DOI: https://doi.org/10.58248/HS62

Overview

In recent years, police forces in England and Wales have worked more closely with health, education and other local partners to address social issues, such as drug use, youth violence and people in mental health crisis.[1] This aims to ensure that vulnerable people are supported by the most appropriate professional, and that certain complex social issues are not automatically met with a criminal justice response.

These initiatives are sometimes referred to as public health approaches to policing.[2] They can include interventions aimed at preventing offending altogether (for example, early years school-based programmes), as well as ones covering offenders or people coming into contact with the police. [3]

In 2018, organisations representing public health bodies, health services, voluntary organisations and police forces signed an agreement to work more closely together to prevent crime and protect the most vulnerable people in England.[4] Public Health Scotland and Police Scotland announced a formal collaboration in 2021.[5] In 2019, Public Health England and the College of Policing published a discussion paper on public health approaches to policing,[6] and the Association of Police and Crime Commissioners issued guidance in 2023 to support implementation of such approaches.3

Research has found that cooperation between police and health services can help to improve social outcomes. For example:

  • a 2017 study in the USA suggested that health services and police forces have worked effectively together to improve police responses to mental health-related encounters[7]
  • research in 2017 highlighted international examples of how formal collaboration between criminal justice and public health agencies helped to reduce youth violence[8]
  • a 2022 study found that nurses and police officers could develop collaborative teamwork practices in police custody suites in England[9] [10]

There are examples of police forces working with health partners and other agencies to improve responses to vulnerable people in England and Wales:

  • Under drug diversion schemes, police refer people caught in possession of small quantities to voluntary sector treatment services, rather than prosecute for a possession offence. As of 2024, diversion schemes were operating in Thames Valley,[11] West Midlands,[12] and Durham police force areas.[13] The College of Policing and the University of Kent have received funding to evaluate these schemes, which is expected to be completed in 2025.[14]
  • The Right Care, Right Person model aims to reduce the deployment of police to incidents related to mental health and concern for welfare, and instead ensure that people receive support from the most appropriate health or social care professional. Humberside Police developed the model, which includes training for police staff and partnership agreements between police, health and social services.[15] From 2023, police forces nationally were beginning to adopt it, with support from the National Police Chiefs’ Council and the College of Policing.[16]
  • Violence Reduction Units (VRUs) bring together police, local government, health and education professionals, community groups and other stakeholders to provide a joint response to serious violence, including knife crime. The London Mayor’s Office for Policing and Crime established the first VRU in England and Wales in 2019. It states that it takes a public health approach to violence prevention,[17] including deploying youth workers in hospitals and police custody suites.[18] Between 2019 and 2022, the government funded 20 VRUs across England and Wales.[19] In 2019, the government provided funding for the Youth Endowment Fund, which funds and evaluates programmes in England and Wales that aim to prevent children and young people from becoming involved in violence.[20]

Since 2020, Scotland has seen increasing use of diversion from prosecution schemes.[21] In October 2024, the UK’s first official consumption facility for illegal drugs, including heroin and cocaine, was opened in Glasgow.[22]

Challenges and opportunities

In 2023, HM Inspectorate of Constabulary and Fire & Rescue Services noted how police forces were often the “service of last resort” doing the work of other public services, especially with regards to mental ill health.[23] For some vulnerable people, police custody may provide their only space for healthcare interventions.10 Both police forces and voluntary organisations suggest that, at a time when police capacity is under pressure, public health approaches can reduce the amount of time police officers spend dealing with people with complex health needs, who may be referred to other health, care or support services.[24],[25] However, this can also lead to demand and capacity pressures being displaced onto these services.

For example, drug diversion schemes may increase the demand on local drug treatment services, which themselves are facing significant pressures. In her independent review of drugs for the government in 2021, Dame Carol Black raised significant concerns about the capacity and resourcing of drug treatment services in England, and the impact of funding reductions.[26] The Criminal Justice Alliance has called for increased funding for local drug services, to accommodate people being diverted away from the criminal justice system.[27]

The government’s 10-year drug strategy (2021) committed to invest £533 million into local authority commissioned substance misuse treatment services in England from 2022/23 to 2024/25, as part of its aim to “rebuild local authority commissioned substance misuse treatment services in England”.[28] In 2023, the Home Affairs Committee called for all police forces in England and Wales to adopt drug diversion schemes.[29] It also expressed concern about the long-term sustainability and security of funding for the drug treatment and recovery sector.26

Similar pressures in mental health services have led to concerns about the safety of the national rollout of Right Care, Right Person. In November 2023, the Health and Social Care Committee identified urgent questions around the available funding for health services, and the lack of evaluation, in the rollout of the scheme[30] The Royal College of Psychiatrists and the Royal College of Nurses agreed that people with mental illness should be seen as quickly as possible by a mental health professional.[31],[32] However, they and other health, local government, and mental health charities, have expressed several concerns about the programme. These include: the speed and consistency of implementation, lack of funding, the potential for gaps in provision, and increased welfare risks.[33],[34],[35],[36]

Key uncertainties/unknowns

Outside the UK, some public health approaches have involved a significant shift away from enforcing drug possession for personal use through the criminal justice system.[37] For example:

  • Portugal decriminalised possession of drugs for personal use in 2001 and instead refers drug users to support and treatment.[38] Analysis of these measures from researchers and policy experts suggests decriminalisation led to reductions in problematic use, drug-related harms and criminal justice overcrowding.38,[39]
  • In the USA, Oregon trialled a policy in 2020 making drug possession a fineable offence.[40]
  • In Canada, British Columbia trialled an approach in 2023 that decriminalised possession of small amounts of certain drugs for personal use in specific non-public locations.[41]

Citing international examples, some drug policy experts have called on the government to go further in its adoption of a public health approach to drug use.37 The Home Affairs Committee stated in 2023 that the government’s drug strategy should have adopted a broader public health approach, and called for responsibility for misuse of drugs to be jointly owned by the Home Office and Department of Health and Social Care.26 In 2019, the Health and Social Care Committee recommended the government shift responsibility for drugs policy from the Home Office to the Department of Health and Social Care, and for the government to “look closely” at the Portugal model for decriminalisation of drug possession for personal use.[42]

However, Portugal’s approach has also faced criticism. For example, a research review in 2021 highlighted continued social and political resistance to some of the measures 20 years after being introduced.[43] A 2023 editorial in the Lancet highlighted how a recent rise in the use of illicit drugs in Portugal had led to renewed criticism of the policy.[44] More recently, some states in North America have reversed decriminalisation policies, reportedly due to adverse consequences of drug decriminalisation.33,[45], [46]

This points to a mixed evidence base internationally for a fully public health approach to drug use. However, it may be difficult to compare international examples, given the different models of decriminalisation that have been adopted, and in a variety of social, economic, political and legal systems.[47]

Key questions for Parliament

  • Should the government do more to support the implementation of public health approaches to policing across England and Wales, considering both the police, and health, care and other local services?
  • Should the police continue to implement the Right Care, Right Person model? Do mental health services have sufficient resource and capacity to bridge the gap?
  • Should drug diversion schemes be rolled out across England and Wales? Do drug treatment services have sufficient capacity and resource to respond to increased demand on services?
  • Should the government go further in taking a public health approach to drugs by decriminalising drug possession for personal use?
  • How effective have government measures to reduce youth violence been?
  • What international comparisons are useful for implementation of public health approaches to policing?

References

[1] For example: Centre for Justice Innovation (2020). DIVERT; College of Policing (2023). Right care right person – Humberside Police; Greater London Authority (2022). Making London’s communities safer through public health.

[2] College of Policing (2019). Public health approaches in policing: a discussion paper

[3] Association of Police and Crime Commissioners and Public Health & Police Collaborative (2023). A guide to taking a public health approach for PCCs and their offices

[4] College of Policing (2021). Policing, health and social care consensus: working together to protect and prevent harm to vulnerable people

[5] Public Health Scotland (2021). Public Health Scotland and Police Scotland launch collaboration to drive national improvements in health and wellbeing

[6] College of Policing (2019). Public health approaches in policing: a discussion paper (PDF).

[7] Wood, J.D and Watson, A.C. (2017). Improving police interventions during mental health-related encounters: past, present and future. Policing and Society, 27: pp. 289-299

[8] Shepherd, J.P. (2017). Policing and public health – strategies for collaboration. Journal of the American Medical Association, 317(15): pp. 1525–1526

[9] Rees, G. (2022). The coproduction work of healthcare professionals in police custody: destabilising the care-custody paradox. Policing and Society, 33(1): pp. 51-63

[10] Rees, G. (2019). Getting the Sergeants on your side: the importance of interpersonal relationships and cultural interoperability for generating interagency collaboration between nurses and the police in custody suites. Policing and Society, 42(1): pp. 111-125

[11] Centre for Justice Innovation (2020). Thames Valley drug diversion scheme

[12] Centre for Justice Innovation (2020). DIVERT

[13] Centre for Justice Innovation (2020). Checkpoint

[14] University of Kent. The PDD project: evaluating police-led diversion schemes

[15] College of Policing (2023). Right care right person – Humberside Police

[16] College of Policing (2024). Right care right person toolkit

[17] Greater London Authority (2022). Making London’s communities safer through public health

[18] Greater London Authority. London’s Violence Reduction Unit – our programmes

[19] Home Office (2023). Research and analysis: Violence Reduction Units 2022 to 2023

[20] Youth Endowment Fund (webpage)

[21] Crown Office & Procurator Fiscal Service (2023). Diversion from prosecution review welcomed

[22] BBC News (2024). UK’s first drugs consumption room to open in October; Glasgow City Health and Social Care Partnership. Safer Drug Consumption Facility

[23]HM Inspectorate of Constabulary and Fire & Rescue Services (2023). State of Policing: The Annual Assessment of Policing in England and Wales 2022

[24] Metropolitan Police Service. Introduction of Right Care, Right Person model | Metropolitan Police

[25] Transform Drug Policy Foundation (2023). Why police should use diversion.

[26] Home Office (2021). Dame Carol Black independent review of drugs part two: prevention, treatment and recovery.

[27] Criminal Justice Alliance (2022). Response to the Home Affairs Select Committee’s Drugs Inquiry

[28] UK Government (2021). From harm to hope: A 10-year drugs plan to cut crime and save lives Gov.uk

[29] Home Affairs Select Committee (2023). Third report – drugs.

[30] Health and Social Care Committee (2023). Urgent answers needed on funding for ‘Right Care, Right Person’ mental health strategy – Committees – UK Parliament

[31] Royal College of Psychiatrists (2023). RCPsych responds to launch of Met police’s ‘right care, right person’ initiative across London.

[32] Royal College of Nursing (2023). RCN position on the National Partnership Agreement: Right Care, Right Person (RCRP)

[33] Mind (2023). Mind reacts to UK government announcement of right care, right person approach

[34] Association of Ambulance Chief Executives (2024). Letter to Home Affairs Select Committee

[35] Local Government Association. Right Care, Right Person: Policing and mental health and welfare checks

[36] Mind (2024). Mind responds to ambulance service concerns over Right Care Right Person

[37] Holland, A. et al. (2022). Analysis of the UK Government’s 10-Year drugs strategy — a resource for practitioners and policymakers. Journal of Public Health, 45(2) pp. 215-224

[38] Hughes, C.E. and Stevens, A. (2010). What can we learn from the Portuguese decriminalization of illicit drugs? The British Journal of Criminology, 50(6) pp. 999-1022

[39] Transform Drug Policy Foundation (2021). Decriminalisation in Portugal: setting the record straight

[40] BBC (2024). Oregon recriminalises drug possession after overdoses rocket

[41] British Columbia (2024). Decriminalizing people who use drugs in B.C.

[42] Health and Social Care Committee (2019). First report – drugs policy.

[43] Rêgo, X. et al. (2021). 20 years of Portuguese drug policy – developments, challenges and the quest for human rights. Substance Abuse Treatment, Prevention, and Policy, 16, 59.

[44] The Lancet (2023). Drug decriminalisation: grounding policy in evidence.

[45] The Times (2024). Why British Columbia is reversing its attempt to legalise hard drugs.

[46] BBC (2024). Oregon recriminalises drug possession after overdoses rocket.

[47] Stevens, A. et al. (2019). Depenalization, diversion and decriminalization: A realist review and programme theory of alternatives to criminalization for simple drug possession. European Journal of Criminology, 19:1.


Photo by: King’s Church International via Unsplash

Horizon Scan 2024

Emerging policy issues for the next five years.