Official Report 581KB pdf
We come to agenda item 4, which is consideration of health and interagency responses to people in distress. I am delighted that we have with us in room, Brian McInulty, assistant inspector of constabulary at HM Inspectorate of Constabulary in Scotland. Joining us online is Kevin O’Neill, programme manager for the Distress Brief Intervention Scotland programme board. Mr O’Neill, you are also very welcome.
We will get started with some questions, and to kick us off, I will hand over to my colleague Marie McNair.
Good morning. I am interested in how we work with charities in consultation with regard to distress brief intervention. To what extent have mental health charities and third sector organisations been involved in developing the DBI programme?
Thanks for inviting me to give evidence on our work on the distress brief intervention programme.
It is an excellent question. I will explain the delivery of the DBI programme so that colleagues understand. A distress brief intervention has two key components. Level 1 is delivered by our front-line services, including police, NHS 24, the Scottish Ambulance Service and mental health assessment teams. Wherever a person presents, those services are able to provide a compassionate response, ease the person’s distress and then, with confidence, refer them on to DBI level 2 support, with the promise of support in two to four hours.
We have 11 third sector organisations across Scotland who are collaborating and working with us to deliver that level 2 support. We really value the experience and expertise that third sector organisations have in delivering person-centred support at the heart of local communities, immersed in their local communities.
That means that those third sector organisations contact the person in distress who has been referred. We have now supported more than 120,000 people across Scotland. They contact the person who is in distress within 24 hours, and through training and a toolkit that has been developed by the University of Glasgow, they deliver problem solving and person-centred distress planning with that person over a period of around 14 days. That enables the person to alleviate their immediate distress and to feel more able to manage their future distress well into the future.
Thanks for that, Kevin. Have organisations given feedback that they have noticed any gaps in the current service provision?
Distress brief intervention is a very inclusive model. We have very high inclusion criteria, and very low exclusion criteria, so very few individuals are excluded. A very small number of individuals that come to DBI—less than 1 per cent—have been referred on numerous occasions, often by a range of different organisations and agencies. Recognising that across the country, and sometimes organisationally and in the local community, can be a challenge. How to support a person who is the most frequent attender across a broad range of services can be a challenge.
We have protocols around how our DBI level 2 practitioners raise that with the person’s general practitioner and local partners, but it depends on the local organisations then taking a much more multi-agency case-management-type approach to working with that person over a longer period.
Have the proposed reforms been redesigned as a result of that feedback from the mental health charities?
Can I ask you what you mean by “proposed reforms”, minister?
Thanks very much for that, but I am not a minister.
Apologies.
Have the mental health charities provided feedback on the redesign?
DBI was first piloted in 2017 in five health and social care partnerships. It was a whole new way of working, informed by the evidence. Since then, it has grown incrementally and has now been implemented across all 31 HSCPs.
At the absolute centre of both the two independent evaluations and the continuous improvement of DBI are the various forums that bring together our third sector organisations. In essence, DBI is heavily informed by those organisations, which bring a wealth of experience on emerging themes, challenges and gaps. They also help us to identify what more we can do at the centre, including through our work with the University of Glasgow, to improve the supportive infrastructure around DBI. That infrastructure enables our third sector organisations to deliver connected, compassionate support and allows people to experience that support.
That is really helpful. Thank you.
Good morning to our witnesses, and thank you for your time today. I have a question for Kevin O’Neill. I have a document in front of me that Police Scotland sent to us, which I will refer to. I would like a better understanding of the DBI pathways. It says:
“Police Scotland has DBI pathways in 11 of the 13 local policing divisions”,
and notes that Edinburgh City East and Forth Valley do not have a pathway. Will you explain why that is?
Yes. When it comes to local pathways, we at the centre have reinforced the importance of having multiple referral pathways to DBI at a local level, because we recognise that people present with different characteristics to different services. For example, referrals from primary care are far more likely to involve women, and individuals are far less likely to be under the influence of alcohol or substances. In contrast, referrals from the police are more evenly split between men and women, and individuals are more likely to be under the influence of alcohol or substances. Therefore, the need to have multiple pathways is really clear.
What local pathways are open is fundamentally dependent on local agreements between the police, the Scottish Ambulance Service and local health and social care partnerships. We have seen positive progress. In 2022-23, 14 of our HSCPs had police referral pathways. This year, that number has risen to 24, and we are heading towards all 31. We are growing incrementally as those pathways become embedded and established.
This goes back to the previous panel discussion that I observed about the need for local partnerships, health boards, HSCPs, the police and the Scottish Ambulance Service to work together to ensure that local pathways are in place. There is an expectation that local pathways, including multiple referral pathways, will be available, but how they are built and implemented incrementally comes down to those local discussions.
But is it fair to say that there are gaps?
That is fair to say at this time.
About 2,800 Police Scotland officers are trained as level 1 DBI referrers, but there are about 16,500 full-time officers in Police Scotland. That is a really small number of trained officers at level 1. That is another gap in support. Talk me through how that works.
Again, it largely relates to the distress brief intervention programme being a new way of working. We have been rolling it out alongside the independent evaluation of DBI, recognising what works well, what else needs to be developed and how it needs to be improved. As I mentioned earlier, it started with five test sites across the corresponding HSCPs in 2017 and has grown incrementally across all 31 HSCPs. At the same time, we have been working really closely with our Police Scotland leads across on DBI to incrementally grow the number of front-line officers who are operating in local communities.
The most recent data that I have is that around 3,000 officers are trained at level 1.
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Is it not fair to say that it is a significant gap?
It is certainly well short of the 16,000 officers.
Please explain. If I am a police officer but am not trained in level 1 DBI, how do I refer to level 2? How do I even know how to make that referral?
Before you are trained and before you can make a referral, strategic discussions take place at health and social care partnership level to ensure that the pathways are open and that the level 2 colleagues in the third sector that I spoke about earlier have the capacity to take referral. When you are trained—
Can I make a referral if I am not trained?
If you are not trained, you cannot make a referral.
That means that there is a huge gap.
We are making progress and working with health and social care partnerships, but there are still gaps.
The referral pathways are not open 24/7. Is that right?
Technically, they are. A person might present in an accident and emergency department or with Police Scotland and many individuals present outwith normal working hours. Following a discussion with front-line colleagues, there will be a decision about a referral then being made to level 2.
Is level 2 available 24/7?
First contact is made within 24 hours of referral at level 2.
I do not understand that. You say that contact is made “within 24 hours”. If I am a police officer who is trained at level 1 and I need a level 2, do I have to wait for 24 hours?
If you are level 1 trained, you will have eased that person’s distress, explained what will happen next and promised that person contact within 24 hours.
What do I do with that person if they are in crisis? I am not sure if I just do not understand, but I have to ask.
You would have a sense that that person is able to wait 24 hours to be seen.
What if they are not able?
That goes back to what was said by the previous panel. If you are concerned that a person remains at immediate risk and requires to be seen urgently, that would take you back to the existing pathways that are already in place at local level so that that person can be supported sooner.
To clarify, if I am not trained in level 1 DBI and if a person is in crisis, what do I do?
You would use the existing pathways.
Within the community.
We have something else alongside that. You heard about the enhanced mental health pathway that Police Scotland has with NHS 24. We also have an agreement with contact and control centres at Police Scotland and at the Scottish Ambulance Service that they can make a direct referral to DBI for anyone aged 16 or over across the whole of Scotland. If Police Scotland feels that someone would benefit from an enhanced mental health assessment or support from NHS 24, they can make a referral and NHS 24 can, in turn, refer to DBI. We know that about 9 per cent of all referrals that go from Police Scotland into the NHS 24 enhanced pathway come to DBI.
That means that a lot of people are referring in. What is the maximum waiting time?
There is no waiting time. Everyone receives a call within 24 hours. There is no waiting time for DBI. That is why we are careful about how DBI is implemented at pace and scale. The level 2 support must be in place for the number of folk who are able to refer into DBI and that has grown to the point where we are now taking more than 2,400 referrals per month across the country—that number has doubled in the past two years. I hope you can see the direction of travel as capacity, confidence and skill are growing.
Okay. Thank you very much.
We move to questions from Maggie Chapman.
Good morning, and thank you for joining us this morning. I, too, have some questions on DBI, and I will turn to Brian McInulty first.
There were some really interesting recommendations in the 2023 HMICS review, particularly around the identification of the culture of risk aversion. I am interested in how you see progress on that in the past three years. Have we moved away from a point where police officers feel that, although there is nothing that they can do, they are the only people who can be there? Have we moved to a point where it is recognised that community provision needs to step into that mental health support space?
Thank you for the question and for the opportunity to come along this morning. It is quite frightening to realise that three years have passed since our 2023 review. Ms McNeill will remember my giving evidence before—I have already taken part in three evidence sessions since then, as was referenced this morning. That provides an indication of the level of complexity around this matter. The overarching recommendation and finding in our review was that this is a very multifaceted issue. There is now one police service, 14 health boards, 32 local authorities and a multitude of third sector organisations working locally and nationally. When we put all of those together, it is a very complex landscape.
As you said, the review found that there was a strong culture of risk aversion. An advisory panel assisted us with our review, and there was representation on that panel from qualified mental health clinicians. We found quite a gap between the appetite for risk among police officers, who are essentially untrained in dealing with mental health, and that among people who are trained in mental health. To really simplify it, if a police officer is dealing with somebody who is in distress and that person articulates that they want to self-harm, the officer would often take that literally, not knowing anything about the person’s medical background, history or condition, and certainly not knowing about the complexities of dealing with somebody who is experiencing poor mental health. That would result in the officer, in good faith, not wanting to leave that person on their own. They would then spend an inordinate amount of time babysitting the person in their home, perhaps encouraging them to go to A and E, and then not wanting to leave them in A and E, because—as we heard quite strongly—if they leave them in A and E and the person then walks out of there, they become a missing person.
There were probably two main drivers of risk aversion across all the people we spoke to. First and foremost, police officers are human beings and they do not want something bad to happen to the person who is sitting in front of them. On a human level, they certainly do not want to walk away and leave that person. Secondly, there is the focus and investigation that would, quite rightly, come from organisations such as the Police Investigations and Review Commissioner if somebody came to harm. There would be a full investigation, which would have a significant impact on the police officers who had been dealing with the incident. That leads to a situation whereby they try to do what they see as the right thing.
We were very ably assisted by Voices of Experience Scotland, so lived experience fed into our review, and that really helped to inform a lot of the recommendations that were made. We heard very strongly that, actually, police officers arriving is the very opposite of what these people need at the time. It is quite traumatic if the police come to your house when you are well; I can only imagine how traumatic it is if you are unwell. You can only just imagine being taken from your house and a police officer sitting beside you in a busy A and E department with a lot of people watching what is going on.
Therefore, there was a lot of risk aversion.
On where we are now, we have been working to help Police Scotland to implement its improvement plan, and guidance and training have been rolled out. DBI is an important part of that, but there is no single quick fix for this complicated issue. There has been a lot of significant progress, but we have not reassessed the situation or done another review. At some point, we might go out and try to measure the impact of the changes that have been made. However, if you are asking for my opinion, I would say that, personally, I think that there is still a strong culture of risk aversion.
I recently spoke to a police officer who, in that conversation, provided an example involving a person who was experiencing poor mental health in a care environment. Due to their ill health, they were regularly assaulting members of the establishment. There had been many case conferences and meetings, but the partners were not able to get to the bottom of the issue and the police were regularly being called to deal with it. Ultimately, the police decided to arrest the person, to escalate matters. That was not taken further by the procurator fiscal, but the partners then realised that they needed to do something. It was only at that point that that happened. In other organisations, there seems to be a culture of waiting for the police to do something and to step into the space.
That example is probably not unfamiliar to members from our casework. We hear that police are called to do a welfare check and that the situation escalates when it should not, because the police should never have been at the door in the first place. There is an issue with the police still being the gateway—I think that DBI suffers from that, too, although maybe “suffers” is not the right word. People still go to the police at the point of crisis.
Within the police and the community and wider support structures, do you see enough conversation about trying to shift that position, so that the police are not the first point of call—and sometimes the only point of call—and are not used as the gateway to mental health services?
During our review, we heard a lot of evidence from officers who had a strong perception that demand was being pushed on to them, particularly at 4 or 5 o’clock on a Friday, when other agencies step back and express concern about people who have not engaged with their service during the week. That results in the police having to check on the welfare of those people. Earlier, somebody talked about right care, right person. We pointed to three specific areas of right care, right person where we believe that Police Scotland should make progress and is now doing so. One of them is that Police Scotland should not be doing that type of welfare check, as that is not a police role. That is our view.
Does that answer your question?
It is a big and difficult question about how to shift the culture in society away from seeing the police as the first point of call when a crisis hits.
A lot of progress has been made, but there is still a long way to go. I am keen to test how effective the approach is. In the framework for collaboration and the collaborative commitments, we have a document that all agencies have signed up to, which should start to result in a reduction in demand for the police. That is positive. We heard a lot of evidence earlier about the good work that is ongoing to shift the needle in terms of the culture.
The issue is a long-standing one. There was a question earlier about the legislation. I have been in and around policing for not far off 40 years, and I believe that the situation has crept in over decades—no single thing has caused it to happen. It is a societal change, clearly. Sadly, many more people are experiencing poor mental health in communities.
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I suppose that the big question that I am grappling with is this. What would it take to make 111 community mental health services and other community, or health, responses always the first point of contact? I know that you cannot answer that—I am not asking you to.
I think that it will be a long journey. Somebody mentioned timescales, but I have to say that I do not see this happening in three or six months. That sort of shift is more a longer-term aspiration.
When we spoke to police officers and police staff members as part of our review, we found that one of the reasons for their being attracted to joining the police in the first place was that they wanted to help people. They are very compassionate and empathetic, and they spend time with people. I can give you a good example of that. When we reviewed Police Scotland’s contact assessment model, we listened to the telephone calls that were coming in and saw service advisers in the control room spending 30 to 45 minutes on the phone with people who were not reporting any crime but who were clearly experiencing poor mental health. Those service advisers were doing a fantastic job—they were very empathetic and compassionate—but that, to me, is not what their job should be. Their spending so long on the phone with a person would only encourage that person to phone again. Therefore, there needs to be a cruel-to-be-kind approach. Ultimately, we want people who are experiencing poor mental health to get the right support from people who have the proper training and experience to guide them into the right space.
Ms Chapman, I know that you have other questions on DBI, and I will come back to them, but, in the interests of time, I will take some other colleagues first.
The points that you have just made are really powerful and highlight what the police service is for, as opposed to how it has evolved. Maggie Chapman is right to ask how we get to the point where the first point of contact is community-based mental health services, not the police.
However, all of this starts, I suppose, with what you described in your story about the half-hour call with someone who is clearly in mental distress. That person will phone back—we know that that will be the nature of the interaction. The problem—it comes across in your work and the report that we are referring to—is the risk aversion because of a sense of fear. The SPA said that the desire to serve and support people comes from a good place, and I get that, but I also think that it comes from a really bad place, which is fear of the consequences of putting the phone down, leaving a person and everything that flows from that.
From your experience as an officer and now as part of HMICS, can you tell us what can be done to change that culture so that police officers feel that they can decide not to take that call, to put the phone down or to say to the person, “We’re going to leave you at this point”? What has to happen?
It has something to do with the training and guidance that officers get when they come in.
If you will forgive me, I will share another quick example from the review that has stuck with me. It relates to an officer who had been in the operational policing environment for about six months after leaving Tulliallan. They were quite a mature individual who had joined the force after a previous career, and they said to us that, at Tulliallan, they were trained in how to give evidence at court—they learned all their definitions and how to deal with crimes and offences. However, after six months in operational policing, they thought, “I’ve actually been trained for the wrong job, because nobody’s taught me how to deal with vulnerability or how to sit and counsel somebody for hours on end while I’m waiting for another service to come in.” Therefore, training and guidance have to incorporate what the role of the police is and what it is not, and how officers can step away from that sort of thing.
Since our report was published, a number of quite encouraging things have happened. For example, we now have a mental health index that lists organisations in each locality that officers can contact. We also have the DBI process, which the review showed to be an excellent way for officers to steer someone towards the right agency and then step away from that situation and go to deal with—
But the demand is still there. They are still spending their time doing that rather than engaging in the core policing activities.
The nature of policing is that, when officers are out and about, they will encounter a range of people in the community, including people who are experiencing poor mental health. I do not think that the Scottish public would ever want us to get to the stage where the police just turn their back on people, but the interactions need to be short, with the officers able to point the people in the right direction.
Would the index that you mentioned be useful at 2 o’clock on a Saturday morning?
That touches on one of the significant challenges. If there was one thing that would make a huge difference in this space, it would be all agencies being available 24/7. SAMH’s nook facilities were referenced earlier today, and during our review we heard a lot of good things about the neuk facility in Perth. Last night, out of interest, I went online to check its hours and I saw that it is open from 9 o’clock in the morning until 9 o’clock at night, seven days a week, which is actually longer opening hours than was the case when we looked at it during the review.
Generally speaking, people in the community can experience poor mental health at 2 o’clock in the morning, 3 o’clock in the morning—
The midnight hours, as it were.
That means that a 24/7 index would be far more helpful for officers.
You said earlier that the issue is multifaceted, and you listed the various health boards, local authorities, charitable organisations and third sector organisations that are involved. That is absolutely correct: there are many moving parts in this. However, from a policing point of view, it is not actually such a complex problem, because the police are still being asked to do things that they are not trained to do. Those interventions do not really fall within their remit; rather, they fall fairly and squarely within the remit of other public organisations. I tried to make that point earlier to the SPA.
The clear position is that the police are absorbing a community-based demand for mental health services that should be met by the NHS. Will you comment on that view?
I agree that the police are absorbing a lot of demand that should be met by other agencies, including the NHS.
Good answer.
A lot of agencies are involved; there is not one agency that should be dealing with the issue. I believe that, as the ACC mentioned earlier, it is important to view the reference to “well-being” that is in the Police and Fire Reform (Scotland) Act 2012 through the lens of policing.
But that is not how practice has evolved, though, is it?
The word seems to have become misinterpreted. The intended meaning should be reinforced.
This is quite sad to say, but another important thing is that there is a fear of the PIRC investigation among a lot of officers. It would be helpful if there were more clarity for officers around what the role of the PIRC is and the important function that it fulfils. There needs to be a realisation that officers may have done the right thing in stepping away from a situation in which something bad was happening.
Individual officers need to feel that they are being supported. Many of them feel that, if they make a judgment call and get it wrong—let us face it, none of us is infallible—it might not only threaten their career but could follow them for the rest of their lives, because there is a stigma that follows a police officer who has faced the consequences that some have faced because what they thought was the right call turned out not to be. That needs to change as well, does it not?
The nature of policing is that, sadly, bad things happen. Officers go home after people have lost their lives for a variety of reasons. That has an impact on officers and their families. They need to be properly supported through that, and, if there is an investigation, they need to be properly supported through that, too.
Does that happen? Anecdotally, there are suggestions—stories—that, in fact, police officers feel left alone and pretty vulnerable in that situation. Therefore, in the moment of making a decision, they will take the most risk-averse approach, because they know that they will be safe, but that approach may not be the right one for them, the service or the community that they serve.
During our review, we heard about a fear of consequences. We did not explore in any detail the support mechanisms that exist, but I am aware that a lot of support is available for officers, although I am unable to comment on whether that support is being delivered to every officer on every occasion.
Is that something that you, as an inspector, would look at in your work? Anecdotally, many of us will have heard that officers feel that they do not get support, least of all from senior officers.
We have recently done a number of reviews of organisational culture and the training and development of officers, and we have made recommendations. The wellbeing of officers is critical—it is such a difficult job. We have made some observations, and the role of first-line managers and their ability to support officers has been a recurring theme. For police officers, those would primarily be sergeants. However, sergeants are very busy now and often do not have time to have those conversations with officers.
We have heard that, too.
For me, those wellbeing conversations are really important. We recommended previously that those conversations should be recorded so that we can see when they are taking place.
There is a certain irony that, although we have focused on the word “well-being” in legislation, and although its meaning seems to have evolved and changed in relation to the police service’s responsibility for the wellbeing of individuals in the community at large, not everything that could be done is being done to support the wellness of the front-line officers who are bearing the brunt of all of this.
A lot of work is being done by Police Scotland in the wellbeing space. The chief constable is very committed to the wellbeing of all officers and staff, but, at 2 o’clock in the morning on a Saturday, lots of things are happening. If an officer deals with something quite traumatic, are those wellbeing conversations taking place before that officer goes home? I am not sure.
I think—again, this is probably anecdotal—they do not have time. That is understood.
I have one last question.
Okay, Mr Kerr.
The review, which is now three years old, made 14 recommendations. My question is very simple, but it might be difficult to answer. What are the marks out of 10 for the implementation of the recommendations by Police Scotland and the Scottish Police Authority and for progress connected to the recommendations?
That should be a nice, brief answer, Mr McInulty.
It is just a number out of 10, convener.
Do you mean in terms of progress?
Yes. Things that have changed for the better.
Six recommendations have been closed off and eight are in progress. My assessment is that there has been significant progress.
Is that 4 out of 10, then?
I am not giving a mark.
Oh. That was my question.
I was always a hard marker, so I would not—
Is it 2 out of 10, then?
You tried, Mr Kerr, and God loves a trier.
I hand over now to Ben Macpherson.
May I also start with you, Mr McInulty? You mentioned earlier the risk of somebody becoming a missing person if they are taken to A and E or another NHS or healthcare facility and not maintained within that facility for an adequate amount of time. When I have spoken to officers here in Edinburgh they have relayed their concern, not just about the person’s wellbeing and safety but about the resource deployment in Police Scotland when additional officers and resources have to be sent out to locate somebody who is reported as a missing person. Do you want to say a bit more about that, based on your investigations? It is important for us to hear more about that.
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When we did our review, we found that, if officers were to take somebody to an A and E department, there were no protocols with staff there about doing a handover of care. On occasion, people have to wait for quite considerable lengths of time in such departments. During our review, an extreme example of that was a wait of 27 hours for somebody to be assessed by a psychiatrist. Officers stayed with that person and changes of shift took place, with other officers coming to relieve them. That was an extreme example, and the average wait duration is 5.34 hours, but there are examples of it taking whole shifts and longer. During our review, if officers had decided to step away and leave somebody in the A and E department and that person walked out of there, they would have been reported as a missing person. That is an extra demand that opens out a whole range of other resources being brought in to find the person.
We visited Humberside Police and looked at the right care, right person model, which was mentioned earlier. We felt that Police Scotland should really be looking at that in relation to, first, handover protocols at A and E. It is really helpful that officers now wear body cams, because, when they walk into A and E, they can say, “We have brought this person here; they are now in your care”, and they can then go away and leave that person. It is appropriate that that should happen and, as we heard earlier, that has now been progressed, which is positive.
Secondly, in line with the right care, right person model, if the person were to walk out of the facility and someone there were to phone the police to report them as a missing person, the position that Humberside Police took at the time was that they were not a missing person. After all, they might just be away home—in which case, the police would take steps to find out whether the person was at home, instead of immediately treating them as a missing person. Again, we pointed Police Scotland towards that because we think that that is good practice, as opposed to an escalation to somebody being a missing person. They have possibly just decided to get the bus home because they are fed up of waiting in A and E.
A lot of progress is being made on that. We have not reassessed it, but I have seen a lot of documentation about the protocols being put in place, transfer of care and the situation regarding people being reported as missing.
It is very helpful for us to be more aware of that. Convener, perhaps we can follow up on the Humberside model and establish what progress has been made on that here.
Following on from that, Mr O’Neill, you spoke earlier in response to my colleague Amanda Bland—excuse me if I misquote you; I do not intend to—about there still being gaps, when she referred to the Forth Valley and Edinburgh areas still not being provided for in the way that is being recommended and progressed elsewhere. Are the gaps due to a resource issue or, because there is so much reliance on third sector partnership, are they due to capacity reasons? Should NHS boards be taking a more national approach? How do we get to a position where full service provision is in place as soon as possible for the benefit of the individuals whom we serve and the demands that are placed on our police service?
On the report that Mr McInulty referred to, I would say that we are on the right trajectory and making progress. As I said, since that report was published, we have moved from having live police pathways in 14 health and social care partnerships to having them in 24 partnerships. We have done a lot of work on that, including having Police Scotland speak at our national gatherings and conferences to reinforce the importance and benefits of police pathways locally. Referrals from Police Scotland have increased from 758 in 2022-23 to 2,085 last year.
I go back to the discussion about the fear of doing the wrong thing preventing people from doing the right thing. We need a broader incremental approach to build confidence, to remove the fear that some people sense and to deliver and implement the training. Regardless of the resource that we have, local implementation requires local partners to come together respectfully to develop the integrated working that DBI involves.
It is important to say that we are not suggesting that the route to DBI is through the police. Some 10 per cent of referrals that come to DBI come through the police, which means that 90 per cent do not. It is about having an ask once, get help fast approach, which I think Mr McInulty referred to. There will be people who present to the police appropriately, for whatever reason, and who are also in distress. DBI is about ensuring that compassion is at the heart of the response, and that front-line officers, in their role and day-to-day duties, feel confident in their skills and able to make a direct referral to DBI. That removes the need for officers to sit for hours in the accident and emergency department, which our front-line colleagues told us was the case prior to DBI as it was the only alternative.
Officers know that they can refer to DBI via their hand-held system, through robust information governance and sharing arrangements; that there is a promise of support within 24 hours; and that the approach has been developed by the University of Glasgow with a robust evidence base, which gives them the confidence to do it. They also know that, having done that, people are less likely to come back to them—that is the evidence that they have shared with us. Ultimately, it is about making sure that, wherever someone presents, our compassionate services respond in the quickest and most efficient way possible, knowing that it will be effective.
All that is understood and considered. The committee is determined to seek solutions and help to progress improvements so that we can fill the gaps that you talked about. I note the progress that has been made, but how do we get to a position in which all 31 partnerships are involved? How do we have a complete picture, or as near a complete picture as is practicable, as soon as possible?
Our strategy up to this point in the DBI central team has been to use our evidence, update our terms of reference for local implementation groups, restate the importance of having police involvement and reinforce the various elements. However, ultimately, it requires health and social care partnerships and health boards to recognise the importance of putting resource into these effective cross-sectoral approaches to working.
When police refer directly to DBI, that reduces the burden not only on police but on other parts of the health and social care system, because people do not then have to go back to their GP or be seen in emergency departments. It is about our health and social care partnerships and health boards understanding the importance of the expectation that DBI should be implemented and sustained. We need a broader push towards encouraging that and towards ensuring, as far as possible, that Police Scotland pathways are seen as a key part of that.
Thank you.
Thank you, Mr Macpherson. I call Pauline McNeill.
Good morning. To be honest, I am finding it quite complicated to follow the system. I acknowledge the progress that has been made, but I am struggling to understand how this is all going to work so I will try to simplify it for myself, if you do not mind.
I want to focus on the out-of-hours service. As Brian McInulty has said repeatedly—and my lines of questioning have always focused on this—the police are the main service that works 24/7. The fact that some of the interconnected agencies do not work 24/7 is, for me, the primary problem, so I want to talk about the protocols.
I want to start with you, Brian. I acknowledge all the progress that has been made and all the work that has gone in—I do not want to underplay any of that—but there is a real urgency to get this sorted, because of the policing issue. We do not have enough officers on the front line, and we are losing officers from the job—Marie McNair is quite right about that. Indeed, I have had the same testimony from officers who think that the job is too hard, and I would say that this is almost an emergency. Should there be a definitive date by which these protocols should, in most cases, be the established practice?
It would be very difficult to put a date on that. I think that everybody will agree that the most important measure of success here is ensuring that people in our communities who are experiencing poor mental health are getting the right support, and it would concern me that, if we were to draw a line in the sand and say, “On this date, Police Scotland is not going to do X, Y and Z”, those people would be left with nobody.
I was not thinking of that at all. You said that there were handover protocols. The problem, in my view, is that health and social care partnerships can easily walk away, while the police cannot. I just do not think that they are motivated or whatever, but this is their responsibility, not the police’s—that is clear. Surely, with these protocols that you have talked about, you would not be leaving the person, because you would be saying, “We’ve done our job; we’ve gone to the distressed person’s house; we’ve taken them and now we're handing them to you.” Why can you not have a definitive, or more definite, date so that you can say to others, “Right—on this date, we’ll be doing our bit, and you’ll be doing yours”?
I go back to the point that has already been made about a whole-system approach. This is a collaborative effort, and everybody needs to be engaged in it. I do not think that we should be saying, “We’re doing this. What are you doing?” It needs to be a collective effort.
But are you satisfied with the situation, then? We had a witness who was the head of mental health services for all the health boards—I cannot remember the doctor’s name—but, to be honest, I have to say that there was no indication from them that there would be any changes to working patterns to mirror the police’s 24/7 service. When someone is in distress out of hours, it is the police who pick it up, and I have not heard a single confirmation that that gap is going to be filled by anyone other than the police.
It is encouraging that the chief constable has escalated this issue and is sitting down with all the health board chief execs. I just think that it is very difficult to put a date on this, but it is really important that the matter is progressed as a priority.
I come back to a point that was made earlier. The strategic workforce plan and resource levels have been mentioned, but—and I realise that this is a very unscientific approach—if you were to go into any sergeant’s room in Scotland and ask them, “How many officers do you need today to police your area?”, they would be able to give you that number. Of course, that could be upset by a missing persons call, or somebody in distress, and, before you knew it, your resource levels would be starting to go down.
11:30
Forgive me if I am stepping out of my lane here, but I think there might be merit in the committee visiting a control room to get an understanding of how it works in practice, to hear the calls coming in, to look at the resources across the country and to get that experience. When I was a police officer, I used to do that with local elected members to give them an appreciation of what was happening in their area. It might be helpful for the committee to get that experience. It is not for me to invite you to the control room, but I am sure that Police Scotland would accommodate it.
I have already asked. [Laughter.]
There is not much more that I want to ask. The chief constable has been brave, I will say that, and I think that that is out of necessity. She is looking out for Police Scotland and her officers by pushing that.
However, I do have one argument about the civilianisation of some jobs that I think are police jobs. Last year, jobs involving investigatory work were advertised. I think that that is police work.
The reason I mentioned that is, could you civilianise some of that role? It has been described as “babysitting” people because you want to ensure that they are okay, that they do not run off and that they are handed over. Should someone else take that on, other than the police? If civilians can do investigatory work, maybe there is a role for civilians to do some of that work, too. What is the silver bullet, if there is one, that could move this on?
Unfortunately, my assessment is that there is no silver bullet. It is positive to start looking at who else can do it, because it should not be police officers.
Earlier, Amanda Bland told a story about when she phoned the police. If you are ever in a situation where you need to do that, you want them to be responsive. You want to see the police in your local community. People tell us that regularly. People do not want the police to be sitting in somebody’s house, waiting on a relative or a mental health service to arrive. Police officers do not want that, either. A lot of officers talk about the impact that that has on their morale, because they feel as though they have not done their job.
Although I do not think that there is a silver bullet, unfortunately, it is important to say that significant progress has been made during the past three years. I would never underestimate the level of complexity around this or how long it has taken to get us to this point. The issue has crept in over decades, so it might be that it is going to take some time to shift it, but if we can roll out and properly resource the protocols that are coming in, such as the transfer of care and the DBI—which is a very positive example of something that is available—that would be another small step forward.
I intend to bring the session to a close by 11.40, and I promised Maggie Chapman that I would transfer some of the balance of my time to her so that she could ask a couple of very brief questions on DBI.
Before I do that, I have a question for Mr O’Neill. I understand that DBI is not currently available to people under the age of 16, but there is some suggestion that that might be looked at. In as brief but informative an answer as possible, can you tell me what the picture is there, and where we might move to?
Yes, you are quite right. An independent evaluation was undertaken to consider DBI for those aged under 16, particularly those in secondary 3 at school—those who are 14 to 16 years of age—which was published back in November last year.
It demonstrated promising outcomes and promising practice, but it also came with a number of areas for consideration and possible development, and across the DBI community, including with our Scottish Government policy leads and the University of Glasgow who led that work, we are in the process of considering the areas for development, with a view to considering how those are best taken forward.
Okay, that was very helpful. I am keen to follow that up, because, based on my constituency caseload, it would be quite pertinent to include the age cohort that you identified—those in around S3 or S4.
I will hand over a bit of my time to Ms Chapman—maybe three or four minutes—for some final questions on DBI.
Thanks very much, convener. I really appreciate that.
Kevin O’Neill, thank you for your contribution. You have already answered one of my questions when you spoke about the evidence that DBI changes outcomes over the longer term, not just in the moment of crisis. That is really helpful. However, are we seeing DBI become a genuinely community-based alternative to crisis intervention, or is it primarily being used once a person has already entered the emergency system?
It is absolutely seen as an early intervention. It is about preventing problems from escalating, and we can see that in the evidence. I would be confident in saying that DBI sits very much within that early intervention area.
Okay. If it is about early intervention, surely the aim is to intervene before a crisis occurs. However, DBI referrals happen only at the point of crisis. How do you see early intervention working if the referral happens at the point of crisis?
Yes, you are right. I think that others have said that DBI is only one part of the solution. Despite all the work that is going on, people find themselves getting to a point of distress. For example, we know that more than a third of those who come to DBI experience suicidal ideation. Many have relationship difficulties, employment issues, money worries and experiences of loneliness. Therefore, it is about empowering our front-line services to enable them to respond more efficiently and effectively, wherever a person presents, by connecting them to an early-intervention service that promises to offers support within 24 hours.
I absolutely agree with you. This must also be seen within a broader framework of preventative work on how we prevent individuals from experiencing distress in the first place. A lot of this is related to wider issues, such as deprivation. We know, for instance, that a significant number of individuals who come to DBI are from our more deprived communities.
I come to my final, very brief, question. We know that some communities are less likely to seek certain types of support. Are you seeing that replicated in DBI? Are certain communities or groups not accessing DBI? Do you collect data on that?
Yes, we absolutely do. We collect a wealth of robust data through Public Health Scotland, which includes equality and diversity monitoring. The data shows that equality and diversity groups are represented, and we monitor that very closely to consider how we can make improvements.
It would be interesting to explore that further. We know that DBI can work in certain situations but that it is not a panacea. However, if some communities are self-excluding, what are we doing to ensure that that support is available? If you could provide us with some of that information, or point us to where to look, that would be really helpful. Thank you.
Mr O’Neill and Mr McInulty, thank you for the evidence and the time that you have given to us this morning. That has been very helpful as part of our scene-setting process for the new session 7 committee. Mr O’Neill, as I understand it, you are joining us from Shetland. If you cannot be in the epicentre of the universe that is Shettleston, Shetland is probably the next best place to be.
11:38
Meeting continued in private until 12:38.