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Profile: Nurses on patrol

Nurses have joined forces with bobbies on the beat to help people who are in need of mental health support get access to healthcare early on

In an effort to help the police with members of the public who may be suffering from mental health problems, nurses are providing back up to triage and plan care for such people.

Jennifer Mayhew is part of a team of four street triage nurses working with Cleveland police and is called in when there is a perceived need for immediate mental health support. 

By helping to redirect those suspected of having mental health issues during their first point of contact with police to relevant social and mental healthcare services, the amount of time and resources that would otherwise be spent putting them through the criminal justice system unnecessarily is greatly reduced.

“We're now capturing people with mental health needs at really early stages. It must be really awful to be unwell and put down the criminal route. Now, we sign post them to the relevant services early on and get the problem nipped in the bud,” says Mayhew, who qualified as a nurse in 2006.

The scheme, which started June last year, resulted from a collaborative effort between Cleveland Police and Tees, Esk and Wear Valleys NHS Foundation Trust, developed in response to Lord Bradley's report in 2009.

 The report stated that too many offenders with mental health difficulties and learning disabilities were ending up in prison without access to appropriate treatment and that many would be better off serving community sentences instead of jail terms.

In an extension of this scheme, nine new police forces have now been chosen to work with the Department of Health to pilot it, including the Metropolitan Police, British Transport Police and West Yorkshire Police. 

The scheme has already been set up in North Yorkshire Police, Sussex Police, Derbyshire Police, Devon and Cornwall Police with the rest of the police forces implementing the scheme on an ongoing basis.

The Cleveland force serves four areas including Middlesbrough, Stockton-on-Tees, Hartlepool and Redcar, which keeps 28-year old Mayhew, very busy as she attends up to four triages a day. 

Working a 12-hour shift from noon to midnight, Mayhew begins the day by waiting in the control room with the other members of the triage team to be called to police assistance if the need arises. 

Equipped with police radios, the team can immediately relay back information to police officers about an offender who is suspected of having mental health difficulties, by searching in their electronic database so that police at the scene can better know how to handle the situation. 

If further assistance is required, two members of the triage team will then go to the scene. 

“We support the police in whatever way they need. It doesn't always have to be a diagnosis of mental health problems. 

If they believe they have a mental health problem, we go out and do a mental health assessment, but sometimes it could be issues related to finance, relationships or they could have a learning disability,” says Mayhew.

Under section 136 of the mental health act police officers have the authority to put an offender into a place of safety - a hospital or police station for example - if they are suspected of having mental health issues that will endanger themselves or compromise the safety of others. 

In such cases Mayhew will accompany the individual to the designated place to help make the transition smoother. 

If on the other hand, the triage team make an assessment that the offender is not a danger to themselves or the public and doesn't need to be detained any further, they will be referred onto various services including mental health, benefits services, drug and alcohol services, bereavement services or family services. 

The team also have leaflets and phone numbers for different services directly at hand to give out. 

Sometimes, offenders may also be asked to refer themselves if appropriate.  

With over half of the offenders complying with referrals, Mayhew says, “Our advice is generally well taken, with a bit of encouragement. We say that we'll give them a ring to see how they're doing and that gives them that motivation.”

After making their assessment, the triage team produce a care plan for the offender before following up on the case the next week. 

If necessary, follow-up will be extended for another week. In between triages, Mayhew, who before qualifying as a nurse, worked as a nursing assistant from the age of 17, liaises with different agencies and gathers information to extend the network of support services available. 

“It's a very rewarding and satisfying job. Putting a plan of care in place to meet people's needs be it at home, in the community or referring them onto secondary health services, it's great to think you've taken a big part in that and been quite pivotal really,” says Mayhew. 

“It's also an eye opener for the offenders and allows them to know about services they may not have even knew existed,” she adds.

Cleveland police put in a bid for the scheme in 2011 after an opportunity to obtain extra funding to expand on the National Liaison and Diversion Development services arose.

Rob King, mental health liaison officer at Cleveland police, who had a key role in winning the bid and developing the street triage model, says: “I pulled some figures together, and it showed that in Cleveland of 511 people suspected of having mental health issues who were placed into protective custody over a 12-month period, 388 were later shown the door and assessed as not requiring mental health services. There's clearly a situation that's brought them to police attention in the first place, and [although it's] not necessarily mental illness, there are still needs [to be met] and action that needs to be taken to provide some sort of follow-up or onward care plan.”

 Citing figures from a report by the Sainsbury Centre of Mental Health in 2009 which estimated the costs of putting someone in and out of police custody to be around £1,780 per person, without taking into account any other charges that may be incurred along the criminal justice system pathway, King says that a saving of over £690,000 per year could be made had the offenders mentioned above been redirected to the correct services at the first point of contact, as they are now with the help of Mayhew and the triage team.

As funding for the scheme comes to £170,000 each year, this amounts to a potential saving of £520,000 on what would have otherwise been spent on detaining offenders unnecessarily. 

Since the scheme has been in place, King says that offenders who would have otherwise presented with the same problem several times a month may now only come to police attention once every few months. 

He adds that there has been a huge reduction in the number of people brought into custody under section 136 and that offenders are now getting the help they need whereas under the old system nobody would have bothered with them until their behaviour was brought to police attention again.

“What we have now is a holistic approach where we look at the mental and social care needs of a person and not just their mental health needs.”

Commenting about how the police have responded to the scheme, King says, “It has made a huge difference to the way they operate bearing in mind the time taken up by mental health cases when they're not equipped to deal with these sorts of incidences.” 

King says that the scheme now freed up a lot of police time, and police can now leave the triage nurses to deal with cases if the offenders are compliant, allowing them to resume with their duties. Previously, a police officer could be tied up for six to seven hours for each case. 

Giving an example of someone who might otherwise be put into a place of safety under the old system, Mayhew talks about an elderly gentleman who had been drawn to police attention for  “making a nuisance of himself.” 

“The gentleman appeared very confused and seemed to be intoxicated but he didn't actually smell of alcohol. All he kept saying was, 'I want my small purple tablet'. While it might not seem to make sense, a mental health professional would realise that's medication for epilepsy.”

 It turned out that the man had had an epileptic attack, and upon being taken to a hospital and receiving the appropriate care, made a full recovery. 

Mayhew also described the case of a woman who had been found wondering around the streets in her slippers having left the hospital where she was receiving treatment. 

When she was questioned, she seemed to not know her whereabouts or explain how she had arrived them, showing symptoms of dementia, even though her husband who later arrived at the scene explained she wasn't normally like that.

 Upon further investigation, it turned out that the woman was suffering from a serious infection, which can sometimes lead to symptoms of confusion. 

Another by product of the street triage scheme is that the team share their knowledge about mental health with police officers with further scope for developing mental health training within police services in the future.  

Given the large number of offenders with mental health needs, Mayhew feels that this is something that police training should definitely work towards incorporating.

Talking about her motivation for taking on the role, Mayhew says: “It's very interesting. You never get the same referral. Every referral is different…It's a totally different way of working and it's great to think that needs can be met early on and that you can help build links and capture those needs.”