Public health providers and police services are two sides of the same coin

It is easy to view policing and public health as two very separate entities. Traditionally we can think about police as solving and preventing crime, providing security and law enforcement. Health practitioners are embedded in health promotion, the eradication and management of disease, medical and psychiatric emergencies and delivery of community-based health care.

Inga Heyman, lecturer in Edinburgh Napier Universitys School of Health & Social Care
Inga Heyman, lecturer in Edinburgh Napier Universitys School of Health & Social Care

Yet, law enforcement and public health are inextricably intertwined. There is a myriad ways in which people come to the attention of both services. For example, police officers regularly deal with victims of sexual trauma, violent crime, people working in the commercial sex industry and people with mental health needs – the same population who are supported by health professionals.

It is critically important that we recognise and acknowledge where these worlds come together, and inter-sectoral approaches are developed and strengthened.

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The important contribution police officers make in the delivery of public health initiatives often goes unrecognised. For example, the enforcing of seatbelt and motorcycle helmet use and mobile phone restrictions when driving, to prevent serious injury and fatalities. This was born out of a public health need.

Similarly, the importance of health practitioners in crime prevention is regularly underestimated. For example, drug treatment and harm minimisation interventions such as methadone and needle exchange are linked to the reduction of drug-related crimes.

No one agency or service is adequately skilled, equipped and resourced to begin to support people to make lasting change. However, the fact that we share the same or related problems in the same communities does not automatically lead to cooperation.

Indeed, the ways in which we work in our occupational silos can inadvertently drive organisational intervention in counteracting ways. Tensions have developed between police and mental health services in how best to support people.

In Scotland, there has long been a focus on the decriminalisation of people with mental health issues. As first responders, police are often called to support people with mental health needs in the community. They will divert people from the criminal justice system towards health services. However, evidence-based mental health care draws on the benefits of community-based care to recovery rather than psychiatric institutions. Therefore, health practitioners will seek to avoid hospitalisation, unless people are seriously ill, and return people to the community.

Other areas of tension lie in identifying whose responsibility it is to support people in mental health distress who are intoxicated. Clearly a busy emergency department is not the right environment. I would argue a police cell is the worst place for someone who is distressed, particularly as they have not committed a crime. Yet, often management falls to police officers who are required to remain with the person until they are sober enough for mental health assessment. Surely this is not a great use of public resources?

We have different financial and regulatory systems, roles and responsibilities, and organisational and professional cultures. There is the constant pressure, especially with policing, to revert to their traditional ‘core business’. Alternatively, there is evidence of a gradual morph in the police role to ‘softer policing’ as they reinvent themselves to work more effectively to the growing demand of vulnerability in the community.

Pressures on staff and resources mean that collaboration with partner organisations is often easier said than done. Yet, there is no doubt that the Scottish Government has led the way in the UK on improving policy and practice, recovery and safeguarding people.

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In 2017, the Scottish Government developed the Health and Justice Collaboration Board. The Board draws together senior leaders from Health, Justice and Local Government. Its purpose is to lead the creation of a much more integrated service response to people’s needs in key areas where Health and Justice services intersect.

There are opportunities to bring about real change by working together. Edinburgh Napier University is developing the Scottish Centre for Law Enforcement and Public Health. As a central base, the national centre will act as a point for national and international universities to integrate both academic and pragmatic endeavours.

By working across disciplines and developing rigorous research underpinned by data and technology, there are opportunities to work collaboratively with policy makers, practitioners, researchers and people in our communities to solve societal problems.

The exploration of this intersectional area has been developed through establishment of an international conference series and a global network of researchers, police, health practitioners, people with lived experience and educators. 
From 21-23 October, Edinburgh Napier will host the 2019 International Law Enforcement and Public Health conference in Edinburgh. Here the shared problems both health and social care and law enforcement are seeking to address will be explored, debated and discussed.

Innovations in practice and research will be showcased, and international, national and local relationships will be strengthened with an aim to make real change to people’s lives.

Inga Heyman, lecturer in Edinburgh Napier University’s School of Health & Social Care