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This academic article examines how an English police force implements the Right Care, Right Person (RCRP) framework for managing mental health crises. Using interviews with police staff and observational data, the researchers map the step-by-step processes officers follow from initial contact to case resolution. The findings reveal that while RCRP provides a structured approach, officers continue to intervene in certain cases due to service gaps, risk concerns, and practical constraints.

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This article presents research findings on the implementation of the Right Care, Right Person (RCRP) framework within an English police force, examining how officers manage mental health crises under this initiative designed to redirect calls to specialised services rather than police. The study employed interviews with strategic and operational police staff, analysis of policy documents, and real-time observations to map incident management processes.

For criminal justice officials, policymakers, and public health professionals, the research highlights ongoing tensions between law enforcement roles and caregiving responsibilities. The findings indicate that despite RCRP's structured approach, police continue to intervene in some cases due to gaps in mental health services, risk assessment concerns, and practical constraints, suggesting challenges in fully transitioning mental health response away from policing. The research discusses practical implications for improving support and ensuring crisis care from appropriate professionals.

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Should police be turning up at all? managing mental health crises in an English Constabulary under the Right Care, Right Person framework

A. Kyprianides Department of Security and Crime Science, University College London, London, UK Correspondence a.kyprianides@ucl.ac.uk
& B. Bradford Department of Security and Crime Science, University College London, London, UK Contribution Supervision, Writing – original draft, Writing – review & editing

Received 08 May 2025, Accepted 23 Mar 2026, Published online: 15 Apr 2026

ABSTRACT

The Right Care, Right Person (RCRP) initiative was developed to ensure appropriate professionals respond to mental health crises, redirecting calls from police to specialised services. While early evaluations focused on operational success, this paper examines how incidents are managed within an English police force implementing RCRP. Using interviews with strategic and operational police staff, policy and strategy document analysis, and real-time observations, we explore the step-by-step processes officers follow, from initial contact to case resolution. This mapping serves as a conceptual framework to highlight the tensions police face in balancing their roles as law enforcers and caregivers. Findings reveal that while RCRP offers a structured approach, officers still intervene in some cases due to service gaps, risk concerns, and practical constraints, underscoring ongoing challenges in fully transitioning mental health response away from policing. Practical implications for improving support and ensuring crisis care from the right professionals are discussed.

KEYWORDS:

Introduction

Police forces in England are increasingly called upon to respond to a wide spectrum of incidents, encompassing not only traditional policing issues but also concerns tied to mental health, welfare, and social care (The Police Foundation Citation 2022). This breadth of responsibility often blurs the lines between policing roles and those typically associated with the NHS and other social support agencies. Police are frequently perceived as an ‘all-encompassing service’, and significant demands on police resources are placed by situations that may align more closely with the expertise of other sectors. On many accounts, this heightened demand diverts officers from ‘core’ policing duties and imposes additional strains on an already hard-pressed service (BBC Citation 2024). The growing scope of these expectations and the associated pressures on police resources were highlighted in a report titled ‘Policing and Mental Health: Picking up the Pieces’ (HMICFRS Citation 2018).

This blurring of roles, however, is not a solely resource-driven development. Empirical studies have noted that the majority of police work consists not of crime control but of service-oriented tasks, including responding to individuals in distress, providing emotional support to victims, and managing situations shaped by social and mental health needs (Lamin and Teboh Citation 2016). Despite this reality, police training, organisational cultures, and professional identities continue to prioritise law enforcement as the core function of the role, creating a form of professional dissonance between what officers are trained to value and what their daily work requires (Rhodes et al. Citation 2023).

The caregiving dimension of policing also carries significant emotional and psychological consequences. Research on officer wellbeing highlights the prevalence of compassion fatigue (Andersen and Papazoglou Citation 2015, Grant et al. Citation 2019), moral distress (Papazoglou and Chopko Citation 2017), and secondary trauma (Foley and Massey Citation 2020) among police who are repeatedly exposed to suffering, crisis, and vulnerability. These experiences can undermine officers’ confidence in their ability to provide care, contribute to emotional withdrawal or cynicism, and exacerbate existing barriers to help-seeking within police organisations (Newell et al. Citation 2022). Importantly, this literature suggests that the tension between care and enforcement is not simply a matter of individual capacity or training, but reflects a deeper structural paradox: officers are expected to act simultaneously as authoritative enforcers of the law and as frontline caregivers in contexts shaped by broader failures in health and social care provision.

Existing research based in the US highlights the particular challenges police encounter when responding to mental health-related calls for service. Surveys point to gaps in training, with officers reporting limited preparation for managing mental health crises, particularly in relation to de-escalation, communication, and the application of mental health legislation (Cooper et al. Citation 2004, Vermette et al. Citation 2005, Wells and Schafer Citation 2006). As a result, individuals experiencing mental illness are at heightened risk of criminalisation, use of force, and injury during police encounters (Kesic et al. Citation 2013, Moribito et al. Citation 2017, Saleh et al. Citation 2018 Pelfrey and Young Citation 2020, Hallett et al. Citation 2021,). Officers themselves describe mental health calls as time-intensive and disruptive to other duties, while also expressing frustration with the limited availability or responsiveness of mental health services when support or transfer of care is required (Wells and Schafer Citation 2006).

Mental health-related incidents are also perceived by officers as unpredictable and potentially dangerous (Ruiz Citation 1993, Ruiz and Miller Citation 2004). US based research suggests that without adequate training or specialist support, officers may approach such encounters in ways that inadvertently escalate situations, particularly when individuals are distressed, fearful of police, and have difficulty understanding or complying with police instructions (Kesic et al. Citation 2013, Xanthopoulou et al. Citation 2022). Communication challenges are compounded by the absence of clear, consistent guidance on effective engagement strategies (Morgan Citation 2024).These operational difficulties are situated within broader organisational and systemic constraints: police organisations have increasingly assumed the role of primary responders to mental health crises due to perceived deficiencies in community-based services (Richmond and Gibbs Citation 2021, Watson and El-Sabawi Citation 2023), despite lacking the resources, expertise, and institutional mandate to provide therapeutic care (Balfour et al. Citation 2021). Together, this literature underscores that police responses to mental health incidents are shaped not only by individual decision-making, but by structural conditions that make such encounters especially complex, risky, and emotionally demanding for both officers and individuals in crisis.

While much of the research cited above is US-based it resonates strongly with the situation in the UK. Humberside Police (Citation 2023), for example, reported an average of 1,566 monthly deployments to incidents involving welfare concerns, mental health crises, or missing persons in 2018/19. In a force of approximately 2,000 officers, this was nearly one incident per officer per month. The force recognised that, in handling these incidents, they might not be offering the most appropriate support for vulnerable individuals, who often need specialised intervention from other agencies. This not only heightened risks for both the public and police officers, but also limited the force's ability to respond effectively to incidents where immediate police intervention is necessary, such as active crimes or life-threatening situations. These pressures are compounded by significant financial and resourcing constraints faced by both policing and healthcare services. Years of austerity measures have led to reductions in funding and staffing across the public sector, limiting the capacity of all agencies involved in crisis response (Arrieta Hernandez Citation 2021). For police forces, this has created a stark tension between growing societal expectations and shrinking operational capacity.

In response, Humberside Police prioritised what it framed as a return to core policing principles established by Sir Robert Peel (Humberside Police Citation 2023), emphasising crime prevention, peacekeeping, and the protection of life and property. To realign resources and clarify responsibilities, the force sought legal guidance to define their duty of care and delineate when other agencies might better serve community needs. This initiative informed the development of the ‘Right Care Right Person’ (RCRP) approach, which aims to ensure that the right agency responds to the right call for service (Humberside Police Citation 2023).

While Humberside Police played a leading role in shaping RCRP, the approach is grounded in national frameworks, including the National Vulnerability Action Plan (NVAP) and the NPCC Mental Health Strategy. These national agreements advocate for a collaborative, multi-agency response to vulnerability, reinforcing the importance of cross-sector cooperation (College of Policing & NPCC Citation 2020, NPCC Citation 2022).

The RCRP initiative is intended to provide a collaborative framework involving partners from ambulance services, mental health care, acute hospitals, and social services. Together, these agencies aim to ensure that each call for assistance receives the most appropriate response, enhancing the quality of care provided to those in need. By channelling cases to the agency best equipped to handle them, RCRP seeks to alleviate pressure on both police and healthcare resources. The framework consists of a variety of tools, including a control room toolkit and specialised training programmes for police personnel, as well as policies and memoranda of understanding that guide cooperation between the police and partner agencies. These resources support call triaging, with the intention of helping police improve their responsiveness and deliver appropriate interventions (Home Office, & Department of Health & Social Care Citation 2024).

Within the academic literature, RCRP is framed as a response to a broader systemic crisis in which police have increasingly become de facto first responders to mental health emergencies due to persistent gaps in health and social care provision (Wondemaghen Citation 2024). This shift has consumed substantial police resources (Penhale and Cummins Citation 2024) while often resulting in responses that are ill-suited to the needs of vulnerable individuals (O’Reilly Citation 2025). At the same time, this literature raises important concerns about implementation, including limited health service capacity, ongoing funding shortfalls, uneven partnership quality across local areas, and the risk that individuals in crisis may fall through service gaps if reductions in police involvement are not matched by equivalent expansion in health and social care provision.

A growing body of research has examined police – mental health partnership and co-response models, including Crisis Intervention Teams (CIT) and joint police – clinician responses, although the overall evidence base remains mixed and limited (Eloi et al. Citation 2025, Teti et al. Citation 2025). Studies of CIT consistently report positive officer-level outcomes, including improved knowledge of mental illness, more favourable attitudes towards individuals experiencing mental distress, enhanced self-efficacy, and greater satisfaction when handling mental health-related calls (Watson and Compton Citation 2019). However, evidence of impact on arrest rates, use of force, injury, or longer-term outcomes is far less consistent, with many studies relying on self-reported measures, lacking appropriate comparison groups, or suffering from limited follow-up (Peterson and Densley Citation 2018, Watson and Compton Citation 2019).

Evaluations of co-response models similarly suggest potential benefits in terms of service linkage and reduced pressure on the criminal justice system, yet robust evidence of effectiveness is scarce (Shapiro et al. Citation 2015). The most rigorous randomised controlled trial to date found no significant differences between co-response and traditional police responses across key outcomes, including emergency service use, hospital admissions, or justice system involvement (Lowder et al. Citation 2024). Across both CIT and co-response approaches, reported outcomes vary substantially between programmes, reflecting differences in local implementation, organisational capacity, partnership quality, and definitional uncertainty regarding what constitutes a mental health crisis call (Rogers et al. Citation 2019 Eloi et al. Citation 2025,). As a result, the literature cautions against treating partnership-based responses as universally effective solutions, instead emphasising the need for context-sensitive, locally grounded analyses of how such models operate in practice (Peterson and Densley Citation 2018, Watson and Compton Citation 2019).

Indeed, the wider adoption of RCRP across England – particularly its adoption by the Metropolitan Police – has not been without controversy over whether police forces are pursuing these changes collaboratively or unilaterally. Some health professionals and commentators have expressed concern that rapid implementation, without adequate partnership input, may compromise safety and coordination, particularly in high-risk situations where mental health staff report feeling unsafe or unsupported (NHS Confederation Citation 2024). Moreover, despite efforts to define agency roles more clearly, it is widely acknowledged that police will continue to play a crucial role as frontline referrers to support services (Lum et al. Citation 2021). Their ability to divert individuals away from the criminal justice system into appropriate care – through tools like out-of-court disposals or referral pathways – remains an essential component of early intervention strategies.

Nonetheless, early internal evaluations of RCRP in Humberside indicated that the approach led to a more collaborative and targeted response to incidents (Humberside Police Citation 2023), with several significant benefits for both police and partner agencies. On average, RCRP resulted in 540 fewer police deployments each month, saving approximately 1,441 officer hours monthly and a total of 46,114 h from May 2020 to December 2022. Additionally, the proportion of mental-health related incidents requiring police deployment dropped substantially, from 78% in January 2019 to just 25% by May 2022. However, this early evaluation was conducted by Humberside Police themselves and was not an independent assessment, which may limit the objectivity of the findings and underscore the need for external validation to confirm these outcomes.

The Home Office (Citation 2024) recently released an evaluation of the national implementation of RCRP. This employed a mixed-methods approach, including qualitative interviews with police, fire, health, and social care staff, surveys with Integrated Care Boards (ICBs) and Local Authorities (LAs), and quantitative analysis of police incident data. Data was collected from five police forces for the quantitative analysis and three police forces for the qualitative data gathering, as well as their corresponding fire and rescue services. The findings highlight the importance of communication, collaboration, and phased implementation in achieving successful outcomes. While RCRP reduced police time spent on mental health-related incidents and improved multi-agency partnership working, significant challenges were identified, including capacity and resourcing limitations in health and social care, inconsistent decision-making, and gaps in service delivery. The Home Office report emphasised the importance of conducting in-depth, localised studies to better understand the implementation of RCRP. This paper directly addresses that recommendation by offering a detailed exploration of how mental health-related incidents are managed in practice within a specific English police force operating under the RCRP framework.

To the best of our knowledge, very little empirical academic research has been conducted on the RCRP initiative. Recent scholarly publications have primarily focused on discussing the emergence of RCRP, examining its redefinition of police roles and boundaries, and exploring its potential benefits and limitations (Hayhurst and Sparkes Citation 2023 Bird et al. Citation 2024,, Crawford Citation 2024). Central to these discussions has been the tension inherent in police management of mental health incidents: balancing the imperative to respond to people in crisis with growing pressures to prioritise enforcement roles. Mental health-related calls for service often require significant time, emotional labour, and resources, positioning police officers as first responders to situations far removed from conventional conceptions of ‘real’ police work. This dual role – as both law enforcers and de facto caregivers – presents significant institutional challenges in fully addressing the needs of vulnerable individuals. This tension is particularly pronounced when mental health crises demand immediate and compassionate responses, a demand often at odds with internal priorities and external perceptions of police work. Frameworks like RCRP, these scholars argue, make this contradiction more evident. By aiming to redirect non-policing responsibilities to specialised agencies, RCRP reflects a growing recognition of the need to alleviate the burden on police while improving outcomes for individuals in crisis. Yet, its implementation highlights broader systemic challenges: how to define the boundaries of police responsibility in mental health responses, how to ensure that specialised services are equipped to fill the gaps, and how to manage public and institutional expectations of the police. For example, these academics have raised critical questions: when can police safely opt not to respond, and who fills that role if they do not? The key challenge is balancing emergency care with traditional enforcement, a core issue in discussions about the evolving role of police in responding to societal vulnerabilities.

Further, this discussion cannot overlook the high prevalence of mental ill health among individuals who come into contact with the criminal justice system. A large body of research indicates that mental health is a key underlying factor in many criminal behaviours (Anderson Citation 1997, Sugie and Turney Citation 2017), which raises ongoing questions about how well policing practices account for vulnerability even in apparent ‘crime’ scenarios. This highlights the dual mandate of police not only to enforce laws, but also to identify and support individuals in crisis – a role sometimes underemphasised in enforcement-focused narratives. By contrast, ‘community policing’ – ostensibly the primary model for ‘policing by consent’ in the UK and often associated with care, trust-building, and problem-solving – can be seen as fundamentally intertwined with mental health response. The dichotomy between ‘care’ and ‘enforcement’ may therefore be overstated, particularly in day-to-day practice. Any analysis of police roles in mental health must take care to avoid oversimplifying this continuum.

The current research

This paper is an exploration of how one English police force manages mental health incidents, focusing on the officers’ dual roles as law enforcers and caregivers. Drawing on a combination of interviews with strategic and operational police staff, analysis of national and local policy and internal police strategy documents, and real-time observations of police activities related to mental health, it provides a detailed account of the processes and challenges police face in handling these incidents, organised conceptually from the initial contact to final resolution. The RCRP initiative serves as a contextual framework to understand how this approach influences, but does not entirely define, the operational handling of mental health cases. Rather than evaluating the effectiveness or outcomes of the RCRP initiative, the paper uses it as a lens to examine broader operational and systemic issues in policing mental health. By unpacking the tensions between caregiving and enforcement at each stage of the policing process, it offers insights into how these competing roles are navigated in practice.

The research questions driving this study stem from academic and policy discussions about the evolving role of police in addressing societal vulnerabilities, particularly the increasing complexity of mental health demands. They also highlight the importance of understanding how these demands are managed in practice and how frameworks like RCRP influence everyday policing. Specifically, the study asks:

  1. How do police officers balance their dual roles as law enforcers and caregivers when dealing with mental health incidents?
  2. What are the key processes and challenges officers face at each stage of managing mental health incidents, from initial contact to final resolution?
  3. How does the RCRP framework influence the handling of these incidents, and what broader systemic issues does it highlight in mental health response? By framing the study around these questions, we aim to better understand how police manage mental health incidents in practice, within the broader context of policy changes like RCRP.

Methodology: a case study approach

This study employed a mixed-methods approach to explore the intersection of policing and mental health within one English police force, combining interviews, document analysis, and observations.

Force context

The police force in this study operates within one of the largest geographical policing areas in England, covering a mix of rural, urban, and coastal environments. The force has a growing number of officers, reflecting ongoing efforts to meet diverse and complex policing challenges across the region. To manage mental health-related incidents, the force employs several key structures and response mechanisms. One such initiative is the Joint Response Unit (JRU) Footnote 1, which pairs police officers with Approved Mental Health Professionals (AMPs) to provide specialist support in responding to mental health crises. The JRU operates under a co-response model, aiming to provide individuals in distress with early intervention through the combined efforts of trained mental health professionals and police officers. Additionally, control room staff use structured decision-making tools to assess mental health-related calls and determine whether a response falls under police or health service responsibility. This policing context – characterised by a large, diverse geographical area, seasonal demand surges, and multi-agency mental health initiatives – frames the operational challenges explored in this study.

Interviews

A total of 14 semi-structured interviews were conducted with key stakeholders involved in policing and mental health. Participants included both strategic and operational police staff. The strategic staff comprised the Head of Custody and Reducing Reoffending, the Prevention Strategic Coordinator, the Victim Care Manager, the OPCC Commissioning Manager, the Mental Health Strategic Coordinator, and the Suicide Prevention Strategic Coordinator. The operational staff included two Control Room Sergeants, two Custody Sergeants, and the Patrol Inspector who also served as the Force Missing Persons Deputy Lead. Additionally, mental health staff from partner services participated, including the Clinical Practice Lead for Criminal Justice Liaison and Diversion, LiveWell staff, and an alcohol and substance abuse mental health worker.

Interviews lasted about an hour, and followed a semi-structured format, with questions focusing on several key areas. First, participants were asked about resource needs, aiming to identify the essential resources required for managing mental health-related incidents. Another focus was on actions and achievements, exploring the specific procedures and actions taken by officers and the outcomes of these efforts in real-life scenarios. The interviews also examined strategies to reduce negative impacts, seeking ways to mitigate the adverse effects of policing on both officers’ and individuals’ mental health. Additionally, participants were asked about current practices and outcomes, to assess the effectiveness of existing approaches in supporting individuals with mental health challenges. Finally, the discussions gathered insights into key resources and procedures, focusing on the most critical tools and standard operating procedures in place for handling these situations.

All interviews were audio-recorded and transcribed verbatim with consent from the participants. Names were anonymised to ensure confidentiality and protect the identity of the interviewees. The interview transcripts were analysed using thematic analysis, following an inductive approach to identify patterns across the data. Initial codes were generated through close, repeated reading of the transcripts, focusing on issues raised by participants rather than on pre-defined categories. Codes were then reviewed, compared, and grouped into broader themes that captured shared meanings and recurring challenges across interviews. The coding and analysis were conducted by the research team, with regular discussion to refine theme definitions and ensure consistency. NVivo was used to support data management and organisation. This process enabled the identification of key themes that provide insight into the challenges and opportunities associated with policing mental health-related incidents.

Documentation

Documentary materials were reviewed to provide contextual understanding of the policy and organisational environment shaping police responses to mental health-related incidents. This review included key national policy and strategic documents underpinning the force’s approach, such as the National Vulnerability Action Plan (2020–2022), the NPCC Mental Health Strategy (2022–2025), and the National Partnership Agreement: Right Care, Right Person (2024). At the local level, while specific internal management statements and operational tactics were confidential and therefore not accessible, contextual insights were drawn from briefings on the overarching RCRP approach, scrutiny panel reports, and internal mental health guidance and training materials shared by the force.

These documents were not subjected to formal qualitative coding or thematic analysis. Instead, they were reviewed to contextualise interview and observational data, clarify policy intent and organisational expectations, and support interpretation of how mental health-related incidents were understood and managed within the force. Documentary materials therefore served a supplementary, contextual role within the overall research design rather than constituting a primary analytic data source.

Observations

Over 48 h in September 2024 the lead author observed key police activities and processes related to mental health in real-time. The observations provided an immersive understanding of several areas. Police control room operations offered insights into how mental health-related incidents are managed at the operational level. During a JRU shadowing, the researcher observed officers’ real-time responses to incidents involving individuals with mental health challenges. Additionally, collaborative efforts were explored through visits to places of safety and custody centres, alongside conversations with healthcare professionals and mental health partnership staff, highlighting the multi-agency approach to mental health in policing. These observations offered valuable data on the daily challenges officers face and the collaborative structures that support their work.

Detailed field notes were recorded during and immediately after each observation period, capturing descriptions of interactions, decision-making processes, and contextual factors relevant to mental health-related incidents. These field notes were subsequently organised and analysed using the same thematic analytic approach applied to the interview data. Observational data were coded inductively and used to complement and contextualise interview findings, allowing for triangulation across data sources and providing insight into how reported practices aligned with observed operational realities. Observations thus formed an integral component of the overall analysis rather than serving solely as illustrative background.

Findings Footnote 2

The findings section presents how officers described managing mental health-related incidents within the RCRP context, and how this shaped (i) boundary work between enforcement and care, and (ii) decision-making across the key stages of incident handling (Figure 1). Across interviews and observations, officers described RCRP as clarifying the intended limits of police involvement, but also emphasised that capacity constraints and risk concerns often pulled police back into a default responder role.

Figure 1. Policing mental health process framework.

Read the detailed description of this figure The figure shows a horizontal process diagram with 3 rounded rectangles connected from left to right by rightward arrows. The first rectangle is labeled "1 Police contact and log management" and contains 2 bulleted sentences. The first bullet states that mental health incidents are identified through 999 emergency calls to the police contact centre or through contact initiated by police during routine patrols or other interactions. The second bullet states that the control room manages demand and incident logs using the Right Care Right Person toolkit to assess and allocate resources. The second rectangle is labeled "2 Police response" and contains 1 bullet explaining that officers, including the Joint Response Unit, are dispatched to attend mental health related incidents according to the nature of the call and the assessed risk. The third rectangle is labeled "3 Custody or place of safety" and contains 1 bullet describing that after attending a mental health incident, officers may take individuals to custody or a designated place of safety, depending on circumstances, in coordination with National Health Service mental health providers, LiveWell place of safety staff, and the Liaison and Diversion team. Display full size

Over-involvement of police in mental health

Participants described mental health as now embedded in day-to-day policing, affecting call-handling, deployment decisions, frontline response, and custody pathways. As one senior participant noted, mental health issues shape ‘the entire process – from the initial contact … to what happens … in custody’ (John, Prevention Strategic Coordinator).

Officers repeatedly returned to the tension between enforcement and caregiving. While RCRP aims to reduce police involvement in non-criminal mental health-related demand, participants argued that the feasibility of withdrawal depends on the availability and responsiveness of partner services. As Mark (Head of Custody and Reducing Reoffending) put it: ‘Over-policing someone who is mentally ill is as bad as under-caring … [yet] there’s that ongoing tension … being the law enforcement agency and the ‘friend to all in distress’ … Right Care, Right Person is great in theory, but it has caused difficulties … ’

In the following sections, we unpack these challenges by examining how police navigate their dual roles as law enforcers and de facto caregivers at each stage of the policing mental health process, from the initial contact through to the final resolution.

Policing mental health: mapping the process

We structure the findings around the stages through which mental health-related incidents were described as progressing – from initial contact and triage, through response and (where relevant) custody outcomes (Figure 1). This framework emerged inductively from the data as an analytic device to organise recurring patterns in participant accounts rather than reflecting a formal internal protocol.

| (1) | Front-end triage and classification under uncertainty |
At the first point of contact, staff described triage as shaped by time pressure, incomplete information, and uncertainty about whether behaviours reflected mental distress, criminality, or both. A control room sergeant summarised the core premise of RCRP as follows:

The whole point is that the police shouldn’t be attending because there are other agencies who can supply a better service … we’re not mental health experts.

(David, Control Room Sergeant 1)

However, officers described several barriers that routinely complicated this logic.

Limited access to mental health information and expertise

Participants reported that accurate early classification often depended on whether officers could access specialist input or reliable background information. While Joint Response Units (JRUs) and Approved Mental Health Professionals (AMPs) could provide additional insight, this support was intermittent and availability-dependent. During observations, officers sought AMP input to determine whether a case should be treated as primarily criminal or health-related, illustrating how decision-making could hinge on access to mental health records. Where this access was absent, officers described greater risk of misclassification, delayed recognition of mental health needs, and avoidable escalation.

Participants also noted efforts to improve this front-end knowledge gap (e.g. developing mental health advice plans), but characterised these initiatives as emergent and uneven. Until such mechanisms are embedded, staff described triage decisions as reliant on partial information and professional judgement, with consequences for downstream pathways.

Distinguishing distress from criminality and managing overlap

Officers emphasised that mental health-related distress frequently presents in ways that resemble criminal or public order behaviour (e.g. aggression, confusion, intoxication, non-compliance), making initial categorisation difficult. A brief example observed in the control room illustrated this overlap: a mother called police after her daughter locked herself in a bathroom following an argument and made threats of self-harm. The incident was logged as having both domestic and mental health dimensions, but because the domestic classification triggered police attendance, officers reflected that the response pathway would likely have differed had it been categorised as ‘mental health only’ under RCRP. More broadly, participants emphasised that early categorisation decisions shaped whether cases moved into enforcement-led pathways or were diverted towards health-led responses.

Rcrp toolkit: clarity, but persistent ‘what if’ pressure

Control room staff described the RCRP toolkit as supporting more consistent triage through structured prompts, particularly in determining when police attendance was justified. However, participants stressed that the emotional and organisational pressure of deciding not to deploy police remained substantial:

Even if you’re following the policy, the worry is always there … what if we say no, and it turns out someone needed help? That responsibility is stressful.

(Laura, Control Room Sergeant 2)

Staff also described ambiguity created by overlap between RCRP and other deployment categories, leading to uncertainty about which policy should take precedence in practice.

When partner capacity constrains triage decisions

A recurring theme was that triage decisions were often made in the shadow of partner capacity constraints. Participants described situations in which the ‘correct’ referral under RCRP still resulted in police involvement because ambulance or mental health services were delayed or unavailable:

When the other services should step in instead of the police, when they're not available, then the whole thing kind of breaks down …

(David, Control Room Sergeant 1)

Participants offered contrasting examples to illustrate the stakes of these decisions. In one incident, control room staff assessed a missing person report as high risk and deployed specialised communication support, enabling timely intervention and conveyance to a place of safety. In another, an incident initially passed to ambulance services escalated during delays, and police later encountered the individual deceased; reflecting on this, an officer asked, ‘should we have done more?’ (David, Control Room Sergeant 1). These accounts reinforced that – regardless of formal criteria – service responsiveness shaped whether police withdrawal was experienced as safe and defensible in practice.
| (2) | Frontline response: preparedness, specialist support, and ‘staying involved’ |
Participants highlighted the varied ways in which police respond to mental health-related incidents once they had been identified and logged by either control room staff or officers on the ground. In responding to these incidents, officers relied – when they had received it – on their mental health training and, whenever possible, collaboration with mental health professionals to manage complex situations.

Training and experience as uneven resources

Participants described improvements in foundational mental health training for new recruits but argued that training alone did not prepare officers for the complexity and volatility of crisis situations. A neighbourhood patrol inspector noted that earlier cohorts received little formal training and relied on ‘experience’ and ‘working with partners,’ whereas newer recruits now receive some structured input (Alex, Patrol Inspector). Nonetheless, staff emphasised that less experienced officers often struggled to apply training confidently in dynamic situations, especially where legal thresholds were unclear and health alternatives were limited. The Head of Custody and Reducing Reoffending highlighted this challenge:

They have received as much training as other officers but they’re trying to apply it with far less experience … It’s not so much a lack of training anymore, but perhaps not as much practice in managing dynamic, complex, and quickly changing situations.

(Mark, Head of Custody and Reducing Reoffending)

The value – and limits – of specialist co-response

Officers described JRUs as a valued resource that increased confidence and supported decision-making in mental health incidents:

The AMP has built my confidence in dealing with mental health jobs; you know they are there to help make decisions and support us when we’re unsure.

(Chris, Police Officer 1)

However, participants repeatedly noted that JRU availability was limited, meaning most mental health-related calls were managed by patrol officers without specialist input.

Crisis management without alternatives

When responding without specialist support, officers described feeling constrained by limited powers and limited options. One patrol officer summarised the dilemma: police are discouraged from unnecessary Section 136 detention yet may have ‘no skills or powers’ to do more than detain when responding alone to suicidal distress (Emma, Patrol Officer). Participants described a recurring pattern in which police remained engaged because health services were unavailable or because once an incident was ‘accepted,’ it was operationally and morally difficult to withdraw.

During our time with the JRU, we observed officers responding to three distinct mental health-related incidents. The first involved a rough sleeper who was reported running through the streets carrying dead animals and attempting to ‘bring them back to life.’ The individual had also assaulted members of the public by throwing the animals at them. Officers described how this person had recently been in custody multiple times for similar behaviour, with mental health issues appearing to be a key factor in the repeated incidents. According to the officer on duty, a police response was deemed necessary due to the criminal element involved, illustrating how mental health-related incidents frequently overlap with law enforcement responsibilities, complicating efforts to separate health-led and police-led responses.

The second incident involved a man who threatened to jump off a bus stop unless he was provided with housing for the night. He told officers that ‘there was no point in living’ without accommodation. In our discussions, the AMP and police officer explained that officers were already familiar with him and did not believe he was at imminent risk to himself. Despite the case not aligning with RCRP criteria, they stated that the JRU attended due to the human element of the situation. The AMP assessed the individual, concluding that he was not an immediate suicide risk because he was making future plans and had arranged accommodation for the following day. The AMP also reflected on the limited physical danger posed by the incident, noting that the worst possible outcome would be a non-fatal injury, given the proximity to a hospital.

While handling the second incident, a more urgent call came through about a suicidal male who had entered the woods. This call was immediately classified as requiring police intervention under RCRP guidelines, given the high risk of serious harm. By the time the JRU arrived, the individual had already tied a rope around his neck and attempted to take his own life, but the tree branch had broken, preventing his death. Given the severity of the incident, the officers considered detaining the man under Section 136 of the Mental Health Act. However, after engaging with officers and paramedics, the individual eventually agreed to go to the hospital voluntarily, eliminating the need for a formal detention. The scene involved a significant response, including four additional police officers, the JRU team, and the ambulance service.

Officers reflecting on rCRP deviations

In both the second and third incidents, officers noted that their presence was not strictly required under RCRP but that they had responded nonetheless. Following the bus stop incident, the AMP and police officer reflected on their attendance, questioning whether their involvement had been necessary:

This shouldn’t really be for us, should it? According to RCRP, we shouldn’t be here.

(Katie, Approved Mental Health Professional, AMP)

A similar reflection was made after the incident involving the suicidal male in the woods, when the police officer and AMP commented on the significant response for just one person in crisis: We shouldn’t be here for this one either, really. Ambulance could have handled this, and now more officers are showing up when it's just one person in crisis.

(Chris, Police Officer 1)

These reflections highlight a recurring challenge in RCRP implementation – officers often respond to incidents even when their presence may not be necessary. We were told that this happens either because health services are unavailable or because police involvement in mental health crises has become routine and difficult to step away from.

Strategic reflections on police attendance in mental health incidents

In our interview with the Prevention Strategic Coordinator, which occurred after our observations of the JRU shifts, he acknowledged that while RCRP is designed to minimise police involvement in mental health-related incidents, operational realities often complicate this goal. He emphasised that cases involving a criminal element – such as the rough sleeper assaulting members of the public – clearly justify police attendance. However, he also highlighted ongoing issues with resource allocation, noting that officers frequently become over-committed to cases that should be handled by other services. Reflecting on the incidents we observed, he stated:

You spent time with officers going specifically to mental health incidents, and while it was absolutely right that they attended the one involving the woman throwing dead seagulls at people – because that had a criminal element – [the] other situations … involved no threat to anyone but themselves. In both cases, there was one police officer from [the Joint Response Unit] and then two more officers turned up. That’s three officers tied up with one individual, and this happens often. Everyone wants to help, and once the job is accepted, it’s difficult to pull back. The easiest way to control someone without harm is to have multiple officers – one on each limb, someone securing their head – but the question remains: should we be turning up at all? This is where ‘Right Care, Right Person’ comes into play, but there are still lots of challenges to address.

(Samantha, Mental Health Strategic Coordinator)

| (3) | Custody and the shortage of appropriate places of safety |
A consistent finding was that custody remained a ‘backstop’ when appropriate health-based alternatives were unavailable. Participants described limited local capacity in places of safety and mental health beds, resulting in delays, repeated handover attempts, and cases in which individuals in crisis were held in police custody despite widespread recognition that it was unsuitable. As one custody sergeant reflected:

This is not the right environment for them really … we are not geared up for people who have got those sorts of issues … We’re the shortfall of everything … we're not a place of safety. We're not a hospital.

(Steven, Custody Sergeant 2)

Staff described acute legal and ethical pressure when detention thresholds were exhausted, but no health placement could be secured. Mark (Head of Custody and Reducing Reoffending) stated: We’re keeping lots of people illegally in the custody suite because we run out of our powers under crime to keep them, and then there isn’t a mental health bed for them to be pushed into … We’ve detained people illegally for days … people in crisis in the police cell.

(Mark, Head of Custody and Reducing Reoffending)

Custody staff described workarounds and emergency arrangements with mental health teams to secure beds, but framed these as symptoms of system strain rather than stable solutions. Participants also noted that embedded mental health support and Liaison and Diversion provision could improve identification of vulnerability and referral pathways. However, they emphasised uneven coverage, limited out-of-hours capacity, and persistent gaps in community support (including for neurodiversity), which constrained what diversion could achieve.

The weight of decision-making in custody

Custody officers reflected on the emotional and professional challenges of making high-stakes decisions about individuals in crisis, particularly when those released from custody later come to harm or pose a risk to others. Participants cited two cases that exemplified these difficulties – one in which an individual went on to commit a serious violent offense following their release, and another in which a detainee took their own life shortly after leaving custody. Footnote 3 While the officers interviewed were not directly involved in these cases, they used them to illustrate the broader pressures they face in balancing risk, adhering to procedures, and dealing with the emotional impact when things go wrong.

One custody sergeant described the difficulty of assessing risk within time-limited detention periods, explaining that despite concerns about an individual’s mental state, release decisions must align with existing legal thresholds:

In custody, we might see that someone poses a serious risk to themselves or others, so we detain them under Section 136, bring in mental health to assess them, and then within 24 h they’re released, and sometimes things go wrong.

(Steven, Custody Sergeant 2)

Another officer reflected on the long-term emotional impact of such cases, describing how staff often carry a deep sense of responsibility, even when they have followed protocol: This is the impact it has on us because, ultimately, we are human, and we do this job because we care about people … It’s a tough world to work in, and there’s only so much reassurance we can offer each other.

(Paula, Custody Sergeant 1)

The fear of legal repercussions and inquests following mental health-related deaths has cultivated greater risk aversion among officers working in custody. The Head of Custody and Reducing Reoffending described how this heightened sense of accountability has made officers more cautious, sometimes at the expense of effective decision-making: What that’s done in 2024 is bred an absolute fear … We’re so scared of it now that it makes it worse. Officers have become risk averse and fearful of inquests.

(Mark, Head of Custody and Reducing Reoffending)

These reflections underscore that custody officers must navigate difficult and often distressing decisions, balancing legal constraints, mental health assessments, and risk management, all while working under intense scrutiny and with limited resources.

Discussion

This study explored how police officers in one English police force manage mental health incidents, focusing on three key questions: (1) how officers balance their dual roles as law enforcers and caregivers, (2) the key processes and challenges they face in handling mental health incidents, and (3) how the Right Care, Right Person (RCRP) framework shapes police decision-making. In doing so, the findings speak directly to existing academic debates on the care – enforcement paradox in policing (Wondemaghen Citation 2024), the operational challenges of police responses to mental health crises (Penhale and Cummins Citation 2024, O’Reilly Citation 2025), the systemic drivers underpinning RCRP (Balfour et al. Citation 2021, Richmond and Gibbs Citation 2021, Watson and El-Sabawi Citation 2023), and the mixed evidence surrounding partnership-based response models (Eloi et al. Citation 2025, Teti et al. Citation 2025).

Our findings indicate that officers frequently navigate a tension between their enforcement duties and their role in safeguarding vulnerable individuals, making situational judgments based on limited information, competing priorities, and the availability of alternative services; reflecting the broader challenge identified in academic discussions on the balance between enforcement and care in police mental health responses (Hayhurst and Sparkes Citation 2023 Bird et al. Citation 2024,, Crawford Citation 2024). This study aligns with a wider body of literature that conceptualises policing mental health as a structurally embedded paradox rather than a problem of individual discretion alone (Balfour et al. Citation 2021, Richmond and Gibbs Citation 2021, Watson and El-Sabawi Citation 2023).

At each stage of a mental health-related incident, officers face specific challenges – from identifying risk at the first point of contact, to managing crises in the field without specialised support, to handling cases in custody when no appropriate place of safety is available. While RCRP provides clearer guidance on when police should and should not be involved, its implementation is shaped by resource constraints, gaps in inter-agency coordination, and the practical realities of responding to unpredictable incidents. As a result, officers often struggle to withdraw from incidents when health services are unavailable, and concerns about risk, liability, and moral responsibility frequently lead them to engage even when RCRP suggests otherwise.

Balancing law enforcement and care

It is clear that the dual role of police as both law enforcers and caregivers creates significant tensions, particularly in situations involving mental health crises (c.f. Hayhurst and Sparkes Citation 2023 Bird et al. Citation 2024,, Crawford Citation 2024). Consistent with existing literature on the care – enforcement paradox in policing (see e.g. Wondemaghen Citation 2024), officers described the challenge of distinguishing between mental health distress and criminal behaviour, particularly when individuals presented with aggressive, erratic, or non-compliant behaviour. These decisions about whether to approach a situation as a crime or a mental health crisis were often made with limited information and under time pressure, leading to a difficult balancing act between enforcing the law and providing care, reinforcing findings from prior studies that highlight professional dissonance between enforcement-oriented training and care-oriented practice (Rhodes et al. Citation 2023). This study extends existing work by showing how these tensions are experienced at a granular, operational level, with officers describing emotional strain and moral responsibility even when acting in accordance with policy guidance. The burden of balancing enforcement and care is not merely a conceptual problem but is emotionally consequential, particularly when officers remain the default responders despite formal efforts to redirect responsibility elsewhere.

Key challenges at different stages of a mental health incident

Our findings map onto the process officers in this particular force followed when handling mental health incidents, highlighting key challenges at each stage of the response. These challenges broadly mirror those identified in the wider, predominately US-focused, literature, which emphasises training gaps, communication difficulties, safety concerns, and systemic inadequacies in police responses to mental health crises (Cooper et al. Citation 2004, Vermette et al. Citation 2005, Wells and Schafer Citation 2006).

Initial contact

Control room staff played a key role in determining risk and deciding whether officers should be deployed. However, officers noted that inconsistent access to mental health records made it difficult to accurately assess situations at this early stage. Misclassification at this stage shaped how cases were handled from that point onward, with some incidents misidentified as criminal matters and others escalating unnecessarily due to a lack of mental health expertise at the first point of contact.

Deployment and response

Officers described how resource shortages in health services often meant that they responded to incidents that, under RCRP, they should not have expected to attend. The availability of Joint Response Units (JRUs), which paired officers with mental health professionals, was limited, meaning that patrol officers often had to navigate crises without specialised support. Some officers expressed uncertainty about how to proceed in situations where they were discouraged from using Section 136 powers but also lacked the authority to direct individuals toward health services.

Custody and places of safety

The force had limited access to designated mental health facilities, leading to some individuals being held in police custody when no alternative was available. Custody officers described this as a source of frustration, as they felt the custody environment was not appropriate for people experiencing a mental health crisis. Some officers reported that they had to hold individuals in custody beyond legal time limits due to delays in finding an available mental health bed.

Much of what emerged here aligns with existing discussions on managing mental health incidents, reinforcing research that policing decisions are shaped by policy frameworks, resource constraints, and situational factors (Home Office Citation 2024), as well as concerns that gaps in health service provision sustain police involvement in crisis care (Bird et al. Citation 2024). The challenges police face in responding to mental health are thus structurally produced, rather than the result of individual failings (Richmond and Gibbs Citation 2021, Watson and El-Sabawi Citation 2023).

The role of rCRP in police decision-making

Participants acknowledged that RCRP had made it clearer when they should and should not be involved in mental health incidents, and some described better coordination with health services as a result. This echoes policy claims that the framework provides clearer boundaries between policing and healthcare responsibilities (Home Office, & Department of Health & Social Care Citation 2024). However, there were also many cases where officers attended incidents despite them not fitting RCRP criteria. This seems to have happened for several reasons: health services were unavailable, leaving police as the only responders; officers felt a moral responsibility to act, even when RCRP suggested otherwise; it was difficult for police to withdraw from incidents once they were engaged, particularly if other agencies had not yet arrived; and the fear of ‘what if we say no and no one turns up’ weighed heavily on officers, with some describing the anxiety of making decisions that could have serious consequences if the wrong call was made. This echoes existing concerns that while frameworks like RCRP aim to direct cases to the most appropriate responders, this relies on the availability of those services on the ground (Home Office Citation 2024).

These findings add to the limited empirical research on RCRP, addressing the need for localised, in-depth analyses of its implementation, as highlighted in the Home Office’s (Citation 2024) evaluation. This study did not assess RCRP’s effectiveness; rather, it explored the day-to-day realities of policing mental health, where RCRP is one of several factors shaping officers’ decision-making. More broadly, the study adds to ongoing discussions about the evolving role of police in mental health response. While RCRP aims to clarify responsibilities, scholars have questioned how well these boundaries hold in practice, given the complexities of real-world incidents (Hayhurst and Sparkes Citation 2023). The findings provide an exploratory glimpse into how officers in one force experience and navigate these challenges in their daily work.

Partnership working and limits of co-response models

Our findings also speak to the broader literature on police – mental health partnerships and co-response models (Lowder et al. Citation 2024 Eloi et al. Citation 2025, Teti et al. Citation 2025,). While officers valued Joint Response Units when available, their limited capacity meant that most incidents were still managed by patrol officers without specialist support. This aligns with existing evidence suggesting that partnership models often improve officer confidence and coordination but do not fundamentally reduce demand or resolve structural gaps in crisis provision. Importantly, this study contributes to the literature by highlighting how variability in availability and implementation undermines the assumed effectiveness of partnership models, reinforcing concerns raised in prior evaluations that such approaches are highly contingent on local context, resourcing, and service capacity.

Study limitations

Several limitations should be acknowledged when interpreting the findings of this study. First, the research focuses on a single English police force, which limits the transferability of findings to other forces operating under different organisational structures, partnership arrangements, or levels of health service provision. While the in-depth case-study approach provides rich insight into frontline decision-making, the findings should be understood as illustrative rather than representative of all policing contexts.

Second, the study primarily captures police perspectives on mental health incidents and the implementation of RCRP. Although observations and documentary materials were used to contextualise these accounts, the absence of direct perspectives from individuals with lived experience constrains the ability to fully assess inter-agency dynamics or service-user impacts. Third, the observational component was necessarily limited in duration, providing snapshots of practice rather than longitudinal insight into how decision-making and partnership working evolve over time.

Finally, this study does not evaluate the effectiveness of RCRP or associated partnership models in terms of outcomes such as service use, arrest rates, or health impacts. Instead, it focuses on the processes and practical realities of policing mental health incidents. As such, the findings are best interpreted as contributing to understanding how RCRP is enacted in practice, rather than whether it achieves its intended policy outcomes.

Practical implications and future research

As an exploratory study, this research does not offer definitive conclusions but is instead intended to provide a starting point for further discussions on how police handle mental health incidents in practice. The findings highlight key areas for consideration, particularly in how officers balance their roles as law enforcers and caregivers. The emotional toll of navigating the tensions between these responsibilities was a recurring theme, reinforcing the need for improved training and structured support mechanisms to help officers manage complex mental health-related incidents more effectively.

Challenges also emerge at each stage of a mental health incident – initial contact, deployment, and custody – where officers face multiple constraints that shape their decision-making. Control room staff rely on structured decision-making tools, but these are only effective when sufficient health resources are available. Officers often find themselves managing crises alone, particularly when mental health professionals are unavailable. In custody, a shortage of appropriate places of safety means officers must sometimes hold individuals in police cells as a last resort, despite widespread recognition that these environments are unsuitable for those in crisis. These findings highlight the need for stronger inter-agency collaboration and improved crisis care infrastructure to ensure individuals in mental health distress receive the most appropriate response.

To improve mental health crisis management and strengthen RCRP implementation, several areas warrant attention, aligning with the Home Office (Citation 2024) RCRP evaluation recommendations. Expanding and standardising mental health training would ensure that officers develop consistent skills in crisis intervention, improving their ability to identify and respond effectively to individuals in distress. Strengthening coordination with healthcare services is also critical, as smoother handovers and increased access to mental health facilities could reduce reliance on custody and ensure individuals receive appropriate care more quickly. Additionally, greater flexibility in RCRP protocols may be necessary for complex or high-stakes situations, where strict adherence to guidance is impractical or alternative responders are unavailable. By addressing these areas, police can strengthen their response to mental health crises. Future research should explore how different forces implement mental health strategies, how local service provision affects police decision-making, and how inter-agency coordination can be improved. The ongoing evolution of RCRP – when paired with better inter-agency collaboration and sustained mental health investment – has the potential to make mental health policing more effective, sustainable, and responsive to real-world challenges.

Further research would benefit significantly from the inclusion of perspectives from senior leaders in mental health and acute healthcare, including those within NHS Trusts, Integrated Care Boards (ICBs), and relevant national bodies. Their insights into organisational constraints, interagency collaboration under the RCRP framework, and systemic responses to persistent challenges – such as inconsistent attendance at mental health incidents – would offer a more balanced, multi-sectoral understanding of both the problems and emerging solutions. Additionally, future work could explore how agencies might collaborate more effectively on preventative strategies, such as through multi-agency data sharing and analysis of mental health trends across individuals, demographics, and geographic areas, to enable more targeted early interventions and address service gaps proactively.

Conclusion

This study used interviews with strategic and operational police staff, policy and strategy document analysis, and real-time observations to explore the complexities of managing mental health-related incidents under the RCRP framework in an English police force. In response to the question posed in the introduction – when can police safely choose not to respond, and who will step in if they don’t? – our findings suggest that this decision is rarely determined by policy alone. Instead, it depends on local service capacity, the availability of alternative responders, officers’ perceptions of risk, and the practical realities of incident management. Where health and social care services are accessible and responsive, police disengagement is more feasible. Where they are not, officers frequently remain involved despite RCRP guidance.

This study makes three significant contributions. First, it provides empirical, practice-based insight into how the care – enforcement paradox is navigated by officers in real time, extending largely conceptual discussions with grounded accounts of decision-making and emotional labour. Second, it offers process-level detail on how mental health incidents unfold across stages of response, illustrating how systemic constraints shape outcomes at each point. Third, it responds directly to calls for localised, in-depth studies of RCRP, demonstrating how national frameworks are interpreted, negotiated, and at times overridden in practice.

The findings highlight the ongoing tension between the police’s role as law enforcers and their frequent position as de facto caregivers in the absence of adequate health service availability. Officers often face difficult, high-pressure decisions about whether to treat an incident as a crime or a mental health crisis, sometimes stepping into a caregiving role even when policy suggests health services should lead. This not only creates an emotional burden but also risks misalignment between enforcement priorities and the needs of individuals in crisis. Strengthening inter-agency coordination, ensuring adequate health service capacity, and refining response protocols will be critical to alleviating these pressures. A system that properly supports both police and health professionals will help ensure that individuals in crisis receive the right care from the right person, reducing the strain on officers and resolving the tension between their dual roles.

Ethical approval and informed consent statement

Ethical approval for this study was granted by the UCL Ethics Committee, and all participants provided informed consent before taking part in the research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data used in this study was qualitative, derived from interviews with strategic and operational police staff, analysis of policy and strategy documents, and real-time observations. To protect the anonymity of both participants and the participating police force, we are unable to share interview transcripts, fieldwork notes, or any related documents.

Additional information

Funding

This research was supported by the Economic and Social Research Council [grant number ES/X003434/1].

Notes

1 Pseudonym used to maintain force anonymity.

2 Pseudonyms have been assigned to participants to ensure anonymity while allowing readers to identify who is speaking and understand their role within the policing and mental health framework.

3 Details of the two cases have been omitted to protect the anonymity of the force and those involved.

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