Recommendations - Northumbria Police, July 2024

The IOPC recommends that Northumbria Police provides guidance to front line officers and the Street Triage Team (STT) in respect of their responsibilities and actions to be taken when encountering a member of the public who has self-harmed in their presence, particularly if that person is exhibiting behaviour which could suggest they are in crisis.

This recommendation has arisen from a Death and Serious Injury (DSI) investigation and review, where officers attended an address following reports that a person had been acting erratically. The person was exhibiting behaviour which could be perceived to be related to their mental health and officers noticed that the person had self-harmed whilst they were present, sustaining what were described as superficial wounds. Officers provided basic first aid but were advised by the force STT to leave the person at the scene and ask them to contact the local CRISIS team for further support. The person was sadly later found deceased at their home address.

The guidance provided by the STT to the attending officers was to advise the member of the public to contact their CRISIS team and withdraw from the scene, as a police presence was obviously a triggering factor for the person. However, when taking into account that the person had self-harmed and been provided with basic first aid by the officers, this may not have been perceived as appropriate.

The Street Triage Team Operational Policy does not currently contain guidance for officers in respect of how best to deal scenarios such as this, particularly in respect of whether or not the fact that alleged self-harm had taken place should have been considered to increase the likelihood of face-to-face triage or further medical attention being required. Guidance to officers would provide further clarity and ensure that more robust and appropriate decision making is made in the future.

Accepted:

We accept the recommendation going forward and as such will review our current operational process for front line officers and Street Triage officers and nursing staff.

Northumbria police already provide training to front line officers in relation to dealing with mental health issues and those in crisis. Every police officer receives a dedicated input on dealing with mental health incidents, and during mandatory operational safety training officers also receive vulnerability and mental health training in relation to responding to incidents involving mental health.

(Action) We will review our operating procedure and training that has been cascaded out across the force to see whether there is any additional content in relation to this recommendation that we can include.

(Action) We will ensure learning experiences are shared and incorporated for front line officers and within our existing training packages in place for both officers and nurses who work in the street triage team. In this we will reinforce the importance of adhering to the escalation process to support officers with their decision making at the scene, should they feel that the advice provided by a clinician at any time is not appropriate and/or they disagree. Thus, providing confidence to challenge decisions and consider further options should they encounter similar situations in the future.

(Action) CNTW will ensure their nurses working in the street triage team have received the most up to date Malignant Alienation training package delivered by the CRHT nurse consultant. This training will be aimed at the nurse’s giving advice. CNTW will ensure their staff have had the training/refresher training by the end of October 2024.

The IOPC recommends that Northumbria Police provides guidance to the Street Triage Team (STT) around the importance of considering the particular circumstances faced by frontline officers when attending an incident, when making a decision about how best to resolve a mental health related matter, to avoid placing too much weight on the patient’s past presentation during other historical incidents which may have occurred several years ago.

This recommendation has arisen from a Death and Serious Injury (DSI) investigation and review, where officers attended an address following reports that a person had been acting erratically. The person was exhibiting behaviour which could be perceived to be related to their mental health and officers noticed that the person had self-harmed whilst they were present, sustaining what were described as superficial wounds. Officers provided basic first aid, but were advised by the force’s Street Triage Team (STT) to leave the person at the scene and ask them to contact the local CRISIS team for further support. The person was sadly later found deceased at their home address.

Whilst the decision to withdraw appears to have been made in the best interests of the member of the public, significant weight for this decision was placed on the person's past presentation, rather than the specific circumstances which were faced by the attending officers. The incidents previously involving the deceased were largely historic in nature and therefore, it may not have been appropriate to rely on them when deciding how best to deal with the matter faced that day. Further consideration may have resulted in more appropriate support being provided to the person at that time.

Accepted:

After discussion with CNTW, we jointly accept this recommendation around the importance of considering the circumstances faced by frontline officers when attending an incident and deciding about how best to resolve a mental health related matter.

The immediate circumstances involving the current situation and potential risk will always take precedence and will contribute to the clinical risk decision made by the nurse.

However, it will still be necessary to consider all available information and intelligence held on a person, including history on both police and CNTW systems to support the overall risk assessment.

CNTW and Northumbria police will be incorporating this into their joint operational policy and refer to it during the training provided to front line officers and street triage policing and nursing staff.

(Action) CNTW will ensure their nurses working in the street triage team have received the most up to date Malignant Alienation training package delivered by the CRHT nurse consultant.  This training will be aimed at the nurse’s giving advice.  CNTW will ensure their staff have had the training/refresher training by the end of October 2024.

The IOPC recommends that Northumbria Police should work with Cumbria, Northumbria Tyne and Wear NHS (CNTW) to review and revise the referral points discussed in the Street Triage Team (STT) Operational Policy document around when a member of the public may require CRISIS intervention or home based treatment, to ensure that the referral points and guidance to staff remain appropriate and offer the best possible support to members of the public, when considering the current demand on front line officers and the STT.

This matter has arisen from a Death and Serious Injury (DSI) investigation and review, where officers attended an address following reports that a person had been acting erratically. The person was exhibiting behaviour which could be perceived to be related to their mental health and officers noticed that the person had self-harmed whilst they were present, sustaining what were described as superficial wounds. Officers provided basic first aid, but were advised by the STT to leave the person at the scene and ask them to contact the local CRISIS team for further support. The person was sadly later found deceased at their home address.

Section 12 of the STT Operational Policy discusses Crisis Referral points when attending mental health related incidents. These are focused on STT staff contacting the Crisis team themselves to arrange that referral and there is no reference to asking members of the public to contact the CRISIS team themselves. It is unclear if this way of signposting a member of the public is commonplace, however it does appear to deviate from the policy as is currently written. Guidance to staff around whether or not this is appropriate may reduce the likelihood of recurrence in the future. Should it be determined that self-referral to the CRISIS team is not appropriate, then this should be clearly stipulated to STT staff.

Accepted:

We accept the recommendation and the STT operational policy will be revisited to more clearly define the decisions made by Northumbria Police and the decisions made by CNTW. Referral or signposting to CNTW crisis team or any other service is based on the clinical decision making of a CNTW mental health clinician. CNTW will retain the decision as to whether the person will be referred to the crisis team or expected to self-refer or indeed left with no onward signposting. 

CNTW have been sighted on the IOPC recommendations and will review the recommendations and decide if amendments or improvements to mental health clinician training can be made as a result of the recommendations.

(Action) Northumbria Police STT officers will be directed to document the clinical rationale for the referral, self-referral advice or no further action approach within the STT update on the STORM log (the force’s incident logging system).