleagues in this role.

Theme two: Impact on the Officer

Theme two relates to how the officers work and how they feel within their job role, alongside how they manage this; often through communicating with others, covering their backs and detaching. Sub-themes include Blame Culture, Communicating With Others, Role Expectations and Emotional Impact.

Sub-theme one: Blame Culture

Blame culture in healthcare settings is defined as a culture with norms and attitudes avoidant of risk taking and accepting responsibility due to fear of punishment or criticism (Khatri et al., 2009). There is little research on this culture within the police force. However, Bert highlighted the importance of following policies to ensure he is protected: ‘a lot of it comes down to people thinking I need to cover my backside, so it doesn’t come back to me, so that’s all down to policy’. Furthermore, Ben highlighted the actions he takes to ensure that people know which decisions were made by him and which were made by other agencies: ‘I put it on the log err I, so if anything did happen that night I’ve explained that i-it’s the mental health professionals that have made decision to leave him how he is tonight’.

Sub-theme two: Communicating With Others

Four of the officers expressed how discussing work-related issues with other people helped, particularly with those who understand their role, be it someone they live or work with: ‘we just bat off at home together as well of stuff we’ve been to, my girlfriend’s in the police as well she’s a PCSO so it’s, it’s I think good that you have people you can talk to that know the situation’ (Elliot); ‘myself and my colleague, who you’ve just interviewed, sort of ranted and slagged of various other agencies for a few minutes and then everything was good’ (Terry).

Sub-theme three: Role Expectations

Role expectations were discussed among many of the interviews, namely the differences between officers’ expectations of their role and the reality. John discussed his experience, ‘the police work with people with mental health on an almost daily basis, erm it’s a frequent sore point at times…not only does it frustrate the patient them self, it frustrates the cops that are there, you know there’s, there’s reports coming in all the time, incidents coming in and we can’t go to ‘em because we’re at hospital’. Bert discussed this further: ‘we’re getting diluted and we deal with everything, we don’t provide the best service across the board’.

Sub-theme four: Emotional Impact

All officers highlighted the emotional impact of working with people with mental health difficulties, including the initial emotions during and after incidents, and the impact over time. Abby stated, ‘I was worried about her and then, I did think about her the next day when I came in and I had a quick look on the system to see whether anything else had been reported for her’. However, whilst there are initial concerns, the officers did not describe being affected to such a degree where they could not continue their role, as emphasised by Lee, ‘you do basically erm become a little bit hardened to it’ and Bert, who stated, ‘we just need to get her up there and get her sorted and that’s it, i-i-it’s a job that needs sorting, right, really’.

Theme two highlights the impact of officers’ roles and how they manage this. Officers often communicate with others who understand their role, in order to vent frustrations and/or process it better. This support network is utilised to help them deal with the demands of the role and the emotional impact their role has upon their private lives. Furthermore, officers have evidenced resilience to these impacts, seeing it as part of their job role and ‘a job that needs sorting’.

Theme three: Understanding Mental Health

Theme three includes the officers describing their lack of knowledge and understanding of a topic so prevalent in their role, yet underdeveloped in training regimes. It includes the sub-themes Knowledge and Recognition, Training and What Works.

Sub-theme one: Knowledge and Recognition

Officers discussed knowledge and recognition: knowledge and recognition of mental health, and knowledge of the person, alongside how this benefits them in their role. Officers recognised the importance of knowledge: ‘I think it’s becoming a more important area of our job and I think we need to know more’ (Leo); ‘it does help when you know somebody, when you’ve known somebody so long you know how they are and how they behave and, and their history’ (Bert). Whereas Dave emphasised their limitations: ‘I’m not a Doctor, I’m not medically trained or I’m not psychia-, psychiatrically trained, I don’t know their needs’. Meanwhile, Lee recognised areas necessary to improve knowledge: ‘perhaps some clarity on erm such like mental incapacity and stuff like that, would, would be a beneficial thing’.

Sub-theme two: Training

Training refers to the training officers receive from their force on mental health awareness, the current regime and the benefits they receive from undertaking training. Officers generally felt training was limited: ‘we get very limited training on, onnn, what to do or how to recognise it i-, a lot of it’s your instinct; you’re seeing a lot less classroom based training and a lot more e-learning erm, I can only assume it’s to do with budget cuts and less trainers than there were before’ (John). Ben also raised concerns: ‘training makes it look straight forward and it’s dead simple and easy and you’re sat there and it’s, it’s not confusing, and then you go out and it’s just a different game’.

However, officers were forthcoming in their suggestions for improvements: ‘if we could have sort of joint training sessions, with other agencies I think might be useful’ (Fred); ‘I’ve been told that there’s a free mental health first aid course in the UK which I’d be very tempted to go on, in my own time to build up my own knowledge’ (Leo). When responding directly to interview questions on training, officers did not refer to their shared learning experience and support from other officers within their role. However, during interviews officers described this as a supportive positive experience.

Sub-theme three: What Works

Despite the officers’ recognition of the need for more training and knowledge to assist them in their role, each officer had a good understanding of what worked and all of them discussed this in their interview. Dave highlighted the importance of utilising the knowledge he has, but also recognised the importance of being compassionate: ‘knowledge of the processes is vital, err I think attitude and empathy as well, that’s gotta be a big thing ‘cause it, w-, its human beings you’re dealing with’. This compassionate approach was consistent within the interviews, with listening, understanding and communicating common factors throughout.

Theme three highlights that despite access to some training and working with experienced colleagues, officers continue to feel ill-equipped when supporting people with mental health concerns. However, officers have made suggestions on where improvements could be made.

Discussion

The interviews centred around the day-to-day experiences of UK police officers when working with those with mental health difficulties. In the current climate, officers interviewed perceived training to be limited, which may explain the difficulties they reported with knowledge and recognition of mental health concerns, including an understanding of the individual’s needs at that time. This supports Wright (2014), who identified that police officers lack support around, and knowledge of, mental health. The officers in the present study recognised their abilities to identify mental illness, but described limitations when identifying specific signs of certain mental health conditions, thus supporting Riley et al. (2011), where people detained under s. 136 felt the police lacked the skills required, and needed a better insight into mental health. Differences in police knowledge may be explained by the independence of police forces from each other and their differing training regimes (Independent Police Commission, 2013). Officers interviewed indicated that they understood resources for training were limited, and offered solutions for addressing this, such as set training days or access to agencies.

They reported mixed experiences when working alongside other agencies, including highlighting concerns about cases not being taken off their hands in a timely manner. This is a national issue with s. 136 cases (Care Quality Commission, 2014), in particular for those in accident and emergency rooms (Adebowale, 2013). This issue may be explained by the guidance (The Royal College of Emergency Medicine, 2017), stating that officers are responsible for the safety of a person under s. 136, unless emergency departments are ‘confident they have staff and resources to deal with the risk of the patient absconding’. This is arguably a wider issue, given that healthcare services have also experienced budget cuts since 2010/11 (McNicoll, 2015).

Officers interviewed reported positive experiences when working with the Street Triage Team. They emphasised difficulties in completing this part of their role without the Street Triage Team’s support. This multi-agency, police-health nexus may support officers to make a well-informed decision about the best interests of that person in accordance with protocol (DoH, 2007). Benefits to a multi-agency approach have been highlighted elsewhere (Mind, 2013), as shown by the ‘Cuppa with a Copper’ weekly surgery run within a psychiatric unit in Leicester (Mind, 2013). This, combined with a designated ‘go-to’ person for expertise in mental health, has shown improved multi-agency working (Mind, 2013). In addition, it has provided a space for information-sharing and fostering trusting relationships between hospital staff and police officers. Furthermore, barriers between patients and police officers, have been broken and relationships established for those who have had previous distressing experiences when detained under s. 136 (Mind, 2013). This suggests a similar multi-agency approach would benefit all forces around the UK.

There was a sense of emotional detachment from Bert, with his reference to it (the s. 136 concern) being ‘a job that needs sorting’, and Lee, who reported becoming ‘hardened’ to it – a response other officers had had when discussing traumatic incidents (Evans et al., 2013). In general, the role of a police officer and the traumatic experiences they face may put them at risk of developing mental health difficulties, specifically post-traumatic stress disorder (PTSD; Clohessy and Ehlers, 1999). Despite this, research (Moran and Colless, 1995; Shakespeare-Finch, et al., 2003) has shown that the majority of emergency service personnel have not shown signs of psychological distress, with some reports of positive effects from this type of work.

This may be explained by the officer-to-officer support discussed in the interviews, as the process of social support is shown to contribute to the resilience of police officers following traumatic incidents (Evans et al., 2013). This is also described as ‘support-related social interactions’, which act as a buffer to increase coping and reduce symptoms of stress (Cohen and Wills, 1985). The quote from Terry suggesting things were ‘good’ following his social interactions supports this explanation. This also suggests that the work-related discussions that officers in the present study had at home are beneficial; an experience and impact on private life which is not uncommon in police officers (32%; Unison, 2014).

Despite some officers appearing emotionally detached, discussion of a compassionate approach was consistent within the interviews, with listening, understanding and communicating mentioned – an approach people valued during interactions with the police (Gilburt et al., 2008). Officers in the present study also highlighted their concerns for the person involved and the impact that the lengthy process had upon them. This supports research (Care Quality Commission, 2015; Royal College of Psychiatrists, 2011) into officers providing caring and empathetic responses to people in crisis and taking a person-centred approach, despite there being no reference to this approach in the guidelines for officers.

This research supports themes highlighted in the Bradley Report (2009), indicating that there are still unresolved issues nine years later. Officer numbers are reducing and those in practice are undertrained in a role which places high demands on each officer. Conflict and confusion are being caused between agencies where mental health is involved. The introduction of the Street Triage Team and the police-health nexus have gone some way to resolving this confusion/conflict, appearing to increase officer confidence in recognition and knowledge of mental health, whilst reducing officer workload. However, access to the Street Triage Team is limited and workload/multi-agency issues remain. This is concerning given the research (Edwards et al., 2000) highlighting increased stress and burnout in health professionals as a result of increasing workloads, increasing administration and a lack of resources. Officers appear to be managing their own mental health and stress through social support and detaching themselves from distressing events. Furthermore, they remain caring and compassionate towards those with mental health difficulties, despite limited guidance and training in this area (The Royal College of Emergency Medicine, 2017).

Practical implications

The role of the police officer is ever-changing. However, there remains a duty to protect, help and reassure the community (Newburn, 2003), which includes those in mental health crisis. Officers need to feel confident in their role, therefore this evidence highlights areas for improvement with the s. 136 process, multi-agency working and training in mental health for police officers. Regular collaborative multi-agency working and/or increased access to the Street Triage Team are suggested, in order to improve the police-health nexus, giving a space to pass on knowledge and increase understanding. It is hoped this will improve relationships with people in crisis and allow for better support. A designated person within each police force, who has established these relationships and has expertise in mental health is also suggested. This will allow for internal training on mental health (utilising the allocated training days already resourced for). Furthermore, it seems appropriate that officers gain access to the free Mental Health First Aid course (Mental Health First Aid England, 2015) in order to better their knowledge and build their confidence. However, with research (McNicoll, 2015) identifying the impact of wider governmental austerity leading to rising homelessness, increased mental health difficulties and reducing resources to manage this, are these suggestions a possibility? This research supports Morgan and Paterson’s (2017) findings on the benefits of health triage. However, they argue that new legislation is required to fully consolidate and embed innovations, such as triage, as a sustainable development.

Strengths and limitations

These findings and implications should be noted cautiously due to some limitations. The interviews were conducted on a small sample of ten officers from one police station in the UK, with selection by an Inspector of the force, which may bias the results and limit the generalisability of the research to other police forces. With the structure of police forces in the UK being independent from one another in all aspects, including resourcing, funding, training and supporting those with mental health concerns, the generalisability is limited once more. Consequently, these results may be limited to this police force. However, the supporting research (Durcan et al., 2014; Gilburt, et al., 2008; Unison, 2014; Wright, 2014) around the UK suggests otherwise.

The interview environment can have a big influence on the quality of the data gained (King and Horrocks, 2010). In this research, one of the interviews took place at an officer’s house, whilst the other nine interviews took place at a police station; six in interview rooms and three in a sergeant’s office. Those conducted at the police station may increase validity through the officers being in their work environment, discussing work-related topics, thus increasing comfort. However, it may have also had a detrimental effect, depending upon the experience that officers have had within these rooms (King and Horrocks, 2010). For example, one officer commented on how strange it was being interviewed in a room he would normally interview others in. Subsequently, it may be possible that the most reliable information was retrieved from the interview conducted at the officer’s house, a place where they felt comfortable and relaxed. Nevertheless, all interviews were of comfortable temperature, private and quiet, with only two interviews interrupted once for a short time, which is likely to minimise any chances of eliciting inaccurate responses. Furthermore, the structure of the interviews (semi-structured) allowed for exploration of the officers’ responses, with further questions in order to gain in-depth, qualitative data.

The interviews consisted of nine white-British officers and one white-Irish officer, which is proportionate to the target police force’s statistics on ethnicity. However, a sample of nine males and one female is not proportionate to the target police force’s gender statistics (27% female) or the UK average of 27.3% female officers (Home Office, 2013). Furthermore, eight of the ten officers worked as response police constables, one as a response sergeant and one as a custody sergeant. Whilst this does give some variation in the sample, there is a predominant focus on mental health in the community. This would explain the reduced discussion of mental health in custody and a focus upon ‘recognising’ mental health, something which response officers are responsible for, rather than those working in custody. Ultimately, this may limit the generalisability to other UK police departments.

The use of thematic analysis has allowed for a flexible interpretation of the data (Braun and Clarke, 2006). Limitations derive from subjective interpretations by the researchers which cannot be fully eliminated in thematic analysis (Braun and Clarke, 2006). However, it is important to note the researcher’s lack of knowledge on this topic prior to conducting interviews and analysis, which is likely to reduce this bias. Ultimately, the research has allowed officers to have a voice and express their concerns about their current role, alongside highlighting potential areas for change and important implications for practice. Furthermore, the results support previous research in this area.

Future research

Taking the conclusions, strengths and limitations into account, this exploratory research guides the way for further research in this topic area. Research into the police-health nexus is recommended to assess the feasibility and efficacy of long-term, nationwide, collaborative working in the current climate of cost improvements. Furthermore, a wider-scale study, given the exploratory nature of this research, to review the process of handling mental health concerns, given the concerns raised from officers, is recommended. Cost-effective suggestions to allow for long-standing changes and to ensure that the best, most efficient support is provided for those with mental health concerns is recommended; examples include regular collaborative multi-agency working; a designated mental health lead within each police force and regular training in mental health, using resourced training days and free mental health courses in the UK.

Footnotes

Authors’ Note

Lamb is now affiliated with Tees, Esk, Valley and Wear NHS Foundation Trust based at Limetrees Community CAMHS Service.

Acknowledgements

The research was conducted by the first author with supervision from the second author. Thank you to the ten police personnel who gave up their time to be interviewed and share their experiences, as well as the Chief Inspector, Force Mental Health Lead and Inspector at the police force who facilitated the process of this research. Also, thank you to Professor Sarah Grogan for her expertise, help and support throughout the research and publication process, and to my partner for his continued support.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Ethical approval for the research was granted by Manchester Metropolitan University Academic Ethics Committee.

Appendix 1: Job roles of officers explained

Appendix 2: Interview schedule

Can you tell me a bit about yourself? Your experience, length of service, time in your role and what you do…

Give an example of a time where you worked with a person with mental health difficulties and you felt it went well…

What highlighted their vulnerability to you? What did you do?

Would you change anything? Do you feel anything impacts your behaviour in your role?

How did you feel during this time? How did you respond to these feelings? Do you find anything in your role affects your feelings?

Give an example of a time where you worked with a person with mental health difficulties and you felt it didn’t go well…

What happened? Would you change anything?

How did you feel during this time? How did you respond to these feelings? Do you find anything in your role affects your feelings?

Has anything scoped your behaviour over time?

In your opinion what do you think works best for people with mental health difficulties? And yourselves as officers? Does anything hinder the process?

What do you know about services and schemes related to the Criminal Justice System to support those with mental health difficulties?

Can you tell me about your experience of mental health awareness training?

What did you do?

Can you describe which aspects you found useful/not useful?

In your opinion what is the most effective aspect to equip you for the role in the field?

What would you do for officers? Support, training, experiences

What are your feelings towards this topic?

How do you feel emotionally during training in this area?

What do you know about access to training in your force and other forces?

What do you know about changes in training over the last few years?

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