Oral evidence: Policing and mental health, HC 202Tuesday 11 November 2014

Oral evidence, 11 November 2014.

Witness

Rt Hon Mike Penning MP, Minister of State for Policing, gave evidence.

Chair

Minister, I welcome you warmly to the Committee on your appointment. This is the first time that you have given evidence to us and we wish you well in your position as Minister of State for Policing.

Mike Penning

This is the fifth Select Committee I have sat in front as a Minister in under three years.

Chair

Then you are more experienced than we are, because we have not had five Ministers for Policing, we have had only two. You are also Minister for Victims, and I would like to clear up a point: are you in involved in any way with the child abuse inquiry in support of the victims, or is that being dealt with very much by the Home Secretary?

Mike Penning

I am Minister for Victims in the Ministry of Justice, so I have no involvement with the inquiry.

Chair

We have heard evidence from the Health Minister and are very upbeat about what the Department of Health is doing. We believe that they understand the concerns that we have heard about how we get people who are mentally ill outside the criminal justice system. Let’s not let them enter in the first place. That would relieve the pressure on police officers and on the system as a whole. I put this case to Mr Lamb and I will put it to you. You have probably seen the case of Matthew Williams who, having just been released from prison, was reported to have eaten a person, Cerys Yemm. He was suffering from paranoid schizophrenia and was not given access to the correct medication. That condition was known to the police. Do you feel that, on release from prison, it is important that those in the community are fully aware that somebody has such a mental illness? As a Justice Minister, as well as Minister for Policing, you do not need to talk to two different Departments because you are two different Departments.

Mike Penning

Yes, I am, which is interesting at times.

Chair

How do you keep it joined up so that the left-hand side of you knows what the right-hand side is doing?

Mike Penning

Perhaps if you bear with me for a few seconds, I will explain how we have done that. I am not a straight replacement for my colleague Damian Green, who I replaced in the reshuffle, in that I have some responsibilities that he did not. I am responsible for police in the Home Office along with the armed forces brief—the veterans brief, which as you know is very important. I also have responsibility for criminal justice in the Ministry of Justice, and for victims and veterans there as well. The case that you mentioned—the Lord Chancellor has announced a review of exactly what happened and how it happened—is interesting in that he had served full sentence, so there was not the sort of protections and monitoring that goes on. That is something that I know the Lord Chancellor is keen to look at in the review. My personal view, which perhaps I should not give but I am honest when I appear before Committees, is that this is something that we need to know. Public protection is the most important thing but, at the same time, people need treatment and continuing help, such as that man who was diagnosed as being schizophrenic. I think I heard his mother on the radio saying that he had not been given his treatment and he could not get his prescriptions, and things like that; in the 21st century, that is not acceptable. We will have to wait for the review to find out exactly what happened, but it is clear that something went seriously wrong, not only with the release from prison, but for his medical needs, which were obviously important.

Chair

That is very open of you. We welcome Ministers being so open. Lessons need to be learnt so that it does not happen again.

Mike Penning

Exactly, and that is exactly why our internal review has started straight away. That will involve several ministerial Departments working with not only the Prison Service—I worked closely with Norman Lamb in my previous role on disabilities, which flows into much of the work we are doing now—but the health side and adult care services. Frankly, as a constituency MP, that is the sort of thing I expect adult care services to pick up on, and local mental health services as well.

Chair

How concerned are you that half of all deaths in custody or following police custody involve detainees with some form of mental health issue?

Mike Penning

Like anyone, I am very concerned. The figures are down on what they were, but they are still nowhere near low enough. The key is the work we are doing with other Departments, because we cannot do this in silos; the police or the Justice Department cannot do this on their own. It has to be done across Government. The key is having people with the right skills to see what the needs of the individual are, rather than just looking at the crime that is perceived to have taken place. That is important, and it is difficult for the police to do. Police are not there to diagnose, they are there to protect us. We are trying to give as many police officers the skills as possible, especially with training—the College of Policing is doing an awful lot of work—not to diagnose but to see the tell-tale symptoms. The triage pilots, which I hope we can talk about in some length, are really working. We will have to wait for the final report—for all the figures to be stacked up and spreadsheets put together—but I have seen it and I am sure the Committee may have done. It is actually working.

Chair

So you are with Mr Lamb, in wanting to stop people with mental health illnesses from entering the system in the first place, rather than dealing with them once they are inside. If we could ensure, for example, that the principles of the triage system works—if everyone is signed up to keeping people outside—do you think that in the long run this will benefit the criminal justice system?

Mike Penning

It will work for the criminal justice system. The evidence that I have seen is that it will work for the individual, and it will work in cost analysis. Perhaps I can use this analogy, Mr Chair. As you know, I used to be a firefighter, and for years I went to what used to be called, inappropriately, RTAs—road traffic accidents—and are now called RTCs. My job was to extract that person as safely as possible and make sure that they got to the best possible medical care when they came into contact with us and the police service. If you have a mental health issue, you will invariably come into contact with the police, as the professional involved. That cannot be right. It is not the job of the police to be that first point of contact; they should be the last resort.

Chair

Do you have a broad figure for us on the cost of policing mental health issues?

Mike Penning

I don’t have a figure off the top of my head, but I would be more than happy to write to the Committee with an analysis. To be honest, I don’t think we have enough data. Since I have been in the Department, one thing I have asked is for the 43 different authorities out there to give us the sort of information that allows us to collate this together. I spoke to a force the other day that had had one person who was known to have vascular dementia—they were known to the local authority, the health service and certainly to the police. She had called the police 600 times, and because of the nature of the call the police had to respond before they could sit down and get a package together for that very vulnerable person—I can give details to the Committee later on, if you wish.

Chair

Please do.

Mike Penning

She has not called the police since. That does not mean that she has had her phone taken away from her; it means that the package is in place to look after her needs as a vulnerable person.

Chair

It would be great if you could write to us.

Dr Huppert

We have had a range of estimates of how much police time is spent on mental health issues, or a combination of complex needs, of somewhere between 20% and 40%. Does that fit with your experience?

Mike Penning

Yes, that fits.

Dr Huppert

One of the custody sergeants we heard from put the proportion of people passing through his custody suite with mental health problems or learning difficulties at around 40%. Again, are you comfortable with that proportion?

Mike Penning

If you take the 43 authorities together, we do not have the exact data on that. You will have some authorities—for example, Staffordshire—that are literally down into single figures because of the work that they are doing in triaging. But yes, it is a huge burden on the police and criminal justice system.

Dr Huppert

Would you say that mental health is now core police business?

Mike Penning

I don’t want it to be, but the police have historically been involved. Norman Lamb and local government Ministers are working with us to address the assumption that we are the point of call for someone who is vulnerable with mental health illness. The other thing I am conscious of is the whole area around learning difficulties. Very often, people with mental health issues have learning difficulties and vice versa, and they may have a drink problem or a drug problem. Either one of those four issues might be the bit that tips them into a situation that means that they come into contact with the police, but it is not the job of the police to be the mental health provision.

Dr Huppert

Many of us would agree that is not what we want the police to be doing, but it is what the police do—

Mike Penning

Yes, and we have to change that.

Dr Huppert

But also poses problems relating to the skill set of police officers. How much is being done to train police to be able to cope with what is a real part of their work?

Mike Penning

It is a real part of their work, but I would emphasise that, no matter how much training there is—a lot of training is going on: the College is doing an awful lot of work, and there is guidance out there—we cannot be medical professionals. That is not the role of the police and it certainly wasn’t my role when I was a fireman, although I will contradict myself and say that, actually, a fireman should have paramedic skills, because that way we would save a lot more lives. But that is a separate issue. The police need to know the basics, but they also need the expertise out there with them on the streets as well as in custody suites so that they are not the first point of call and are not the taxi to the A and E, a safe property or the custody suites. That is not the role of the police.

Dr Huppert

You have spoken a lot about the variety around the UK, and the figures suggest huge variability, with some places doing very well and some rather less so. What have you done to look at other countries? Presumably they must face similar challenges. Where is there good practice in the rest of the world?

Mike Penning

It is interesting that you ask that, because there are very few countries with a national health service that works like ours. As I understand it from the evidence that I have seen—the Committee may have seen other evidence—there are very few countries in which the police have the level of interaction with people with mental health illnesses that our police have. Interestingly, a lot of other countries are now coming to us and saying, “We are interested in what you are doing,” because you are right that they have similar concerns. In the evidence I have seen, I have not seen expertise in other countries that is better than what we are starting to do now.

Michael Ellis

Minister, further to the point you were just making on the role of the police, let us be frank: it should not be the responsibility of the rank and file police to be mental health professionals, should it?

Mike Penning

No, and they are not. It is wrong to use them in that way. To be honest, from the evidence I have seen, that has been the attempt—for the police to be the first port of call.

Michael Ellis

And it is not fair on the front-line police officer to expect him or her to be all things to all people at all times—a mental health professional, a social worker or the many other roles they are expected to play. I suppose one of the issues that arises when it comes to training is whether there is room and scope for liaison with the College of Policing so that a little more training can be given to police officers on how to deal with these difficult situations, or do you think that that is following an unhelpful path?

Mike Penning

This is unusual to say, but I think a little bit of knowledge is useful, but we must not attempt to become health professionals. To give examples of what I have seen around the country in the short bit of time I have been in post, where we have police officers seconded alongside mental health professionals within the custody suites and going out, that seems to work really well. They have that extra bit of training. Let us say it is a Friday night in my constituency. We have some lively entertainment areas in my constituency on a Friday night, and the police officer will struggle, unless he knows the individuals, to know that that person has mental health problems if they have been drinking heavily or doing other things. It is all part of the training, but the key is to try to intercept before we get to custody.

Michael Ellis

We must be realistic in our expectations of our police officers. As you say, they cannot be mental health professionals, paramedics, firefighters, social workers and everything else that we expect them to be, but we would like them to have some basic understanding and training so that, where mistakes can be avoided, they duly are. Do you have any observations on the things that are going well, generally speaking, and in particular those areas where through good practice and hard work your Department and others are performing well? Do you have anything you want to say about that?

Mike Penning

I can very easily turn around as a Hertfordshire MP and say that Hertfordshire is doing really well.

Michael Ellis

I am sure that Northamptonshire is also doing very well. Maybe Leicester, too.

Mike Penning

I paid a visit the other day to Stoke and the Staffordshire constabulary. They have a very large custody facility there, which is in excess of 40 cells. The one thing that impressed me enormously about it was that inside that unit were police constables who had that little bit of enhanced training that we are talking about alongside mental health professionals. Their need in that force to use section 135 and section 136 orders has been absolutely decimated. I think the key thing you can look at, as you look at your evidence as a Committee on how forces are doing it, is how often they are using section 136.

Michael Ellis

In the Stoke area.

Mike Penning

Yes, in the Stoke area it is very low. If you want to look around the country at how well they are doing it, it is about the amount of section 136 orders issued. We are almost certainly going to have to continue to use them. In all the things that we are doing, we are not going to eliminate the fact that on occasions our police will have to do what they can. I think the work that is going on at the moment is transformative. I have been in many Departments that have the silo mentality—no matter who runs the Government, that mentality is there—but for once with this particular issue that has been massively broken down.

Michael Ellis

Briefly, what are they doing in Stoke that is having such a positive effect? Is it because they are working collegiately?

Mike Penning

The health professionals have access to individuals’ medical data. Very often, when they go out to attend an incident or are there when someone is brought in, they know those people. They know what their needs are and how vulnerable they are. That sort of work saves a huge amount of time for the police and ensures those people are in a suitable, safe place. The other thing that is clearly showing in Stoke—this is why they invested in it—is that is saving the constabulary a huge amount of money.

Michael Ellis

Yes.

Mike Penning

Let’s not beat around the bush; inappropriate use of the police force costs a lot of money.

Michael Ellis

It is not in anyone’s interest.

Mike Penning

No, absolutely.

Michael Ellis

Minister, thank you very much. Perhaps you will send our thanks to those who are doing such good work in this area.

Mike Penning

I hope they are listening.

Chair

I am sure they are always listening to the Minister for Policing.

Lorraine Fullbrook

Minister, you made it very clear that the police are not the people to deal with this issue, and that they are not a taxi to the A and E department. In your travels and your conversations and discussions with police officers—I think this will be anecdotal—how often do the police raise mental health issues with you that they are dealing with?

Mike Penning

I have been lucky enough to patrol with the police for nearly 20 years in one position or another and in many different constabularies, and it is something they raise on a regular basis. Often, they do not feel that they are qualified or are the right people to be dealing with it, and often they feel that they are being used and abused. People go to the police first as the easy option. That has been going on for too long, and although we are moving away from it we have not eliminated it. It is a major issue. On the point you raised in your opening question, I have been with the police when they have taken an individual not to the cells but to an A and E for help—I have raised this with Norman Lamb, so he won’t mind me saying it—and two hours later the same individual was back on the streets being picked up again because there weren’t the skills within the A and E to look after them. That is a fascinating point.

Lorraine Fullbrook

Norman Lamb made it very clear that the NHS is responsible for dealing with this issue, so it cannot absolve itself of responsibility when it calls in the police. NHS staff are the primary carers. How does what front-line police officers tell you differ from what senior officers and chief constables tell you?

Mike Penning

It is one of the messages that you get across the board, although they may look at it slightly differently. The senior officers—you had a very senior officer here today talking about something slightly different—look at the effectiveness of their force and the cost implications. You can draw that right down to the front line. These are compassionate people. You don’t become a policeman or policewoman in this country if you are not compassionate. They know when they come into contact with those individuals that the system is not working, and they are not shy of telling you that that is the situation. As Norman said—I think it is brilliant that the Health Minister is not shying away from this—a place of safety for someone is not necessary the local A and E. That was brought home to me on more than one occasion long before I got this job.

Lorraine Fullbrook

Could I ask you about the street triage project? The Committee has taken evidence that the street triage greatly improves the outcomes for people with mental health issues and, indeed, for the police who operate the triage. The Home Secretary announced that it will be expanded across the country. You talked about Stoke. Is that one of the things that Stoke is doing?

Mike Penning

Stoke have done it slightly differently. They completely embedded it in Staffordshire police force, where I was. A very senior member of management oversees this whole area. They were really worried about the amount of 136s; that is what they were looking at. They knew that the officers often use their powers on very vulnerable people. They looked at two things. They looked at how under-18s are being looked after, long before the Secretary of State’s announcement last week. They also looked at people who were vulnerable. They tried to work out whether they could intercept someone coming into the criminal justice system who was ill and get that person to the appropriate place of safety to get help and treatment. When they do that—Hertfordshire are quite good at this—it is not necessarily a police car or police vehicle that takes them to that facility. You can imagine; if you are ill, the fact that you are in the back of a police vehicle which is taking you not to a cell or custodian facility but to a hospital unit for help is very difficult. It is traumatic enough as it is. They are looking at different ways that it can be done. For instance, in Hertfordshire, if you are going to one of the units and the police do take you there, it is out of the public’s sight; it is not obvious what is going on or that a police car has arrived. The effect on patients is very significant.

Lorraine Fullbrook

What is your Department doing in conjunction with the Department of Health to have a total overview of this and how it will drip down?

Mike Penning

Officials are not just talking but working with each other. There are financial consequences for the Department of Health and there are financial consequences for us; all Departments are very interested in that. One thing that we have got my officials to do is to go out to the constabularies. They divided up the 43 authorities into seven or eight, so that we can know exactly what is happening and share best practice. The Department of Health is then sharing best practice with us. There is no one size fits all with this. The nature of this great country of ours means that we have huge metropolitan parts and we have some beautiful rural parts of this country; some of them are quite close to each other and others are not. One size will not fit all, but we will be able to have the evidence base for what is working for vulnerable people and a cost analysis of how that is working. If we do not have the cost analysis and the evidence base, the Treasury will be all over me like a shot.

Dr Huppert

A brief question so that we are all clear—I think that all of our witnesses so far have supported the removal of police cells as a stated place of safety in the Mental Health Act. Do you share that view?

Mike Penning

Yes. It should be the last place—is that the point you were making?

Dr Huppert

The Mental Health Act does currently list police cells as an entry. We are not saying that cells could not be used if someone has committed a crime and is still a threat, but that cells would not count as a place of safety for the purposes of the Mental Health Act.

Mike Penning

I think that that would be right. We are not in a perfect situation. In some circumstances, individuals might go to different places. However, the bit that I have been trying to push for is for us to understand why that person has got into that position of being the offender, as well as looking at the offence. That is quite complicated and difficult.

Dr Huppert

In terms of general amendments to the Mental Health Act, the Home Secretary announced that there would be a review of sections 135 and 136. Where is that review? What has come out of it so far?

Mike Penning

I will probably get a nudge in the back, but I think that it will be towards the end of the year. We are not far off—this year. I would hope that it will be by the close of Christmas recess.

Dr Huppert

Would you want to have our report ahead of that, to inform your decisions?

Mike Penning

That would be very helpful. I have seen some of the evidence being given to the Committee, and it is similar to what I have heard before. It will be very interesting to know how the Committee interpret the evidence and if it is in the same way that we do. We can feed that into our evidence base as well.

Chair

We will all wait for these reviews and pilots and the work in progress, because people are concerned about this. We have noted the work of Devon and Cornwall Police Federation branch. They brought a motion to the conference last year, and they are very concerned about it. We listened to Sir Peter Fahy say that mental health is now the main issue facing Britain’s police forces. If you were sending out a message to your front-line staff—the police officers in the custody suites who we have taken evidence from—in the interim, until we have all these reports, what would it be? What would you say to the custody sergeant faced with this on a wet Friday night in Dudley?

Mike Penning

First, I would thank him or her for the work that they do. This is probably the first time that I have not thanked the police in my opening remarks for what they do for us day in, day out. I would tell them to use their experience, because custody sergeants tend to be very experienced officers—use their experience and compassion to try to understand, as I alluded to a moment ago to Dr Huppert, why that person is there and whether they show the sorts of signs that would indicate that they need help as well as addressing the problems behind why they are there. I cannot stress enough that the compassion of a police officer in dealing with people with learning difficulties as well as mental health issues is vitally important.

Chair

And what is your message to your colleagues in the Department of Health? You gave us an example of A and E where you saw for yourself what happened? Someone was taken and then released. What is your message to them and the Department of Justice?

Mike Penning

That message is coming across. What NHS England in particular is doing is informing the police better about where the experts are and so where that point of safety is for those individuals. Traditionally they would have gone to the cells while waiting to be assessed. Then we asked: could we take them to A and E? Actually, now, let us have it in the pocket notebook for the guys and girls out there: the place where we should be holding them as a place of safety is X. My mother was a mental health nurse for many years. There are fantastic units out there. I just stress to the Department of Health—they know this; I have repeated this and I will be working on this. Quite often that is not in A and E, unless they have that expertise within that A and E unit. There may be another facility in the hospital, interestingly enough, so they don’t have to go to A and E in the first place. But it is vital that we share that information. I have worked in five Departments and I don’t think I have been in any Department which has worked as closely across on one issue as we are doing at the moment with the Department of Health and with Norman Lamb in particular.

Chair

That is very reassuring. As you are here and as we are coming to an end, I shall put to you a question that a colleague who is unable to be here wanted me to put to you. It concerns police leadership. You rightly praise the work of the front line. Are you concerned about the number of chief constables who are either suspended or being investigated by the IPCC and the large number of cases that are outstanding? How do you get the message across that the leaders of the police service are absolutely vital to ensuring the highest possible morale?

Mike Penning

The first thing I would say is that there are 43 police forces. The vast majority of chief constables, PCCs and officers throughout the ranks are not under investigation. They have no complaints against them and they are doing a simply fantastic job. Where complaints are made, it is right that the IPCC investigate them fully. We were talking the other day about how long people are on bail for. Investigations need to be as thorough as possible, but they also must be expedited as fast as they can. If there is no substance to a complaint that needs to come out quickly. The IPCC have a wide-ranging remit and the number of referrals they get is huge. We are looking at how that can be addressed too.

Chair

Good, and finally, when do you think the Home Secretary’s review on police bail will be completed? She has just announced it. You also share concerns about the number of times people have extended police bail. Do you have a timetable?

Mike Penning

I do share her concerns. We discussed this before it was announced. It takes up a huge amount of police time as well. People on bail have to report. The front of house in many police stations is not open. I agree with that as they were so little used, including in my own constituency. I don’t have a date for when we expect to do that but I will write to the Committee about that when I do.

Chair

That would be very helpful. I am sure that you will come before us on some other issue before Parliament rises. Thank you very much for coming on this issue today. Oral evidence: Policing and mental health, HC 202 10