Impact case study database

Within England, the House of Commons Home Affairs Committee estimated that between 20% and 40% of all police encounters are associated with a person experiencing some form of mental disorder or crisis. A 2019 BBC Radio 5 Live investigation found evidence that Police Forces are dealing with an increasing number of mental health incidents. Until the introduction of the PPEAT, and its successor, the PPEAT-R, the police had no evidenced based mechanism to help them identify people with mental health problems or crises, or to appropriately respond to them. This tool is currently the only one of its kind in use in the world. It is credit card sized and front and back are illustrated below:

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At a local level, in 2009 the PPEAT was first introduced within Lancashire Constabulary, and used by street-level police officers. It was also adopted by the Lancashire Independent Custody Visitors service, for the purpose of assessing the mental wellbeing of detainees. As a consequence of this work, the PPEAT received a Lancashire Police & Crime Commissioners award [A].

At an emergency tri-service event in September 2012, the PPEAT was introduced to the Metropolitan Police Service (MPS), London Ambulance Service and London Fire Brigade. The Metropolitan Police Service subsequently adopted the PPEAT when it became integrated into the Vulnerability Assessment Framework (VAF). Then, in 2014 the Home Office issued ‘Supporting vulnerable people who encounter the police: A strategic guide for police forces and their partners in which they listed the ‘Vulnerability Assessment Framework,’ using Wright and McGlen’s terms, as an ‘ABCDE tool’.[D] They noted that it was ‘used by the Metropolitan Police Service’, and that there were also ‘similar approaches in Hertfordshire, Northamptonshire and South Wales.’ The Met began training all of Greater London’s 31,000 police offers in its use [B, D]. In December 2013, the PPEAT was presented to the office of the Rt. Honourable Theresa May (Home Secretary) [D]. Frankie Westoby, now Chief Inspector of Hertfordshire Constabulary, but then Detective inspector with the Met, said: ‘My professional opinion of the PPEAT is it is a very clear and simple tool that can be used by all. Whilst I was working on the PPEAT in the Metropolitan Police, it was developed further with UCLANs permission, through Karen Wright and Ivan McGlen who were pivotal in the research and supporting the MPS [Metropolitan Police Service] in the further development, to assist in the overall identification of vulnerability. This was particularly aimed at vulnerable adults but used for all and became part of the Metropolitan Police Vulnerability Assessment Framework’ [A] .

Street triage schemes were launched in 2013 by the Department of Health due to the increased involvement of police forces with individuals suffering from poor mental health. Street Triage involves a team of people attending public events where a person appears to be suffering for a mental disorder in a public place; its introduction has been transformative, but costly, since both experienced police officers and mental health practitioners attend the scene. However, instead of enabling street-level police officers to comprehend the features of mental disorder, it added professionals to the team in order to do it. From a safeguarding perspective, it enabled the triage team to better identify such people, and, even where there has been a criminal act, refer them on to the most appropriate health or social care service to meet their mental health needs [B, C]. This shift was from a paradigm defined by an assumption of criminality, to one defined by the interpersonal; one in which police officers recognised and responded to a person’s mental health and well-being.

On 3 October 2014, the PPEAT became the assessment framework within the Safety in Mind initiative [F]. Produced in partnership with South London and Maudsley NHS Foundation Trust (SLaM), the Metropolitan Police, London Ambulance Service and UCLan, the PPEAT demonstrated the value of a common tool to improve the quality of the mentally disordered person’s assessment, care and transition through the emergency and healthcare services. In February 2014, the PPEAT was cited as a case study within the Department of Health and Concordat signatories (2014) document, Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis [G]. The PPEAT therefore had a significant impact on national policy in respect of mental health identification. Furthermore, this document noted that all front line MPS police officers were trained in the use of the PPEAT by April 2014. In July 2014, the London Strategic Clinical Networks (2014) reported the following in relation to the success of the PPEAT within Greater London: ‘Since this [Vulnerability Assessment Framework] system went live over 55,000 reports have been completed, enabling the police and partners to identify individuals that are becoming vulnerable far earlier and enabling early intervention’ [H, p.30].

In 2015, the PPEAT was adopted by the College of Policing under the name ‘Vulnerability Assessment Framework’ as the national professional guideline for the assessment of mental vulnerability and illness [I, J]. The Vulnerability Assessment Framework now forms part of the training available to all 123,000 police officers in England and Wales. It is now implicit within the National College of Policing National Vulnerability Action Plan [J, K]. The revised PPEAT-R was introduced in 2018. The use of this tool produced a number of benefits, including an increase in mental health literacy amongst police officers [A]. The PPEAT-R was a very useful adjunct to the police officers’ operational practice, achieving not only individual, but team situation awareness. Police officers used different combinations of the concepts, at different stages of their interaction, to gather information necessary to identify features of mental disorder. Chief Inspector Frankie Westoby comments: “As part of the Vulnerability Assessment Framework development, adults coming to police notice are now recorded on a police system called Merlin, these reports follow the PPEAT structure and are known as Adult Coming to Notice reports in 18/19 117,754 adult coming to notice reports were submitted across London. These are shared appropriately with partner agencies to enable early intervention where appropriate and/or to identify patterns. … The simplicity of the tool, makes it easy for officers to remember and therefore it is used. Often the risk assessments that are required are so complex, the actual vulnerability is missed and the PPEAT prevents this” [A] .

To date, the PPEAT(-R) has been used by a wide range of other agencies. Mind, and the Association of Chief Police Officers advocate the use of the PPEAT [L]. The Open University has utilised it within their ‘Collaborative problem solving for community safety’ course [M]. Humberside Police have incorporated it into their guide to vulnerability [C]. Pathway, in partnership with Lambeth Council, South London and Maudsley NHS Trust, ThamesReach, the Greater London Authority and EASL have utilised the PPEAT into their guidance for the mental health assessment of rough sleepers [N]. In 2019, the PPEAT-R was cited within the Lifesavers category of the MadeatUni initiative [O].