People in mental distress, police and out-of-hours health services: a qualitative exploratory case study of experiences and the intersect of safeguarding services.

The aim of this study was to explore the experiences of people in mental distress, who come to the attention of police and healthcare professionals outwith routine hours. Some people in the community call on police officers to help manage their self-harm behaviour, with the intention of preventing serious harm. As conduits to healthcare and in keeping with police safeguarding policies, officers will seek healthcare practitioner assessment and support. This can be problematic when an individual's needs are not associated with a severe mental disorder or time-critical medical emergency, or when the person is intoxicated. Consequently, police officers may feel unable or insufficiently confident to discharge safeguarding responsibilities when they or the individual perceive that needs are unmet. This can find some people, police officers and healthcare practitioners exposed to lengthy wait times and repetitive distress presentations. This thesis addresses a gap in existing literature through the exploration of the relationships and experiences of people in mental distress, and police and health care professionals involved in their safeguarding during out of hours. It also provides an in-depth account of those factors and features of police and health care professional processes that facilitate or impede safeguarding journeys. An in-depth, qualitative case study was conducted in three phases. This study was underpinned by broadly social constructionist perspectives, with each phase building on the in-depth understanding and interpretation of data. Phase one featured semi-structured interviews (n = 12) with police and health managers, providing a landscape of the police / health care intersect when supporting people in mental distress. Phase two featured further semi-structured interviews (n = 15) that critically explored three clinical cases, in which police and healthcare practitioners responded to people in mental distress. Phase three featured three focus group interviews with operational police officers and healthcare practitioners (n = 18), exploring front-line perspectives of supporting people in mental distress, and helping contextualise and enhance findings from phases one and two. Template analysis supported the thematic analysis of findings, which elaborated on and were interpreted through the inter-related theoretical lens of Defeat and Entrapment Theory (Gilbert and Allan, 1998), Cry of Pain Model (Williams and Pollock, 2001) and the Conceptual Model of Suicide (Stark et al., 2011). The study found that health and police systems and human responses can influence individuals' experiences and undermine safeguarding journeys. A predominantly medicalised model of unscheduled care, gaps in inter-agency safeguarding policies and legislation, inconsistencies in levels of sobriety to conduct mental health assessment and availability of appropriate safeguarding environments can find people displaced between criminal justice and health services. Police and healthcare practitioners' organisational cultural and professional perspectives of peoples' needs find those practitioners working in conflicting ways and the individual inadvertently overlooked. These factors were particularly problematic when people were distressed, intoxicated or aggressive. This study identifies a relationship between feelings of entrapment, intoxication, aggression and inter-agency safeguarding. Police officers encounter situations where an individual is distressed, intoxicated and aggressive and who cannot be assessed by health services. Collectively, these factors can create situations exposing people to additional stressors such as inappropriate safeguarding environments, such as police custody as a safeguarding space, police-escorted transportations, and coercive processes like using handcuffs and strip-searching. This leads to a lack of dignity and re-traumatisation, therefore reinforcing cyclical distress journeys. This study concludes that there exists a gap in environments, policies and processes to safeguard people in mental distress, which impacts upon safeguarding journeys. Police and health system shortcomings may result in a person in mental distress being managed in the criminal justice system, if no other options are available. This is due predominantly to a medicalised model of emergency care, which is further complicated if the person in mental distress is intoxicated. For the person in mental distress, their reality is a safeguarding journey that may be convoluted and cyclical, and which reinforces rather than supports their distress needs. Although unintended, police and healthcare professionals' responses reinforce a cyclical safeguarding journey that does not meet the needs of the person in mental distress, and can place pressure on police and out-of-hours health services. These findings have important implications for trauma-informed Police and health care professional practice. The issue of how police and health care professionals respond to people who are distressed, intoxicated and aggressive should be explored in further research