Right Care, Right Person

In November 2018, Her Majesty’s Inspectorate of Constabulary and Fire and Rescue (HMICFRS) produced the report Policing and Mental Health: Picking Up the Pieces. The report highlighted the need for greater joined up working and for the police to be the last response rather than a first option when responding to people with mental health difficulties.

The aim was to achieve better service user experience, whilst ensuring most effective use of resources so that people experiencing mental health crisis receive the right help, at the right time and by the most appropriate service.

Right Care, Right Person was initiated by Humberside Police in 2019 and is a phased programme of partnership working and withdrawal of the police (where appropriate).

Where there’s immediate risk to life or a risk of serious harm, police will continue to attend. However, where threshold for police intervention is not achieved, signposting to the most appropriate service will take place.

“There will still be times when we need to attend incidents alongside medical or mental health workers, and we remain fully committed to protecting people in our communities where there is a risk to life or a risk of serious harm.” Assistant Chief Constable Bill Dutton

Our mental health urgent care services have been working with partners with the aim of achieving Right Person, Right Time since 2016 and have benchmarked current practice against the four phases highlighted by Humberside Police.

Our liaison and diversion and triage car services, acknowledged as effective and appropriate, are separate and will co-exist within this approach.

Police forces will introduce RCRP in four phases.

Phase 1 - Concern for Welfare

• Reduce the calls relayed to police for concern for welfare checks
• In Mersey Care a concern for welfare may be raised by any of the teams within the Mental Health Care Division with a move over the last few years to alert the police as a first response
• This is also reflected in the response by other partners such as local authorities and acute trusts.

Humberside model

• Where appropriate and risk to staff isn’t an issue, the individual’s care team (crisis resolution home treatment, community mental health team) is contacted to make attempts to locate them
• Contact made with family to support locating service user and updating on concern for welfare
• Liaise with triage cars (North West Ambulance Service, police or British Transport Police) to support in locating service users who are absent without leave (AWOL)
• Use of RAVE.

Phase 2 - Health care walk outs 

Absconded patients - a patient who has left the department unexpectedly, without the knowledge of clinical staff, and in whom there remains a potential risk of harm to self or others either through neglect or deliberate means.

AWOL patients (detained under the Mental Health Act (MHA)). A patient becomes AWOL if they:

• Absent themself from hospital without leave granted under MHA ​
• Fail to return to hospital at the expiration of any period of leave or on being recalled from leave​
• Absent themself without permission from any place where they are required to reside in accordance with conditions imposed on any grant of leave.

RCRP will provide clarity of roles and responsibilities as well as direction on:

• The differences between AWOL and abscond
• Police powers to return patients and when they can or should be used
• When a patient is a missing person and when they are not
• Reasonable enquiries expected from partners.

Humberside Model

• Where appropriate and risk to staff isn’t an issue, the individual’s care team (CRHT, CMHT) is contacted to make attempts to locate them
• Contact made with family to support locating service user and updating on concern for welfare
• Liaise with triage cars (NWAS, police or BTP) to support in locating AWOL
• New workforce model aligns support workers to all core 24 teams to support carrying out of observations and reduction in AWOLs, irrespective of commissioning
• Use of mental health hub to support closer observation of service users with mental health needs
• Use of RAVE.

Phase 3 - Section 136 withdrawal

Right Care, Right Person programme aims to support, where appropriate, the withdrawal of police within an hour of arriving at a place of safety (PoS).

Humberside Model

• On arrival at the PoS, staff carry out joint assessment and where appropriate, take over the observation of service users in Liverpool University Hospitals (Aintree and Royal), Knowsley Resource and Recovery Centre and Hollins Park site
• Process in place to advise police regarding Section 136 and navigate to most appropriate PoS
• Two additional assessment suites developed and paid for by Mersey Care to support diversion away from accident and emergency departments (AED)
• Workforce model aligns support workers to PoS to provide observation, where appropriate
• Workforce model has management of PoS under one clinical service manager to enhance oversight and resilience.

Phase 4 - Conveyancing

Reduce reliance on police to convey service users with mental health needs.

Humberside Model

• Mental Health Care Division has a contract with Secure Care UK, secure patient transport specialists, to convey service users out of AED and PoS, internal ward, community and court transfers
• Division’s working with internal transport to develop conveyancing option for the above.

Phase 1 of RCRP went live within Cheshire Constabulary on 8 January 2024.

Before going live, the constabulary:

• Reviewed 1,000 concern for safety incidents
• Engaged with 76 agencies across 60 workshop hours
• Interpreted 5 pieces of primary legislation, 24 pieces of case law, 5 professional guidance documents and 7 policies, condensing it into a 2 page A4 guide for operators
• Trained 338 (99%) police staff and officers within the force control centre.

Cheshire Constabulary will no longer act as incident coordinators for partners or the public. Where they are able, people will be asked to call other service providers as they’re best placed to answer questions about their needs. Local authority referral hubs have been added to the force website so the most appropriate service can be chosen and it’s where callers will be signposted to: Right Care, Right Person | Cheshire Constabulary

It won’t stop police attending incidents where there’s a threat to life or a crime is being committed as they have a duty to protect our communities and will continue to do so.

Find out more about the escalation process in the attached document.

Here’s how it went for Cheshire Constabulary over the first 72 hours:

• Received 160 incidents
• Deployed to 43% (on these days in 2023, deployed to 69%)
• Operators sought advice about 15% of incidents
• Incidents are split - 36% from partners, 64% from public
• 0 adverse outcomes
• 0 complaints.

One incident was escalated: a service called to report one of their services users had left and was feeling suicidal. Using the toolkit, the operator reached a no deployment decision. The caller insisted they attend because they ‘always do’. The incident was escalated to the supervisor who ratified the operator’s decision.

Where there’s disagreement on deployment decisions, please raise them on the call or as soon as possible, and directly to the force control centre so they may trigger the escalation process and make a further assessment as soon as possible.

The project team is reviewing hundreds of concern for safety incidents to make sure (amongst other things) that:

• They’re reaching the right decision
• They’re using the RCRP process
• They’re documenting decisions
• Call times remain satisfactory
• They’re escalating incidents properly
• They’re using the end statement and making it clear where the duty lies at the point of call
• Language reflects circumstances.

This is in addition to the wider quality assurance processes that’s conducted as part of daily business. They’ll use this data to report and identify where their staff need more support and training as well as performance management.

Phase 2 go live date 13 May 2024

This is about patients who walk out of health care facilities. They can be split into two groups: AWOL (detained) and absconded (not detained), either can become a missing person. Health care facilities include: 

• Acute hospitals
• A&E departments
• GP surgeries
• Mental health services
• any other NHS facility where a patient may have attended for treatment, whether medical or psychological.​

They do not include: care homes, residential homes, nursing homes or locations with looked after children.

Useful reading

The Royal College of Emergency Medicine best practice guidelines “The Patient that Absconds” includes information on legal principles and reasonable enquiries.

Please share  

It’s critical to have representation at strategic, tactical and practitioner levels from hospitals, emergency departments, GP surgeries and mental health services at Phase 2 meetings. Please make contact if you’re not involved in our working groups or tactical and strategic coordination groups. If you think someone else should be involved, let us know and let them know.

If you have any questions, please contact the team on rightcare.rightperson@cheshire.police.uk

The Merseyside approach

• Ensure we have an approach to RCRP that is right for the communities of Merseyside
• Work in collaboration with partners to design and inform the Merseyside approach
• Ensure we have robust strategic and tactical delivery boards to ensure effective governance
• Work through any challenges, concerns and risks together using task and finish working groups.

Engagement

• Partnership Impact Survey was circulated to partners to record funding issues, concerns and how RCRP may impact policies/procedures
• NWAS, local authorities, mental health trusts, acute hospitals, primary care, housing associations, care providers, DWP, schools and regional police forces have had regular communications
• Merseyside engagement from coroner’s office has been positive with further meetings scheduled for autumn 2024
• Cheshire and Mersey NHS Crisis Oversight Group (formerly CCC) has RCRP as a standard agenda item - Merseyside Police attend and present
• Children and Adult Safeguarding Boards have attended extraordinary meetings held by police to ensure that RCRP is understood and assurance is provided
• Partners tasked to provide updates on training, briefing to operational staff and any policies/procedures or obstacles/opportunities are brought to the attention of the project team. 

Decision making toolkit considerations

• Is there an immediate risk to life/serious harm? 
• Is there a ‘present and continuing’ risk to any other person, other than the subject?
• Is a crime suspected of being committed?
• Are the police required to provide a physical restraint to save life?
• Is the location of the individual known?
• Have reasonable enquiries been made to establish the whereabouts?
• Who is reporting the concern? Member of the public/partner agency
• Is the subject under 18? Is there an immediate safeguarding risk to prevent significant harm?

Training

Trained over 400 colleagues on a one day course comprising:

• Contact resolution officers and supervisors
• Dispatch officers and supervisors
• Control room managers
• Force incident managers
• Mental health triage officers
• Mental health investigators.

Further training will be provided to 30 general enquiry officers.

Phased approach

A phased approach will be adopted to ensure all organisations have time to complete business readiness assessments.

If you have any questions please contact: RCRP@merseyside.police.uk

North West Ambulance Service (NWAS) have shared this letter outlining their position in relation to Right Care Right Person. The table summarises the situation.

Scenario 1

Concern for wife, she has left the address (10 mins ago), she's sent a text saying she is sorry. She has been suicidal recently and suffering with her mental health for weeks. Has had a mental health assessment today and was deemed in need of a bed, she is on a waiting list. They have said that if she leaves the house then she is to ring police straight away so she can be sectioned. They have said it will change if she is at home. They have said that the best thing for her safety will be a Police Section.

RCRP: Unsure about police deployment.

Scenario 2

A mental health nurse at a prison is requesting transport for a prisoner who must be transferred to a mental health ward under Section 2. The prison is about to release her and cannot detain her when they do, so are requesting police attendance ASAP. She is known for violent offences though not being violent now.

RCRP: No deployment.

Scenario 3

Caller’s 90 year old father suffers from dementia. He is throwing things around and the caller thinks he is a danger to others. Caller says they've sought help but not got it because he is self funded. Police are her last resort.

RCRP: No deployment.

Scenario 4

Caller is reporting identity theft as the NHS keep calling her by the wrong name. She is also reporting that people are making indirect threats to her because they stare. She is struggling with her mental health and cannot say things over the phone.

RCRP: No deployment.

Scenario 5

Crisis line have been speaking to an adult male. He is rambling. He states that police forced entry to his home yesterday because he was suicidal. He states he's not now suicidal, he's homicidal. They are asking for a welfare check.

RCRP: No deployment.

Scenario 6

A man feels suicidal so he’s gone for a walk leaving his toddler home alone. In his frustration he’s kicked his neighbour’s car wing mirror off on the way. So, there’s a mental health related incident, an incident involving a child and a crime report. The force control room call takers examine all three aspects separately.

RCRP: If police attend for the damage and the child, they do not necessarily take ownership of the mental health issue.

Q: Why now?

• Her Majesty’s Inspectorate of Constabulary and Fire and Rescue report Picking up the Pieces​ (November 2018)
• Highlighted that the police are not the most appropriate agency to support people in mental health crisis and the negative impact this has on peoples’ experiences and wider policing
• RCRP was developed by Humberside Police through a three year programme involving partners in ambulance, mental health, acute hospitals and social services
• There is an agreed, published, National Partnership Agreement between the Department of Health and Social Care and NHS England to develop and support the implementation of RCRP
• Police primary focus – prevent and detect crime, keep the peace and protect life and property
• Police do not have the required skills, training or legal framework in many situations to provide an effective response.

Q:What are the implications for health and care?

Q: How will Right Care, Right Person be rolled out?

A phased approach will be adopted to ensure all organisations have time to complete business readiness assessments. Cheshire Police implemented RCRP from 8 January 2024 and Merseyside Police from 29 April 2024.

• Phase 1 Concern for welfare
• Phase 2 AWOL
• Phase 3 Sections 135/136

Q: What is Phase 1 – Concern for welfare?

Concern for welfare is concern for a person or group of people expressed by another person or partner agency. Those concerns are made directly or indirectly to the police in the expectation that the police will assume responsibility and legal liability for those people and seek to mitigate or minimise any apparent risk posed. This will usually present as a request made via the force control room for a welfare check or visit to be made.

Q: What are the changes that staff need to be aware of for phase 1?

The police will only attend a Concern for Welfare call for service if it is deemed:

• An immediate threat to life or serious harm
• A crime is reported
• Partnership staff are in danger of death or serious harm
• Police action is required to prevent a child from suffering significant harm.

Unless this threshold is reached the police have no duty to act.

Q: What tools will police use to determine an incident response?

Right Care, Right Person will primarily involve changes in how and what police deploy from their control room. Control room operatives will use a deployment toolkit to support decision making.

Deployment Toolkit (Cheshire)

Q: Why are 48% of calls inappropriate to Cheshire Constabulary in the first month since going live?

• Misunderstanding of own statutory obligations or other professional guidance. For example: 
• GP requests a welfare check following a missed appointment. The call recipient explains the no deployment rationale. GP says: “Well I’ve done my bit by calling you”
• When reporting an absconded patient, A&E nurse states that any obligation on the hospital ends when the patient walks beyond the hospital boundary
• A mental health ward states the obligation to return a patient to care, whose location is known, is the responsibility of the police
• Understanding policing lawful threshold to force entry to private dwellings
• Understanding of the Mental Capacity Act
• Understanding of the principles of least restriction
• General lack of awareness of RCRP.

For detail on the National Partnership Agreement: Right Care, Right Person, click this link.

Please find an overview of the autumn 2023 RCRP Integrated Care Board survey findings from Department of Health and Social Care and NHS England. The overview provides a snapshot of progress towards implementation up to autumn 2023. It does not reflect any further progress that has been made since October 2023.