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Dailey SF, Dubrow S. Police-mental health partnerships and persons with severe mental illness: An exploratory study of perceived risk and use of force. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101968. [PMID: 38394859 DOI: 10.1016/j.ijlp.2024.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/30/2023] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
There is a need to maximize understanding of conditions under which officers are most likely to use lethal force when interacting with persons with severe mental illness (SMI) and whether utilization of a mental health professional (MHP) serves to reduce use of force (UoF) severity. Using a mixed methods concurrent triangulation design framework, this exploratory study examined UoF with individuals exhibiting signs of psychosis and whether police-MHP partnerships decrease UoF severity. Findings indicate officers use more severe forms of force with armed individuals displaying signs of psychosis and that MHP presence did not reduce force severity in such cases. Qualitative themes provide context for these findings and include (1) concerns for MHP safety, (2) planned collaborations support safety, and (3) MHPs support de-escalation. Discussion highlights a need for increased officer education on SMI, appropriate de-escalation strategies, co-created engagement/disengagement protocols for MHPs, and defined standards of practice for police-mental health collaborations.
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Affiliation(s)
- Stephanie F Dailey
- College of Education and Human Development, George Mason University, Fairfax, VA, USA.
| | - Samantha Dubrow
- Homeland Security Systems Engineering and Development Institute (HSSEDI), Fairfax, VA, USA
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Clibbens N, Booth A, Sharda L, Baker J, Thompson J, Ashman M, Berzins K, Weich S, Kendal S. Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis. Int J Ment Health Nurs 2023; 32:1636-1653. [PMID: 37574714 DOI: 10.1111/inm.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.
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Affiliation(s)
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
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Clibbens N, Baker J, Booth A, Berzins K, Ashman MC, Sharda L, Thompson J, Kendal S, Weich S. Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-161. [PMID: 37837344 DOI: 10.3310/twkk5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Background Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances. Aim The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work. Objectives The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes. Design This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory. Main outcome The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care. Data sources Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts. Review methods A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working. Results Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve. Strengths and limitations Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity. Conclusions Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion. Future work Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research. Study registration The study is registered as PROSPERO CRD42019141680. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Leila Sharda
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield, UK
| | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - Scott Weich
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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Stakeholder Perspectives on Implementing a Police-Mental Health Collaborative to Improve Pathways to Treatment. J Behav Health Serv Res 2022; 49:299-314. [PMID: 35000102 PMCID: PMC8742697 DOI: 10.1007/s11414-021-09782-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
High rates of criminal justice involvement among individuals with mental illness have led to collaborative efforts between law enforcement agencies and mental health providers to improve crisis responses and pathways to treatment. The development and implementation of these police-mental health collaborations (PMHCs) have received little attention in the literature, but these processes are crucial in understanding feasibility and sustainability. The PMHC discussed here is an interagency effort to identify individuals involved with law enforcement who have unmet behavioral health needs and engage them in services. Perspectives from leaders, service providers, and clients highlight the importance of developing PMHCs that support individuals with serious mental illness at multiple points, from initial crisis to independent management of treatment. In an environment where police responses to individuals with mental health and substance use disorders are increasingly scrutinized, it is critical to highlight and evaluate ways that behavioral health and law enforcement agencies work together to collaboratively address these problems.
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Costigan CL, Woodin EM, Duerksen KN, Ferguson R. Benefits and Drawbacks of Police Integration Into Assertive Community Treatment Teams. Psychiatr Serv 2022; 73:447-455. [PMID: 34615367 DOI: 10.1176/appi.ps.201900549] [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: 11/30/2022]
Abstract
OBJECTIVE Assertive community treatment (ACT) teams provide outreach services to individuals coping with severe mental illness. Because such individuals are at increased risk for involvement with law enforcement, a model that integrates police officers into ACT teams (ACT-PI) was developed for ACT teams serving clients with or without forensic involvement. The goal of this study, conducted in British Columbia, was to evaluate the benefits and drawbacks of the ACT-PI model. METHODS Qualitative semistructured interviews were conducted with 21 ACT-PI clients (in 2017) and 22 ACT-PI staff (in 2018). Thematic analyses identified key themes related to the benefits and drawbacks of officer integration into the ACT-PI model. RESULTS Perceived benefits of police integration were opportunities for relationship building between officers and clients, improved safety, more holistic care due to embeddedness (i.e., effective interagency collaboration between police and health care providers), the prevention of future problems, and police officers' authority enhancing compliance. Perceived drawbacks included risk for legal consequences, stigma from police interaction, escalating distress of clients, low officer availability, and the risk for changing the nature of ACT teams. CONCLUSIONS Participants reported that the model of officer integration into ACT-PI teams may improve both client and staff well-being. In some communities, and with certain precautions, ACT-PI may be a viable model for ACT teams serving clients with and clients without a history of forensic involvement.
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Xanthopoulou P, Thomas C, Dooley J. Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review. BMJ Open 2022; 12:e055393. [PMID: 35115355 PMCID: PMC8814746 DOI: 10.1136/bmjopen-2021-055393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders. DESIGN A systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants' experiences were included. DATA SOURCES MEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed. RESULTS We identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where 'frequent attenders' are repeatedly let down by mental health services. CONCLUSION Lack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.
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Affiliation(s)
| | - Ciara Thomas
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jemima Dooley
- Mood Disorders Centre, University of Exeter, Exeter, UK
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Meurk C, Wittenhagen L, Bosley E, Steele ML, Bunting D, Waterson E, Edwards B, Martain B, Heffernan E. Suicide crisis calls to emergency services: Cohort profile and findings from a data linkage study in Queensland, Australia. Aust N Z J Psychiatry 2022; 56:144-153. [PMID: 33904321 DOI: 10.1177/00048674211009604] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Police and paramedics play a crucial role in responding to suicide crises in the community. However, little is known about the nature, extent, precipitating factors, pathways and outcomes of a suicide-related call to emergency services and what responses will most effectively and compassionately meet the needs of those in crisis. Partners in Prevention: Understanding and Enhancing First Responses to Suicide Crisis Situations (PiP) was established to address these knowledge gaps. METHODS This article describes (1) the methodology used to construct the PiP dataset, a population-wide linked dataset that investigates the characteristics and health pathways of individuals in Queensland who were the subject of a suicide-related call to police or paramedics; and (2) preliminary findings on service demand, demographics and health services utilisation. RESULTS We identified 219,164 suicide-related calls to Queensland Police Service or Queensland Ambulance Service that were made over the 3-year period 1 February 2014 to 31 January 2017. A total of 70,893 individuals were identifiable via records linkage. The cohort linked to more than 7,000,000 health records. We estimated that police or paramedics in Queensland received on average 209 calls per day, with increases year on year over the study period. Analysis of demographic data highlighted the heterogeneous nature of this cohort and important demographic variations between individuals in contact with police versus ambulance services. DISCUSSION The PiP dataset provides a strong foundation for a multi-modal dataset that can be built on over time, both cross-sectionally and longitudinally. Further linkages to Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and social care datasets are planned. CONCLUSION Detailed population-level analysis that data linkage can provide is critical to improving understanding and responses to suicide crisis situations. The PiP study is a world first and provides a unique opportunity to improve responses to this public health problem.
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Affiliation(s)
- Carla Meurk
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Lisa Wittenhagen
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Emma Bosley
- Information Support, Research & Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron, QLD, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megan L Steele
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Denise Bunting
- Information Support, Research & Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron, QLD, Australia
| | - Elissa Waterson
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Ben Martain
- Queensland Police Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Ward B, Kollios J, Smith F, Klim S, Senz A, Kelly AM. Characteristics and outcome of patients transported by police to emergency departments under section 351 of the Mental Health Act 2014 (Vic). Emerg Med Australas 2021; 34:263-270. [PMID: 34643031 DOI: 10.1111/1742-6723.13879] [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: 06/02/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the ED under section 351 (s351, police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV). METHODS This is an observational cohort study conducted in two metropolitan teaching hospitals in Victoria. Participants were adult patients brought to ED under s351 of the MHAV. Data collected included demographics, event circumstances, pre-hospital and ED interventions and outcome. Analyses are descriptive. RESULTS The present study included 438 patient encounters. Median age was 34 years. In 84% of encounters (368/438) patients were co-transported with ambulance. The most common primary reason for detainment was suicide risk/intent (296/438, 67.6%) followed by abnormal behaviour without threat to self or others (92/438, 21%). In ED, parenteral sedation was administered in 11% (48/438). Physical restraint was applied in 17.6% (77/438). Psychiatric admission was required in 23.5% (103/438). In 63 cases, psychiatric admission was involuntary (14.4%). Most patients (297/438, 67.8%) were discharged home. A subset of patients had recurrent s351 presentations. Eighteen (5.6%) patients accounted for 22% (96/438) of all events. CONCLUSION Most patients brought to ED under s351 of the MHAV had expressed intention to self-harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s351 is consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of the use of these powers. There were a concerning number of patients with multiple s351 events over a short period.
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Affiliation(s)
- Beth Ward
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Jason Kollios
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Fiona Smith
- Department of Emergency Medicine, Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Ainslie Senz
- Emergency Department, Footscray Hospital, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Alderwick H, Hutchings A, Briggs A, Mays N. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health 2021; 21:753. [PMID: 33874927 PMCID: PMC8054696 DOI: 10.1186/s12889-021-10630-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Policymakers in many countries promote collaboration between health care organizations and other sectors as a route to improving population health. Local collaborations have been developed for decades. Yet little is known about the impact of cross-sector collaboration on health and health equity. METHODS We carried out a systematic review of reviews to synthesize evidence on the health impacts of collaboration between local health care and non-health care organizations, and to understand the factors affecting how these partnerships functioned. We searched four databases and included 36 studies (reviews) in our review. We extracted data from these studies and used Nvivo 12 to help categorize the data. We assessed risk of bias in the studies using standardized tools. We used a narrative approach to synthesizing and reporting the data. RESULTS The 36 studies we reviewed included evidence on varying forms of collaboration in diverse contexts. Some studies included data on collaborations with broad population health goals, such as preventing disease and reducing health inequalities. Others focused on collaborations with a narrower focus, such as better integration between health care and social services. Overall, there is little convincing evidence to suggest that collaboration between local health care and non-health care organizations improves health outcomes. Evidence of impact on health services is mixed. And evidence of impact on resource use and spending are limited and mixed. Despite this, many studies report on factors associated with better or worse collaboration. We grouped these into five domains: motivation and purpose, relationships and cultures, resources and capabilities, governance and leadership, and external factors. But data linking factors in these domains to collaboration outcomes is sparse. CONCLUSIONS In theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers. Ultimately, local collaborations should be understood within their macro-level political and economic context, and as one component within a wider system of factors and interventions interacting to shape population health.
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Affiliation(s)
- Hugh Alderwick
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Adam Briggs
- Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
- University of Warwick, Coventry, CV4 7AL UK
| | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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10
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Meurk C, Wittenhagen L, Steele ML, Ferris L, Edwards B, Bosley E, Heffernan E. Examining the Use of Police and Ambulance Data in Suicide Research. CRISIS 2020; 42:386-395. [PMID: 33241741 DOI: 10.1027/0227-5910/a000739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Police and paramedics are often the first to respond to individuals in suicide crisis and have an important role to play in facilitating optimal care pathways. Yet, little evidence exists to inform these responses. Data linkage provides one approach to examining this knowledge gap. Aim: We identified studies that examined suicide behaviors and linked to police or ambulance data. Method: A systematic search of PubMed and Scopus was undertaken to identify data linkage studies that: (1) examined suicide behaviors, and (2) included police or ambulance data. Studies were reviewed to identify: aims; suicide behaviors examined; how these were measured; how the cohort was defined; topic area; and what datasets were linked. Results: Eight studies met the inclusion criteria. Six studies included police data, and two studies included ambulance data. No study included both. Two topic areas were identified: (1) suicide-related contact with police or ambulance services; and (2) associations between suicidal behaviors and violence, victimization, and criminality. Limitations: Limitations to the review include the potential to have missed studies that investigated or reported on suicidality under the guise of mental health problems; complexities and nuances arising from the role of police data in coronial investigations; and limitations in the number of databases searched. Conclusion: Police and ambulance data represent a currently underutilized source of valuable information relevant to suicide crises, and further research should aim to address this gap.
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Affiliation(s)
- Carla Meurk
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Lisa Wittenhagen
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,Queensland Forensic Mental Health Service, Queensland Health, Brisbane, QLD, Australia
| | - Megan L Steele
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Laura Ferris
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | | | - Emma Bosley
- Queensland Ambulance Service, Kedron, QLD, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Queensland Health, Brisbane, QLD, Australia
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11
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Neilson S, Chittle A, Coleman T, Kurdyak P, Zaheer J. Policies and procedures for patient transfers from community clinics to emergency departments under the mental health act: Review and policy scan. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101576. [PMID: 32768104 DOI: 10.1016/j.ijlp.2020.101576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The objective of this commentary is to summarize the few findings from the scientific literature pertaining to humane mental health transfer practices in the province of Ontario as well as the broader Canadian and international context. These findings are juxtaposed with a policing policy scan concerning the Ontario and Canadian contexts. The practice of default restraint use during transfers is surprisingly widespread practice, despite advocacy to the contrary, and is presented as the consequence of stigma and the lack of codified restriction of restraint use by police in their policy guidelines. METHODS (1) Literature search to discover relevant articles which were summarized using narrative review due to the lack of high-quality studies available in this area, and (2) Scan of publicly available policy documents in use by Ontario police agencies in March and April of 2018, as well as contacting several police agencies and community resources to review policies and procedures. RESULTS We review the available evidence on the use and impact of restraints in patient transfer to emergency departments from police settings, highlight police practices in four Ontario jurisdictions, and summarize recommendations from police and mental health advocates regarding mental health transfers. DISCUSSION Synthesizing the available evidence, policies, and procedures, we illustrate that the Ontario-wide variability in both who transfers PMI on a Form 1 to hospital and whether restraints are utilized reflect systemic failures to utilize least restrictive means of transfer. We offer a look at future areas of research and advocacy to improve practices in Canada.
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Affiliation(s)
- Shane Neilson
- Waterloo Regional Campus of McMaster University, Canada
| | - Andrea Chittle
- Department of Family Medicine, McMaster University, Canada
| | | | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health; ICES; Department of Psychiatry, University of Toronto, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health;Department of Psychiatry, University of Toronto, Canada.
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12
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Chidgey K, Procter N, Baker A, Grech C. Suicide deaths following police contact: A review of coronial inquest findings. DEATH STUDIES 2020; 46:675-683. [PMID: 32362242 DOI: 10.1080/07481187.2020.1758243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We analyzed 10 years of Australian coronial inquest documents on people who died by suicide or suspected suicide following recent contact with the police. We identified 149 cases of suicide or suspected suicides via coronial websites, 34 of which contained recommendations. We developed four themes from these recommendations, the most common of which was for police to change current practices or policies and modify police officer training. Coroners considered effective working relationships with external stakeholders able to assist police an important means of reducing risk of suicide.
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Affiliation(s)
- Kelly Chidgey
- Clinical Health Sciences, University of South Australia, Adelaide, Australia
| | - Nicholas Procter
- Clinical Health Sciences, University of South Australia, Adelaide, Australia
| | - Amy Baker
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Carol Grech
- Chancellery and Council Services, University of South Australia, Adelaide, Australia
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13
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Schucan Bird K, Shemilt I. The crime, mental health, and economic impacts of prearrest diversion of people with mental health problems: A systematic review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:142-156. [PMID: 30972840 PMCID: PMC6850079 DOI: 10.1002/cbm.2112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/27/2018] [Accepted: 02/11/2019] [Indexed: 06/04/2023]
Abstract
BACKGROUND Prearrest diversion strategies are being adopted across the Western world, enabling the police to identify and divert people suspected of having mental disorder towards health and community services rather than the criminal justice system. AIMS To quantify longer-term criminal justice and mental health outcomes after prearrest diversion of people with suspected mental disorder and consider economic correlates. METHODS A systematic review of published literature on longer term outcomes after prearrest diversion. RESULTS Only two quasi-experimental studies, with four independent samples, could be included. Findings for criminal and mental health outcomes were inconclusive, but potential for adverse outcomes was identified. Ten studies with cost data suggested that prearrest diversion can lead to overall cost savings. CONCLUSIONS There is still inadequate evidence on which to base prearrest diversion programmes. Although some benefits have been identified by the review, so have possible harms. Future research and funding strategies must build in high-quality, systematic evaluation of outcomes before implementing a theoretically attractive strategy more widely.
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Affiliation(s)
| | - Ian Shemilt
- EPPI CentreUCL Institute of EducationLondonUK
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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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Abstract
Purpose
Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care.
Design/methodology/approach
This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the “state of play” in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n=52), Social Care (n=31) and Health (n=18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange.
Findings
On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals’ own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection.
Research limitations/implications
This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views.
Practical implications
This paper reports on a Scottish study that focused on the coordinated and integrated practices amongst the police, health and social services’ professionals who support and protect adult members of society at risk of harm and has implications for their practice.
Social implications
Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts.
Originality/value
Studies on the joint-working practices amongst police and health and social services’ professionals who support and protect adult members of society at risk of harm are uncommon. This study investigated professionals’ perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection.
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