By Professor Liz Hughes and Professor Martin Webber. Published: 20 December 2024.
Right Care, Right Person
Right Care, Right Person (RCRP) was introduced into every police force in England and Wales from 2023 to reduce police involvement in mental health calls. The first evaluations published by the Home Office/Department of Health and Social Care and the University of York/King’s Fund in December 2024 provide an insight into the impact it is having.
RCRP aimed to address the concerns of police chiefs about increasing numbers of health and welfare-based calls and rising numbers of detentions under Section 136 (s.136) of the Mental Health Act 1983 by the police. A College of Policing toolkit set out how police forces would withdraw from responding to requests to:
- check on the welfare of vulnerable people known to health and care services;
- find people who have walked out of healthcare and mental healthcare establishments;
- transport people to hospital; and
- how to reduce handover times to healthcare professionals.
Police officers still respond to mental health emergencies when there is a real and immediate risk to the life of a person, or where there is a risk of serious harm to someone. However, mental health professionals or paramedics may be best placed to respond in other situations, though often lack capacity to do so due to rising demand on mental health services.
The number of s.136 detentions in England and Wales peaked at 34,685 in 2022/23 and fell to 31,213 in 2023/24. This may be a consequence of the implementation of RCRP, though attribution is problematic. However, the two evaluations published in December 2024 provide the first insight into how the policy is being implemented in practice and what the outcomes are.
Rapid process evaluation
The Home Office (HO) and Department of Health and Social Care (DHSC) published a rapid process evaluation of RCRP which consisted of interviews and observations from three police forces, and analysis of data from five police forces. It also included findings from surveys of Integrated Care Boards and Local Authorities.
The report found that on average there were some reductions in deployments to calls for concern for safety which saved police time. However, this data only covers a short period and may be affected by other factors such as seasonal variation. What this data does not show is whether the decision not to deploy a police resource had a consequence for other agencies picking it up (which may or may not have been more appropriate). It also does not show if these calls returned at a later time by which time the risk had escalated and police resources had to be deployed. It is also not clear whether the reduction in deployment had any unintentional harmful consequences.
Handover times to NHS care remain a significant issue, especially in the case of s.136 detentions to health-based places of safety. Police informants felt that in some of these cases, they should be able to hand over to NHS staff much earlier than they do, though long waiting times in Emergency Departments (EDs), for example, prevent formal handovers occurring quickly.
The DHSC survey data revealed that partner health and social care agencies expected an increased demand on their services because of RCRP, including mental health crisis teams/helplines, ambulance and urgent/emergency care. For example, the ED of an acute hospital becomes the default place to take people who may be having a mental health crisis if they have harmed themself (such as suspected overdose) or have injured themselves (such as a fall because they are intoxicated). However, the ED is not a suitable environment for people in mental distress who, as a consequence, often experience some of the longest waiting times for psychiatric assessment.
Police are hoping to reduce their waiting times at EDs but if there is a co-occurring medical concern (such as needing treatment for an injury) it is difficult to see where else they could take the person. Crisis houses (often run by the third sector) are showing promise as places where people in distress can attend. However, they may not be able to accept someone who is significantly intoxicated, actively suicidal and/or violent.
Clarity around roles
One of the key concerns highlighted in the report is the lack of clarity around roles and responsibilities of police, ambulance, fire and rescue services (FRS), and health and social care services, in a number of situations. As a result of RCRP, police were diverting 999 calls to other agencies if they were related to one of the four areas covered by RCRP guidance. Therefore, there was a risk of a person’s needs not being addressed due to lack of clarity over who is responsible.
Integrated Care Boards and Local Authorities expressed concern that some calls would not be picked up by any agency. This includes requests for welfare checks for people with suicidal ideation who were deemed not to be at imminent risk. To attend would be a breach of RCRP, but without an alternative response available from other agencies, there is a risk that this person could fall through the gaps and come to harm.
There is an increasing awareness of a growing group of people who are high users of emergency and unplanned care, yet do not fit within existing service provision. This includes people who have so-called “diseases of despair” such as drug and alcohol use, self-harm and suicidality. Mortality is increasing in this cohort. This group are likely to have contact with police, ambulance and emergency departments but do not meet criteria for, or engage with, mental health services. There remains a lack of integrated care for people within this group, partly because substance use and personality disorder diagnoses are often an exclusion criteria for some mental health services.
One troubling finding was that it was suggested that ambulance and other services were altering how they communicated their request for assistance, intimating that they “exaggerated” the risk in order to obtain a police response. This is a rather one-sided finding and based on anecdote and perception rather than being directly observed. However, this is understandable given concerns about safety among health and social care staff. The BBC has obtained data that there were 44,926 physical or verbal assaults on ambulance staff between 2019 to 2023, and there was a 40% increase in incidents reported by the London Ambulance Service in the year up to April 2024. Ambulance staff do not have the training or resources to defend themselves when physically threatened and therefore it is understandable that they occasionally require police back-up.
Another area of concern related to some misunderstanding around who is responsible for gaining entry to a property when there is a concern for safety. FRS say they have been called by police to gain entry on behalf of the ambulance service. Indeed the powers under the Fire and Rescue Services Act 2004 are actually more limited than perception may be and mainly apply to fires and people trapped.
An unintended consequence of RCRP is that police officers will not respond to a call that ends up in significant harm or death of a person. The report highlighted that this is a concern shared by both police and partner agencies. The speed of implementation has meant that no gap analysis has been undertaken. Health and social care partners have largely had to find ways to meet needs left unfilled by RCRP, but in the absence of additional resources.
Health and social care perspectives
The second report was commissioned by the NIHR Policy Research Programme and undertaken by a collaboration between researchers at the University of York and the King’s Fund. This was a rapid exploration of the views of health and care staff on the impact of implementing RCRP. Researchers interviewed 29 senior managers or service leads from mental health services, social care services, EDs, Ambulance services and voluntary sector organisations in six locations.
The researchers found that the health and social care agencies developed policies to better manage concerns for welfare of people or walk-outs from healthcare facilities. Ambulance services picked up some of these calls, though managers noted that they were not provided with additional resources for doing so. Respondents referred to partnership arrangements which were established after RCRP was introduced, or pre-dated it, which managed the withdrawal of police from responding to these calls. These were often one-sided, with health and social care agencies needing to commit their resources to manage this work. However, co-location of police and mental health staff has appeared to work well in building relationships, though this was not a common arrangement.
A knock-on effect of RCRP was that it has been more difficult to secure police involvement in mental health-related work not specifically included in RCRP. For example, police officers routinely assist Approved Mental Health Professionals (AMHPs) undertaking Mental Health Act assessments in people’s homes where there are high risks of a ‘breach of the peace’ or an assault being committed. Their presence often helps to contain a situation and minimise the risk of harm being caused. However, AMHPs have found it increasingly difficult to secure police attendance at these assessments without a warrant (s.135 MHA), which gives police the authority to enter someone’s home if there is reasonable cause to suspect that a person is being ill-treated or unable to care for themself. The warrant is provided by a magistrate and it is arguably being over-used, just to secure police involvement. AMHPs have also reported that even with a warrant, getting through the police switchboard can prove challenging once ‘mental health’ is mentioned.
The most significant constraint reported by health and social care services was the limited workforce capacity to respond, which is partly responsible for the problem in the first place. There has been no redistribution of funding from the police to health and social care agencies to manage this additional work. Concerns were expressed about strains on the systems and the workforce, and the impact on people needing an urgent response.
This research was limited by focusing on the perspectives of senior managers and leaders rather than practitioners or people using health and social care services. Our study on routine policing and mental health in the Vulnerability and Policing Futures Research Centre aims to address this gap.
Summing up
These two reports need to be read to fully understand their findings, but they are not without their limitations. They provide a partial view on the implementation of RCRP and do not provide views from health and social care practitioners or people experiencing mental health emergencies, for example. However, they highlight that RCRP has displaced the response to urgent need to different agencies rather than addressing the root cause of systemic underfunding of health and social care services. Public sector funding cuts have undermined inter-agency working, which has contributed to a lack of full understanding about different agencies’ roles in responding to mental health emergencies. While it is not always clear who is best placed to respond, clear agreements need to be in place to help decision-making and services need to be adequately resourced in order to meet the rising demand for an urgent response.