Cross-disciplinary partnerships between police and health services for mental health care

Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data

Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.

Effectiveness of a contact-based anti-stigma intervention for police officers

INTRODUCTION

Police force interaction rates with individuals with mental health conditions are on the rise. International research reveals that the presence of a mental health condition increases the risk for detention and use of force by police officers. Stigmatization of individuals with mental health conditions as dangerous and unpredictable is assumed to have an impact on the likelihood of police use of force. The following study examines a trialogical intervention to reduce stigmatization of individuals with a diagnosis of schizophrenia in a police officer sample.

METHOD

1318 police officers participated in a trialogical contact-based intervention with the aim to reduce stigmatizing attitudes and beliefs. Emotional reactions, stereotypes and social distance were assessed prior to and after the intervention in a one-group design.

RESULTS

Negative stereotypes were positively associated with social distance in individuals with a diagnosis of schizophrenia and were positively associated with anxiety. Dependent sample t-test revealed reduced anxiety towards individuals with a diagnosis of schizophrenia, less negative stereotypes, and less social distance post intervention. All results were significant, and all effect sizes showed a small to moderate effect.

CONCLUSIONS

Trialogical contact-based, short-term anti-stigma interventions appear to reduce stigmatizing attitudes towards individuals with mental health conditions in a large police force sample. A missing control group is a key study limitation. Further research is needed to examine the effectiveness of the intervention in a randomized-controlled trial. However, the results clearly suggest that anti-stigma interventions could be beneficially introduced into police training.

Co-creation of five key research priorities across law enforcement and public health: A methodological example and outcomes

WHAT IS KNOWN ON THE SUBJECT?: Between policing and health, there are many shared issues. Mental health distress and crises and caring for people who may be vulnerable are priority areas. Working together in partnership is challenging, and fragmented systems and processes are the result. This leads to poor experiences for the police, health professions and the public. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes an event that brought together 26 stakeholders involved in law enforcement and public health. The aim of this work was to identify the biggest shared challenges that they experience in their day to day jobs. The five key priorities were as follows: vulnerability; mental health crisis; decision-making around assessment and triage across professional groups and professional roles; peer support and organizational well-being; and information and data sharing. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper demonstrates the strength of bringing partners together throughout law enforcement and public health, making proper time to actually discuss the "big issues" which affect them, how they each experience these issues, and how they might have overcome these within their own professions. Only through working together as partners and having everyone on the same page with the shared priorities can we really start to make a difference in the areas and with the people who matter. The focus on "vulnerability" and "mental health crisis" demonstrates the complexity of the issues between the professions, and that they need to find effective ways to work together to support people. No one professional group can solve inter-professional challenges alone. ABSTRACT: Introduction Law enforcement professions now assume more responsibility for tackling mental health issues alongside public health colleagues than ever before. The term "vulnerability" is frequently used within Law Enforcement and Public Health (LEPH) to identify those requiring emergency mental health care. However, there are ongoing challenges within LEPH to determine whose responsibility this is. Aim To co-create the most important priorities for LEPH research in Scotland. Method The paper describes a collaborative workshop which brought together an Expert Advisory Group (EAG) of 26 senior stakeholders, from academia, policing, mental health nursing, psychiatry, paramedics, emergency medicine, people with lived experience, policy makers and third sector. Results The five key priorities included: vulnerability; mental health crisis; decision-making around assessment and triage across professional groups and professional roles; peer support and organizational well-being; and information and data sharing. Discussion The paper discusses the EAG group event as a co-production process, focusing on how key LEPH research priorities were derived. Implications for practice This paper demonstrates the inextricable link between co-production and co-creation of value via EAG group consensus on LEPH research priorities. Shared vision and professional will are not enough to ensure progress: there must also be shared policy, knowledge and access.

Mental health street triage: Comparing experiences of delivery across three sites

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: MHST represents transformation at the forefront of policing and mental health to people in crisis with the aim of providing a better and more efficient response. Current knowledge has largely focused on service development, informed by narratives of risk, and this study applies an alternative focus by considering the interplay in practice. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper adds to emerging work on mental health street triage, offering original insights into the interplay of police officers and mental health nurses in practice. The evidence presented shows how the dynamics between officers and nurses were informed by perceptions of trust, belonging and legitimacy which shaped decision-making and outcomes. This study also reveals the impacts of leadership continuity and staff turnover to service efficacy and the potential of strategic "drift." WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses who work in MHST operations should be prepared to share knowledge, learning and insight into how different mental health conditions present in practice and support the assessment of risk posed to officers. Alternative pathways available to detainment by police under the Mental Health Act should be identified and communicated to officers, both in the control room and in situ, to avoid unnecessary detentions. Strategies should be developed to extend the communication of mental health education and knowledge beyond those immediately involved in MHST to support the police to better respond to mental health. ABSTRACT: Introduction The limited evidence on mental health street triage (MHST) is largely focused on service development and is overly police-centric dominated by narratives of risk. This paper considers the interplay between officers and CPNs in practice situated within strategic and operational contexts, illustrating the importance of place to service developments and trust within practice. Aim This study was conducted to compare the processes, experiences and perceptions of MHST in three sites in England. Method Semi-structured interviews were completed with 27 police and health service staff in strategic and operational roles over a three-month period in three sites in England. Results Four themes were identified: "Reducing and improving the use of mental health detainments," "Importance of local contexts and partnerships," "Enhancing officer confidence" and "Developing street triage." Discussion Mental health street triage decision-making and outcomes were influenced by issues of trust, belonging and legitimacy within the interplay between officers and nurses. Continuity and staff turnover influenced strategic and operational development. However, MHST was perceived to be an effective and cost-saving model. Implications for practice Mental health nurses are well positioned to lead awareness and education of officers in relation to mental health crisis response. Staff need to develop communication strategies that extend beyond those immediately involved in MHST.

[A Police Perspective on the Interaction with Individuals with Mental Disorders]

OBJECTIVE

Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer.

METHODS

N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances.

RESULTS

Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge.

CONCLUSION

Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.