‘It’s crucial to really cooperate closely in tackling problematic behaviour resulting from mental health needs’

The number of notifications about people with problematic behaviour as a result of mental health needs has risen again over the past year; it now stands at almost 150,000, a 6% increase on the previous year. Such notifications take up a lot of police time, which the police would like to reduce. According to Bauke Koekkoek, an expert on such behaviour, the way to do this is to improve cooperation, both between the police and healthcare professionals and within the police organization itself.

Bauke is a lecturer at the Netherlands Police Academy, where he specializes in behaviour resulting from mental health needs. He comments, ‘It’s not enough just to pass on information every now and then. Often different authorities not understanding each other’s approaches is a greater problem than lack of resources.’

When the police encounter a person who seems confused, it is often difficult for them to assess how serious the situation is. So a few years ago, the police in Arnhem experimented with having a healthcare professional in the emergency control room. ‘The trial was very valuable’, Bauke reports. ‘If the healthcare professional can already deal with the notification from the control room, the police don’t need to send a patrol car’.

'Where necessary, this professional can access files in the mental healthcare institutions in the region, and can request further background information from the out-of-hours GP surgery and addiction care and public mental healthcare facilities. In this way, the healthcare professional may be able to use their knowledge and information to reassure the control room operator. Or they may be able to refer the person making the notification for an appointment planned for the next day, for instance.’

'If the person can manage to hold on for one more day, then nobody needs to call in on them immediately. Or the healthcare professional can take over the conversation. Even just with information and reassurance by phone we already achieved a considerable number of good results.’

Lack of clarity between partners

The trial was stopped after a certain time. ‘It’s not that the money ran out, but it was quite complex from an administrative point of view’, Bauke realizes. ‘It wasn’t really clear for the partners where the responsibility for this position lay. It’s important that the healthcare professional is actually there in the control room in person. Then you can see each other and you really experience the number of phone calls coming in. If you’re there with the team, working together, sharing coffee breaks, or whatever, there’s more of a connection.'

'After a while, it was a problem finding enough healthcare professionals to cover the whole schedule. So then it was decided they would no longer be actually in the control room, but available by phone. That was easier to arrange, because then the person could also do other work. But basically at that stage you’re already moving further apart.’

'The police didn’t really fight for it either. They were due to move to a new location anyway, where three control rooms were to be merged. So they had enough new partners to work with.’

No fixed agreements

‘Cooperation agreements beween the police and healthcare providers are often pretty loose’, in Bauke’s experience. Besides being a lecturer, he is also a nurse with the crisis support team. ‘What you often see is that the police, municipal authorities, and semi-public healthcare institutions do have regular consultations at the local level.’ He’s referring to the mental healthcare services, mental disability care services, and the social domain. ‘But the latter parties are also free to say “no”. They can just say: “we’ve reviewed our aims and we’ve decided to leave these consultations”.’

'I’ve brought the issue up with Commissioner Janny Knol, and she agrees with me that this is strange. “In this network for acute problems we should be able to rely on one another”, she said. That struck me as a pretty strong comment. In this sensitive area, it should be possible to hold healthcare institutions to certain agreements, as indeed applies to the police.’

Less a matter of choice

Bauke has seen for himself, on a small scale, that this is possible. ‘We have regular consultations between our crisis support team and the frontline police teams we work with. These are attended by at least one fixed representative of the police, who speaks on behalf of the police on the ground. They ask around about what’s going well and what could be improved. We have those consultations regularly every few weeks, regardless of whether or not there have been incidents.’

‘You can see that even this really improves cooperation. It works much better than only dealing with one another on an ad hoc basis. You could organize it like that at various levels. These sorts of consultations already take place in quite a lot of places. But it shouldn’t be that the police or the municipality has to chase after all sorts of healthcare organizations to persuade them to join in.

'The police have certain agreed response times they have to meet, and these are monitored. At the moment there’s no legal basis to demand that all these parties have to hold consultations. It should be less a matter of choice. Because in the present set-up you can’t really have proper discussions together.’

Asking the right questions

In addition, Bauke believes there is room for improvement in how the police themselves tackle cases involving problematic behaviour. ‘It’s really important, when the police do address the issue of problematic behaviour resulting from mental health needs, that they ask the healthcare institutions the right questions. We’ve been trying for some time now to do research into all the notifications of problematic behaviour the police receive.'

'Can we distinguish between all those notifications in terms of how serious they are? What underlying demands for healthcare partners emerge from all those notifications, demands that are currently not being met? In the present approach, a code is used in each case to indicate that a notification concerns problematic behaviour. But this doesn’t include whether there were serious injuries involved, or whether a quick chat was enough. For that sort of background information you’re dependent on how detailed the official police report is.'

'For us, as the police, it’s not possible to find information about the time required for all these 150,000 notifications. How was an incident reported, and what happened next? If we know that, we can estimate how things might go in a similar incident in the future. Then we can adjust deployment accordingly. That may be important for the issue of capacity.’