We should push for non-police alternatives to mental health crisis response

In May 2023 the Metropolitan Police commissioner, Mark Rowley, wrote a letter to health and social care services announcing the Metropolitan Police’s withdrawal from 999 calls related to mental health incidents from 31 October this year. Rowley said that patients were being failed by the process of sending police officers instead of medical professionals to people in a mental health crisis1—and I couldn’t agree more.

At present, police officers possess unique legal powers under the Mental Health Act. These enable them to transport someone in a state of mental health crisis to a place of safety for assessment by a mental health professional. Although this represents only one facet of police involvement in mental health services, it’s by far the greatest form of police presence that our patients experience.

As a trainee psychiatrist I witness the impact on patients of being restrained by police officers, handcuffed, and brought to a psychiatric facility in the back of a police car. Some are left too terrified to speak to me or to enter the assessment room, and they’re highly vigilant against mental health staff out of fear that we’ll treat them in the same way as the police if they don’t comply. For others—many of them young, working class Black men—the encounter is reminiscent of a lifetime of racial profiling and being stopped and searched by the police, rendering their contact with mental health services traumatic from the outset.2

These fears and experiences are far from unfounded and arise from a context of institutional racism across the police force, where Black people in England and Wales are subject to 25% of police use of firearms, 16% use of police restraint, and 8% of deaths in police custody, despite comprising only 3% of the population.34 This disproportionate use of force is compounded by mental illness: Elish Angiolini’s damning report on deaths and serious incidents in police custody found that almost half of deaths in policy custody involved individuals experiencing a mental health crisis, many involving types of force and restraint inappropriate to use on vulnerable people in a state of crisis.5 This is even more worrying when we consider that Black people are more likely to undergo a mental health admission via the police.6

Some people argue that by criminalising some harms and not others, and by criminalising some non-harms, policing protects the same racist power hierarchies that produce poverty, death, and disease and that policing should therefore have no role in a healthy, equal society.7 Police presence in medical institutions creates a barrier to people from marginalised groups seeking help, and it can lead to the criminalisation of mental illness.8 It’s not simply unfortunate, but predictable, that Black and racially minoritised people will find themselves disproportionately on the receiving end of police involvement.