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Transforming our response to mental health

Control Room Triage 1


  • Work begins to identify alternative places of safety for children and young people in mental health crisis.
  • Multi-agency work is so effective that custody is ruled out as a Place of Safety for young people detained under Section 136


  • Adebowale Report into Mental Health and Policing is published; although it focuses on the Metropolitan Police it has national implications
  • Review of our own services against the findings revealed the need for improvement in leadership and record keeping relating to mental health and provision of mental health and suicide prevention training


  • January: Dept of Health £25million investment on L&D leads to Mental Health practitioners being embedded in custody to signpost people affected by mental health and ensure they receive treatment and / or support from NHS or the Criminal Justice System.
  • January: New mental health ‘tag’ created on command and control system to help us identify calls from those in mental health crisis and identify recurring themes
  • March: Significant multi-agency work sees opening of Mason Unit providing additional places of safety; prior to this there was just one space for the whole of Avon at Callington Road
  • April: PCC Sue Mountstevens and ASC Chief Officer launch work on the Crisis Care Concordat at a conference; PCC encourages NHS partner agencies to take a lead
  • Autumn: Work begins with partner agencies to secure financial backing for a  Control Room Triage programme
  • November: PCC Sue Mountstevens invites CCG chairs to join us in formally signing up to the Crisis Care Concordat
  • December: PCC Sue Mountstevens signed Avon and Somerset Constabulary up to the Concordat, and…
  • The first meeting of the Force Mental Health Board takes place


  • January: Role of Mental Health Officer is created to take responsibility for implementing initiatives with external partners and within the Constabulary
  • April: Tailored Action Plans describing how Local Policing Areas will support the Crisis Care Concordat are incorporated into NHS work

Control Room Triage 2

Case Study One

One Working with vulnerable, homeless people

Mental health professionals in the North East LPA were working with a homeless person who refused to give their name or any other details. The patient was extremely vulnerable, living a chaotic lifestyle whilst profoundly mentally ill. The triage team assessed the patient and agreed detention was the only option; it transpired he had been missing from the family home in the north of the UK for over a year. His family had given him up for dead. The patient returned to his local area and is now receiving the specialist help he needs.

  • May: Avon and Somerset Constabulary announces its commitment to prohibiting the use of custody for Under 18s detained under S135 or S136 under any circumstances
  • September: Street Triage begins in Bristol, commissioned through the Bristol CCG and Avon & Wiltshire Mental Health Trust; since it was launched 40% of calls relating to mental ill health have been diverted form the S136 detention route; programme funding has been commissioned through 2017


  • May: further Crisis Care Concordat meeting; PCC Sue Mountstevens challenges partners about changes in the acceptance of adults and young people in custody
  • June: ASC announces a commitment not to accept a person in mental health crisis detained under S136 into a custody suite unless exceptional circumstances apply. In the first six months after going live, just 4 individuals in crisis have come into custody

Case Study Two

Exceptional detentions

one was extremely large and aggressive, spitting blood; he could not be calmed or negotiated with

one had jumped from a bridge onto the muddy banks of a river before being detained and violent

one was so aggressive and determined to self-harm; after two critical incidents in a hospital ward he had to be taken to police custody

the fourth had tried to jump from a moving vehicle on to the motorway; he assaulted a police officer when he responded to a call to help nursing staff regain control

Mental Health Concordat
  • September: A multi-agency funded Control Room Triage is launched, with a force wide remit
  • December: The Control Room Triage has already assisted officers on over 2,500 occasions

Case Study Three

Mitigating the risk of suicide

A father rang Police after his 20 year old daughter went missing; she had taken an overdose and refused to speak to him or the police. As the medication began to affect her she became disorientated and would not disclose where she was.

The Police treated her as a High Risk missing person but could not locate her despite using all the resources available to them.

A Control Room Triage nurse called the patient and spent over an hour developing a rapport with her and winning her trust. After lengthy negotiation, the nurse identified her location and arranged for her to receive appropriate emergency care. She encouraged her to be frank about the true nature of her illness with Emergency department staff.

The patient received the support she needed; she is in recovery, receiving longer-term care, and wrote to the nurse thanking her for saving her life.

Case Study Four

The frontline perspective

The partner of a woman in mental health crisis called the police, She was self-harming and he felt she needed to be restrained but he was panicking and did not know how to help her.

When they arrived officers found the patient in distress and threatening to commit suicide. She refused to accept any offers of help and they had no legal powers to restrain her.

Enquiries with the Control Room Triage team soon identified a regular pattern of behaviour as a means of securing care and attention from agencies and officials.

This information helped officers to appropriately challenge the patient and encourage her to take part in a community based treatment plan.

Our Mental Health Journey continues

What next?

  • A network of Mental Health Lead Advisors, one for each Local Policing Area, will receive specialist mental health training, brief our staff on changes to mental health legislation and policy, and build and sustain contact with partner agencies
  • A similar network of Mental Health ‘Tactical’ Advisors will receive specialist training so they can provide real time help and support to colleagues dealing with incidents involving people in mental health crisis. It is our aim to have a MHTA on each Response Team. 
  • We will work with partners on the Prevention Concordat to improve support for people contemplating suicide and those involved in dealing with the consequences
  • Training is in development to support officers in recognising and treating Acute Behavioural Disorder (Excited Delirium). We are working on a Memorandum of Understanding with NHS partners to ensure that people we meet who we believe are suffering from this condition receive the necessary life-saving interventions.
  • Early work is in train for the Constabulary to become Dementia Friendly and Autism Friendly.