GPs are still calling the police to attend mental health crises including suicidal ideation cases, despite an initiative trying to prevent this, a Government analysis has found.
Police forces in England have stopped attending mental health callouts where there is no immediate risk to life or a crime is being committed, as part of the Right Care Right Person (RCRP) programme launched last year.
However, in a new analysis published this week, the Government said that police ‘identified some challenges’ when engaging with partners, including GPs.
Policing leads told the Government that there was ‘limited GP engagement’, with some GPs viewing the initiative ‘as not relevant for them’.
But GPs have told Pulse that the lack of engagement could be due to unclear roles in the initiative, insufficient training and resources around the programme, and gaps in mental health services provision.
The Government analysis was conducted to understand how RCRP is being implemented, including evidence from police forces, ICBs and local authorities across England, and found that there are ‘potential gaps in services’, resulting from ‘a lack of clarity about who should respond to certain calls or inconsistent decisions being made’.
It included an example of one GP who called the police ‘regarding a patient expressing suicidal ideation’, contrary to the RCRP advice.
The patient was therefore advised to attend an emergency department, but when the GP found out the patient had not attended, they called the police for a welfare check to be conducted.
One policing lead said: ‘We’ve had a bit of a challenge and then some pushback is from the GPs. It was always going to be challenging, you can bring certain people to those forums and discuss, give them the opportunity to go back to their own organisations and networks to understand what that means for them in terms of any change and to then raise any concerns around gaps in service […] perhaps hasn’t worked so well in terms of the GPs.
‘But of course, when you’ve got 30 more nearly up to 40 practices all individually run, that was always going to be a challenge.’
The report mentioned that it would be ‘helpful’ for GPs to be involved in talks and meetings with their local police force to see how RCRP ‘may introduce change for them’ or to raise any concerns around gaps in services.
It added: ‘Another respondent mentioned how, through RCRP, closer work between the police, GPs and coroners may help the coroner’s system. It was noted that GPs would also gain from having an awareness of when to ring the police in relation to RCRP.’
Threshold for police response as part of RCRP
Threshold for a police response to a mental health-related incident as set out in the NPA:RCRP is where there is a need:
- to investigate a crime that has occurred or is occurring; or
- to protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm. (This person could be the person with mental health needs, a family member or carer, a mental health worker or other member of the public.)
Source: RCRP guidance
Professor Azeem Majeed, a GP and head of the primary care department at Imperial College London, told Pulse that a ‘lack of clarity’ around GPs’ specific role in the initiative and limited access to mental health services for referrals have hindered participation.
He said: ‘GPs might not fully engage with the Right Care Right Person initiative due to their current high levels of workload, unclear roles in the initiative, and insufficient resources.
‘GPs already face significant pressures from high patient demand and staff shortages, and they will find it difficult to take on additional responsibilities – such as taking part in RCRP – without adequate support, training, time and funding.
‘Additionally, challenges in collaboration with mental health and social care partners, along with fears of service gaps or delays for vulnerable patients, may lead to frustration and disengagement by GPs. If the initiative is perceived by GPs as disruptive or poorly integrated into existing systems, this would also pose a barrier to participation.
‘Addressing these issues through better communication, training, resource allocation, and fostering trust and collaboration will be key to ensuring future GP engagement with the RCRP initiative.’
NHS England has recently published guidance on implementing RCRP, which pointed out that ‘no additional funding’ has been provided for RCRP delivery and yet it involves the health service ‘taking on significant additional activity’.
The Doctors’ Association UK GP spokesperson Dr Steve Taylor said that RCRP is a ‘better approach’ to mental health crisis and is improving some aspects of crisis management, but it has highlighted service gaps.
He said: ‘GPs are not emergency services but often need to be able to access urgent support for their patients. Their role in patient care and safety, is supposed to be supporting patients with their engagement with the right services and management of long-term care.
‘There is a vital need to ensure that patients are supported as well as other services, including the police who need quick access to mental health teams.’
Hampshire GP Dr Emma Nash, who is also a mental health lead for her ICB, told Pulse she was ‘surprised’ at the report’s findings.
She said: ‘I only think we would [call the police] if we couldn’t physically restrain or control someone who was a danger to themselves or others.
‘We might sometimes call for help (not 999) as a welfare check, but otherwise no. Despite being a mental health lead, this hasn’t come into my field of practice at all.’
Challenges highlighted in the report
Barriers to implementation
The main barrier to RCRP implementation was identified as capacity and resourcing limitations within health and social care for responding to incidents that had been dealt with by the police before the introduction of RCRP. Absorbing this demand has been made more challenging by wider increases in demand for health and social care services and ongoing resource challenges in many ICBs.
Unintended consequences, risks, and learning
A key risk identified by ICBs, local authorities and the police was potential gaps in services. These gaps could result from a lack of clarity about who should respond to certain calls or inconsistent decisions being made. Decision making can be difficult for control room staff, incidents are often not clear cut, and decisions are based on information staff are provided with, which can be incomplete.
NHS England told Pulse that ‘more needs to be done’ to improve capacity and collaboration as part of the initiative.
An NHS England spokesperson said: ‘It is vital that people experiencing a mental health crisis are given appropriate support and the NHS is committed to working with local police forces and their partners to ensure the right professional responds.
‘While this report highlights that police, local NHS systems and local authority staff have reported improvements in partnership working since the phased implementation of Right Care, Right Person began, it is clear that – amid increased demand for mental health services – more needs to be done to improve capacity as well as collaboration, to ensure the best care for those experiencing a crisis.’
A Government spokesperson said: ‘This evaluation of the Right Care, Right Person (RCRP) scheme is vital and will help ensure that healthcare partners and police deliver the best possible support for the public.
‘As well as helping people get the correct response when in need of health and social care support, including mental health, the approach has been successful in saving valuable police time, allowing forces to focus their resources on stopping and solving crimes.
‘Further guidance has been produced to help with the local implementation of RCRP. Any areas of concern will be considered by the national oversight group of healthcare and policing experts to ensure the approach works as efficiently as possible.’
I think GPs would engage with Right Care Right Person more if it correctly identified that GPs were also not the right person if someone is in a mental health crisis and the ‘scheme’ was able to ‘easily’ remove GPs from the equation.
It shouldn’t take an hour to make a crisis mental health referral. It shouldn’t be difficult for a GP to speak directly to a consultant psychiatrist who is then comitted to taking responsibility for the patient (adult or child).
In my recent experience, we had one case where there was an immediate threat to life; appropriately communicated from clinician to police; and the clinician was accurately aware that there was no hope of responding without police assistance. Then after an hour of the GP failing to get in, the police did finally respond to break in. Thus this system just served to waste everyone’s time.