Multi-agency action learning: Challenging institutional barriers in policing and mental health services

Engagement and motivation

In the first meeting careful attention was given to ensure the presence of at least one representative from every organisation that the research team considered could, in some way, be affected by the introduction of PolQuest. The group began positively with 13 people attending. There was consensus that the group objectives addressed an important multi-agency issue and members spoke with enthusiasm about potential developments and opportunities to work collaboratively.

‘The group as a whole seems to have immediately signed up to the idea and I expect most of them will continue to attend. Two people approached me to discuss options for staying involved for the dates they would have to miss.’ (Facilitator notes, November 2012)

However, this observation may have been too optimistic. After the first meeting, some organisations that focused on community based services or did not specialise in mental health felt they were less directly affected by what happened in police custody and should not continue to attend group meetings. Interestingly, though they wanted to be included in group communications, and some were willing to comment on materials in absentia or attend specific meetings where their service would be the focus of the discussion. Upon reflection, it may have been beneficial in the first meeting to have spent more time discussing the wider impact of PolQuest on partner agencies and how they could benefit from being involved in the action learning sets.

‘Some people saw themselves as less directly linked to police custody operations and thought they were not going to be useful or were unsure why they should be part of the group. I don’t think enough time was spent on exploring how people with “indirect” services may be affected by the study.’ (Facilitator notes, November 2012)

Regular in-person participation came from those who saw their organisations as most directly affected by PolQuest, for example the police, CJMHL&D, private custody healthcare and the Appropriate Adult service. Initially the group facilitator was concerned that a lack of wider participation would be a disadvantage, as some decision-making may be hampered due to the absence of certain agencies. Whilst it was acknowledged that it might have been beneficial for those agencies who had, early in the process, judged their role as indirect to have had a more prominent presence, the group overall appeared to understand why they had chosen to remain at arms-length and ultimately felt the right people and agencies were in regular attendance.

‘I think the right people were around the table – I agree that for some agencies there was no direct or immediate benefit but there was for everyone else that was here, yes they were the right people’. (Action Learning Group Staff Member)

The purpose of inviting a wide range of multi-agency representatives reflected the potential ripple effect of PolQuest, as judged by the research team. We felt that the introduction of PolQuest may reveal an unknown level of mental healthcare need by, for the first time, systematically screening each adult detainee individually for mental ill health. This could not only increase the number of people requiring an assessment by the CJMHL&D service, but also impact upon wider service provision if, as a result, more detainees were referred into community health and social care services. Perhaps importantly, some participants from community agencies, expressing that their services were already overstretched, displayed a defeatist attitude to a potential increase in rates of referral. Thus, holding on to traditional patterns of ‘silo working’ may have been a factor which deterred some services from engaging fully in the action learning process.

Relinquishing control

Throughout the meetings, the group began to show a dependence on the facilitator. Although encouraged to ‘make the group their own’, initially this was not fully taken on board. This may be because the action learning groups were expected to contribute to a research project which, by the time of their involvement, had been running for over a year. Group members may therefore have felt reluctant to ‘take charge’, as they had not set the over-arching agenda themselves. The role of facilitator is meant to support the group focus and challenge assumptions (Dixon, 1998); however, in this particular case, the facilitator had a significant professional interest in achieving specific outcomes for the success of the research project overall, a conflict which contributed to a struggle in handing over responsibility to the group.

‘In this meeting I learned that I need to be more assertive with delegating tasks and more trusting to let members contribute in their own ways. I need to make more of an effort to pass responsibility onto others in the group.’ (Facilitator notes, April 2013)

As running the action learning sets was part of her role as a member of the research team, the facilitator felt ultimate responsibility for the production of outputs which would be regarded by the extended research team as fit for purpose. It is possible that, since group members were aware of this, that it impacted upon the group’s dynamics. Whilst members would participate actively during the meetings, they often looked to the facilitator to confirm final decisions and assign actions. When asked to provide feedback on drafted materials, the group gave constructive and creative input; however many members were resistant to independently taking the lead to draft materials from scratch.

An obstacle of action learning is that, whilst members view the group as their own, the consequences linked to failure often rest solely on the facilitator. In our work, this feeling of responsibility experienced by the facilitator was mitigated over time by an acknowledgement and confidence that group members had diverse expertise and skills which were perfectly suited to achieving successful project outcomes, thus it was both possible and important to explore and exploit these to their full extent. The inability of a facilitator to relinquish control has been widely discussed within the action learning literature (Rothwell, 1999; Stark, 2006; Weinstein, 1999). Reflecting on the action learning process with other facilitators can assist in discovering behaviour and thought patterns, addressing doubts and finding appropriate solutions (Weinstein, 1999). In this case, the group facilitator was supported by a senior action learning facilitator who provided initial training, reviewed and commented on the facilitator’s reflective diary and observed occasional group meetings, providing immediate feedback. This resulted in the facilitator’s increased awareness of her behaviour, its impact on group dynamics, leading to a more assured style of facilitation.

Careful consideration was required as to the level of work members were given between meetings. We chose not to require individual reflective diaries, aware that the project would require substantial action in between meetings and thus mindful not to overload members with ongoing tasks. It became apparent that the setting of ‘excessive’ homework resulted in noticeably low attendance at the following meeting thus, over time, the facilitator worked hard to ensure a balance. As meetings progressed and deadlines approached, those with the highest stake in the success of the project, for example the police and custody-based healthcare clinicians took the lead, making useful contributions which had been discussed within, and were clearly supported by, their own teams. Upon reflection, this was perhaps due to an unintended lack of clear communication on the part of the group facilitator. Initially, six action learning meetings were scheduled but, part way through the process, two further meetings were scheduled to allow more time to complete the project objectives, so perhaps this action led to group members being unable to identify a clear project end point, impacting upon their contributions.

Overcoming the defeatist mindset

A recurring challenge at the start of the action learning group meetings was to manage the tendency of some members to focus on examples of worst case scenarios in which it was suggested that the usage of PolQuest could ‘grind the police custody process to a halt’, resulting in pandemonium.

‘The further need for mental health assessments could slow down the custody process dramatically … it is likely to lead to more Appropriate Adults being required … could open the floodgates to lots of legal challenges on past cases … opportunists could use it to slow down the custody process and get pointed down an alternative pathway than the criminal justice system’. (Action Learning Group Staff Member)

Police custody can be a high stress and volatile environment where things can, and sometimes do, go wrong. However, it is equally true that it is very controlled, bound by strict rules and predominated by a set of routines which have developed over time. For the facilitator, it became increasingly important to focus members on the bigger picture, concentrating on what usually happens, rather than allowing them to extrapolate a small number of discrete, particularly challenging cases and thus falling prey to defeatist attitudes. Williamson and Prosser (2002) stated that, since action research is aimed at change, it can be perceived as threatening for individuals and organisations and the question ‘how could things be done differently’ can be extremely daunting.

Group members routinely positioned their working lives within a context of harsh and repeated budget cuts; loss of services through commercial competition; high turnover of staff through recruitment and retention issues; and unmanageable workloads for which they believed they would not receive appropriate levels of support from within their own organisations.

‘People were very focused on the details such as staffing and resource implications … some representatives from community services were dismissive, stating they were already overworked and had a backlog of referrals so what would it matter if they got more’. (Facilitator notes, November 2012)

Discussions that were intended to be taken to extended staff groups were initially met with a ‘can’t do’ attitude, constantly stating ‘lack of capacity’ as an insurmountable barrier. Instead of challenging this situation, group members tended to sympathise with each other, accepting this as a viable reaction. One technique that worked particularly well for our group was the use of a grid where members were asked to identify individual problems or areas of concern, but were discouraged from listing additional barriers until a solution to the first barrier was written on the board.

‘Creating a chart that mapped each issue raised and corresponding solutions was invaluable. The group responded well to this and were able to cover a lot in a short period of time. We made excellent progress. This is a strategy we should continue in other meetings.’ (Facilitator notes, December 2012)

This method quickly created an enlightening list of barriers, all accompanied by potential solutions, thus maintaining focus on the positives, rather than the negatives.

Group dynamics

Many of those who attended the meetings already knew each other from other areas of their working lives as some, such as the police, CJMHL&D and the private healthcare provider, routinely worked together. As a result, group members were generally comfortable with each other from the outset. Initially, this was considered to be positive.

‘What is good is that most people already know each other or have working relationships outside the group. They felt comfortable around each other and were discussing how to support each other with group actions’. (Facilitator notes, January 2013)

Unsurprisingly, those with the greatest stake in the success of PolQuest, and those who were well known by other group members, tended to dominate conversations. Noticeably, the pre-established amiability and familiarity amongst some members could prove challenging when asking the group to consider new solutions and changes to current practices. Group members were generally diplomatic and professional, however, sometimes to the detriment of challenging each other critically and objectively.

‘Participants wanted to speak truthfully about how things were in practice but often seemed to bite their tongues in favour of diplomacy. Manageability of workload and “covering their backs” when something had the potential to go wrong appeared to be the priority.’ (Meeting minutes, April 2013)

Upon reflection, it may have been beneficial to have more people present without pre-existing relationships to other group members, to assist members in seeing their issues in a new light, thus encouraging optimism for change. In the absence of this, it was often the facilitator who challenged the group in an attempt to assist them in being open to new ways of thinking.

Securing the regular attendance of a service user at meetings was a struggle. Although in the earlier stages of the study a number of service users were willing to take part, reasons for not attending included feeling uncomfortable with the group setting, periods of mental ill health and an inability to arrange escorted leave to attend from the secure mental health facility in which one service user was formally detained.

Involving service users with mental health problems and a past history of offending in a research project over time can present unique challenges. Such individuals may lead complex lives and may still experience regular periods of ill health. Additionally, many ex-offenders with mental health issues have not had particularly positive experiences with the police or mainstream mental health services and therefore attending a meeting with such professionals can be daunting. When absent from the actual group meetings, service user input was continued by arranging separate meetings between the facilitator and individual service users, as well as engaging the professional lead for a local service user involvement group. When a service user did attend the meetings, there was a tangible, and positive, change in group dynamics. Staff noticeably became more optimistic and enthusiastic about creatively exploring service improvements above and beyond the project objectives. The service user was also best placed to pose the difficult questions that challenged staff to consider innovative solutions.

‘What went really well was having a service user attend. It offered invaluable insight, everyone seemed to appreciate that he was there and enjoyed talking to him. It was clear that staff were also interested in asking him a variety of questions that could help them improve their services in general outside of the meeting objectives. He was incredible. I was reminded of the importance of having a service user present in staff meetings and I think the other staff were reminded of the value of service user insight as well.’ (Facilitator notes, July 2013)

This change in group dynamics demonstrated the benefit of having service users and staff work closely together to identify barriers and solutions. The thrill of having a service user with lived experience, willing to share his story, reflect on the challenges facing staff and propose well thought out solutions became an asset for engaging staff participants. Staff were occasionally inspired to ‘sneak in’ questions and conversation topics that reflected a specific challenge they faced, outside the remit of the group agenda. The professionals experienced first-hand the value of service user input in their work. Additionally, the service user gained confidence in his ability to speak to, and be heard by, professionals in positions of power. When the project was completed, the service user who had attended the group spoke at a national conference about mental health and policing, confidently sharing the speakers’ platform with two members of the House of Lords, senior police officers from the United States of America and the UK, as well as a range of highly respected clinicians and academics (Noga, McKinnon, Sansbury, & Booth, 2013).

Strengthening partnerships

A benefit to the action learning method is that participants tend to strengthen their working relationships outside of the group as a result of the discussions that take place throughout the action learning process itself (Walsh et.al., 2014). One of the most practical unintended outcomes came from a discussion on the Appropriate Adult policy between the police and the local county council. Throughout the discussion it was apparent that some confusion around the current protocol existed between the agencies that had not previously been investigated.

‘This is a significant gap in services [regarding Appropriate Adults] which needs addressing … This discussion has actually resulted in changes to the county council Appropriate Adult protocol to provide clarity in the service they offer and make it easier for officers to contact them.’ (Meeting minutes, January 2013)

Through their own initiative, the representatives from the police and the county council subsequently revised the Appropriate Adult protocol and changed the wording to provide clarity and improve procedures, thus strengthening their partnership more broadly as a result of participation in the group.

Group members generally felt that the process had strengthened the working relationships they currently shared and had facilitated additional dialogue between themselves and other agencies. Some group members noted areas where their services could further develop partnerships, intending to explore these options with their newly strengthened contacts.

‘Two group members stated that even though they did know each other prior to the group, they hadn’t really sat down and discussed specific improvements to agency practices and reflected on how to implement them but, as a result of the meetings, they were now working together better.’ (Facilitators notes, July 2013)

Participation in the group also resulted in increased levels of confidence and self-esteem as they now felt their concerns were understood and shared by others, reducing feelings of professional isolation. One member stated that she

‘was given the courage to bring forward some concerns and challenges she had in her everyday working practices and as a result, relevant managers were now in an on-going discussion regarding this issue.’ (Meeting minutes, July 2013)

Group members commented on how quickly the action learning meetings were able to achieve outputs. Their previous experiences in developing multi-agency protocols had taken much longer, attributed to the absence of a clearly identified group of individuals meeting regularly to complete defined tasks.

‘Appreciating how long things take when done as multi-agency – this project has been achieved relatively quickly’. (Action Learning Group Staff Member)

Action learning was judged by participants to be an effective method for focusing group members on the task at hand, ensuring that dedicated time was set aside. Additionally, those with the questions were sitting across from those with the answers, allowing clarifications in professional roles and institutional practices to be provided quickly.

Participation in the action learning group also resulted in new partnerships. Most interestingly, emboldened by the experience of working with the police as an equal partner, rather than against them as an offender, the service user representative invited the police representative to speak to the ex-offending members of a local services user involvement group. They have since begun to work alongside the police by attending meetings and providing consultancy services on the police custody and detention process (personal communication, September 2013). Additionally, the service user involved and the CJMHL&D representative have set up a local community forum to involve the public in improving custody healthcare services (personal communication, May 2014). This is a significant step for ex-offending service users who have spent a significant amount of their lives in conflict with the police and society; prior to involvement, some service users could barely mention their experiences without becoming distressed. One service user commented;

‘For me, this [project] has been life changing’. (Action Learning Group Service User Member)