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Olmstead B, Hoffman R, Brown GP, Hirdes JP. Using the interRAI brief mental health screener to identify persons with mental disorders having repeat contact with police. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101816. [PMID: 35751991 DOI: 10.1016/j.ijlp.2022.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Repeat contacts between persons with serious mental disorder (PSMD) and police officers are costly to both police services and hospitals in terms of service utilization and can be viewed as a direct indicator of unmet needs and gaps in service provision. The intent of the current study was to examine the demographic and clinical characteristics of PSMD who had repeat contact with police officers in London, Ontario from 2016 to 2019 using data collected using the interRAI Brief Mental Health Screener (BMHS). Negative binomial regression was used on a sample of 4143 cases to develop a model predictive of repeat police contacts. The most parsimonious model predicting police contact based on items on the BMHS included age, command hallucinations, lack of insight, verbal abuse, known to possess weapons and family, friends and caregivers expressing concern over the possibility of self harm. Delusions were also independently significantly associated with repeat encounters. Unique to this study is the observation that possessing a weapon in the past 12 months was included in the predictive model. The results of the study add to the sparse research devoted to identifying the characteristics of PSMD who have repeat contact with police officers. Recommendations include integrating the findings into police training to ensure police officers flag those who have the potential for repeat encounters and refer them to appropriate community mental health service providers for proactive outreach services.
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Affiliation(s)
- Benjamin Olmstead
- Faculty of Applied and Professional Studies, School of Criminology and Criminal Justice, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada
| | - Ron Hoffman
- Faculty of Applied and Professional Studies, Chair, School of Criminology and Criminal Justice, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada.
| | - Gregory P Brown
- Faculty of Applied and Professional Studies, School of Criminology and Criminal Justice, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
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McKinnon I, Moore J, Lyall A, Forrester A. Screening for mental disorders in police custody settings. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.
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Ting SY, Lan TH, Shen LJ, Lin CY, Lee SK, Ma WF. The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413392. [PMID: 34949001 PMCID: PMC8707910 DOI: 10.3390/ijerph182413392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Background: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). Method: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients’ status according to three scale criteria and six action plans of recommendations. Results: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. Conclusions: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.
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Affiliation(s)
- Shuo-Yen Ting
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- School of Nursing, Asia University, Taichung 41354, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Tsuo-Hung Lan
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli 35053, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Lih-Jong Shen
- Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei 115204, Taiwan;
| | - Chun-Yuan Lin
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Sport, National Changhua University of Education, Taichung 41354, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan;
| | - Wei-Fen Ma
- PhD Program for Health Science and Industry, China Medical University, Taichung 406040, Taiwan
- School of Nursing, China Medical University, Taichung 406040, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Correspondence: ; Tel.: +886-4-22053366-7107; Fax: +886-4-22053748
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Hoffman R, Harman J, Kinsell H, Brown G. Costs and Savings Associated With the Police Use of the interRAI Brief Mental Health Screener. Front Psychiatry 2021; 12:726469. [PMID: 34733187 PMCID: PMC8558366 DOI: 10.3389/fpsyt.2021.726469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The police response to calls for service identified as being related to mental health continues to be highly controversial. Strategies to improve the police response include Crisis Intervention Team (CIT) training and various forms of co-response models neither of which have been subjected to comprehensive evaluations, particularly as to cost-efficiency. A new approach is the use of the interRAI Brief Mental Health Screener to enhance police officer ability to identify persons with serious mental disorders. The purpose of the current study is to evaluate the costs and cost efficiency of the police response to mental health calls using the interRAI Brief Mental Health Screener. Method: Secondary data was analyzed from the use of the screener from 2018 to 2020 by police officers in a mid-sized Canadian city. Changes were measured in the overall number of interactions police officers had with persons with mental health disorders, the number of incidents where police officers referred the person to hospital, and the time officers remained in the emergency department. Results: A total of 6,727 assessments were completed with involuntary referrals decreasing by 30%, and voluntary referrals by 34%. The overall time police officers were involved in involuntary referrals decreased from 123 min in 2018 to 113 min in 2020. The average emergency department wait time for voluntary referrals dropped from 41 min in 2018 to 27 min in 2020, while involuntary referrals decreased from 61 min in 2018 to 42 min in 2020. Each averted involuntary referral to the emergency department resulted in a savings of $81, on average during the study period. Conclusion: An analysis of the costs and costs savings associated with the use of the screener demonstrate that it is a worthwhile investment for police services. An additional benefit is its ability to collect mental health statistics that may be useful to police leaders to justify budgets. Future studies should attempt to devise some method of collecting pre-implementation data that would reveal the true costs and cost-efficiency of using the BMHS, which have been shown to be significant in the current study however, undoubtedly are under-estimated.
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Affiliation(s)
- Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Jeffrey Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Heidi Kinsell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States.,Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Gregory Brown
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
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Huey L, Andersen J, Bennell C, Ann Campbell M, Koziarski J, Vaughan AD. Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.
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Affiliation(s)
- Laura Huey
- University of Western Ontario, London, ON, Canada
| | | | | | | | | | - Adam D. Vaughan
- Texas State University, School of Criminal Justice and Criminology, San Marcos, TX USA
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Feeney A, Umama-Agada E, Curley A, Asghar M, Kelly BD. Police Involvement in Involuntary Psychiatry Admission: A Report From the Dublin Involuntary Admission Study. Psychiatr Serv 2020; 71:1292-1295. [PMID: 33050793 DOI: 10.1176/appi.ps.201900614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to compare diagnostic and demographic factors among patients who were involuntarily admitted to psychiatry care with or without police involvement. METHODS All admissions to psychiatry units in two university hospitals in Ireland were studied over a 3.5-year period. RESULTS Of 2,715 admissions, 443 (16%) were involuntary; complete data were available for 390 of these involuntary admissions, of which 78 (20%) involved police. Patients with police involvement did not differ significantly from those without police involvement in gender, marital and employment status, or diagnosis. The former patients had a longer mean admission duration and were more likely to be admitted under the "risk criterion" of the Mental Health Act 2001. Multivariable testing indicated that these variables do not independently predict police involvement. CONCLUSIONS The diagnostic or demographic factors examined did not contribute to police involvement in involuntary admission. Features such as homelessness, social exclusion, or criminogenic factors might underlie police involvement.
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Affiliation(s)
- Anna Feeney
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Emmanuel Umama-Agada
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Aoife Curley
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Muhammad Asghar
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
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Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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Crilly J, Johnston ANB, Wallis M, Polong‐Brown J, Heffernan E, Fitzgerald G, Young JT, Kinner S. Review article: Clinical characteristics and outcomes of patient presentations to the emergency department via police: A scoping review. Emerg Med Australas 2019; 31:506-515. [DOI: 10.1111/1742-6723.13300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/08/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health Service, Gold Coast University Hospital Gold Coast Queensland Australia
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
| | - Amy NB Johnston
- Department of Emergency MedicineGold Coast Hospital and Health Service, Gold Coast University Hospital Gold Coast Queensland Australia
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
- School of Nursing, Midwifery and Social WorkThe University of Queensland Brisbane Queensland Australia
| | - Marianne Wallis
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast and Sunshine Coast Health Institute, Sunshine Coast Queensland Australia
| | - Josea Polong‐Brown
- Department of Emergency MedicineGold Coast Hospital and Health Service, Gold Coast University Hospital Gold Coast Queensland Australia
| | - Ed Heffernan
- Queensland Forensic Mental Health Services, Queensland Health Brisbane Queensland Australia
| | - Gerard Fitzgerald
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
| | - Jesse T Young
- Melbourne School of Population and Global HealthThe University of Melbourne Melbourne Victoria Australia
- School of Population and Global HealthThe University of Western Australia Perth Western Australia Australia
- National Drug Research InstituteCurtin University Perth Western Australia Australia
| | - Stuart Kinner
- Melbourne School of Population and Global HealthThe University of Melbourne Melbourne Victoria Australia
- Centre for Adolescent HealthMurdoch Children’s Research Institute Melbourne Victoria Australia
- Griffith Criminology InstituteGriffith University Gold Coast Queensland Australia
- Mater Research Institute‐UQThe University of Queensland Brisbane Queensland Australia
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
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