People in Mental Distress, Police and Out-of-Hours Health Services: A Qualitative Exploratory Case Study of Experiences and the Intersect of Safeguarding Services

Heyman, Inga

Abstract

Aim: To explore the experiences of people in mental distress who come to the attention of police and healthcare professionals outwith routine hours.

Background: 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, time-critical medical emergency, or the person is intoxicated. Consequently, police officers may feel unable or insufficiently confident to discharge safeguarding responsibilities when they, or the individual perceive needs are unmet. This can find some people, police officers and healthcare practitioners exposed to lengthy wait times and repetitive distress presentations.

This thesis explores the impact of this gap on the person in distress, police and out-of-hours health services.

Methods: An in-depth, qualitative case study with three phases, was conducted. This study was underpinned by broadly social constructionist perspectives with each phase building on the in-depth understanding and interpretation of data;

1. 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.
2. Three clinical cases in which police and healthcare practitioners responded to people in mental distress were explored critically, using semi-structured interviews (n = 15).
3. Three focus group interviews with operational police officers and healthcare practitioners
(n = 18) explored front line perspectives of supporting people in mental distress and helped contextualise and enhance phases 1 and 2 findings.

Template Analysis supported the thematic analysis of findings, which elaborated on and 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 Stark et al. (2011), Conceptual Model of Suicide.

Findings: 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.

Collectively, these factors can create situations exposing people to additional stressors such as inappropriate safeguarding environments, e.g. police custody, and a lack of dignity and re-traumatisation, thus reinforcing cyclical distress journeys.

Conclusion: There exists a gap in environments, policies and processes to keep people in mental distress safe 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 which may be convoluted, cyclical and one which reinforces, rather than supports, their distress needs. Police and healthcare professionals’ responses reinforce a cyclical safeguarding journey which does not meet the needs of the person in mental distress and can place pressure on police and out-of-hours health services.

Citation

Heyman, I. (2021). People in Mental Distress, Police and Out-of-Hours Health Services: A Qualitative Exploratory Case Study of Experiences and the Intersect of Safeguarding Services. (Thesis). Robert Gordon University. http://researchrepository.napier.ac.uk/Output/2769181

• Thesis Type: Thesis
• Online Publication Date: Jun 8, 2021
• Deposit Date: Mar 12, 2025
• Publicly Available Date: Mar 13, 2025
• DOI: https://doi.org/10.48526/rgu-wt-1357998
• Keywords: Mental distress; Psychological distress; Self-harm; Police; Health services; Out-of-hours emergency health services; Trauma; Safeguarding journeys
• Public URL: http://researchrepository.napier.ac.uk/Output/2769181
• Award Date: Dec 31, 2020