Today is World Mental Health Day, a chance to celebrate the fact that large parts of society now recognise the that mental health problems are prevalent and as ‘normal’ as physical health problems – and to encourage the demise of the sometimes fatal taboos around talking about mental health problems. It is also the day a student was sentenced to an indefinite hospital order after being convicted of manslaughter on the grounds of diminished responsibility for stabbing academic Jeroen Ensink to death not far from where I live in London. The story and its timings have me thinking about the knotty question of links between mental health and violence and I have concluded that we need to shift as much mental health work away from the criminal justice system as possible – a job not just for the criminal justice system but for a wealth of government agencies and society as a whole.
Before, I make the case for this, let’s quickly acknowledge that this issue is pretty hard to talk about at all, let alone reach conclusions on. If you say there is a connection between mental health and violence, you risk stigmatising whole groups of mental health sufferers unfairly. Sufferers of schizophrenia for example will rightly tell you of the damage caused by past attempts to associate the condition with crime and violence. The vast majority of schizophrenia patients will never perpetrate serious violence so it is wrong to create over-inflated fears. On the other hand, if you don’t talk about connections you risk downplaying the significance of mental health in crime – and neglecting a subject that quietly pervades entire justice systems. Our prisons are full of people suffering mental health problems (though I shouldn’t overdo the link), and a vast amount of police time is dedicating to dealing with those who are mentally ill.
Why should we try to ensure mental health is not criminalised?
I have spent less time than I should have examining the links and thinking about the routes to addressing the nexus of issues around mental health and crime. Fortunately, however, others have – and we should celebrate the work of people like Inspector Michael Brown for the College of Policing and others who have conducted primary and secondary research. From their work and wider reading, it seems pretty clear that the following things are true – and are all problems.
- The police are not the best people to respond to mental health incidents – but often are. Community health and social services are not 24/7 services, and it is generally paramedics and the police who end up dealing with even non-urgent incidents involving mental health problems. Unfortunately, the police are not specialists in recognising or dealing with those suffering from mental health issues – and though some fast become gifted amateurs, the outcomes from police contact are not good when compared to specialist response…
- The prison system is not currently a safe place for the vulnerable, including mental health sufferers. Rising suicide and self harm in prisons has been hitting the headlines recently but it’s always been the case that many in prisons are there because of shortages of secure mental health units (which are more expensive…)
- The issue of mental health among police and prison staff remains under-acknowledged. I personally reckon we’d all be better served if the Police Federation campaigned on this rather than the risks of officer assaults (another important issue but often most important in that it has a mental health impact). I remember looking at the stats in my book and in the US police suicide rates are similar to those in the military – which certainly suggests all is not well in police workforce practices. Prison guards are leaving the service in droves and recruitment is a real problem, suggesting an urgent need to find ways of ensuring the job is satisfying and conditions manageable.
How can these problems be addressed?
All these facts are pretty much recognised but doing something about them requires a lot of work. I personally don’t think we’ll address the first issue until we have a much more sophisticated cross-public-service system for managing emergency and non-emergency requests for assistance. We need to find ways to triage calls to call centres and have the option of allocating a wide range of services (the New York 311 system is a good starting point) – and mental health services need to work the right hours to meet levels of demand that exist. We need smarter on-the-ground methods of ensuring appropriate responses too, something that is constantly being worked on but hard. The second issue is about as complex as it gets and yet utterly simple. The simple response is to fund both secure accommodation options and mental health services for prisoners properly. The complex question is if you’re not willing to do that, how can prison governors create a better prison environment, which is particularly attentive to mental health issues? That is perhaps a question for another (less busy) day. The third issue is important both in itself and because it affects the quality of the public services those coming into contact with the justice system receive. I hope that World Mental Health Day encourages leaders in the justice system to ask themselves the question of whether enough is being done – and how progress, or lack of it, will be tracked.
There are definitely ways to make things better. And I’m sure that one route to ensuring things do get better when it comes to issues at the nexus of mental health and criminal justice is to operate on the principle that the less we use justice responses to mental health issues the better…