Criminal Justice Committee

Meeting date: Wednesday, May 18, 2022

Official Report 727KB pdf

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Policing and Mental Health

Hello. Welcome to the 16th meeting in 2022 of the Criminal Justice Committee. Audrey Nicoll, our convener, joins us remotely. Jamie Greene is running slightly late and will be with us soon.

Our first item of business is a round-table evidence session on policing and mental health. I refer members to papers 1 and 2. It is my pleasure to welcome: Dr Inga Heyman of Edinburgh Napier University; Alan Staff of Apex Scotland; Martyn Evans of the Scottish Police Authority; David Hamilton of the Scottish Police Federation; and Assistant Chief Constable John Hawkins and Superintendent Mairi MacInnes of Police Scotland.

Thank you all for providing the committee with written evidence, which we have had a chance to look at. If you would like to answer a question, try to catch my eye or that of the clerk, Stephen Imrie, and we will do our best to bring you into the discussion. We have about 80 minutes in total for this session.

I will kick off—that is one of the benefits of convening, I suppose—with a question for ACC Hawkins. How many Police Scotland officers have lost their lives to suicide in recent years?

I do not have that information with me, but I would be happy to provide that to the committee.

Okay—thank you. I am asking about that because, a couple of years ago, I made inquiries to that effect. At that point, it did not appear to be something that anyone was keeping record of. Furthermore, none of those who had died by suicide was subject to a fatal accident inquiry. Are you aware of that issue?

No, but we would be able to provide information on that to you.

Okay. Might the Scottish Police Federation know something about that?

I can tell you that there have been two suicides and two attempted suicides recently. We have evidence, but we did not include that in our written submission due to sensitivities around that. However, suicide is a problem. It seems to come in clusters. In recent years, I am aware that there has been a cluster of between two and four suicides, and that that happens almost yearly. That is perhaps indicative of the problem that we have.

I was aware of a cluster not so long ago. I was speaking to a former police officer who is a friend of two officers who took their own lives in quick succession. One did so in a police station. The former police officer believes that the protracted nature of the complaints process to which the officers might have been subject could have been a contributory factor in their deaths. However, without a fatal accident inquiry, we have no way of knowing whether that is the case. Is that something that you are aware of?

I refer you to my previous answer. I am more than happy to get information about suicide and FAI rates for the committee.

The Crown Office and Procurator Fiscal Service is not here to explain why it is choosing not to do FAIs. Would you support FAIs?

It would perhaps depend on the circumstances. Sometimes, suicides are entirely to do with personal reasons and an FAI would not necessarily be appropriate. Where a work element is involved, we would, of course, welcome an FAI. However, I do not know the full details of all the cases. We are aware of them, and we are always alert to the possibility that a work element is a factor. We tend to have discussions with different commanders regarding that, if we have concerns about anything.

In fairness, Police Scotland is good on the engagement side of things. Such suicides are a loss to the whole police family. We try to work things through. I do not think that there is any suggestion that anything is being hidden under the carpet. However, as with all such incidents, we are perhaps talking about layers of stress that are building up in people and, sometimes, it is the straw that breaks the camel’s back. As such, there might be elements that are not immediately obvious.

Before we move on, I ask Mr Evans whether the SPA has any data on, or has conducted any form of investigation into, suicide among police officers.

We have conducted no investigation—it has been looked at very much at the board level. Mary Pitcaithly, who chairs the SPA’s people committee, has expressed concern when it has happened and has looked for more information. If we hold such data, I will send it to you, convener, along with a note about what the board’s inquiries were and the suicides of which it was made aware.

Thank you very much. The next question comes from Fulton MacGregor.

It is just a wee supplementary to your line of questioning, convener—it is probably for David Hamilton. He said that there might be personal or work-related reasons for suicide. How do we make a judgment on that? Everybody’s life is complicated, and various elements might be intertwined. For example, a person’s work might lead them into substance abuse at home, which might then become the precipitating factor for a crisis. How would the police—or anybody, in fact—identify which factor was more prevalent? Does that make sense?

Yes, it entirely makes sense. The honest answer is that I do not know. Unless someone left a note that specifically referenced something, we would not know. Other than that, all that we can do is speak to friends and colleagues afterwards and give them support, and we might sense something there.

Again, the nature of that type of incident is that it often comes as a huge surprise to everybody. On one of the recent occasions, one of my colleagues had been speaking to the officer just hours before that officer took his own life, and was absolutely stunned by what had happened. The officer had made arrangements for the following week, so it was unexpected. I do not know how you would know—I would have to refer to the medical professionals as to how best to untangle that.

I apologise—I know that it is a difficult question in a very sensitive area. With regard to the instances that have been described, I take the opportunity to pass on my condolences to all the witnesses, who have obviously experienced the loss of friends and colleagues in the service.

I think that Audrey Nicoll may have a question for us online.

Good morning to the panel. I hope that you can see me—I have a wee bit of a problem with the light in my room. I would like to pick up on the current legislative provision in Scotland. I will come to Inga Heyman first on that.

Dr Heyman, I very much welcomed your comprehensive submission. You picked up on the challenges with the current legislative provision in Scotland, and the legislative barriers that exist. At present, one of the barriers appears to be the Mental Health (Care and Treatment) (Scotland) Act 2003. When officers come to assess an individual to decide whether they might wish to take them to a place of safety, the 2003 act allows them to take someone only from a “public place”, whereas we know that a lot of people are in their homes at the time.

Secondly, the wording of the 2003 act refers to a situation where a police officer

“suspects that a person ... has a mental disorder”.

We know that police officers are not trained to make such an assessment, and it would be inappropriate for us to expect them to be able to do so.

The main issue that officers currently face concerns situations in which individuals are in some distress. I am interested in what you feel that we, as a committee, should be thinking about with regard to making the legislative provision more appropriate, and more of a fit for the growing number of scenarios in which officers encounter someone who is in poor mental health. I will come to Inga Heyman first, and then bring in ACC John Hawkins.

I welcome the opportunity to participate in this round-table session.

A number of elements of your question point to the medicalisation of the legislation in making it dependent on disorder. If we look at not just the 2003 act but the Adult Support and Protection (Scotland) Act 2007, we will see that they depend on people being assessed as having a disorder. A huge number of people in mental health distress do not have a mental disorder and should not be diagnosed as such, and we should not be putting on individuals a label saying that they are disordered. There is therefore a gap in the legislation with regard to the medicalisation of the terms that are used.

At this point, it is important to acknowledge that the reform of the Mental Health Act 1983 is being looked at very seriously at the moment, and it would really be worth flagging this area up to our colleagues John Scott QC, Jill Stavert and Colin McKay, who are working on that reform. This is all about specific terms in the legislation really restricting how we support people; after all, if the distress results from social issues, the support that they will get through that legislation will not be sufficient.

As for the issues for police officers, I understand that there is a gap in section 297 of the 2003 act with regard to private dwellings. That is a significant issue, because it puts quite a restriction on individuals when the aim of the mental health legislation is to take the least restrictive approach. When someone is held in their own house, because there is no option, things become incredibly difficult for that individual, and their voice is missing in the legislation in that respect. It is also a huge challenge for police officers, who are left between a rock and a hard place, because they cannot remove someone forcibly from their home. That raises a question whether we should be changing the legislation to be more restrictive to allow police officers to remove somebody, but where does it leave police officers with regard to breaking the law?

There are many complexities to this matter that need to be pulled apart. It is not just a matter of giving more powers through the legislation; we need to think about what is the least restrictive approach for an individual, and that should come back to the reform of the mental health legislation and ensuring that the individual’s voice forms part of that work. The police voice needs to be part of that, too, but I am not sure that the consultation has been extended on the forensic side to allow that discussion to happen.

I am sorry—that was a very long-winded response.

No, I appreciate it. It really set the landscape out very well. ACC Hawkins, do you have anything to add?

No. I think that Inga Heyman has covered the issues really well, specifically the point about powers that cover public spaces becoming problematic when an event takes place in a private space. It is pretty clear that that is a problem, and it would benefit from further consideration.

It also speaks to the broader point that, very often, it becomes inevitable that such cases end up in a criminal justice rather than a health outcome. These are individual cases involving individual difficulties but, far too often, they end up with an individual being arrested because the situation has deteriorated instead of their having access to health provision. I just would not want that broader point to be lost when we look at what is a very obvious but specific challenge with regard to section 297 of the 2003 act.

09:45  

I want to ask a quick follow-up question. I am happy to go back to Inga Heyman and ACC Hawkins. We know that, if officers use the provisions in section 297, they can take someone to a place of safety, and they are often turned away for lots of different reasons that we know about. That can be for very legitimate reasons. Essentially, they are left holding the baby. I know that you are working on that and that there is progress across Scotland on pathways. Bearing in mind the challenges of remote and rural areas, what should we be thinking about as the optimum pathway in local areas?

One of the challenges is that we try to fit people into a binary system—into either the criminal justice system or the mental health system. As I said earlier, there are people who do not fit in either system—and neither should they. We criminalise people because we cannot fit them into the health system. There are people whom we should not force into the mental health system. There is the idea that people simply need a mental health response, but that is not necessarily right. We know about the harm that is done by putting people into hospital. We can do more harm by putting people into psychiatric care.

Part of the response that we need to think about is broadening that. Maybe we need to think about a third response that is focused on social care for individuals, rather than trying to fit people into two systems. There is another area that we could think about. People could get a much less restrictive response. An example is that police officers might be able to take somebody not to a place of safety from a legislative perspective but to a safe place in which a person can be supported to manage their distress and would not necessarily go into either system. It is about being quite bold and thinking about another option rather than trying to fix the mental health and criminal justice legislation.

On the appetite in Scotland at the moment, as was said earlier, there have been many changes in the past little while. Amazing work is happening in Police Scotland around the mental health pathways, and there is the unscheduled care pathway work. A lot of work is going on, and the appetite to think out of the box and think beyond policing or criminal justice is really good.

I will supplement the discussion. I agree with everything that has been said, particularly about private space.

From a police officer’s perspective, the frustration is that police officers do not have the powers to deal with that, and they are dependent on, for example, a general practitioner coming along and doing so. The issue is what is done in the gap between. There will be a delay in waiting for the GP to get there and make an assessment. If they make that assessment and the person needs to be taken somewhere, there will be another journey of delay and frustration.

On section 297 of the 2003 act and the public sphere, our difficulty is that, when we take people to a place of safety, we end up queuing, because we have a responsibility to the patient right up until a disposal or determination has been made by the practitioner at the place of safety. That might take hours—it often does—and sometimes those patients are in a distressed state that requires them to be handcuffed and restrained. Again, that falls on the police officers, who take a personal risk and try to work out how best to look after a person who has not been assessed. Police officers have to look after them, and we are very limited in our capabilities with regard to what we can do.

In the evidence that we submitted in the annex to our paper—incidentally, there was an unprecedented response to this from our membership, who are concerned about the issue—we included the example of an occasion where it was felt that it was necessary to take a woman out of handcuffs because she had had them on for too long. She then began to attack the officers, and the situation escalated into a further problem.

Therefore, in many ways, waiting for assessment is the other part of the problem with section 297. Of course, police officers accept that they have a role in that, but what is critical is to bring safety and order to the situation before handing on to another agency that is better equipped and more qualified to deal with it. However, at the moment, it is basically a case of stacking up teams of police officers with patients waiting to be assessed by an underresourced function in the health service. Therefore, all that risk then comes back on police officers. Further, when they are doing that, they are not doing other parts of the job, which creates further pressures and so on.

That picture comes through loud and clear in those 20 submissions. Mr Staff, I wonder whether you might have a different perspective on that issue.

Yes. My perspective goes back about 30 years when we were tackling exactly the same issues and problems. It appears to me that, if progress is to be made, it must be made through a multiagency, multisectoral approach. The stresses that the police are under are as much about public expectation of them and the expectations of their superiors and other agencies as they are about anything else. Our experience is that there are huge gulfs between the different agencies involved and that there is a great deal of blaming going on: “It’s your job”, “You didn’t do it—why didn’t you do it?”, “It’s your job—no, we don’t have the resources, so it has to be you” and that sort of thing. That is not new, it is not unusual, and there are no easy answers. However, the solution that we would look to is greater collaboration at the local level between agencies and the formation of some sort of crisis response team, if you like—if you want to take a team approach. However, the solution must certainly be one that involves all the agencies concerned reaching a joint agreement and taking joint ownership, rather than sitting back and saying, “No, it is your job.”

The convener asked a question about additional powers, which is important. That is addressed in Dr Heyman’s paper. However, I want to add to what has been implied and said by others, which is that it should be a service that is available to officers. Occasionally, an officer does not have the coercive powers to undertake their responsibilities, and that is called out in that paper. The evidence from the Scottish Police Federation is very good. I point you to the evidence from officer 20 in that submission. The officer says that their frustration is not that they do not have the powers but that that service is not there to go to. However, they also recognise the improvements in services. They call out the mental health hubs and give a very good analysis about their weaknesses as well as their strengths.

Therefore, I would add two things. With regard to public policy, there is a very high assessment bar to get into a mental health service. What happens when someone does not get into that service? These people remain vulnerable and they remain in high distress, but they cannot get into a formal service. That is consistently the case across the United Kingdom in reporting in that area.

The second thing that I would add is the need for an intoxication strategy. You will not be assessed if you are intoxicated by drugs or alcohol. As the police evidence shows, those are often some of the most difficult cases with regard to dealing with, restraining, supporting and safeguarding people who are vulnerable and distressed.

Therefore, as Inga Heyman’s paper demonstrates, there is a legislative gap, which is important, but the massive issue is about the services available to the officer as they attend a distressed and vulnerable person. Quite often, it is not the case that they need more powers to make that person do something. What they need is to be able to use their authority as an officer—that is why we have police officers—to direct a service to take the person on. That does not happen as much as it should. The evidence from more than 20 officers that David Hamilton submitted reinforces that sense of frustration on the part of officers about being caring and human in their endeavour and yet not being able to help. That comes back to your question right at the beginning, Deputy Convener. That situation creates additional significant stress for officers and for contact command and control division staff—the non-officers—because they feel helpless to do anything. It is a vicious cycle.

Superintendent MacInnes, you deal with custody cases and manage officers every day. What impact does dealing with patients have on officers losing hours?

We have more than 100,000 custody cases coming through our doors each year, and a high proportion of those people have complex needs, by which I mean problems with, for example, mental health, substance addiction, alcohol or isolation. Generally, it is a combination of all those factors. We have healthcare provision in place with our partners, but when the issue relates to mental health, that will often require a further assessment off site. That is an abstraction of our time. The important point is that people who are in our care get the help that they need, but it is not helpful that it takes so long for them to get a referral. Sitting in a custody suite is not the right place for someone experiencing a mental health crisis.

We move on to a question from Jamie Greene.

I apologise, convener, for my tardy arrival. The traffic has been unkind to me this morning.

I read the officers’ submissions last night. I was quite struck—in fact, I was very much saddened and quite distressed—by some of the anecdotes that they shared about the abuse that they have had to put up with and the effect on their own mental health, which I know we will come on to discuss.

For me, the theme that came out—and which I am keen to explore—is that, although we might have a conversation about whether more legislative powers are needed, it is abundantly clear that, more and more often, the police are being used as the first point of contact in the absence of other services being available, whether they be health or social care partners or the local authority. That might involve the police simply driving someone to hospital, spending hours on site trying to restrain or look after someone or dealing with a health emergency in a private environment where they have limited powers to intervene from a medical point of view.

I want to explore that further. Putting the legislative issue aside, can you say what further short to medium-term interventions the Government can make to alleviate the immediate burden that is resulting in so many police officers effectively having to become mental health workers instead of tackling crime? That question is for anyone who wishes to answer.

I will kick off. It is worth just stressing the prevalence of mental health problems and distress in society—that is an important starting point.

Every year, 3.2 million calls come in to the police, or one call every nine seconds, but fewer than 20 per cent of those result in a crime being recorded. Overwhelmingly, calls on the policing service are now in the vulnerability space, including mental health. That is a situation that has changed hugely over my time in the service. Policing was not like that once upon a time—it was much more clearly about crime and criminality—but I do not think that policing is alone in experiencing that societal change. It is affecting all parts of public service, all of which are wrestling with the same prevailing problem. The same people are popping up as victims, as service users and as accused.

I genuinely think that the first step is to have a joined-up discussion about the system instead of dealing with it in silos. We need to think about that not just in terms of the demand made on policing. The average time taken to deal with a mental health call is seven hours and 20 minutes. That has a huge impact on policing and our ability to do other things, but what about the citizen who is at the centre of that moment and has found themselves edging towards and ending up in crisis?

We must have a multi-agency and joined-up conversation that has to be more about prevention and early intervention. It is great to come and have this discussion in a criminal justice setting, but my sense is that it needs to be much broader. It is important to make that point at the outset.

10:00  

In your written evidence, you say that you struggle to quantify the demand on police to deliver services that you probably should not be delivering but which you are happy to deliver as a first port of call, and that that comes down to issues with recording systems, information technology systems and how an incident is interpreted. What is being done to improve that?

An awful lot of work is being done in policing through our demand analysis unit, but it is also important to ask what is being done at a systemic level to understand an individual citizen’s journey through services. One might argue that continuing to build more sophisticated single-agency data sources or analysis techniques is missing the point.

Thank you for the question, Mr Greene. As you would imagine, we have given a lot of thought to what the short to medium-term solutions might be.

There are, from a police officer’s perspective, two stops or problems in the current system, the first of which relates to what we talked about in relation to section 297 of the 2003 act with regard to the inability to deal with somebody in a private dwelling. If somebody is out in the street, we can deal with that but, if they go into their house, we cannot. There is something illogical about that. The principle of somebody’s home being their castle might well be understood, but given the nature of the calls, we might wish to review that again.

The second problem is what happens when people are handed over and received at a mental health hub. If there were some kind of facility to enable mental health professionals, whether they be nursing staff or others, to look after people at the hub on receipt, it would free up officers to go and do policing tasks and then, if necessary, come back and support those staff. That would make a huge difference to demand and take a call lasting seven hours and 20 minutes right down to a couple of hours at the most, which would change the system. Of course, somebody else will have to pick up what happens in that space, but the patient would also get better-quality, professional nursing and medical care as opposed to police officers sitting with them in handcuffs.

I have read some of the testimonies. Given that mental health hubs are pretty few and far between across the land, most people will be taken to accident and emergency or hospital in the first instance if harm is involved. There are stories of nurses having to ask the police to restrain people so that they can medically intervene.

What is your view on the role of the police in that environment versus that of the medical professional, whose job is to administer medication by whatever means possible? At what point are you asked to act as security guards and physically restrain someone who has become a danger to themselves? Indeed, there are examples in the evidence that I have read of officers and others being assaulted. When does the line get crossed?

The difficulty is that we are talking about a spectrum, so the situation presents itself in different ways. With high-end violence, we can look at criminal justice outcomes; in our heart of hearts, that is not where we want to be, but it is the only tool that we have, and the police officers who use that tool set are having to ask themselves what the best outcome is that they can get for the individual and the other individuals affected by the situation. We hit the same blockers time and again.

I describe policing as being in many ways like brokering. You have to try to deal with a chaotic problem, bring some order to it and move it on, because we do not have the capability or capacity to put longer-term investment into many of these issues and people. Therefore, what would help with the police side of things in the medium to short term would be to get rid of those two pinch points of having to wait for medical intervention in a private space and not being able to release officers at a suitable assessment centre because the medical profession cannot take the individual on at that point.

Thank you. I think that Mr Evans is keen to come in on this.

The points that I will make relate to things that I have been learning about in my time on the Scottish Police Authority, especially through my closer involvement with the contact assessment model and the contact, command and control—or C3—division.

Often, we talk about the demand that comes in through calls for service, which, as ACC Hawkins said, are received every nine seconds. The ability for vulnerable people—indeed, for all of us—to call on the police is a hard-won achievement that is not available in every society but which is available across the United Kingdom. Being able to call a warranted police officer in distress is a precious right.

The point is not to stop those calls from coming in. Instead, the point is that when a warranted officer with powers is present—and the evidence shows that this does happen—they are expected to be able to direct things in order to help the individual in question, perhaps by using their authority to place them somewhere. That is where things can be lacking, but it is important to say that it is not a universal lack. As can be seen from the meeting papers, the response is outstanding in some areas of Scotland and very poor in others. It is frustrating that we cannot replicate the excellent practice.

Secondly—and this surprised me—the 101 number started off as a joint endeavour with local government, but it has now been taken over entirely by the police service. We need to look at a person-centred approach. The Christie Commission often talked about prevention, but I would just note that the first bullet point of its report was about the need for person-centred public services. A person-centred public service will not separate out the services required by someone who calls in distress according to whoever is on the other end of the telephone, how they can apply and so on. After all, the best responses are those that are multi-agency, as I think Alan Staff has said, and interdisciplinary. We have to look at 101’s engine room so that we can direct people.

The last point is on cost. We already have very good cost information, but we are also going to get new information through the board on the cost in police officer time, which is important, and the actual financial cost. However, the real issue is the opportunity cost. The lack of handover, which David Hamilton talked about, and the need for two officers to spend up to eight hours responding to each mental health case represent an enormous opportunity cost. The harms in our society that we need warranted officers to deal with are getting pushed down the agenda chain as officers have to step into situations where they have to do very little other than hold the hand, in the best possible way, of someone in distress—to their immense frustration, as comes through in the evidence, and to the detriment of their own mental health. The feeling is one of helplessness and irritation with the service. To be frank, they feel that what they are being called on to do is not what they were trained for and not what we pay them to do. Indeed, it is an expensive way of doing that sort of thing.

When it comes to the handover that David Hamilton talked about, we should be talking far more about the need for civil society to step into that space. That does happen around Scotland—there are, as the written evidence shows, some fantastic local community schemes—but that is not universal.

Following ACC Hawkins’s comments about the changing nature of policing over the years, I have a question for David Hamilton. Has the training for police officers kept up with the massive changes that have happened over the years? Do they get adequate training on what they should expect, how to recognise people who have mental health difficulties and—the other side of the coin—how those situations might affect them and their own mental health?

It is not adequate. There has been some training, but it tends to happen remotely, which, as we know from all our survey work, is loathed by officers. With something so important, we need more interactive training. According to feedback from officers, some of the training has been quite useful, but the cap is on how far we want to train them and what we want them to do. We have distress brief interventions and so on. Although they are probably used to deal with more lower-level situations, they have been a good addition.

However, what causes us big problems are the more severe and acute issues for which we do not have training. Sometimes, those are about returning calls from or about people whom we deal with regularly; sometimes, they are about children. Indeed, our submission mentions an officer who talked about a child who tried to stab her mother. This is heartbreaking stuff. How do we train an officer to deal with that?

Exactly. As far as police officers’ mental health is concerned, do you feel that there is enough support in the police service for officers who find it hard to deal with such really difficult situations?

The problem is that the service’s response to wellbeing has been very reactive when what we need to do is to stop problems happening in the first place. We are constantly putting plasters on to stop bleeding when we need to prevent the bleeding from starting in the first place.

The challenge highlighted in our evidence and in the surveys that we and Police Scotland have carried out is that people are burning out because they are so busy with work—not least dealing with mental health calls—that they are not getting a chance to get away from it. It is constant, and they are getting to the critical stress level at which people burn out. That is what all the data tells us: police officers are burning hot just now and are beginning to fail. Whatever we do in response, we need to stop that sort of thing happening in the first place and before it needs to be fixed.

Thank you very much.

I failed to say at the outset of the meeting that witnesses and members should try to keep questions and answers as brief as possible. We have a lot to get through.

I call Pauline McNeill.

I have two questions. I want to explore what I have just heard about police officers being the first responders and, in effect, the last resort. What is the answer to that? I also want to ask about the resource impact.

The testimony that the federation has submitted to the committee is very useful but very difficult to read. It amplifies what we have perhaps always known, which is that the police service is the only service that cannot walk away. As a politician, I do not think that that is recognised enough and, however we have arrived at holding this round-table session, it is a crucial issue.

On the part of Professor Heyman’s submission about section 297 of the 2003 act, I do not understand why the police would even be involved when there has been no self-harm and no offence has been committed. Of course, I understand that police officers need to step in if there is harm involved. We have heard from David Hamilton about the long wait times for people to be seen by healthcare staff. It seems as though every other service can say, “We can’t take you,” but the police cannot. It is fundamental that we resolve that.

ACC Hawkins has suggested that multi-agency discussion seems likely, but we have heard that 101 services are now almost exclusively operated by the police. Is such discussion going to lead anywhere? From what I have heard, we need to make specific provision for the police not to always be the service of last resort. I do not know enough about mental health services to know what duties need to be imposed on them. Why should mental health services be able to walk away from a person who is at risk, yet the police cannot?

My question is for ACC Hawkins in the first instance. Do you not feel that, even if there is multi-agency discussion, the police will still be left as the last resort and we will get no further forward?

I certainly hope not. There is a role for parliamentarians such as you to help us with regard to that scenario.

10:15  

The truth is that there are a number of examples of good, collaborative working. The mental health pathway, which we worked hard on with the Scottish Ambulance Service and NHS 24, is a sign of what is possible. Training is being provided in that area. We now have mental health nurses in our control centres who are able to help us to refer calls to a health-staffed hub, and fewer than 10 per cent of the calls that go there end up requiring a subsequent emergency response. Many of the provisions in custody are also very helpful.

However, I genuinely believe that that happens only when there is a meeting of minds and the stars align in such a way that such collaboration is supported, funded and prioritised and it takes place. Single-agency discussions miss the point. There are enough examples out there of the type of initiative and response that works, and they need to be prioritised.

I do not know whether this is for you to answer, Professor Heyman, but you say in your submission:

“If no offence has been committed and there is not at immediate risk of life, police may not legally remove them from their home for assessment or safeguarding—from a Place of Safety”.

Can you tell me why the police are involved in cases like that?

People will call on the police if they are in distress because they want that distress and pain to stop. The agility of health services—GPs have been mentioned—is constrained by time constraints. Some might say that it should not be a police officer who attends in such circumstances but, for a lot of people, police officers have the authority to contain situations and to help them to manage their distress in a way that others cannot, so there is a reason why they are involved. As well as bringing authority, the police will come quickly, so there is almost a revolving-door effect—because they arrive quickly, people use the service. Their agility allows them to be there. The police are not necessarily a last resort.

I keep harking back to this, but the issue that a person has might not be mental health related. People keep saying, “Let’s take them to emergency health services,” but it is rightly pointed out that it might not be a mental health problem. The person’s distress might be because of unemployment, because they are intoxicated or for a lot of other reasons, but not because of mental health.

Would it not make sense for another service to pick that up?

Yes, but we do not really have a system for that at the moment.

That is the obvious thing to have, is it not?

It is worth considering that there are opportunities to do more remote assessment using technology. We do not need to take somebody to A and E, which is incredibly undignified. I would be distressed in that situation—if I were sitting between two police officers in an emergency department, my distress would escalate.

We should consider whether there are smarter ways of doing things. For example, technology could be used to do a remote assessment, if that is what is needed. Loads of work is being done by Police Scotland on the development of technology, but the voices of individuals are not really being heard. We speak about people as patients, but they are human beings. We have lost sight of their humanness and of what they need as individuals.

We have discussed the need for personalised responses. Could we use information sharing between services to help with that? We are very poor at sharing information. We should involve people’s voices in that process. That way, services could talk to one another and some of the conversations could be untied. A person could have an advance statement prepared about what they need in circumstances in which their distress is unmanageable and they have called the police.

I think that the way in which the system works—it is a push-and-pull system—just retraumatises people, so we should not be surprised that they keep phoning the police.

I want to ask about resource implications, and I will put the question to David Hamilton. Rona Mackay asked about the distress to officers, and I will quote one of the statements that is made in the SPF’s submission:

“I have seen my hands shaking on my way into some nightshifts knowing I may only have 1 or 2 cars available, just that added stress of increased call volume and low staffing levels is shocking.”

Further on, there are comments from other officers about not being able to get leave, which impacts on the service. As we know, if we lose a lot of police officers under the McCloud judgment, we will be left with a lot of less experienced officers. That would have a huge impact on the mental health of officers, who are having to deal with other individuals who are experiencing mental health issues. Is resourcing for mental health a big issue in the police service?

It is critical. We have been saying that for a long time, and people have looked at the issue. We are beginning to lose faith in the concept of partnership working, because when times get tough, people retreat to their base. We have run pilots with different agencies, but they quietly dissipate into nothing, and there is no sustainability or long-term aspect to them because everyone retreats back to their base.

The Parliament had a joint health and criminal justice forum on which different committees came together, but I have no idea what it achieved, if anything. The problem is that we go around talking about the issue and saying that we need to do more partnership working, but it never actually changes anything. We have exactly the same issues today that I used to deal with 20 years ago as a constable working in Tayside. Nothing has changed. We have slightly different legislation, but the issues are the same. The problem is that demand has skyrocketed, and that is where we are feeling the pinch. We need to get on top of the demand, because it is getting ever greater.

We have heat maps that show when mental health incidents are happening. Funnily enough, when we look at those, we see that it is at 4 o’clock on a Friday, when everybody else finishes for the week, that issues are handed over to the police. We suddenly get hit with a whole lot of incidents and a whole lot of cases of mental health-related missing persons. Those often come from social work agencies and homes and so on, but because those services are not 24/7 and staff will not be back at work until the Monday, they phone the police and hand the incident over.

As long as such behaviour persists, we will get hammered as a result, because part of our statutory responsibility is wellbeing in society. I have issues with that, because that could include telling people not to smoke because it is bad for them. Where does the limit lie in that respect? Sir Michael Barber addressed that in his recent review of policing in England and Wales, when he said that police officers should have a locus to act where they have powers to do so, but that policing should not go beyond that. There is a lot of sense in that approach, because it constrains an otherwise insatiable demand.

Your question about why we are getting involved in such cases is a good one. The answer is that it comes down to policing principles and what the act legislates for, but there is no control over that, so people know that we have to step in. In truth, with policing as it is, we want to help, and we will not walk away and see people left, because we also know that we are the service of last resort. The problem is that that is being taken advantage of. What we need in order to function in that way is a supportive mechanism that prevents everything from being dumped on us. We need a filter that stops all that coming down to the officers you have read about in our submission. They are having to pick up the pieces and deal with those issues.

The knock-on consequence for resourcing is that there are fewer and fewer officers on the street, because we are dealing with those issues. Frankly, it is about demand. We need to get on top of the situation, because we have taken on so many new functions without new resources and, on top of that, we are losing resources. Even if we had more resources, we could not recruit officers quickly enough at the moment.

I agree with an awful lot of what has been said. On the particular instance that Pauline McNeill talked about, we would refer to that as a concern-for call—a non-criminal call in which concern has been raised about a member of the public. Over the past five years, there has been a 60 per cent increase in adult concern calls and a 36 per cent increase in child concern calls. There is a growing non-criminal demand on the service.

I associate myself with Inga Heyman’s point. We are talking about human beings—fellow citizens—getting the wrong response in their moment of need. Although it is entirely right to discuss demand and displacement, how we can collectively provide a more appropriate level of service to individuals in their moment of need is the central issue that we need to challenge ourselves on.

I know that we need to move on, but what you have said really chimes. We have talked about the issue for 20 years, and we know that there is a solution. If the pilot schemes lead to nothing, I do not know whether it will be for the police to be a bit more forthright in respect of their responsibilities or whether the issue is for the Government. Will you touch on that quickly?

I am not sure that I fully agree with David Hamilton on that point. Pilots have certainly come and gone, but I think that the mental health pathway, which I have referred to already, has real potential for the future. The collaboration between us, the Scottish Ambulance Service and NHS 24 has received Government funding, which has allowed us to accelerate that through Covid. However, I would like to see more of the same. In a sense, that has given us a signpost for the kind of initiative that is needed.

My question follows on from the discussion that we have had. I want to reflect on what David Hamilton said.

For the record, I should declare an interest; this is in my entry in the register of members’ interests. Before I became an MSP, I was a social worker in criminal justice and child protection.

What David Hamilton said has always been the case, and I am now thinking about that in a new light, as I am seeing the issue from a different perspective. We were always told that the police were the last resort, and the police were used quite frequently. People would be told, “This is a police matter.” I go back to points that Mr Evans made. Should other agencies have more power and more confidence to take things? It is not necessarily the fault of social workers or health workers if they think that something is a police matter.

Another thing that Mr Evans said chimed with me. He said that we are a society that can call on the police. We definitely do not want to lose that. It is quite a difficult balance to find.

We have heard the term “burn-out” and about the pressures that police officers are clearly under. We all know police officers in our own lives. I have friends as well as constituents who are police officers, and I have heard from the ones whom I have spoken to that they still love their jobs, but they are feeling more pressure than they ever have. I hear that across a range of services.

Maybe ACC Hawkins could answer this question. Has any analysis been done of what the main contributing pressures are that lead to the feeling of burn-out that has been described? We have heard a lot about dealing with mental health and more complex issues. Where does Covid come into it? Where do resources come into it? Has any overall analysis been done?

Yes, there has been analysis. There has been analysis of particular conditions or challenges when people are absent. The medical condition, such as anxiety, depression or alcohol abuse, tends to be described rather than what is behind that and has caused it. That goes back to an earlier point. Is that a financial issue? Is it a family issue or a work-related issue? We do not have that level of analysis, but we can break down, and we do look at, the medical descriptors, such as depression, insomnia, debility and bipolar. We have analysis at that level, but not at the wider level.

That is similar to the question about the cause of suicide. What was the driver? We do not have that.

What does the analysis point to or indicate? Even though, as you said, it is not very detailed, has the force come to any conclusions on that analysis?

10:30  

We know that anxiety through a psychological disorder is the number 1 cause of absence, followed by depression and a range of other psychological disorders, including postnatal depression, post-traumatic stress disorder and schizophrenia.

Over time, have you noticed a marked increase in those absences?

Yes, there has been an increase in the amount of working time that is lost as a result of psychological disorder. In 2021-22, just over 50,000 working days were lost, which is about 1.6 per cent of the total amount of working time lost. We analyse the data. It is a big figure, and we seek to address that through the range of support measures that we have in place, which include financial support and support and advice around any number of contributory background conditions that might be behind those disorders.

I am sorry to keep pressing you on this, because I know that it is a very difficult and sensitive area, and I appreciate the responses that you are giving. We are getting a clear indication from you that anxiety and depression have increased. We would not expect you to do so when they are suffering but, when the time is right, are you going back and asking those officers who are off with anxiety and depression to indicate any work-related pressures that they felt led to that? Do you try to pull that information together?

That kind of thing does happen. Obviously, patient confidentiality needs to be respected and medical support needs to be provided to people in their moment of need, but we also seek to understand any work-related matters.

We have another process called trauma risk management—TRiM—which is the response that is provided to officers who have dealt with a particularly traumatic incident. An intervention takes place to help individuals to process the trauma and, if possible, to minimise its impact. That is subject to on-going review and refinements. There are a number of mechanisms, and we certainly seek to learn and improve as we go.

Convener, I was nearly finished, but that last answer leads me to another question, because that is a really good point. I imagine that you and your officers regularly deal with what the rest of us would consider really traumatic experiences. Has there been an increase in those really traumatic experiences? We have heard about the increase in contact from members of the public in relation to mental health issues, and I think that we are going to hear later about some quite disturbing increases in issues that affect children. Is that also on the increase?

In 2021-22, there was a 32 per cent increase in the use of the trauma risk management intervention, compared with the previous year. I hope that that is partly due to growing awareness of the intervention and growing willingness to refer people to use it, but that undoubtedly also speaks to an actual increase. We are seeing an increase in the provision of such high-end trauma support.

Thank you for that. There are plenty of issues there for the committee and the Government to consider.

I think that Martyn Evans would like to come in on that. We do not have a lot of time, so please keep your answer brief.

I will keep it very brief. That is like the evidence question. The evidence comes from Durham University, which interviewed 7,000 police officers in Scotland about how they felt they were. The asset base and the positive view that I take from that is that police officers were clearly resilient and committed, and they had pride in their job. We should celebrate that, because it is great.

Two strands of issues came out of the research. The first issue was about how wearing the futility of some of their job was, which is what we are discussing now. Officers respond to vulnerability, but their hands are tied, because they cannot direct anything to happen for those people. That is frustrating.

The second issue was trauma. That affects a smaller number of people, but traumatising in policing is quite different. It is quite similar in forensic services. People are traumatised by an incident, and they are retraumatised by having to relive it, investigate it and repeat that in court. It is very unusual to have that kind of retraumatisation.

To simplify, the issues are the futility of officers being left with the vulnerable person with the services not being available, and the traumatisation.

On taking forward evidence-based solutions, the organisational implementation plan is coming before the SPA’s people committee on 1 June. The plan has 20 ambitions, champions have been identified, and it includes milestones for improvement.

We will always be interested in improvement. There will be a process of continual improvement in how we support staff—who are, as I have said, an asset to us, are resilient, have pride in the job, and are committed—through the stresses, futility and trauma that they experience in their very unusual jobs, in which they must engage with hugely unpleasant scenes and difficulties.

We will wait to see what happens, but I am very pleased with the measures and milestones that are in the plan. The SPF and other staff associations will be at the June meeting. I ensured that they were invited, and I am very pleased that they will be able to attend that meeting.

Speaking of the SPF, I see that David Hamilton wants to come in on that issue.

One of the challenges of the your voice matters survey was that it did not go into the granularity of the causes and so on. I think that Mr MacGregor was looking for information on that. However, the SPF did a survey just before that one. Unfortunately, I would not exactly say that Police Scotland has fully taken on board its outcomes. Our survey shows that 45 per cent of officers experience high or moderate levels of burn-out, and one third say that they go to work mentally unwell. Those are pretty devastating figures for the organisation.

We did further analysis of that, and one point that became clear was that, although we expected the pressures to be on our female officers—particularly those who were trying to juggle their family and work lives during the pandemic—it was single male officers who were in the worst condition. The researchers, who were from Carleton University in Canada, undertook clinical measurements and came up with conclusions. Based on that, we think that the big difference is to do with post and role. The difference is that young men are more likely to be on the front line for a longer period, and a higher proportion of women tend to go into back-office roles and support functions, which seems to be skewing things. Therefore, mental health issues are a problem for front-line workers.

When we look further into the qualitative data, we see that the key messages to come out about the causes of burn-out are: insufficient staff; staff being unable to say no, either by choice or by requirement; public expectations; and the volume of work. Burn-out is a result of the type of work that staff are doing and their not getting a chance to get away for a breather. Everybody mentions their leave and rest days being interrupted, as well as issues to do with the court system. Matters compound until we get to a difficult position in terms of the wellbeing of our workforce.

We have the data, and we would be happy to facilitate input from Professor Duxbury from Carleton University, if the committee wants us to do that.

Thank you very much. Collette Stevenson would like to ask some questions.

Offending and mental ill health go hand in hand. I think that it is fair to say that many people suffer from mental health issues to varying degrees at the point when they offend. What approach are the police and partner agencies taking, as it is obvious that mental ill health is a huge contributory factor to offending behaviour?

I have another issue that I would like to explore further. At the point at which someone is charged and the police are writing up their report, are the police able to refer to mental health issues so that that is noted on the file for when the matter gets to court?

I do not mind starting off; perhaps Mairi MacInnes could come in with a bit more detail.

You are quite right. Some 40 per cent of people who come into custody self-declare as having had mental health issues at some point. When additional complex needs are taken into account, the figure goes up to around 60 per cent. Therefore, a very high proportion of those who come into police custody have mental health issues. That is a fact. Typically, they will have been arrested, because broader public safety concerns have had to be addressed and the officers involved have deemed arrest to be the most appropriate way of dealing with and defusing the situation. A number of approaches are then taken. There is training support for officers, and assessments are done in custody. With your forbearance, deputy convener, Mairi MacInnes can give you some more information on that.

When an offender comes in with symptoms—or a recognition—of a mental health issue, the issue, first and foremost, is to get them care. The healthcare practitioners will carry out an initial on-site assessment, and potentially, as I mentioned earlier, there will be a secondary offsite assessment at a hospital. From that, we will get an assessment of whether the person is fit to be detained or needs to be taken elsewhere. That does not necessarily mean that they are fit to be interviewed, but it is a consideration with regard to the care that they will get while in custody.

As for what happens when the individual goes to court, whether the mental health issue is referenced in the police report will depend on its scale. However, we do not know what follow-up takes place or what happens then to their mental health—the mental health assessment that we carry out is very purposeful and is purely for when they are in our care.

You have touched on distress brief interventions. Are they awarded to people in custody? Do third sector organisations come in during their period of custody? Can you talk about the level 2 aspect, too?

It depends on where you are. Third sector provision varies across Scotland, and it all depends on the referral options and whether those organisations can come on site. That sort of thing does not always happen on site; quite often, it happens after the individual has been to court or is out of custody. However, we can put that referral in.

I also want to ask about the pilot schemes that you have already touched on—the DBI scheme and the mental health pathway pilot. How effective have they been? What lessons have been learned about what can be done better? For instance, notwithstanding the involvement of the national health service, the police and the Scottish Ambulance Service, should a dedicated emergency service line be put in place? Would that be effective as far as mental health responders are concerned? Can John Hawkins respond to that?

I am happy to do so.

I can talk about the mental health pathway pilot, which at present is for non-emergency calls. We should remember that the public can dial NHS 24 directly on 111 and seek resolution in that respect; indeed, that is a really impressive, clinically designed model that is provided by our health colleagues and which navigates the caller towards a lot of self-help preventative intervention. My sense is that the emergency stuff is dealt with pretty well through 999 and the blue lights, whether they be police or ambulance. If we could collectively focus on and push that non-emergency lower-level provision, it would have a huge impact, given that it covers by far the biggest volume of mental health-related matters.

In the past two or three months, we have gone into the second phase of the pilot by bringing community psychiatric nurses into our control centre, and it is encouraging the transferring of calls. Our organisational culture is such that many police officers would rather go and check things out themselves—it is in our DNA—but we are trying to encourage the transferring of lower-level matters to the health service, because that is where we think that we will get the best resolution. That approach will be subject to detailed evaluation when the pilot finishes, and that might give you more insight into how things have worked and what we need to do next. That evaluation is planned and in place.

When is the pilot finishing?

10:45  

It is running now; the second phase will finish in about four months. Just this week, we have had to reassess our plans because we are struggling to recruit mental health nurses. Recruiting is easier said than done, partly because of Covid and partly because of demand for that particular skill set. Nonetheless, my sense is that the pilot will continue for about four months, and then there will be an evaluation process.

We have four and a half minutes left. I will bring in Jamie Greene. Over to you, Jamie.

I have a basic question. Is it time for fundamental reform of how people access emergency services? That picks up on the point about 101 versus 999. I have gone through the experience of calling both numbers in the past month, and those experiences were vastly different from each other. The 999 call involved a medical emergency to which the police turned up because there was no ambulance, and the 101 call involved a police situation in which an ambulance that was not needed turned up—that was utterly bonkers.

Is it time for fundamental reform? Could we have a proper triage system that deals with non-urgent access to all emergency services and public services? Things could be properly triaged and filtered out to the appropriate public service, and that would be a 24/7 service, so there would be no need to fall back on the police. If so, who would need to lead the charge for that? Which minister in Government should we lobby for it, and—this is the most important question—which fund should resources for it come from?

I see that ACC Hawkins is smiling at me, so I will go to him first.

I now have three minutes in which to answer that.

In short, the answer is yes. We have an opportunity in Scotland to do that, with the creation of national services that are increasingly mature and increasingly willing and keen to work together. The elements that need to be deconstructed are some of the organisational and departmental boundaries—some of our own self-imposed restrictions on how we describe and view those issues.

In a country the size of Scotland, we should be having a conversation about 999 and 101 and the 111 service that puts the citizen at the heart of the process and works out how best to provide support in the moment of need.

Does anyone else want to answer? We are running out of time.

The other witnesses can respond very briefly.

I will be very brief.

On the question about vulnerability, I want to mention the collaboration framework that Police Scotland forged last year—very impressively—with Public Health Scotland. That is a major change—it will create a public health approach to offending and to criminality and non-criminality. It is early days yet, but that is an indicator, despite what David Hamilton said, of the step changes that are happening in relationships, often because there is a single police service.

My second point, which is a point that has been well made by the Association of Scottish Police Superintendents, is about pilots. Pilots require human and financial resources, and they are not often able to be continued. They involve learning, refinement and replication, but we often fail on the refinement and replication side. I am very worried that some of the great work—there is a stack full of pilots—is not being replicated.

My third point is about the 101 service. I would look at the other end, which is the hyperlocal part. We have some very good examples of local police plans and community planning partnerships in which collaboration actually happens in real time. There are real cross-sectoral responses to distress and vulnerability, often with the third sector and the community sector engaged as well. We need both parts. What we lack, in some ways, is the social capital and the organisational structure to enable that hyperlocal delivery. However, where that works well, it works incredibly well.

My Convention of Scottish Local Authorities colleagues tell me that, as they are under funding constraints, they take out their voluntary resource because they have to concentrate on statutory responses.

Thank you. We will finish with David Hamilton and then Inga Heyman.

It is an interesting question. I am instinctively drawn to the concept that Jamie Greene outlined, but the difficulty that I see is that it would need to involve not just the emergency services but local authorities and the primary care aspect. The question is how, in reality, all that could be brought together into something that could work. That is a challenge, but it might be worth exploring further.

There is an opportunity for collaboration at a strategic level. We could have a multi-agency hub that comes together to have those conversations, instead of having them all happen separately; it would sit very much at the strategic level. There are already good examples of collaborations—for example, Public Health Scotland’s work with Police Scotland, which is a really good start.

Great initiatives are happening—for example, the work that John Hawkins is doing is really important. It is important that we continue and extend such work, but we also have to think about which other partners, such as COSLA, need to be part of that work at a strategic level. We need to be working together instead of doing things separately, as we currently are.

From a strategic perspective, there are huge opportunities to collaborate. Maybe we could go back to the original position in which Government was taking a working together approach. It has been said that that did not work very well, but there is evidence that huge bits of work came out of that collaboration, in particular around mental health pathways.

As ever, we have barely touched the sides, and there is much more that we could have gone into, but I appreciate everyone’s time today. If there are any issues that you need to follow up, I ask you to do so in writing, please. I thank you all for your time.

10:51 Meeting suspended.  

11:00 On resuming—