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Compton MT, Pope LG, Watson AC. Community-Based Mental Health Crisis Response: An Overview of Models and Workforce Implications. Psychiatr Clin North Am 2024; 47:491-509. [PMID: 39122342 DOI: 10.1016/j.psc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Communities across the United States are working to improve community-based mental health crisis response, with 1 goal being to reduce criminal legal system involvement among individuals with mental illnesses, behavioral disorders, or mental health crises. Existing and recently developed models can generally be divided into non-law enforcement-based response models and law enforcement-based response models. Wide variation exists in terms of staffing, how response teams are called out or dispatched, hours of operation and immediacy of response, and approaches to crisis resolution.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Amy C Watson
- School of Social Work, Wayne State University, Deroit, MI, USA
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Zitars J, Scharf D. Matching Mobile Crisis Models to Communities: An Example from Northwestern Ontario. J Behav Health Serv Res 2024; 51:355-376. [PMID: 38691301 PMCID: PMC11180628 DOI: 10.1007/s11414-024-09882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/03/2024]
Abstract
Police are often the first to encounter individuals when they are experiencing a mental health crisis. Other professionals with different skill sets, however, may be needed to optimize crisis response. Increasingly, police and mental health agencies are creating co-responder teams (CRTs) in which police and mental health professionals co-respond to crisis calls. While past evaluations of CRTs have shown promising results (e.g. hospital diversions; cost-effectiveness), most studies occurred in larger urban contexts. How CRTs function in smaller jurisdictions, with fewer complementary resources and other unique contextual features, is unknown. This paper describes the evaluation of a CRT operating in a geographically isolated and northern mid-sized city in Ontario, Canada. Data from program documents, interviews with frontline and leadership staff, and ride-along site visits were analyzed according to an extended Donabedian framework. Through thematic analysis, 12 themes and 11 subthemes emerged. Overall, data showed that the program was generally operating and supporting the community as intended through crisis de-escalation and improved quality of care, but it illuminated potential areas for improvement, including complementary community-based services. Data suggested specific structures and processes of the embedded CRT model for optimal function in a northern context, and it demonstrated the transferability of the CRT model beyond large urban centres. This research has implications for how communities can make informed choices about what crisis models are best for them based on their resources and context, thus potentially improving crisis response and alleviating strain on emergency departments and systems.
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Affiliation(s)
- Jillian Zitars
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
| | - Deborah Scharf
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada.
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Childs KK, Elligson RL, Brady CM. Testing the Impact of a Law Enforcement-Operated Co-responder Program for Youths: A Quasi-Experimental Approach. Psychiatr Serv 2024:appips20240003. [PMID: 38938094 DOI: 10.1176/appi.ps.20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The authors examined whether use of a co-responder program reduced the likelihood of an involuntary commitment examination as the disposition of a police encounter with youths experiencing a mental health crisis and 1 year after the initial incident. METHODS Using a quasi-experimental design, the authors compared 206 incidents that involved the co-response program with 327 incidents that did not involve the program. Propensity score matching was used to balance groups on demographic and incident characteristics. The dependent variables included the disposition of the incident (deescalation or involuntary commitment examination), whether the youths experienced a later involuntary commitment examination within 1 year of the initial intervention, and time to the subsequent examination. Propensity score-weighted binary logistic regression and time-to-event analysis were used. RESULTS The co-responder program was associated with a significantly lower likelihood of police officer-initiated involuntary commitment examinations and a lower likelihood of an involuntary commitment examination within 1 year. Eighty percent of the incidents that resulted in a co-response involving a police officer and a mental health professional were deescalated, allowing the youth to remain in the community with a safety plan, whereas 17% of incidents with a police-only response ended with crisis deescalation. CONCLUSIONS These findings provide further support for the implementation of co-responder options that are available to police officers during encounters with children and adolescents experiencing a mental health crisis.
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Affiliation(s)
- Kristina K Childs
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
| | - Richard L Elligson
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
| | - Caitlin M Brady
- Department of Criminal Justice, College of Community Innovation and Education, University of Central Florida, Orlando (Childs); Department of Criminology, College of Behavioral and Community Sciences, University of South Florida, Tampa (Elligson); Department of Criminal Justice and Criminology, College of Behavioral and Social Sciences, Georgia Southern University, Statesboro (Brady)
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Anestis JC, Halkitis PN, Cordeiro A, Lanman MJ, Passannante MR. ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program. Behav Med 2024:1-10. [PMID: 38449435 DOI: 10.1080/08964289.2024.2324793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Perry N Halkitis
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Alana Cordeiro
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, USA
| | - Melissa J Lanman
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
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Petreca VG, Barros JT, Hoblock C, Burgess AW. The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing. J Adv Nurs 2024. [PMID: 38225816 DOI: 10.1111/jan.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
AIM This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response. DESIGN This study used a descriptive, qualitative exploratory design and was informed by Systems Theory. METHODS The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed. REPORTING METHOD The Standards for Reporting Qualitative Research (SRQR) guidelines were used. RESULTS Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation. CONCLUSION This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents. IMPLICATIONS Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system. IMPACT The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Makin DA, Carter P, Parks M. Examining Implementation of Crisis Centers on Police Officer Emergency Hold Petitions. Community Ment Health J 2023; 59:1150-1162. [PMID: 36790536 PMCID: PMC9930032 DOI: 10.1007/s10597-023-01097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
In this study, we examine to what extent availability of a crisis center in a behavioral health district is related to changes in emergency hold petitions and outcomes of those holds as submitted by police officers. Using data from between 2010 and 2020 and a series of interrupted time series analysis, we analyze 22,619 police petitions for involuntary commitment and their outcomes related to crisis center availability. Results show inconsistent and varied effects between availability of a crisis center and emergency hold petitions. Similar results are observed for the emergency hold evaluation process outcome and associated final disposition outcome. The implementation of crisis centers in the study site may not have achieved the immediate goals of reducing the use of the emergency hold petitions nor relevant outcomes. The results vary in direction and magnitude indicating there is more research to be done to understand if, and how, crisis center availability and use are associated with changes in the involuntary emergency hold system.
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Kuehl S, Kim AHM, Every-Palmer S. 'An accident waiting to happen' - experiences of police officers, paramedics, and mental health clinicians involved in 911-mental health crises: a cross-sectional survey. J Psychiatr Ment Health Nurs 2023. [PMID: 36932909 DOI: 10.1111/jpm.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/27/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under-prepared. The single frontline service approach is time-intensive and risks a coercive pathway to care. The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services. Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services. Police and ambulance staff found it hard to work with mental health services. WHAT ARE THE IMPLICATIONS FOR PRACTICE The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes. Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls. New models such as co-response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated. ABSTRACT INTRODUCTION: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi-agency perspectives of such work. AIM/QUESTION To understand the views of police officers, ambulance and mental health staff attending mental health or suicide-related crises in Aotearoa New Zealand and to discover how they experience current models of cross-agency collaboration. METHODS A descriptive cross-sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis. RESULTS Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter-agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff. DISCUSSION Frontline services struggle managing mental health-related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services. CONCLUSION The single-agency frontline response may be detrimental to service users in crisis and under-utilizes the skills of mental health staff. New ways of inter-agency cooperation are required, such as co-located police, ambulance and mental health nurses responding in partnership.
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Affiliation(s)
- Silke Kuehl
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Alice Hyun Min Kim
- Biostatistics Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
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Balfour ME, Zeller SL. Community-Based Crisis Services, Specialized Crisis Facilities, and Partnerships With Law Enforcement. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:18-27. [PMID: 37205037 PMCID: PMC10172540 DOI: 10.1176/appi.focus.20220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
How a community responds to behavioral health emergencies is both a public health issue and a social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments, boarding for hours or days while awaiting treatment. Such crises also account for a quarter of police shootings and 2 million jail bookings per year, and racism and implicit bias magnify these problems for people of color. Fortunately, the new 988 mental health emergency number compounded with police reform movements have created momentum for building behavioral health crisis response systems that deliver comparable quality and consistency of care as we expect for medical emergencies. This paper provides an overview of the rapidly evolving landscape of crisis services. The authors discuss the role of law enforcement and various approaches to lessening the impact on individuals experiencing behavioral health emergencies, especially for historically marginalized populations. The authors provide an overview of the crisis continuum, including crisis hotlines, mobile teams, observation units, crisis residential programs, and peer wraparound services that can help ensure that linkage to aftercare is successful. The authors also highlight opportunities for psychiatric leadership, advocacy, and strategies for creating a well-coordinated crisis system that meets the needs of the community.
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Affiliation(s)
- Margaret E Balfour
- Connections Health Solutions, Phoenix, Arizona, and Department of Psychiatry, University of Arizona, Tucson, Arizona (Balfour); Department of Psychiatry, Vituity, Emeryville, California, and Department of Psychiatry and Neuroscience, University of California, Riverside, Riverside, California (Zeller)
| | - Scott L Zeller
- Connections Health Solutions, Phoenix, Arizona, and Department of Psychiatry, University of Arizona, Tucson, Arizona (Balfour); Department of Psychiatry, Vituity, Emeryville, California, and Department of Psychiatry and Neuroscience, University of California, Riverside, Riverside, California (Zeller)
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Lee K, Bolton SL, Shterenberg R, Bolton JM, Hensel JM. Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. JMIR Form Res 2022; 6:e39861. [PMID: 36252139 PMCID: PMC9640197 DOI: 10.2196/39861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic.
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Affiliation(s)
- Katherine Lee
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Ravit Shterenberg
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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Marcus N, Stergiopoulos V. Re-examining mental health crisis intervention: A rapid review comparing outcomes across police, co-responder and non-police models. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1665-1679. [PMID: 35103364 DOI: 10.1111/hsc.13731] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Police are the default first responders in most mental health crisis intervention models worldwide, resulting in a heavy burden on police, perceived criminalization of individuals with complex mental health needs, and escalation of aggression that resort to violence. Models, such as crisis intervention teams (CIT), and co-response programmes aim to improve service user experiences and outcomes by providing mental health training to police, or pairing law enforcement officers with mental health clinicians, respectively. Despite these efforts, mental health-related calls continue to result in negative outcomes, and activists and policymakers are advocating for non-police models of crisis intervention. Evidence-based practice in mental health crisis intervention is urgently needed. The present review's main objective was to examine, synthesise and compare outcomes across police, co-responder and non-police models of mental health crisis intervention internationally using a rapid review framework. A systematic search of four electronic databases of studies published between 2010-2020 and a grey literature search was conducted, yielding (n = 1008) articles. A total of 62 articles were included in the present review. Studies were largely observational, lacking control groups and were of low-moderate quality with a high potential for bias. Overall, there is little evidence to suggest that the CIT model impacts crisis outcomes. Co-responder models evidenced improved outcomes compared to police only models, however, evidence was often mixed. Non-police models varied significantly, and studies tended to be too low quality to make comparisons or draw conclusions, however, research on youth models and crisis resolution home treatment suggested positive outcomes. Findings highlight the need for high-quality studies and policies to facilitate the implementation and evaluation of novel approaches not involving police. Cross-sectorial collaboration and service user input are urgently needed to inform, develop, test and disseminate effective models of crisis intervention acceptable to service users.
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Affiliation(s)
- Natania Marcus
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Jones N, Gius B, Shields M, Florence A, Collings S, Green K, Watson A, Munson M. Youths' and Young Adults' Experiences of Police Involvement During Initiation of Involuntary Psychiatric Holds and Transport. Psychiatr Serv 2022; 73:910-917. [PMID: 34911351 DOI: 10.1176/appi.ps.202100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past decade, police involvement in behavioral health crisis response has generated concern and controversy. Despite the salience and timeliness of this topic, the literature on service user experiences of interactions with officers is small and studies of youths and young adults are nonexistent. The authors aimed to investigate youths' and young adults' experiences of police involvement in involuntary psychiatric hold initiation and transport. In-depth interviews were conducted with 40 participants (ages 16-27) who had experienced an involuntary hold; the 28 participants who reported police involvement are the focus of this analysis. Data were inductively coded, and codes were grouped into larger themes. A majority of participants reported negative experiences; major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication. The authors also characterized the positive experiences of officer involvement reported by a minority of participants and youths' perspectives on the degree of control officers could exert over initiation and transport decisions. Findings help center the voices of youths and young adults with mental health challenges and raise important questions about contemporary policies regarding police involvement in crisis response and, more broadly, about coercive responses to distress or emotional crisis.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Becky Gius
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Morgan Shields
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Ana Florence
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Shira Collings
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Kelly Green
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Amy Watson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Michelle Munson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
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Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatr Serv 2022; 73:658-669. [PMID: 34666512 DOI: 10.1176/appi.ps.202000721] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.
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Affiliation(s)
- Margaret E Balfour
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Arlene Hahn Stephenson
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ayesha Delany-Brumsey
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Jason Winsky
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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13
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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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14
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Bailey K, Lowder EM, Grommon E, Rising S, Ray BR. Evaluation of a Police-Mental Health Co-response Team Relative to Traditional Police Response in Indianapolis. Psychiatr Serv 2022; 73:366-373. [PMID: 34433289 DOI: 10.1176/appi.ps.202000864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Criminal justice and emergency medical service (EMS) outcomes were compared for individuals experiencing a behavioral health crisis who received a response from a co-response team (CRT) or a usual response from the police after a 911 call. METHODS A prospective, quasi-experimental design was used to examine outcomes of a CRT pilot tested in Indianapolis (August-December 2017). Weighted multivariable models examined effects of study condition (CRT group, N=313; usual-response group, N=315) on immediate booking, emergency detention, and subsequent jail bookings and EMS encounters. Sensitivity of outcomes to follow-up by a behavioral health unit (BHU) was also examined. RESULTS Individuals in the CRT group were less likely than those in the usual-police-response group to be arrested immediately following the 911 incident (odds ratio [OR]=0.48, 95% confidence interval [CI]=0.25-0.92) and were more likely to experience any EMS encounter at 6- and 12-month follow-up (OR range=1.71-1.85, p≤0.015 for all). Response type was not associated with jail bookings at 6 or 12 months. Follow-up BHU services did not reduce bookings or EMS encounters. CRT recipients with BHU follow-up were more likely than those without BHU follow-up to have a subsequent EMS contact (OR range=2.35-3.12, p≤0.001 for all). These findings differed by racial group. CONCLUSIONS CRT responses may reduce short-term incarceration risk but not long-term EMS demand or risk of justice involvement. Future research should consider the extent to which CRT and follow-up services improve engagement with stabilizing treatment services, which may reduce the likelihood of future crises.
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Affiliation(s)
- Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Bailey, Ray); Department of Criminology, Law and Society, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia (Lowder); School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis (Grommon); Center for Health and Justice Research, Public Policy Institute, Indiana University, Indianapolis (Rising)
| | - Evan M Lowder
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Bailey, Ray); Department of Criminology, Law and Society, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia (Lowder); School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis (Grommon); Center for Health and Justice Research, Public Policy Institute, Indiana University, Indianapolis (Rising)
| | - Eric Grommon
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Bailey, Ray); Department of Criminology, Law and Society, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia (Lowder); School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis (Grommon); Center for Health and Justice Research, Public Policy Institute, Indiana University, Indianapolis (Rising)
| | - Staci Rising
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Bailey, Ray); Department of Criminology, Law and Society, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia (Lowder); School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis (Grommon); Center for Health and Justice Research, Public Policy Institute, Indiana University, Indianapolis (Rising)
| | - Bradley R Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Bailey, Ray); Department of Criminology, Law and Society, College of Humanities and Social Sciences, George Mason University, Fairfax, Virginia (Lowder); School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis (Grommon); Center for Health and Justice Research, Public Policy Institute, Indiana University, Indianapolis (Rising)
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15
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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16
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment under the light of clinical psychiatry. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It focuses on how patients experience CT and its impact on their mental health and treatment programs, the reasons for the use of CT versus voluntary treatment and what efforts have been made to reduce, replace and refine the presence of CT in psychiatry.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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17
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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18
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Blais E, Brisebois D. Improving police responses to suicide-related emergencies: New evidence on the effectiveness of co-response police-mental health programs. Suicide Life Threat Behav 2021; 51:1095-1105. [PMID: 34254702 DOI: 10.1111/sltb.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/01/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several police organizations have implemented training programs and co-response police-mental health programs to improve interventions among people in crisis. Some researchers have questioned the "one size fits all" approach of these programs and their ability to improve the management of specific psychosocial emergencies such as suicide-related behaviors. OBJECTIVES This study evaluates the effect of a co-response police-mental health program introduced by the Laval Police Department to improve interventions in suicide-related calls. METHODS Propensity score matching techniques were used to match 130 observations of a control group with 251 observations of a treatment group. Average treatment effects (ATEs) were then computed. RESULTS Results indicate that the co-response program was associated with significant decreases in police use of force (ATE = -0.077; p ≤ 0.05) and transports to hospital (ATE = -0.773; p ≤ .01). Increases were observed in referrals to community resources (ATE = 0.285; p ≤ 0.01), and individuals managed through their social network (ATE = 0.530; p ≤ 0.01). CONCLUSION The findings suggest that co-response police-mental health programs can improve the management of people showing suicide-related behaviors.
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Affiliation(s)
- Etienne Blais
- School of Criminology, Université de Montréal, Montreal, Canada
| | - David Brisebois
- School of Criminology, Université de Montréal, Montreal, Canada
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19
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Ghelani A. Knowledge and Skills for Social Workers on Mobile Crisis Intervention Teams. CLINICAL SOCIAL WORK JOURNAL 2021; 50:414-425. [PMID: 34803191 PMCID: PMC8591592 DOI: 10.1007/s10615-021-00823-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Public outrage over police-involved deaths of people in mental health crisis has prompted governments to expand access to crisis services that partner police with social workers. Mobile Crisis Intervention Teams (MCIT) offer assessment and support for people in distress while averting escalation. Little attention has been given to the requisite competencies for social workers on MCITs. This narrative review, informed by crisis theory and the author's experience as an MCIT social worker, provides a roadmap of knowledge and skills to familiarize practitioners, educators, and students with this growing intervention model. Social workers on MCITs should have the capacity to engage complex clients, de-escalate tension, assess for risk, plan for safety, provide brief addiction counselling, diffuse interpersonal conflict, link clients with community resources, advocate for change, challenge systemic racism, build constructive relationships, and document services with awareness of relevant legislation. The role of social workers on MCITs is multifaceted and requires attention to balancing client well-being, client safety, and community safety. The practice insights discussed in this article are relevant to preventing harm and loss of life while facilitating engagement between clients and mental health services.
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Affiliation(s)
- Amar Ghelani
- Faculty of Social Work, Wilfrid Laurier University, Kitchener, ON Canada
- Health and Counselling Centre, University of Toronto, Toronto, Canada
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20
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An Evaluation of a Community-Based Mobile Crisis Intervention Team in a Small Canadian Police Service. Community Ment Health J 2021; 57:567-578. [PMID: 32676879 DOI: 10.1007/s10597-020-00683-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
The current study examines the impact of a recently implemented community-based Crisis Outreach and Support Team (COAST) in a small Canadian police service. COAST pairs a police officer from the South Simcoe Police Service in Ontario, Canada with a crisis response worker from either the Canadian Mental Health Association or York Support Services Network. Through a pre- versus post-implementation analysis, key outcome variables were examined. Results demonstrated that there were significant differences between general patrol and COAST in terms of time spent on crisis-related calls and this was associated with a reduced cost to the service. Additionally, compared to pre-implementation rates, the Service saw an increase in community resources provided to clients in need and a decrease in involuntary apprehensions. These initial findings provide some preliminary support for the value of the COAST initiative in the South Simcoe Police Service.
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21
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Pepler EF, Barber CG. Mental health and policing: Picking up the pieces in a broken system. Healthc Manage Forum 2021; 34:93-99. [PMID: 33499683 DOI: 10.1177/0840470420979635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A key theme of this article is the need to view the intersection of public safety and public health through a new lens to break down the traditional information silos of the many agencies that serve vulnerable populations and the impact of inadequate community-based mental health services that contribute to the increasing number of calls to police in responding to people in or approaching a mental health crisis. The manifestation of this crisis in the community is that the police are too often the first port in the storm. This article suggests the system is broken and needs fixing. Implementing a population health approach to identifying the high utilizers in the community and building a case for sustained funding, partnerships, resources, and accountability together with data sharing agreements, community partners and police collaboratively design and evaluate outcome approaches aimed at prevention and recovery to minimize contact with the police.
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Affiliation(s)
| | - Clay G Barber
- Royal Roads University, Faculty of Leadership, Victoria, BC, Canada
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22
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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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23
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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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24
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Abstract
De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.
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25
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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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26
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Crilly J, Zhang P, Lincoln C, Scuffham P, Timms J, Becker K, Buuren N, Fisher A, Murphy D, Green D. Characteristics and outcomes of patient presentations made by police to an Australian emergency department. Emerg Med Australas 2019; 31:1014-1023. [DOI: 10.1111/1742-6723.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health ServiceGold Coast University Hospital Gold Coast Queensland Australia
- School of Nursing and Midwifery, Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
| | - Ping Zhang
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
| | - Cathy Lincoln
- Gold Coast Forensic Medicine, Department of Emergency MedicineGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Paul Scuffham
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
| | - Jo Timms
- Department of Emergency Medicine, Gold Coast Hospital and Health ServiceGold Coast University Hospital Gold Coast Queensland Australia
| | - Ken Becker
- Southport Watch HouseQueensland Police Service Gold Coast Queensland Australia
| | - Nelle Buuren
- Gold Coast Forensic Medicine, Department of Emergency MedicineGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Andrew Fisher
- Department of Emergency Medicine, Gold Coast Hospital and Health ServiceGold Coast University Hospital Gold Coast Queensland Australia
| | - Danny Murphy
- State Operations Unit, Emergency Management UnitQueensland Ambulance Service Gold Coast Queensland Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast Hospital and Health ServiceGold Coast University Hospital Gold Coast Queensland Australia
- Menzies Health Institute QueenslandGriffith University Gold Coast Queensland Australia
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Rodgers M, Thomas S, Dalton J, Harden M, Eastwood A. Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Police officers are often the first responders to mental health-related incidents and, consequently, can become a common gateway to care. The volume of such calls is an increasing challenge.
Objective
What is the evidence base for models of police-related mental health triage (often referred to as ‘street triage’) interventions?
Design
Rapid evidence synthesis.
Participants
Individuals perceived to be experiencing mental ill health or in a mental health crisis.
Interventions
Police officers responding to calls involving individuals experiencing perceived mental ill health or a mental health crisis, in the absence of suspected criminality or a criminal charge.
Main outcome measures
Inclusion was not restricted by outcome.
Data sources
Eleven bibliographic databases (i.e. Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, EMBASE, MEDLINE, PAIS® Index, PsycINFO, Scopus, Social Care Online, Social Policy & Practice, Social Sciences Citation Index and Social Services Abstracts) and multiple online sources were searched for relevant systematic reviews and qualitative studies from inception to November 2017. Additional primary studies reporting quantitative data published from January 2016 were also sought.
Review methods
The three-part rapid evidence synthesis incorporated metasynthesis of the effects of street triage-type intervention models, rapid synthesis of UK-relevant qualitative evidence on implementation and the overall synthesis.
Results
Five systematic reviews, eight primary studies reporting quantitative data and eight primary studies reporting qualitative data were included. Most interventions involved police officers working in partnership with mental health professionals. These interventions were generally valued by staff and showed some positive effects on procedures (such as rates of detention) and resources, although these results were not entirely consistent and not all important outcomes were measured. Most of the evidence was at risk of multiple biases caused by design flaws and/or a lack of reporting of methods, which might affect the results.
Limitations
All primary research was conducted in England, so may not be generalisable to the whole of the UK. Discussion of health equity issues was largely absent from the evidence.
Conclusions
Most published evidence that aims to describe and evaluate various models of street triage interventions is limited in scope and methodologically weak. Several systematic reviews and recent studies have called for a prospective, comprehensive and streamlined collection of a wider variety of data to evaluate the impact of these interventions. This rapid evidence synthesis expands on these recommendations to outline detailed implications for research, which includes clearer articulation of the intervention’s objectives, measurement of quantitative outcomes beyond section 136 of the Mental Health Act 1983 [Great Britain. Mental Health Act 1983. Section 136. London: The Stationery Office; 1983 URL: www.legislation.gov.uk/ukpga/1983/20/section/136 (accessed October 2017)] (i.e. rates, places of safety and processing data) and outcomes that are most important to the police, mental health and social care services and service users. Evaluations should take into consideration shorter-, medium- and longer-term effects. Whenever possible, study designs should have an appropriate concurrent comparator, for example by comparing the pragmatic implementation of collaborative street triage models with models that emphasise specialist training of police officers. The collection of qualitative data should capture dissenting views as well as the views of advocates. Any future cost-effectiveness analysis of these interventions should evaluate the impact across police, health and social services.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Sian Thomas
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
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Puntis S, Perfect D, Kirubarajan A, Bolton S, Davies F, Hayes A, Harriss E, Molodynski A. A systematic review of co-responder models of police mental health 'street' triage. BMC Psychiatry 2018; 18:256. [PMID: 30111302 PMCID: PMC6094921 DOI: 10.1186/s12888-018-1836-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Police mental health street triage is an increasingly common intervention when dealing with police incidents in which there is a suspected mental health component. We conducted a systematic review of street triage interventions with three aims. First, to identify papers reporting on models of co-response police mental health street triage. Second, to identify the characteristics of service users who come in to contact with these triage services. Third, to evaluate the effectiveness of co-response triage services. METHODS We conducted a systematic review. We searched the following databases: Ovid MEDLINE, Embase, PsycINFO, EBSCO CINAHL, Scopus, Thompson Reuters Web of Science Core Collection, The Cochrane Library, ProQuest National Criminal Justice Reference Service Abstracts, ProQuest Dissertations & Theses, EThoS, and OpenGrey. We searched reference and citation lists. We also searched for other grey literature through Google, screening the first 100 PDFs of each of our search terms. We performed a narrative synthesis of our results. RESULTS Our search identified 11,553 studies. After screening, 26 were eligible. Over two-thirds (69%) had been published within the last 3 years. We did not identify any randomised control trials. Results indicated that street triage might reduce the number of people taken to a place of safety under S136 of the Mental Health Act where that power exists, or reduce the use of police custody in other jurisdictions. CONCLUSIONS There remains a lack of evidence to evaluate the effectiveness of street triage and the characteristics, experience, and outcomes of service users. There is also wide variation in the implementation of the co-response model, with differences in hours of operation, staffing, and incident response.
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Affiliation(s)
- Stephen Puntis
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Devon Perfect
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX UK
| | - Abirami Kirubarajan
- MD Program, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8 Canada
| | - Sorcha Bolton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Fay Davies
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX UK
| | - Aimee Hayes
- Coventry and Warwickshire Partnership NHS Trust, Wayside House, Wilsons Lane Coventry, Warwickshire, CV6 6NY UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Andrew Molodynski
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX UK
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