Mental Health Awareness for Police Officers 18 th November, 2014 Police Federation, Leatherhead

1. Mental Health Awareness for Police Officers 18th November, 2014 Police Federation, Leatherhead mind.org.uk

3. Your Trainer for today • James Moore • Psychiatric background • Working in the field since 1983 • Associate Trainer with Mind since 1998 • Currently working part-time in practice with service users who experience a range of mental health difficulties as well as with Mind as well advising organisations as a consultant on dealing with mental health issues in the workplace

4. 1 in 4people will experience a mental health problem in any one year. Source: Goldberg and Huxley (1992), Common mental disorders, Routledge

5. This week in the UK… 104people will take their own life 250,000people will visit their doctor about a mental health problem 750,000prescriptions for antidepressants will be issued.

6. The Brain

7. Mental Health Spectrum

8. Mental health can be conceptualized as a state of well-being in which the individual realizes his or her own abilities can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community What is Mental Health ?

9. Factors in mental ill health Lifestyles LIFE EXPERIENCES BIOMEDICAL MENTAL HEALTH CRISIS OUT OF CONTROL STRESSES

10. Overview of Main Psychiatric Conditions

11. Depression

12. Types of Depressive Conditions 1. DYSTHYMIC DEPRESSION 2. Bi – Polar Depression 3. POST NATAL DEPRESSION 4. SEASONAL AFFECTIVE DISORDER

13. Feeling sad or unhappy or having a ‘low’ mood Feeling unable to enjoy things like you used to Loss of confidence and/or loss of self-esteem Feeling particularly guilty or self-blaming Feeling that things won’t get better in the future Thoughts of self-harm or suicide Psychological

14. Poor concentration or memory Not wanting to see people or do things Irritability or more frequent arguments with people around you Difficulties managing work, family responsibilities or other usual activities Social

15. depression Signs and symptoms of Bi-polar mania Increased energy Decreased sleep Elation Irritability Fast thoughts Fast speech ‘grandiose’ thoughts and ideas Impulsivity Agitation Anxiety Disinhibition Psychosis Low mood Loss of interest, pleasure Lack of motivation Sleep disturbances Appetite disturbances Feeling bad, guilty, useless Feeling bleak and hopeless Agitation Anxiety Suicidal thoughts and feelings

16. Anxiety

17. Anxiety Disorders

18. The most common symptoms of anxiety are physical changes such as Sweating Rising blood pressure Racing heart or palpitations Rapid breathing Muscular tension and pain Headaches Nausea Churning of the stomach Bowel disturbances Restlessness Tiredness All caused by too much adrenalin Signs and symptoms of GAD

19. Psychological symptoms of GAD Fear Heightened alertness Being ‘on edge’ Being unable to relax Being extremely preoccupied with whatever is worrying us Needing lots of reassurance Difficulties in perceiving that the problem might not be as huge as it appears, although some problems are of course enormous Difficulties with motivation, concentration and decision making Being irritable Getting things out of proportion

20. Psychosis/Schizophrenia

21. Psychosis • Perceptual experiences that others cannot perceive (hallucinations) • Holding unusual beliefs that other people don’t share (‘delusions’) • Like waking dreams – real and intense

22. POSITIVE SYMPTOMS The main positive symptoms are: • Delusions • Hallucinations • Lack of insight no awareness of the abnormality of ones thoughts, experiences and behaviour • Suspiciousness, which in some cases can become paranoia

23. Delusions A delusion is a fixed belief in something manifestly absurd or untrue, and that can't be overcome by reason

24. Hallucinations Of all five senses Auditory Visual Olfactory Touch Smell

25. Obsessive Compulsive Disorder

27. Post-traumatic stress disorder Types of triggers: • Fear of death or severe injury • Being a victim of serious violent crime e g rape • Surviving a serious accident or disaster • Witnessing incidents whilst being a member of the armed forces or emergency services • Having had a severe illness, such as traumatic childbirth • Witnessing the death, near death or serious injury of another person

28. Post-traumatic stress disorder According to NICE guidelines the symptoms of PTSD include: • Unwanted thoughts and memories of the trauma • Flashbacks • Nightmares • Being overly vigilant or on the look out for threat, exaggerated startle responses (the body’s automatic response to the unexpected, such as a loud noise), irritability and difficulty in concentrating or sleeping. • Avoiding talking about the trauma and all things associated with it. • Feeling emotionally numb or not being able to remember some of the event. • Suffering from depression, generalised anxiety, shame, guilt and reduced libido. • Finding it difficult to be close to anyone

29. Continuum of personality functioning

30. Personality Traits Patterns of thinking, feeling and behaving that characterise us in our day to day life Relatively stable and predictable Flexible, adaptable

31. Definition of personality disorder ‘An enduring pattern of inner experience that deviates markedly from the expectations of the person’s culture’ Characteristics of Personality Disorder: • Problematic • Persistent • Pervasive

32. Different types of PD Odd and eccentric:schizoid; schizotypal, paranoid Emotional, erratic and dramatic:borderline; antisocial; histrionic; narcissistic Anxious and avoidant:obsessive compulsive; avoidant; dependent

33. Lunch Break

34. Interaction between Police and Individuals with Mental Health Challenges

35. While police officers are not doctors and it can't be expected for officers to diagnose people with mental ill-health, the Police need to make sure that they can recognise people who might be vulnerable and require expert medical care

36. Don’t need to tell you -Policing is a complex process. Police officers are called on to perform a number of roles in addition to detecting crime and arresting offenders. • Police officers can have a key role to play in situations where individuals are experiencing some sort of crisis related to their mental health. • They are the emergency service that is most likely to be contacted by relatives if those in acute distress are putting themselves or others at immediate risk. • If a person in acute distress is in a public place, the likelihood of police involvement is increased significantly • In large parts of the country they are the only Emergency response to mental health crisis.

37. The Context • Mental health puts increasing demands on the police • In 2012, the Metropolitan Police received 61,258 calls specifically related to mental health( 168 per day) • 21,741 more than those connected with robbery, • 47,203 more than for sexual offences • the scale of the problem in London, with figures showing an estimated 15 to 25 per cent of all incidents dealt with by police were linked to mental health Source: Lord Adebowale Report May 2013 The Independent Commission on Mental Health and Policing

38. Lord Adebowale Report May 2013The Independent Commission on Mental Health and Policing • Frontline police were given incomplete or wrong information that led to treating something as a crime rather than a medical emergency. • Found examples of vulnerable people being transferred in police vans instead of ambulances and received poor care while being held in custody. • care pathways must be recognised and developed, and there must be greater operational cohesion, including inter-agency liaison within the NHS and clinical commissioning groups • it was evident that some police on the street lacked understanding of medical health issues, including vulnerability and adults at risk.

39. Jones and Mason’s (2002) study of people who had been subject to section 136 of the MentalHealth Act 1983 ‘Police procedures in the police station removedmore than just their personal possessions;it also stripped them of a sense of being anindividual in the real world.’

40. Data on Usage of Section 136 • in 2011/12, more than 9,000 people were taken into police custody under section 136 of the Mental Health Act (HMIC) • section 136 detainees spend an average of 10 hours and 32 minutes in custody ( HMIC) • The data for England found 7035 such assessments in 2007–2008, rising in successive years to 8495 and 12 038 (Care Quality Commission, 2010)

41. Use of Police Station as Place of Safety In many of the 70 cases examined in detail, the reason why the police used custody as a place of safety (as opposed to a hospital, for instance) was not given. When this was recorded, the most common explanations were: • insufficient staff at a health-based place of safety; • the absence of available beds at the health-based place of safety; • the person had consumed alcohol; • or the person either was displaying violent behaviour, or had a history of doing so Source: HM Inspectorates of Constabulary Report June,2013

42. Her Majesty’s Inspector of Constabulary, Drusilla Sharpling, said, on behalf of all the inspectors: “This report finds that too many people are being detained in police custody under section 136. Their only ‘crime’ is that they have mental disorders, but they are treated in many ways as if they are criminals. This deplorable situation cannot be allowed to continue. “To ensure the correct care and consideration is given to these vulnerable people our report outlines a series of recommendations not only for the police service, but also for other organisations responsible for protecting those suffering with mental health disorders.”

43. Rule of Thumb on S136 Where officers have a “136 option” and another option involving arresting for an offence (including alcohol offences), choose the offence, unless : • It is a trivial offence, or actually a victimless offence. • The victim is not ringing about the crime, but about mental health support for the person concerned. • In all the circumstances, suspected mental health problems are the main issue in play.

44. Coffee Break

45. Management of Mental Health in the Community

46. NHS Response

47. Primary Care

48. Community Care

49. Secondary Care

50. 10 Improvements needed • improving the responsiveness of some out of hours services so that we didn’t see demand deliberately deflected to 999 services; • improve monitoring of section 136 usage, so that repeat s136 detentions and the detentions of already-known MH patients is routinely reviewed to capture the learning that this offers.  • Single point of Access 24/7 with speedy response psychiatric response • Better specific in-patient provision for Under 18’s