By Alan Roden
Somewhere amid the noise and chaos of an A&E department on a weekend night in any Scottish city, you will almost certainly see a police officer.
They will have been sitting there for hours – even though no crime has been committed.
The wait in A&E has taken them off the beat, leaving fewer officers to tackle the late night antisocial behaviour taking place outside, deter the car thieves, or catch the shoplifters.
Alongside the officer in the ward is a vulnerable patient in mental health distress.
This is not the right place for them, and the police cannot provide the right care, but there is no other option. So they wait… and wait.
A few hundred miles south, it is a different scenario in London.
There, the officer is not sitting in an A&E; they are policing the streets of one of the biggest cities in the world. Doing the job they signed up for and keeping people safe.
Since November 2023 the Met has adopted a ‘right care right person’ (RCRP) strategy that is now in place across most of England and Wales.
That means officers will not attend cases where help from a medical professional is more appropriate.
In the first three months of implementation, the reduction in deployment to ‘concern for safety’ incidents saved 56,740 officer hours – a 56 per cent saving year-on-year.
Every month, that’s the equivalent of 129 additional officers able to tackle and prevent crime.
But people in mental health distress in London still need help.
They may end up in A&E, where waiting times of several hours are common – just as in any Scottish city.
But if they are in Ladbroke Grove in the west of London, they may be seen within just ten minutes. And not by an A&E nurse; by a mental health specialist.
This area’s Mental Health Crisis Assessment Service is one of the first ‘mental health A&Es’ – a model now being rolled out in England’s NHS.
A journalist from The Times visited the centre, describing how the team includes two miniature pinscher dogs providing emotional support for patients in the waiting room, with “fresh fruit, biscuits, tea and coffee laid out for everyone, and the shelves stacked full of board games to help people pass the time”.
A far cry from the chaos of A&E.
Toti Freysson, the mental health nurse who manages the service, told the paper: “Anybody who walks in is seen by a mental health specialist within ten minutes.”
And Dr Mehtab Rahman, a consultant psychiatrist at the centre, added: “These are people who might be hearing voices in their head telling them to kill themselves – imagine having to wait four to six hours to be seen.”
The right care from the right person; that’s what they need.
These specialist crisis centres will open across England over the next decade as part of the Labour government’s 10-year plan for the NHS.
It’s the right policy, and – as with so many other parts of the health service – Scotland is being left behind.
A recent report for the Institute for Fiscal Studies found that Scotland’s NHS has gone backwards in all but one of the key performance metrics.
Yet in England nearly all the measures have improved – including a reduction in the percentage of people waiting more than four hours in A&E.
Our NHS is in crisis.
The Scottish Government argues that it is investing a record £21 billion in health and social care, but no amount of political spin can hide the scale of the emergency.
At the last Holyrood election, the SNP committed to “ensure that, by the end of the parliament, 10 per cent of our frontline NHS budget will be invested in mental
health”.
Time is running out; the figure has decreased from 9.12 per cent in 2011/12 to 8.53 per cent in 2022/23, according to the latest available data.
The Royal College of Psychiatrists in Scotland has calculated this is a £54 million cut when adjusting for inflation.
“Meeting the 10 per cent budget target could provide care by community mental health teams for more than 55,000 additional patients each year – freeing up A&Es and freeing up police time”
South of the border, there is an expectation on local NHS bodies to meet the ‘mental health investment standard’, which means increases in mental health spending should be at least as large as overall increases in funding.
Ministers here should listen to demands from the Royal College to implement a “legislative mechanism” to ringfence the mental health budget in Scotland, echoing measures already in place in England and Wales.
Meeting the 10 per cent target could provide care by community mental health teams for more than 55,000 additional patients each year – freeing up A&Es and freeing up police time.
Encouragingly, however, there are some positive measures taking place north of the border, with a ‘scoping report’ on “additional safe spaces” for mental health patients being considered, and an ‘enhanced mental health pathway’ in place.
Justice Secretary Angela Constance recently told the Scottish Police Federation’s (SPF) conference that more than 10,600 calls to the police control centre have been redirected to NHS 24’s mental health hub.
And she promised “this year you will see results”. Officers should hold her to that pledge ahead of next year’s Holyrood election.
The SPF has described the mental health crisis as “the single biggest inhibitor in operational officers across Scotland being able to carry out their core function to deliver basic policing services across our communities”.
Chair David Threadgold said “our view is that a more ‘right care, right person’ approach, as adopted in other areas of the UK, may eventually be required if we are to see meaningful change and capacity creation for policing in Scotland”.
But delivering the right care by the right person requires government to adopt the right policies.
The time for that is right now.