Criminal Justice Committee

Meeting date: Wednesday, November 15, 2023

Official Report 679KB pdf

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Policing and Mental Health

Our next agenda item is an evidence session on His Majesty’s Inspectorate of Constabulary in Scotland’s report, “Policing Mental Health in Scotland—A Thematic Review”. I am pleased to welcome Craig Naylor, chief inspector with His Majesty’s Inspectorate of Constabulary in Scotland; Mr Brian McInulty, lead inspector with HMICS; and Dr Arun Chopra, medical director at the Mental Welfare Commission for Scotland and HMICS advisory group member. A warm welcome to you all.

I refer members to papers 3 and 4. I intend to allow up to an hour for this session. I invite the chief inspector to make some opening remarks.

Thank you, convener and committee, for the invitation to speak to you this morning. The genesis of our report was work that Lady Elish Angiolini did about three years ago. One of her recommendations was that there should be a review of the system that deals with mental health crisis in Scotland. I would love to have done that collaboratively but, in the interests of getting something done, we went out on our own. However, recognising that we are not the experts in everything on mental health, we sought help and advice from people, such as Dr Chopra, who formed an independent advisory group. I pay tribute to that group, who challenged our thinking and our understanding and brought to the table real lived experience, as well as experience from research and professional capacity from across Scotland. Our report lists the advisory group members and groups like Pen Umbra, Includem, VOX Scotland, the Forensic Network and various other people, including Dr Chopra, hugely influenced how we thought about mental health crisis when looking at the policing side of things.

I will make a few short comments, convener, if you do not mind. We see crisis in mental health as a multifaceted, complex and challenging area. It is not one organisation’s responsibility to deal with it; it is a whole system that needs to respond to make sure that the people who are facing challenges in their mental health, whether that is a mental health diagnosis and illness or a crisis in the moment, are dealt with in a way that improves their wellbeing in the long term.

My review team spoke with a large number of officers and heard the voices of people with experience, and we were aware that people with experience often see police officers as a safety net—people who can respond to them and provide an empathetic response. We were hugely impressed by the officers and staff within Police Scotland who respond. They have to deal with people at their lowest point, in a way that tries to ensure that there is no worsening of their condition and puts them into the right place to get the right treatment. Many officers we spoke to believe that they are filling a gap and that gap causes us concern. It is a health, social care or wider societal gap that means that there is not someone to look after people in their moment of need.

I mentioned VOX Scotland, which produced a report on our behalf from people with lived experience of poor mental health. Reading that hugely influenced our thinking, particularly when people describe how police officers come and stop things getting worse, but then place them in the back of a police vehicle, often in handcuffs, often with a blue light on, often taking them to an accident and emergency department to sit for many hours. That did not improve their wellbeing or their mental health. It may have got them into some form of treatment, but what damage has been done in that intervening period between the crisis moment and the treatment occurring?

The Police and Fire Reform (Scotland) Act 2012, which established Police Scotland, sets out a remit for policing in Scotland that is slightly different to that in England and Wales, in that there is a requirement

“to improve the ... well-being of persons ... and communities in Scotland”.

Police Scotland holds that very dear. It works and strives endlessly to do that.

As part of our work, we looked at what is happening in England and Wales and at what is described as the “right care, right person” approach, which has been implemented by Humberside Police, the Metropolitan Police and many other police services across England and Wales. To my view, there is a lot of merit in some of the things that they do, but that approach does not meet the responsibility that Police Scotland has in terms of community and personal wellbeing.

As such, we have not recommended that Police Scotland follows suit and implements that approach, as England and Wales have done or are doing. However, we think that there can be some learning from it, particularly in understanding what responsibilities Police Scotland has and, rather than responding to every demand and every call for assistance that comes to it, being a bit more discrete in its thinking on that and responding more effectively in that space.

In a lot of the things that we saw, we found that police officers join policing on the back of an advert that shows them jumping out of helicopters, riding fast cars and so on and responding to crime. However, the reality is often very different in that they spend a lot of time looking after people in crisis. We found that the training to support that is not as good as it should be, so that needs to be changed. The management structures that oversee that are often risk averse and concerned that something bad will happen that will lead to an investigation by the Police Investigations and Review Commissioner into what the officers have done.

We find that that paralysis—the terror of doing the wrong thing—causes officers to make decisions that are often about protecting themselves and the organisation rather than the long-term wellbeing of the individual. We totally understand why that happens, because that is the system that they operate in.

We are keen to see a different approach from Police Scotland, and, more importantly, a different approach across the whole system to understand how we break down the barriers to effective service and how we get people who are in crisis into treatment at a much earlier point, rather than being stigmatised by sitting beside a cop in a waiting room for a long period of time.

11:45  

I have stepped outwith my authority and made a recommendation to the Scottish Government to look at a whole-system review. Coming to this committee allows me to start that thinking again and start encouraging people to join up the dots between silos in Government and improve overall outcomes rather than just bits of the system.

We think that policing provides an effective catch-all service and that that should continue, but there should be better ways of getting people to the service and the treatment that they need at an earlier point, rather than staying with a police officer for a long period of time.

I reiterate my thanks to the independent advisory group. It gave us a lot of challenge and pushback on where we were, and it gave us an understanding that having a police officer deal with someone in a mental health crisis may not be the wellbeing improvement that we all think that it might be.

Thank you very much for those opening remarks. I will kick things off by picking up on your comments about management structures and wanting to see a different approach across not just Police Scotland but the whole justice system. I will reference some of the key findings in your report under the heading of leadership and vision.

For the benefit of members, I will tease out some of your points in the key findings. You say that there is

“a perception among officers that senior leaders focus”,

as you have outlined,

“on safe outcomes, seeking to minimise every possible threat, risk and harm. This is normally achieved by police officers remaining with the person in crisis until they are either accepted into the care of the NHS or a family member. This approach to organisational and reputational risk results in a lack of focus on reflection and opportunities for improvement, often to the detriment of the individual concerned.”

You go on to say that

“Police Scotland cannot wait until a review of the whole system is undertaken before developing and implementing its own mental health strategy. We believe the current situation is unsustainable.”

In the following paragraph, you say that

“Police Scotland must now develop and implement a mental health strategy and seek to understand its legal and moral position and role within the whole system”.

I think that we all understand and relate to those remarks. Will you expand on the last point about understanding the legal and moral position and help us understand what you were thinking about in those comments?

The legislation around how police can intervene in a mental health crisis is all focused on public space. We very often find that people who are suffering from some form of immediate crisis are not in a public space but are in a private space—their home or somewhere similar. There is an expectation that the police can come along and take some action that will keep them safe, reduce the harm and improve their wellbeing in the longer term.

One difficulty that we find is that there are no police powers to enter a house, or to put hands on someone, or to take someone to a place where they can get treatment. That puts officers in a very difficult position, because they then have to use the powers of persuasion—non-coercive power—to encourage the individual who is probably not thinking as clearly as they would otherwise think to go somewhere other than where they may feel safe.

The legislation does not help in that space and it causes the officers to feel vulnerable because, if they leave someone who is suffering a crisis, which often leads to a suicidal-type situation, and that person then harms themselves or, even worse, takes their own life, there will be an investigation into the conduct of the officers and whether they did enough to mitigate that risk. Such investigations by the Police Investigations and Review Commissioner are good, thorough, balanced and proportionate, but it is difficult for any officer who has tried to save someone’s life and is feeling guilty about what has happened to go through an investigation into the circumstances of what took place.

The issue is complex, difficult and challenging and, in our inspection, we found that the Police Scotland policy that sits around it, with regard to the roles, the requirements, the powers and the expectation on the officers, is not as clear as it could be.

In our constituency and regional roles, we probably all speak to our local police officers and hear about the volume of calls of this nature that police officers are attending. Have you had any discussions with Police Scotland about how it will take forward the recommendations in the review, given the sheer commitment that officers and police staff are having to make to this particular policing challenge?

We have had a number of conversations, most recently when Dr Chopra and members of the independent advisory group came along to a meeting at St Andrew’s house at which we introduced them to senior leaders in Police Scotland who are responsible for taking this issue forward. One of the recommendations is that Police Scotland makes use of the independent advisory group and the expertise that it brings. I will allow Dr Chopra to speak for himself, but it was a warm and positive meeting and many good ideas were set out around the table about what steps to take in relation to many of our recommendations.

Dr Chopra, the Mental Welfare Commission published a report on “The role of police officers in mental health support: a review of repeated uses of police place of safety powers under the Mental Health Act”. In your key findings, you state:

“Rates of conversion from all s297 detentions to emergency or short-term detention are about 15%. This is about three times higher than the rate among those being repeatedly detained under s297 which is at 5.34%.”

I know from my past experience that recourse to a place of safety is not an uncommon course of action for police officers, so that figure of just above 5 per cent is incredible. Could you say a bit more about that particular finding?

Good morning. I start by saying that it was a privilege to work with other members of the advisory group and colleagues from HMICS on that report. I found the HMICS team to be responsive to the discussions that we held to bring ideas forward, and the discussions were open and helpful.

Thank you, convener, for highlighting our finding about the use of section 297 powers, and specifically the issue of people who are repeatedly detained under section 297. Whereas we see people who are being detained under section 297 having subsequent detentions in about 15 per cent of cases, when people experience repeat detentions, that figure is only 5 per cent. That suggests that those people who are experiencing repeat detentions under section 297 are much less likely to then require further admission to hospital. That illustrates one of the major problems that we have, which is that the 1983 act is designed around mental illness, whereas, actually, what police officers are often responding to is mental distress. That is a key distinction that ought to be brought through.

The second point that follows from that rather low number that the convener has drawn our attention to is that it probably means that the appropriate ways forward for that group of people are not available, and health professionals are left with a rather binary option of either admitting someone into hospital or doing nothing, which often means that police are responsible for taking the next steps.

One of our other findings with regard to the group of people who are subject to repeat section 297 detentions is the absence of care planning. You would expect that someone who is subject to more than one detention under section 297 would have a robust care plan that has been put together by the health professionals who have been working with them in collaboration with Police Scotland, so that the crisis does not happen again or so that, if they are presenting in crisis, there are alternative pathways for them.

What we found was that up to a third of people who had experienced repeat section 297 detentions did not have a care plan. For those who did have a care plan, Police Scotland had not been part of that work. Many of those individuals will be known locally to the police service and to health professionals, so there is a massive opportunity here for collaboration between officers and clinical professionals on the ground in those areas to produce trauma-informed person-centred care plans, so that, when people present repeatedly, the default process is not just to take them to a place of safety, followed by admission or nothing. Instead, there would be an alternative. That is the key finding from our report, and it sits nicely with the work of the HMICS thematic review, which calls for such collaboration and joint training. That is why those two reports segue nicely.

I completely agree with that. I would like to ask lots of follow-up questions, but a good number of members want to come in.

I will rattle through my questions as quickly as I can, because there is a lot to go at. Page 31 of the report states that police officers who attend A and E with someone who needs treatment are often left waiting and that they suspect that they are

“deliberately being provided an unprioritised service so they could remain in the hospital and provide a visible deterrent to disorder”.

In other words, police officers are being treated like national health service security guards and are therefore being removed from the streets, where they should be. I find that shocking. What is being done to address that with the NHS?

That is one person’s view that we replicated in the report, but that was not the only time that we heard that view. A visible policing presence in an A and E department started many years ago, but we now often see many police vehicles parked outside A and E because officers are supporting individuals who are there for physical or crisis treatment for various reasons.

On what is being done about it, we have a structure across Scotland of a number of health boards and divisions. Getting one minimum standard across Scotland is difficult. One of the points that we make in the first recommendation is that mental health provision needs to be looked at as a system. That is not a system for Dumfries, Glasgow or Aberdeen but a system for Scotland. We need to establish a fair and acceptable way of doing business. We are calling for that whole system to be looked at to reach an understanding of where the blockages and difficulties are and whether there is evidence to support police officers’ assertions that they are used as a visible deterrent when they sit alongside somebody who is suffering a crisis.

You make 14 recommendations in the report. I do not know whether I understood your opening statement correctly, but I think that you said that the first recommendation might go slightly beyond your remit. Indeed, that recommendation calls for

“a strategic review of the whole system”

from start to finish. The question is whether the Scottish Government has welcomed that suggestion—whether such a review looks likely—and whether the other 13 recommendations are, temporarily at least, redundant until recommendation 1 is either accepted or rejected.

That is a very interesting question. Yes, I am going beyond my remit. I am entitled to make recommendations only to the Scottish Police Authority and Police Scotland, but I would much rather seek forgiveness than permission on some of these things. Therefore, we have followed up on what Lady Elish Angiolini said about taking a combined approach, because it is not one organisation’s responsibility to resolve mental health crisis and distress in the community. I do not think that the other recommendations are redundant until such a review is done, and I will come back to your point about what the Scottish Government has said.

12:00  

We say quite clearly in a number of places in the report that Police Scotland needs to get on and develop its own strategy and then review it once we come to a conclusion on the wider review. There is a lot of work and training to be done, and there is a lot of understanding needed on how police officers can work more effectively in communities to deal with distress in the first instance.

On the response to the recommendations, we had two members of the Scottish Government health department at the meeting with the IAG. Plans are being looked at and consideration is being given to what such a wider review should look like, but as yet we do not have any terms of reference or anything similar.

Just to follow up on that, an important theme that came through in our review was that there has been quite a considerable shift in the role of a police officer in that space. Craig Naylor and I could reflect back to when we were younger officers, when we were primarily dealing with crime, antisocial behaviour and we were being proactive in our local communities.

Going back to your point about accident and emergency departments, we heard a lot of frustration from officers who were sitting and waiting for considerable periods of time until the person they were with was medically assessed. All the while they could hear the radio going with things happening in their local community. There are things that can be done in the short to medium term while the whole-system review is waited on.

One of those things, which Mr Naylor referenced, is the right care, right person approach. A lot of good work is being done in terms of protocols around accident and emergency departments and, in the short to medium term, those could be looked at and tightened up. If officers arrive at what is essentially a place of safety—I recognise that it is not an ideal place of safety—they should then be able to hand over to NHS staff and go back out and patrol. That was a frustration that we heard.

There is another line in the report, on page 59, which really jumped out at me. It says:

“Police Scotland does not yet have a clear purpose, vision or strategy for its continued provision of mental health-related policing services”.

That begs the question: why on earth not, given that it has been such a big issue for such a long time?

However, instead of asking that question, I will ask one final question about what the report does not cover. It is 80 pages long and it is all about the policing of mental health in the community, but it does not address the mental health of officers. That is not a criticism, but we have been working with police officers who have had often life-changing, career-ending mental health problems, and the families of officers who have died from suicide. There is a sense that the report should have at least attempted to address some of those issues, but it does not. Is HMICS intending to do that as a standalone piece of work at some point?

We will publish our report on wellbeing in January. We are calling it “Frontline Focus”, because it is very much about the front line of policing and how police officers deal with their own mental health, how their supervisors support them and what support mechanisms are in place. We do not have a date yet, but sometime in January we will publish that report. We have done most of the fieldwork.

I sat in on some of your sessions with some of the officers and I thank the committee for that opportunity. You will not be surprised that we are very clear that officer mental health is a challenge, and that this part of dealing with the public can be incredibly challenging for police officers. The issues are absolutely interlinked.

Okay. That was fantastic. Thank you very much.

My question might come under the topic of the need for a strategic review of the whole system. I have heard comments that the police are running an out-of-hours service, because it seems that, after 9 to 5 and at the weekends, a lot of their time is taken up in dealing with mental health issues. Did you recognise that when you were doing the report? Is enough work being done with other agencies to address that issue so that they can give police the support that they need out of hours?

There are some pockets of good practice across Scotland where that does not happen, and where there is more of a 24/7 capability. Police Scotland has taken action to have health advisers in its control room and to have pathways that can direct people into the appropriate service. Those have all been driven by policing, with good collaboration from local partners. However, there is no national standard that fits the whole of Scotland, and it is in that regard that we need to get better.

We have heard those anecdotes. When I was a detective inspector many years ago, at half past four on a Friday afternoon, we would get four or five phone calls from partners. Those would be along the lines of their saying, “We’re a bit concerned about Jimmy—we’ve not seen him for three days. We’ve been trying to find him, but we can’t find him. Can you take him as missing? There might be a mental health issue.”

The issue is not new—that was 20-plus years ago—but we are seeing a growth in people being aware of concerns for individuals and trying to get a service when their service is no longer in place. It is difficult to know how else to deal with the issue. There has to be different thinking. We cannot solve today’s problems with yesterday’s thinking.

Brian, do you want to come in?

I want to address your question but, first, I return to Mr Findlay’s point. He said that he was not asking us to answer it, but it was a really important point. We heard a lot about demand shift—that is how it was described to us. Predominantly towards the end of the working day, the end of the working week or over holiday periods, Police Scotland experienced a lot of demand from agencies that were not able to deal with matters out of hours. That was an important theme.

I go back to Sharon Dowey’s point about the whole system. Reflecting back on the work that we did, I do not think that we have arrived here by design. We have, incrementally, year on year, got into a position in which we are asking the police to do something that is fundamentally different from what they were asked to do 20 or 30 years ago. That is why some of the legislation really is not in sync with what we are asking of police officers.

Mr Findlay’s point was about the purpose of what Police Scotland asks of its officers and staff. There was a lot of confusion around that among officers and staff to whom we spoke. Some people felt that they were there to fill in any gaps in the system; others felt that they should be dealing only with high-end threat-to-life incidents. Those were not just the views of operational officers; some very senior officers had different views as well. That is why we think that, in the short term, Police Scotland needs to articulate what it expects officers and staff to do, whether that be in a written-down strategy or in a communication to the organisation. For me, the piece of paper is less important. It is about Police Scotland ensuring that it articulates to officers and staff what it expects them to do and then training them in line with that expectation.

I will build on Craig Naylor and Brian McInulty’s points in response to Sharon Dowey’s observation about out-of-hours work and the fact that the police service often becomes the service of default at that point. Some really good work is taking place in the redesign of urgent care, and the Scottish Government convenes and is responsible for the unscheduled care network. One mechanism to address Craig Naylor’s point about the fact that there is no single national way of ensuring consistency of response would be to align the psychiatric emergency plans that each health board has with the Police Scotland mental health and place of safety protocol. If the psychiatric emergency plans and the protocol for dealing with those situations were aligned, that might provide a degree of consistency and would be a mechanism to scale up some of the good practice that Craig Naylor has just mentioned.

Thank you. Brian McInulty mentioned the enhanced mental health pathway. However, I think that your report mentions that not enough calls are referred by the contact, command and control teams. Is anything being done to train people in CCC to ensure that they send calls in the right direction, to try to relieve police officers from getting involved?

We interviewed service advisers who operate in the control room where calls from the public are received. The enhanced mental health pathway has fantastic potential to get better outcomes for people earlier. However—this goes back to the seeming risk aversion and lack of confidence among service advisers—many of the advisers that we spoke to felt that they would benefit from more training on and understanding of mental health. I have taken that forward with the commander for the contact, command and control division, which is already, as part of the pathway, looking to refresh training.

One way in which we really benefited from the work of the advisory panel was hearing about lived experience. We have asked Police Scotland to bring in people’s lived experience when it is developing the training. The evaluation report shows that the pathway has done some fantastic work. It has great potential, but one area where it could improve is in giving confidence to service advisers.

I wrote down earlier that training is an issue. People are scared of doing something wrong—they want to protect themselves and the organisation. Is more work still to be done on training, not only for police officers but for command and control staff, so that they know the right pathway and have the confidence to take the right action?

That is an important point. Mr Naylor mentioned how impressed we were with the officers and staff that we spoke to. What came across strongly was how much they care. They want to do their very best for people. On a human level, if they have been spending quite a bit of time with somebody, they do not want something bad to happen to that person.

The other part is that there is also the potential for a PIRC investigation, although I would say, based on the interviews that I did, that that is secondary. The issue is more that, on a human level, they do not want something adverse to happen to the person. That has lead to situations where officers remained with a person despite having been told by mental health professionals that that was detrimental to the person’s health and went against their care plan. Training is really important to empower people and give them confidence.

Will the police be able to implement that, or is there a cost implication?

Quite a number of members want to come in. I know that that is a crucial issue, but perhaps I can bring in Jackie Dunbar and then Fulton MacGregor.

I have a quick question on the delivery of mental health services in policing. I am fully aware that Police Scotland is a national force, but I am also aware that some initiatives appear to be based locally, which I think is the best way forward. I am a former Grampian police board member, so that is probably the reasoning behind my thinking, but do you have any evidence to show that the practice of local divisions working with NHS services is being shared across Police Scotland? How would you expect such practice to be shared?

That is a good question. A lot of the practice is shared through the division in Police Scotland that has responsibility for mental health response, which is called partnerships, prevention and community wellbeing. It is the sort of hub of the wheel, with all the divisions as the spokes.

The difficulty is not so much the willingness of Police Scotland to take good initiatives that work well, get better outcomes for individuals and reduce demand on the front line; it is more the partners that Police Scotland needs to persuade to do things differently. I am not denigrating any of the partners; I am just saying that, sometimes, the partners are not as willing to have the conversation, because they are busy doing other things.

The approach of, “It wasn’t invented here,” can be a difficulty in some places. That is why I am saying that, although I recognise that local capability is really good, and that having that capability is where we want to be, there needs to be a national minimum standard. That would set the minimum that we can expect, and people could then consider how that could be enhanced with local initiatives that take account of geography and capability.

Just to be clear, I am keen on that, but I am also aware that one size does not fit all and that we need a national approach.

I think that Brian McInulty wants to come in, convener.

I beg your pardon. Sorry, Mr McInulty.

I welcome your comments on that. I would not like a whole-system review to stifle excellent local initiatives such as the neuk in Perth. The unscheduled care network, which Dr Chopra mentioned, is one way of sharing good practice, and we heard of good practice in Forth Valley, Edinburgh and Perth. There are lots of good things happening out there without, it seems, strategic oversight or co-ordination, so we would not want to stifle that.

12:15  

I apologise for my lapse. I bring in Fulton MacGregor.

Good afternoon to the panel. I have two questions. The first is on the issue of missing people, which was mentioned a couple of minutes ago. I did a wee bit of work on that in the previous parliamentary session after a very tragic incident in my constituency, not long after I was elected in 2016.

The police were going through a review at that point of how they dealt with missing people. We will all be familiar with information being shared on our social media feeds very early in the process, which was well fought for. It is very good that the police engage the public in those searches. Did the mental health component of missing people come up in the review? Did that issue come up when you spoke to officers about missing people? How do the police manage that component of a missing person inquiry?

I will touch on a couple of things and then pass over to Brian McInulty. As part of our scrutiny plan, we have committed to doing an inspection on missing persons, and we will publish terms of reference on that next week. That follows on from the comments that I made in my annual report this year; based on Police Scotland statistics, dealing with missing persons, on average, takes up 900 full-time equivalent officers per year.

From recollection, around a third of missing person demand is people who have a mental health diagnosis, so it is a massive—absolutely huge—problem. We are committed to trying to join up a number of bits of the system; mental health is one of them and missing persons is the next bit of our journey. We seek to look at the process for dealing with missing persons to understand how vulnerability is built into that and how that is shared with partner organisations to make sure that there is more upstream preventative activity with people who have gone missing and then been found and who had a mental health reason behind that.

A number of issues associated with missing persons arose throughout our review. I have been sharing those with my colleague who is starting the missing persons review. The issue was deliberately left out of the terms of reference for the review of policing mental health in the knowledge that we were going to do a thematic inspection of missing persons.

To go back to the accident and emergency department, one of the reasons that officers give for remaining with somebody until they are assessed is that, if an officer leaves that person and they walk out of the hospital, the hospital often reports them as a missing person, which leads to a lot more demand on the local police services.

We found that protocols are being tightened up in the right care, right person approach in England and Wales, because on most occasions the reason why somebody leaves A and E is that they decide to go home, so they are not technically a missing person on most occasions. The protocols around that are very important, because missing persons investigations are so important. One of the risks is that, if you have too many investigations, you need to consider how to prioritise them. That was another theme that came out of the review.

That is interesting. I will be interested in the findings of your future work on missing persons, as I am sure the rest of the committee will be.

My second question is about the recommendation for Police Scotland to produce a mental health strategy, which you have spoken about at great length. Was any thought given to embedding health professionals within the police structure? I know that some work has been done on that.

The unfortunate nature of the situation is that, although there is a multi-organisation approach, the police are the first responder for many people and organisations. Was any thought given to or were any discussions had on embedding mental health professionals as direct employees of Police Scotland to assist, or is that just a pie in the sky idea of mine?

It is an interesting concept. In previous organisations that I have been responsible for, we had mental health professionals working with police officers in the response to the mental health crisis. That can work very well, but it sometimes blurs the boundaries between what is a policing response and what is a health response. I am not saying that that is a bad thing, but the question is how you govern that and ensure that a health professional’s clinical responsibility is not compromised by sitting in a car with a police officer, sharing information and all those sorts of things.

I do not feel that we should be telling Police Scotland to employ mental health practitioners. We should be saying what we expect the outcome to be, which is an effective strategy to guide police officers and Police Scotland staff on how they deal with people in crisis and distress. If Police Scotland employs someone who is a mental health professional to guide it on that, I would have no difficulty with that, but I do not feel that I should tell it who to employ or how to employ.

Fair enough. Thank you.

Mr Naylor, you used a phrase way back in your opening statement that intrigued me a bit, and I wonder whether you could expand on it and put it into context. I think that you said that the officers responding should be “discrete” in their thinking. What did you mean by that? Was that in response to inquiries? Would they have to take a more nuanced position? Is that what you were saying?

We ask a lot of our police officers. We train them, hopefully well. We guide them and coach them in the first two years of their service, after which we basically let them off the leash to make decisions in critical and difficult situations.

We want them to be thinking about the best outcome for the individual, and we want them to be challenging all the options that are available to them when faced with something that is developing in front of them. One of my former colleagues used to call it the “strategic police officer”. I am not the person who sets the strategy for policing; it is the person at three o’clock in the morning who makes a decision, who is often the most junior member of staff on duty. That decision can often lead the service into difficulties or to great outcomes. We want them to be great outcomes every time, but it is very difficult.

We want officers to have clarity of thought, clarity of purpose and clarity of training, so that they are able to make good decisions when they are faced with something that they have probably never seen before.

It goes back to what Mr McInulty and everybody else has been saying about the importance of good, thorough training to give officers confidence, and so on.

Has there been a change in the nature of crisis calls? Are you finding that there is more need to respond to issues that are related to drugs, alcohol and homelessness? Has that been increasing over the years, or has it pretty much always been like that?

It is many years since I was a response officer in policing. Maybe I am wearing rose-tinted glasses, but I remember responding to crimes. I remember trying to lock people up for breaking into houses, dealing drugs and things like that.

What we are seeing and what we are told on a regular basis is that the majority of the incidents that officers are sent to nowadays involve a crisis rather than a crime. Officers are having to go to accident and emergency or places of safety much more than Brian McInulty and I ever recall doing.

Do I think that that is a societal change? It probably is. Certainly in the past three or four years since the pandemic, we have seen more people who are in crisis and not able to deal with the situation that they are facing, and are turning to the service that they know will come, which is either an ambulance service or a police service.

Do I think that that is right? The legislation has set Police Scotland up to do that—to improve wellbeing. If people seek that support, that is what they are going to get, but it has moved officers away from dealing with housebreaking, people breaking into cars and so on, which was our bread and butter when I was a young cop.

One of the challenges that we have highlighted in the report is that we heard anecdotally from all the officers and staff to whom we spoke that demand is increasing. We also heard that from members of the advisory group and other agencies. Everybody is saying that demand is increasing, and we do not doubt that. However, one challenge is that Police Scotland does not fully understand the demand at the moment. There is more work to be done around that, because demand is very complex and different systems are involved. Whether it is more to do with drugs, as you asked, is a piece of information that would be really helpful for us to understand.

Yes—I just wondered whether you had that information. Clearly, that work could be on-going to find out—

The demand and productivity unit in Police Scotland has done a lot of good work to try to better understand the demand, but it recognises that it is on a journey and that more needs to be done.

Sure. Dr Chopra?

On demand, very clear data is available that shows that demand has gone up. Ten years ago, there were maybe about 600 place of safety incidents, and now there are about 1,345, so the rate has more than doubled.

I want to make a point about training, in response Craig Naylor’s point about decisions being made at 3 o’clock in the morning. It would be really helpful for that training not to occur in a silo—for just the police officers on their own—but for it to take place jointly with health professionals. One way to do that is for the Royal College of Psychiatrists in Scotland, along with stakeholders, to produce a series of vignettes or case studies and road test them with Police Scotland officers and health professionals who will be involved at those times and at other times to see how they would respond. That would take away some of the difficulty that is related to risk aversion that we spoke about earlier, because there will be a shared sense of how to proceed in those cases.

By working together.

Yes.

Thank you for the quality of your evidence and for how loudly you are voicing what I think is probably the most serious operational issue for Police Scotland. The work that you have done is critical. I suppose that the way forward is not that easy.

Craig Naylor, I was really struck by what you said about individual officers being terrified to make these decisions. At that moment, they are trying to save a life and carry out their duties, but then there is an investigation of whether they did the right thing. That seems grossly unfair to me.

What will prevent that from happening? Does it lie in what you say on page 11 of your thematic review that

“Demand is passed to Police Scotland from partner agencies towards the end of the working day and working week.”?

I think that Sharon Dowey asked you that question. I cannot see any way around this other than other agencies changing the way in which they work. Am I getting it right?

You have got to the nub of the issue that we are all trying to deal with. I do not think there is one simple answer—there is no silver bullet that we can fire that will answer all the problems.

An awful lot of this is about people recognising what their duties are in this space. Sometimes, because of the fear of investigation, Police Scotland will go the extra mile because it is fearful that something bad will happen. It does that for very good reasons, and often because it does not want people to become more unwell or to take their own life for example.

The difficulty that we have is that it is written into law that, if there is death or serious injury within, I think, 48 hours following police contact, there will be a mandatory referral to PIRC for an investigation. If there is a death for which the police are seen to be responsible, there will be a fatal accident inquiry. That level of investigation can last many years. It puts people under pressure and affects their mental wellbeing during the period of investigation.

Police officers and staff do not want that. The result that they want to get is that people who are in distress get the treatment that they need very quickly and effectively, without worrying that something bad will then happen.

Can I intervene on that point?

Certainly.

Does PIRC take into consideration in its investigation that police officers are not trained as mental health officers? Do you have any examples of that?

12:30  

I am not here to justify anything about PIRC, but it is in a very different position to where it was about seven or eight years ago. Its work is very much about meeting its statutory responsibility, and then investigating what is appropriate. It will bring into that the evidence of the other parties that have been involved. Therefore, PIRC covers that, but it still has a statutory responsibility that it cannot walk away from—

Yes, I understand that.

Dr Chopra, in answer to another member’s question, you talked about aligning psychiatric emergency plans. Will you elaborate on that? That seems to me to be part of the answer. Do you mean aligning staffing as well, or just the plans?

Staffing is part of it because you cannot deliver without it. Staffing has been a key issue across the mental health sector in relation to some of the problems that people are facing.

On alignment, I was suggesting that the protocol that the police use for responding to emergencies and dealing with situations ought to be placed in the context of the psychiatric emergency plan, so that the health board and Police Scotland are singing from the same hymn sheet. Aligning that bit would make things work better.

I thought that your previous question was really helpful. We have spoken about some of the fear that police officers experience, but I want to say that one of the things that we at the Mental Welfare Commission for Scotland hear from patients who contact us—we saw it in the VOX Scotland report as well—is how compassionate police officers are in responding to these situations. They are often described to me as the most compassionate part of the system and I think that that needs to be recognised.

Today, we have also spoken about the right care, right person approach. One of the things that is particularly good about HMICS’s thematic review is the balanced approach that it has taken to looking at that approach. Rather than setting out what it thinks is the way forward, it has looked at areas for which there is some evidence that that might be helpful in Scotland, and it has also considered the fact that some data is not quite there yet, in relation to what the outcomes will be in Humberside, the Metropolitan Police and other places. It is really important to point out that the data is not fully out there.

The short answer to your question is collaboration. The key aspect is greater collaboration, both at an operational level and at a strategic level, between health and policing. That is the way forward, and that includes training, which is the example that I have given already. Increasing collaboration will prevent some of the huge demand that is currently falling to the police.

Thank you.

Before I bring in Katy Clark, I will pick up on the comments that you have made. I am really glad that Pauline McNeill asked a question about psychiatric emergency plans. Having been part of the review of the Grampian plan many years ago, I know about the spirit of psychiatric emergency plans in underpinning that collaborative approach to poor mental health, whatever end of the spectrum that might be.

Should we be looking to develop the role of psychiatric emergency plans to underpin all the challenges that we have been discussing today? I am interested to hear your commentary on that. Am I right in thinking that psychiatric emergency plans sit within mental health legislation? Should we be using them much more robustly?

Yes, to all of your points. I think that it is mentioned in the HMICS report that the code of practice has a clear reference to the psychiatric emergency plans. I do not want to get too operational, but one aspect could be that the psychiatric emergency plan requires that a care plan is created for someone who has come through Police Scotland and has accessed healthcare through that mechanism. That would not prevent something from happening, but it would ensure that, the next time that that person presents, a plan is in place for them.

Little ideas like that that could be embedded in the psychiatric emergency plan would make a wholesale change. That would also build on the work that the Scottish Government is already doing on the redesign of urgent care, and build very closely on the recommendations that Craig Naylor, Brian McInulty and the team have made. It would provide a really good mechanism to build on what we already have, rather than starting from scratch, which I do not think that we need to do.

Thank you. That is most helpful.

I echo Dr Chopra’s comments. His thinking on this is exceptional. I will take the point a step further. When care plans are put in place, Police Scotland should be notified of them and the contacts within them—in particular, the kinship and family care that can be brought into them. Having a mechanism to build in a family member or someone else that could assist would be a long step forward towards stopping people from having to go to places of safety.

Were you referring to psychiatric emergency plans or individual care plans?

To individual care plans.

I have a brief question about data, particularly in relation to assaults. We are very aware of assaults on officers. Last week, Unison Scotland published a survey that has been on-going since 2006. It has captured information about 55,000 assaults on public sector workers in Scotland in 2022-23, which was a 31 per cent increase from the previous year. In relation to civilian police staff, whom Unison Scotland organises, will you point us in the direction of, or share with us, the data that you have on abuse and assaults? Perhaps you could also share with us any roles that face particular issues. I know that there has been a trend for a variety of different roles to move from officers to civilian staff.

I certainly do not think that we have any data that could answer your question, so I apologise for that. I suppose that the roles that are relevant to your question are probably those in the custody space. Police custody support officers interact with people who are generally there on criminal matters and less so on mental health matters. That is where there is likely to be an increase in recorded and reported assaults.

Could you look into that and share with us any information that you are able to get? Obviously, civilian police staff carry out a range of public-facing roles. Perhaps you could come back to us on that.

I am sorry, but I do not really understand what you are asking me to come back on.

You were speculating. Is that as far as you can go? Is that the level of the organisation’s knowledge?

If you were to look for crime data on assaults on police staff, that would have to come from Police Scotland. We do not have data on it.

Thank you.

I will ask one final question, then we will have to bring the session to a close. It is about where we go now. Many issues that we have discussed require to be addressed across organisations—the third sector, the public sector and, potentially, the Scottish Government. I will come to Craig Naylor first, then to Dr Chopra. How do you see that collaborative work going forward, and should it be done at Government level? You might want to just answer yes or no.

We made a recommendation to the Government to look at a whole-system review. I am ambivalent about what that review should look like, but I want people from health, mental health, social care, policing, the third sector and others to sit round a table to consider what it could look like.

We have started that process. In our IAG’s introductory meeting with Police Scotland, all those members were present and the conversation was incredibly positive. The conversation has started. However, if we do not hear very much more by the end of January, we will start jagging people about how else we can encourage that conversation. At the same time, we know that Police Scotland will be coming forward with an action plan to address the other recommendations that we have made.

We are very happy to come back to you at some point to give an update on how things have gone and what that piece of work looks like but, rest assured, we will have our sharp elbows out and will seek forgiveness rather than permission in asking the Government and others to do what we think is right.

I agree with what Craig Naylor has just said. The collaboration needs to be at the strategic, operational and training levels. It also needs to build on the existing mechanisms, which are good and are working but need to be built on.

There may be a role for a review in looking at some of the aspects that were picked up in an earlier exchange around what is happening locally. Brian McInulty gave examples of some areas of good practice. What is the mechanism for ensuring scalability from those local practices, which we know are good, to make them national? Where is that discussion taking place? That might be a helpful aspect on which to have collaboration, which the Scottish Government might be in a good position to convene and to scale.

Thank you to all of our witnesses. The session has been really informative. I am sure that we could have continued to ask questions.

That concludes the public part of our meeting. Next week, we will review the evidence that has been taken so far on the Victims, Witnesses, and Justice Reform (Scotland) Bill, consider a draft report on our pre-budget scrutiny, and consider correspondence that has been received about deaths in custody and about the Domestic Abuse (Scotland) Act 2018.

12:41 Meeting continued in private until 12:57.