Revisiting mental health street level triage

Here we are, and it’s 4th June already. Time flies. I have a growing sense of there being ‘one life, so live it’ as each day passes. This came to mind last week when I read the story of the Metropolitan Police (Met) and their plans to stop attending emergency calls related to mental health incidents. I will come back to this story shortly. But reading the story, I was reminded of a PhD student I nearly had many years ago.

I completed my PhD some 23 years ago. It was one of the best things I have ever done. I loved every moment of doing it. I was fortunate to have a wise supervisor who opened my mind to so much.  He was a compassionate and caring man, someone who had an infinite amount of patience. He was also the most well-read person I have ever known, and he could quote from the many books he had read with complete ease. Sadly, he is no longer with us, but his approach to supervision was something I tried to emulate with all my doctoral students over the years.

I have successfully supervised 23 doctoral students to completion. Each student’s successful completion felt like a triumph of collaboration. I have never had a student fail. However, there were two students I nearly had, but who fell by the wayside after I worked with them for 12 months. That first year of doctoral studies is crucial. It is a time where the student must take their big idea, and reduce it down to a manageable question to be answered. It is a process of challenge, exploring ideas, concepts and theories and of making decisions about methodology and philosophy. It is tough, but without this period of initial study, it’s unlikely anyone would be able to undertake a PhD programme.

And that is what happened to the two students I nearly had. One student wanted to explore the use of art in therapeutic relationships. A great idea, and one I was very enthusiastic about working with. However, she was never able to find a way of articulating a question that would be the focus for her studies. And it wasn’t for the want of trying on my part. I tried every which way to help her clarify what it was she wanted to study, to no avail. After nearly 11 months, she eventually stopped turning up for supervision and left the programme soon after.

The other student was an incredibly enthusiastic mental health nurse who was desperate to do a PhD. His enthusiasm was, at first, infectious. Fairly quickly it was replaced by frustration on my part as he steadfastly refused to heed my advice. One of the ways to get through that first year is to listen and consider the advice provided in each supervision session. He consistently refused to do so, and eventually was removed from the programme, as he could not produce any work that indicated he was able to study at doctoral level. Both these students gave rise to a sense of failure on my part. But doing a PhD is incredibly difficult. If it were easy, everyone would be called Doctor.  

It was a shame the mental health nurse had to leave the programme as his big idea was to explore the impact of a mental health ‘street level triaging’ initiative with which he was involved. This project happened many years ago. It involved mental health nurses working with ambulance paramedics and the Police to help people in distress and/or experiencing mental health problems literally on the street. It sounded like a very interesting scheme, but I never got to find out how successful it was and eventually I forgot about the initiative. That was until I read the story about the Met and their proposed withdrawal from attending mental health related incidents.

At one level, I can see why this withdrawal of their support has been proposed. Research has shown that police officers in London spent almost a million hours a year in hospital emergency departments waiting for patients to get a mental health assessment. In many cases it can take up to 14 hours to hand over a patient to the care of health professionals. Whilst not directly comparable, the time spent waiting is the equivalent of attending 500,000 domestic abuse incidents or 600,000 burglaries or similar crimes. London is a special case of course. There are some 9 million people living there, and it’s not a homogenous population. London will take a lot of policing! The relationship between the Police and a myriad of local health and care providers is likely to be complicated and complex, making it difficult to implement schemes such as the Right Care, Right Person project seen in Humberside. This approach has had a huge impact on massively reducing the hours Police spend on attending mental health related incidents, whilst ensuring people with acute mental health problems receive prompt care and treatment. 

And in the strange way that some things happen sometimes, last week I was in a meeting that was considering plans for improving mental health care across Greater Manchester (GM). During the meeting a colleague asked the question as to whether Greater Manchester Police were likely to follow the stand taken by the Met in London. The answer was no. Discussions are advanced as to how the Right Care, Right Person approach might be best adopted across GM. Interestingly, for me at least, a number of examples were given of projects already being taken forward. These included mental health nurses working in Police control centres, and a number of ‘street level triaging’ schemes involving mental health nurses and paramedics working together in responding to acute mental health incidents, both out on the streets and in people’s homes. I don’t know if my former PhD student is involved in these schemes or not. I kind of hope he is, albeit, gaining a PhD is not for everyone.