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Zitars J, Scharf D. Matching Mobile Crisis Models to Communities: An Example from Northwestern Ontario. J Behav Health Serv Res 2024:10.1007/s11414-024-09882-7. [PMID: 38691301 DOI: 10.1007/s11414-024-09882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Becker-Haimes EM, Schaechter T, Green KL, Bridges K, Jager-Hyman S. Mobile Crisis Services: A Clinician Survey of Current Suicide Prevention Practices and Barriers to Care Delivery. Community Ment Health J 2024; 60:562-571. [PMID: 37982974 DOI: 10.1007/s10597-023-01208-9] [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: 05/11/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Temma Schaechter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | | | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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Lowder EM, Grommon E, Bailey K, Ray B. Police-mental health co-response versus police-as-usual response to behavioral health emergencies: A pragmatic randomized effectiveness trial. Soc Sci Med 2024; 345:116723. [PMID: 38422686 DOI: 10.1016/j.socscimed.2024.116723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/27/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND People with mental illness are overrepresented in United States (US) criminal legal systems. In response, alternatives to traditional police response to behavioral health emergencies have become more common, despite limited evidence for their effectiveness. We conducted the first randomized controlled trial of a police-mental health co-response team to determine program effectiveness relative to a police-as-usual response on key outcomes identified by community stakeholders. METHODS Between January 2020 and March 2021, we randomized behavioral health emergency calls for service in one of six police districts in Indianapolis, Indiana to receive a co-response or police-as-usual response during operational hours between 10 a.m. and 5 p.m. Mondays - Fridays. Eligible calls for service were determined via pre-specified phrases indicating a behavioral health incident over the police dispatch radio. Researchers then communicated random assignment with the co-response team to indicate whether they should respond or withhold. Logistic and negative binomial regression were used to assess group differences in emergency medical services (EMS) events within 12 months of the randomized incident along with jail booking, outpatient encounters, and emergency department visits. FINDINGS We randomized 686 calls for service with co-response completed in 264 cases and police-as-usual response in 267 cases. The overall rate of attrition was similar across conditions and the final sample included 211 co-responses and 224 police-as-usual responses. We found no significant differences in any EMS event (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 0.85-1.88, p = .246) or event counts (incidence rate ratio [IRR]: 0.85; 95% CI: 0.52-1.37, p = .504). We also found no differences in secondary outcomes (jail booking, outpatient encounters, and emergency department visits). DISCUSSION A police-mental health co-response team model was not more effective than traditional police response on key outcomes. Co-response team models, such as the one reported here, may unintentionally foster emergency services utilization among persons with behavioral health needs. Without a functioning national mental health system, communities in the US will continue to struggle to identify solutions to meet the needs of community members with complex behavioral health issues.
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Affiliation(s)
- Evan Marie Lowder
- George Mason University Department of Criminology, Law and Society, 4400 University Drive, 4F4, Fairfax, VA, 22030, United States
| | - Eric Grommon
- Indiana University O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street BS 3025, Indianapolis, IN, 46202, United States
| | - Katie Bailey
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Bradley Ray
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, United States.
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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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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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Lanser I, Freimer NB, Craske MG. Reducing policing in mental health crises: A vision for university campuses. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2295-2298. [PMID: 34495820 DOI: 10.1080/07448481.2021.1967363] [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: 11/09/2020] [Revised: 07/01/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
University campuses could become leaders in developing alternatives to policing for managing public health and safety, yet, nearly all campuses rely on campus or local police to respond to mental health emergencies. Herein, we present the available evidence for campus mobile crisis intervention teams (MCITs) as an alternative to policing, consider what colleges and universities can learn from existing community MCIT models, and propose initial steps for the development and implementation of a campus MCIT.
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Affiliation(s)
- Isabelle Lanser
- Department of Psychology, University of California, Los Angeles
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Fix RL, Bandara S, Fallin MD, Barry CL. Creating Comprehensive Crisis Response Systems: An Opportunity to Build on The Promise of 988. Community Ment Health J 2023; 59:205-208. [PMID: 35997872 DOI: 10.1007/s10597-022-01017-6] [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: 05/02/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
The implementation of a national suicide prevention hotline is imminent and will need to be supported by comprehensive crisis systems, which are currently rarely implemented in part due to their cost. In this Commentary paper we identify three core components of a high-functioning, integrated crisis service system. We identified regional crisis call centers, mobile response teams, and crisis receiving and stabilization centers as core components of an integrated crisis service system. We then outline how this approach has been used in Arizona. Building out these systems and sustainable funding models to support these systems is necessary to ensure that 988 implementation lives up to the promise of creating a lifeline to support services for individuals in crisis.
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Affiliation(s)
- Rebecca L Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington Street, 21231, Baltimore, MD, United States.
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington Street, 21231, Baltimore, MD, United States
| | - M Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington Street, 21231, Baltimore, MD, United States
| | - Colleen L Barry
- Cornell Jeb E. Brooks School of Public Policy, Ithaca, NY, United States
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8
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Spolum MM, Lopez WD, Watkins DC, Fleming PJ. Police Violence: Reducing the Harms of Policing Through Public Health-Informed Alternative Response Programs. Am J Public Health 2023; 113:S37-S42. [PMID: 36696619 PMCID: PMC9877383 DOI: 10.2105/ajph.2022.307107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/26/2023]
Abstract
Police violence is a public health issue in need of public health solutions. Reducing police contact through public health-informed alternative response programs separate from law enforcement agencies is one strategy to reduce police perpetration of physical, emotional, and sexual violence. Such programs may improve health outcomes, especially for communities that are disproportionately harmed by the police, such as Black, Latino/a, Native American, and transgender communities; nonbinary residents; people who are drug users, sex workers, or houseless; and people who experience mental health challenges. The use of alternative response teams is increasing across the United States. This article provides a public health rationale and framework for developing and implementing alternative response programs informed by public health principles of care, equity, and prevention. We conclude with recommendations for public health researchers and practitioners to guide inquiries into policing as a public health problem and expand the use of public health-informed alternative response programs. (Am J Public Health. 2023;113(S1):S37-S42. https://doi.org/10.2105/AJPH.2022.307107).
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Affiliation(s)
- Maren M Spolum
- Maren M. Spolum, William D. Lopez, and Paul J. Fleming are with the University of Michigan School of Public Health, Ann Arbor. Daphne C. Watkins is with the University of Michigan School of Social Work, Ann Arbor. Daphne C. Watkins and Paul J. Fleming are also with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, Ann Arbor
| | - William D Lopez
- Maren M. Spolum, William D. Lopez, and Paul J. Fleming are with the University of Michigan School of Public Health, Ann Arbor. Daphne C. Watkins is with the University of Michigan School of Social Work, Ann Arbor. Daphne C. Watkins and Paul J. Fleming are also with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, Ann Arbor
| | - Daphne C Watkins
- Maren M. Spolum, William D. Lopez, and Paul J. Fleming are with the University of Michigan School of Public Health, Ann Arbor. Daphne C. Watkins is with the University of Michigan School of Social Work, Ann Arbor. Daphne C. Watkins and Paul J. Fleming are also with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, Ann Arbor
| | - Paul J Fleming
- Maren M. Spolum, William D. Lopez, and Paul J. Fleming are with the University of Michigan School of Public Health, Ann Arbor. Daphne C. Watkins is with the University of Michigan School of Social Work, Ann Arbor. Daphne C. Watkins and Paul J. Fleming are also with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, Ann Arbor
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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: 17] [Impact Index Per Article: 8.5] [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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Purtle J, Brinson K, Stadnick NA. Earmarking Excise Taxes on Recreational Cannabis for Investments in Mental Health: An Underused Financing Strategy. JAMA HEALTH FORUM 2022; 3:e220292. [PMID: 36218958 DOI: 10.1001/jamahealthforum.2022.0292] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York
- Global Center for Implementation Science, New York University, New York, New York
| | - Kylie Brinson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Nicole A Stadnick
- Department of Psychiatry, University of California San Diego
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center
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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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Vakkalanka JP, Neuhaus RA, Harland KK, Clemsen L, Himadi E, Lee S. Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis. West J Emerg Med 2021; 22:1086-1094. [PMID: 34546884 PMCID: PMC8463043 DOI: 10.5811/westjem.2021.6.52276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. Methods We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015–2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score–matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit. Results The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6–93 days) for the MCO patients and 88 days (IQR: 20–164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27). Conclusion The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.
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Affiliation(s)
- J Priyanka Vakkalanka
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa.,University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa
| | - Ryan A Neuhaus
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Karisa K Harland
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa.,University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa
| | - Lance Clemsen
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
| | - Elaine Himadi
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa
| | - Sangil Lee
- University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa
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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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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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15
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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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16
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Abstract
The United States has the highest incarceration rate in the world. With a substantial number of inmates diagnosed with mental illness, substance use, or both, various diversion strategies have been developed to help decrease and avoid criminalization of individuals with mental illness. This article focuses primarily on the first three Sequential Intercept Model intercept points as related to jail diversion and reviews types of diversion programs, research outcomes for diversion programs, and important components that contribute to successful diversion.
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17
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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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18
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Bailey K, Paquet SR, Ray BR, Grommon E, Lowder EM, Sightes E. Barriers and facilitators to implementing an urban co-responding police-mental health team. HEALTH & JUSTICE 2018; 6:21. [PMID: 30467739 PMCID: PMC6755583 DOI: 10.1186/s40352-018-0079-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND In an effort to reduce the increasing number of persons with mental illness (PMI) experiencing incarceration, co-responding police-mental health teams are being utilized as a way to divert PMI from the criminal justice system. Co-response teams are typically an inter-agency collaboration between police and mental health professionals, and in some cases include emergency medical personnel. These teams are intended to facilitate emergency response by linking patients to mental health resources rather than the criminal justice system, thus reducing burdens on both the criminal justice systems as well as local healthcare systems. The current study examines the barriers and facilitators of successfully implementing the Mobile Crisis Assistance Team model, a first-responder co-response team consisting of police officers, mental health professionals, and paramedics. Through content analysis of qualitative focus groups with team members and interviews with program stakeholders, this study expands previous findings by identifying additional professional cultural barriers and facilitators to program implementation while also exploring the role of clear, systematic policies and guidelines in program success. RESULTS Findings demonstrate the value of having both flexible and formal policies and procedures to help guide program implementation; ample community resources and treatment services in order to successfully refer clients to needed services; and streamlined communication among participating agencies and the local healthcare community. A significant barrier to successful program implementation is that of role conflict and stigma. Indeed, members of the co-response teams experienced difficulty transitioning into their new roles and reported negative feedback from other first responders as well as from within their own agency. Initial agency collaboration, information sharing between agencies, and team building were also identified as facilitators to program implementation. CONCLUSION The current study provides a critical foundation for the implementation of first-responder police-mental health co-response teams. Cultural and systematic barriers to co-response team success should be understood prior to program creation and used to guide implementation. Furthermore, attention must be directed to cultivating community and professional support for co-response teams. Findings from this study can be used to guide future efforts to implement first-response co-response teams in order to positively engage PMI and divert PMI from the criminal justice system.
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Affiliation(s)
- Katie Bailey
- Center for Health & Justice Research, Indiana University Public Policy Institute, 334 N. Senate Avenue, Suite 300, Indianapolis, IN, 46204, USA.
| | - Staci Rising Paquet
- Center for Health & Justice Research, Indiana University Public Policy Institute, 334 N. Senate Avenue, Suite 300, Indianapolis, IN, 46204, USA
| | - Bradley R Ray
- Indiana University - Purdue University Indianapolis, School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN, 46202, USA
| | - Eric Grommon
- Indiana University - Purdue University Indianapolis, School of Public and Environmental Affairs, Indianapolis, USA
| | - Evan M Lowder
- Indiana University - Purdue University Indianapolis, School of Public and Environmental Affairs, Indianapolis, USA
| | - Emily Sightes
- Center for Health & Justice Research, Indiana University Public Policy Institute, 334 N. Senate Avenue, Suite 300, Indianapolis, IN, 46204, USA
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19
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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: 37] [Impact Index Per Article: 6.2] [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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20
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Coates D. Service Models for Urgent and Emergency Psychiatric Care: An Overview. J Psychosoc Nurs Ment Health Serv 2018; 56:23-30. [DOI: 10.3928/02793695-20180212-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 11/20/2022]
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21
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Evidence for the effectiveness of police-based pre-booking diversion programs in decriminalizing mental illness: A systematic literature review. PLoS One 2018; 13:e0199368. [PMID: 29920560 PMCID: PMC6007921 DOI: 10.1371/journal.pone.0199368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/06/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose People with mental illnesses are at a significantly greater risk of police arrest than the general population. This pattern of arrests has been associated with a phenomenon referred to as the criminalization of mental illness such that people with mental illnesses are inappropriately diverted to the criminal justice system rather than to treatment. To decrease arrests of people with mental illnesses experiencing a crisis, pre-booking diversion programs have been developed to intervene at the point of police contact. This systematic literature review examines the state of knowledge regarding the effectiveness of police-based pre-booking diversion programs by addressing the question, “What is the evidence for the effectiveness of police-based pre-booking diversion programs in reducing arrests (i.e., reducing criminalization) of people with mental illnesses?” Methods Systematic literature searches of seven databases were performed during May 2017. The searches sought to identify studies that examined the effectiveness of pre-booking diversion programs in decreasing arrests. A multi-phase screening process was completed independently by two pairs of reviewers as well as a risk of bias review. Results A total of 2,750 unique citations were identified. Of these, 4 met the inclusion/exclusion criteria; all were from the US. Three of the studies examined the effectiveness of Crisis Intervention Teams and one study looked at a mobile crisis program. Two of the studies were at moderate risk of bias and two at high risk. Conclusions This review indicates that this line of inquiry is still developing. There are a number of gaps yet to be filled. The current evidence for the effectiveness of police-based pre-booking diversion programs in reducing arrests (i.e., reducing criminalization) of people with mental illnesses is limited. However, these studies indicate there is moderate evidence that these programs increase linkages to mental health services.
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22
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Lamanna D, Shapiro GK, Kirst M, Matheson FI, Nakhost A, Stergiopoulos V. Co-responding police-mental health programmes: Service user experiences and outcomes in a large urban centre. Int J Ment Health Nurs 2018; 27:891-900. [PMID: 29044920 DOI: 10.1111/inm.12384] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
As police officers are often the first responders to mental health crises, a number of approaches have emerged to support skilled police crisis responses. One such approach is the police-mental health co-responding team model, whereby mental health nurses and police officers jointly respond to mental health crises in the community. In the present mixed-method study, we evaluated outcomes of co-responding team interactions at a large Canadian urban centre by analysing administrative data for 2743 such interactions, and where comparison data were available, compared them to 16 226 police-only team responses. To understand service user experiences, we recruited 15 service users for in-depth qualitative interviews, and completed inductive thematic analysis. Co-responding team interactions had low rates of injury and arrest, and compared to police-only teams, co-responding teams had higher overall rates of escorts to hospital, but lower rates of involuntary escorts. Co-responding teams also spent less time on hospital handovers than police-only teams. Service users valued responders with mental health knowledge and verbal de-escalation skills, as well as a compassionate, empowering, and non-criminalizing approach. Current findings suggest that co-responding teams could be a useful component of existing crisis-response systems.
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Affiliation(s)
- Denise Lamanna
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Maritt Kirst
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Flora I Matheson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Arash Nakhost
- Mental Health and Addictions Service, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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23
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Kane E, Evans E, Shokraneh F. Effectiveness of current policing-related mental health interventions: A systematic review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:108-119. [PMID: 29052275 DOI: 10.1002/cbm.2058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/05/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There are three commonly used mental health interventions associated with policing: liaison and diversion, street triage and having specialist staff embedded in police contact control rooms. Crisis intervention teams (CITs), already used in the USA, are now attracting wider interest, including in the UK. Investment in these interventions is growing, so it is important to have evidence of their effectiveness. AIM To conduct a systematic literature review to answer questions about effectiveness of police-mental health service models for responding to people with mental disorder and suspected offending or public safety problems. METHODS A population/participant, intervention/indicator, comparator/control, outcome (PICO) framework was developed and keywords used to locate research studies within 29 databases. The 3179 results returned were screened by two researchers against preset inclusion and exclusion criteria. This resulted in 23 studies being included from which were taken the study methodology and findings and on which a narrative synthesis was conducted. RESULTS Twenty-three studies could be included, overall showing a positive impact of the interventions considered, but no well-designed randomised controlled trials to test this optimistic view rigorously. CONCLUSIONS Overall, rather than indicating that one approach is more effective than another, the review points to the need for a multi-faceted approach within a structured and integrated model, such as the CIT model. This is generally not the current pattern of interventions, and policy makers, service commissioners and providers may wish to review future options. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eddie Kane
- Centre for Health and Justice, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Emily Evans
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Farhad Shokraneh
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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24
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Parker A, Scantlebury A, Booth A, MacBryde JC, Scott WJ, Wright K, McDaid C. Interagency collaboration models for people with mental ill health in contact with the police: a systematic scoping review. BMJ Open 2018; 8:e019312. [PMID: 29588323 PMCID: PMC5875664 DOI: 10.1136/bmjopen-2017-019312] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify existing evidence on interagency collaboration between law enforcement, emergency services, statutory services and third sector agencies regarding people with mental ill health. DESIGN Systematic scoping review. Scoping reviews map particular research areas to identify research gaps. DATA SOURCES AND ELIGIBILITY ASSIA, CENTRAL, the Cochrane Library databases, Criminal Justice Abstracts, ERIC, Embase, MEDLINE, PsycINFO, PROSPERO and Social Care Online and Social Sciences Citation Index were searched up to 2017, as were grey literature and hand searches. Eligible articles were empirical evaluations or descriptions of models of interagency collaboration between the police and other agencies. STUDY APPRAISAL AND SYNTHESIS Screening and data extraction were undertaken independently by two researchers. Arksey's framework was used to collate and map included studies. RESULTS One hundred and twenty-five studies were included. The majority of articles were of descriptions of models (28%), mixed methods evaluations of models (18%) and single service evaluations (14%). The most frequently reported outcomes (52%) were 'organisational or service level outcomes' (eg, arrest rates). Most articles (53%) focused on adults with mental ill health, whereas others focused on adult offenders with mental ill health (17.4%). Thirteen models of interagency collaboration were described, each involving between 2 and 13 agencies. Frequently reported models were 'prearrest diversion' of people with mental ill health (34%), 'coresponse' involving joint response by police officers paired with mental health professionals (28.6%) and 'jail diversion' following arrest (23.8%). CONCLUSIONS We identified 13 different interagency collaboration models catering for a range of mental health-related interactions. All but one of these models involved the police and mental health services or professionals. Several models have sufficient literature to warrant full systematic reviews of their effectiveness, whereas others need robust evaluation, by randomised controlled trial where appropriate. Future evaluations should focus on health-related outcomes and the impact on key stakeholders.
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Affiliation(s)
- Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Arabella Scantlebury
- Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, UK
| | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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25
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Carpenter RA, Falkenburg J, White TP, Tracy DK. Crisis teams: systematic review of their effectiveness in practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.039933] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.
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26
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Lester NA, Thompson LR, Herget K, Stephens JA, Campo JV, Adkins EJ, Terndrup TE, Moffatt-Bruce S. CALM Interventions: Behavioral Health Crisis Assessment, Linkage, and Management Improve Patient Care. Am J Med Qual 2017; 33:65-71. [DOI: 10.1177/1062860617696154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Kendal Herget
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - John V. Campo
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric J. Adkins
- The Ohio State University Wexner Medical Center, Columbus, OH
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27
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Evangelista E, Lee S, Gallagher A, Peterson V, James J, Warren N, Henderson K, Keppich-Arnold S, Cornelius L, Deveny E. Crisis averted: How consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis. Int J Ment Health Nurs 2016; 25:367-76. [PMID: 26931611 DOI: 10.1111/inm.12218] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
When mental health crisis situations in the community are poorly handled, it can result in physical and emotional injuries. The purpose of this study was to ascertain the experiences and opinions of consumers about the way police and mental health services worked together, specifically via the Alfred Police and Clinical Early Response (A-PACER) model, to assist people experiencing a mental health crisis. Semi-structured in-depth interviews were conducted with 12 mental health consumers who had direct contact with the A-PACER team between June 2013 and March 2015. The study highlighted that people who encountered the A-PACER team generally valued and saw the benefit of a joint police-mental health clinician team response to a mental health crisis situation in the community. In understanding what worked well in how the A-PACER team operated, consumers perspectives can be summarized into five themes: communication and de-escalation, persistence of the A-PACER team, providing a quick response and working well under pressure, handover of information, and A-PACER helped consumers achieve a preferred outcome. All consumers acknowledged the complementary roles of the police officer and mental health clinician, and described the A-PACER team's supportive approach as critical in gaining their trust, engagement and in de-escalating the crises. Further education and training for police officers on how to respond to people with a mental illness, increased provision of follow-up support to promote rehabilitation and prevent future crises, and measures to reduce public scrutiny for the consumer when police responded, were proposed opportunities for improvement.
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Affiliation(s)
- Eloisa Evangelista
- South Eastern Melbourne PHN (previously Bayside Medicare Local), Heatherton, Australia
| | - Stuart Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | | | | | - Jo James
- South Eastern Melbourne PHN (previously Bayside Medicare Local), Heatherton, Australia
| | - Narelle Warren
- School of Social Sciences, Monash University, Melbourne, Australia
| | | | | | - Luke Cornelius
- Victoria Police, Southern Metropolitan Region, Melbourne, Australia
| | - Elizabeth Deveny
- South Eastern Melbourne PHN (previously Bayside Medicare Local), Heatherton, Australia
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28
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Lee SJ, Thomas P, Doulis C, Bowles D, Henderson K, Keppich-Arnold S, Perez E, Stafrace S. Outcomes achieved by and police and clinician perspectives on a joint police officer and mental health clinician mobile response unit. Int J Ment Health Nurs 2015; 24:538-46. [PMID: 26597480 DOI: 10.1111/inm.12153] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite their limited mental health expertise, police are often first to respond to people experiencing a mental health crisis. Often the person in crisis is then transported to hospital for care, instead of receiving more immediate assessment and treatment in the community. The current study conducted an evaluation of an Australian joint police-mental health mobile response unit that aimed to improve the delivery of a community-based crisis response. Activity data were audited to demonstrate utilization and outcomes for referred people. Police officers and mental health clinicians in the catchment area were also surveyed to measure the unit's perceived impact. During the 6-month pilot, 296 contacts involving the unit occurred. Threatened suicide (33%), welfare concerns (22%) and psychotic episodes (18%) were the most common reasons for referral. The responses comprised direct admission to a psychiatric unit for 11% of contacts, transportation to a hospital emergency department for 32% of contacts, and community management for the remainder (57%). Police officers were highly supportive of the model and reported having observed benefits of the unit for consumers and police and improved collaboration between services. The joint police-mental health clinician unit enabled rapid delivery of a multi-skilled crisis response in the community.
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Affiliation(s)
- Stuart J Lee
- Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia.,Department of Psychiatry, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Phillipa Thomas
- Department of Psychiatry, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Chantelle Doulis
- Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Doug Bowles
- Victoria Police Centre, Melbourne, Victoria, Australia
| | - Kathryn Henderson
- Department of Psychiatry, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Eva Perez
- Victoria Police Centre, Melbourne, Victoria, Australia
| | - Simon Stafrace
- Department of Psychiatry, The Alfred Hospital, Melbourne, Victoria, Australia
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Wang JP, Wu CY, Chiu CC, Yang TH, Liu TH, Chou P. Police referrals at the psychiatric emergency service in Taiwan. Asia Pac Psychiatry 2015; 7:436-44. [PMID: 26104683 DOI: 10.1111/appy.12195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. METHODS The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. RESULTS Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. DISCUSSION Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES.
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Affiliation(s)
- Jen-Pang Wang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei City, Taiwan.,Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chia-Yi Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Tsu-Hui Yang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.,Medical Affairs Division, Department of Health, Taipei City Government, Taipei City, Taiwan
| | - Tzong-Hsien Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei City, Taiwan
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Kirst M, Francombe Pridham K, Narrandes R, Matheson F, Young L, Niedra K, Stergiopoulos V. Examining implementation of mobile, police-mental health crisis intervention teams in a large urban center. J Ment Health 2015; 24:369-74. [PMID: 26383041 DOI: 10.3109/09638237.2015.1036970] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mobile Crisis Intervention Teams (MCITs) have emerged as a police and mental health system co-response to assist police in responding to individuals experiencing mental health crises. There is a gap in knowledge regarding the critical program components that contribute to successful MCIT implementation. AIMS This evaluation study aimed to understand processes of implementation of a multi-site MCIT program in a large urban center and to identify program strengths and challenges, as well as levels of satisfaction in service delivery. METHODS Fifty-seven stakeholders participated in qualitative interviews and focus groups, including: MCIT consumers and staff, individuals from the health system, police services, and community organizations. RESULTS Overall, program stakeholders perceived the MCIT program positively and viewed it as meeting its key goals. The implementation evaluation has highlighted the importance of respectful interaction with consumers, cross-sector training and collaboration, and ensuring clarity in program mandate and staff roles. These program components can continue to be built upon to improve MCIT service delivery. CONCLUSIONS Future studies should further evaluate the role of key strengths in MCIT program implementation as well as the impact of recommended improvements on program outcomes.
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Affiliation(s)
- Maritt Kirst
- a Centre for Research on Inner City Health, St. Michael's Hospital , Toronto , Canada .,b Dalla Lana School of Public Health, University of Toronto , Toronto , Canada .,c Toronto Central Community Care Access Centre , Toronto , Canada
| | | | - Renira Narrandes
- b Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Flora Matheson
- a Centre for Research on Inner City Health, St. Michael's Hospital , Toronto , Canada .,b Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Linda Young
- d Toronto East General Hospital , Toronto , Canada , and
| | | | - Vicky Stergiopoulos
- a Centre for Research on Inner City Health, St. Michael's Hospital , Toronto , Canada .,e Department of Psychiatry , University of Toronto , Toronto , Canada
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Carpenter RA, Tracy DK. Home treatment teams: what should they do? A qualitative study of patient opinions. J Ment Health 2015; 24:98-102. [DOI: 10.3109/09638237.2015.1019046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Williams CL, Cooper WO, Balmer LS, Dudley JA, Gideon PS, DeRanieri MM, Stratton SM, Callahan ST. Evaluation and disposition of Medicaid-insured children and adolescents with suicide attempts. Acad Pediatr 2015; 15:36-40. [PMID: 24942933 PMCID: PMC4268101 DOI: 10.1016/j.acap.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans-all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. METHODS We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions. RESULTS Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55-0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39-2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41-0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01-2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. CONCLUSIONS In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.
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Affiliation(s)
- Candice L. Williams
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William O. Cooper
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leanne S. Balmer
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Judith A. Dudley
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia S. Gideon
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle M. DeRanieri
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shannon M. Stratton
- Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S. Todd Callahan
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Co-responding Police-Mental Health Programs: A Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:606-20. [DOI: 10.1007/s10488-014-0594-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Burns-Lynch B, Murphy AA, Gill KJ, Brice G. Persons in Recovery, Family Members, and Staff Perspectives of Psychiatric Crisis Needs. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2014. [DOI: 10.1080/15487768.2014.903874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chmiel C, Rosemann T, Senn O. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care. Patient Prefer Adherence 2014; 8:383-90. [PMID: 24707172 PMCID: PMC3972023 DOI: 10.2147/ppa.s53950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures. METHODS This was a questionnaire-based cross-sectional study (November 2010-April 2011). The number of patient-psychiatrist encounters, modes of contact, and patient and psychiatrist characteristics were assessed. Diagnoses were coded with ICD-10 (International Classification of Diseases, version 10). RESULTS From 167 duty episodes, 74 (44%) were recorded. Of the psychiatrists (n=44), 52% were female, and mean age (standard deviation) was 49.9 (5.2) years. The median number of encounters per episode was 4 (interquartile range 0-8), mainly in the evenings. Demand for "face-to-face" (direct) patient visits was significantly more common (64.0%) than practice (1.3%) or telephone consultations (34.7%). In 83.8%, psychiatrists judged the encounter as adequate at the patient's location. A total of 43 different diagnoses were recorded: mainly schizophrenic disorders (23.9%), suicidal behavior (15.2%), and acute stress reactions (10.3%). Psychiatrists felt burdened by services (62.5%): in 39.2%, they felt threatened; and in 6.8%, violence occurred. In 32.4%, bills were not paid for. If services were optional, 45.2% would participate. CONCLUSION Our findings indicate justified demand for direct mobile patient visits, suggesting that emergency care should be multifaceted, and sole provision of psychiatric care at stationed emergency facilities may not always be appropriate. Reorganization of 24-hour emergency services should carefully evaluate patient and provider's needs before changing established structures.
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Affiliation(s)
- Corinne Chmiel
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
- Correspondence: Corinne Chmiel, University of Zurich, Institute of General Practice and Health Services Research, Raemistrasse 100, 8091 Zurich, Switzerland, Tel +41 44 255 8509, Fax +41 44 255 9097, Email
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
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van den Brink RHS, Broer J, Tholen AJ, Winthorst WH, Visser E, Wiersma D. Role of the police in linking individuals experiencing mental health crises with mental health services. BMC Psychiatry 2012; 12:171. [PMID: 23072687 PMCID: PMC3511214 DOI: 10.1186/1471-244x-12-171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The police are considered frontline professionals in managing individuals experiencing mental health crises. This study examines the extent to which these individuals are disconnected from mental health services, and whether the police response has an influence on re-establishing contact. METHODS Police records were searched for calls regarding individuals with acute mental health needs and police handling of these calls. Mental healthcare contact data were retrieved from a Psychiatric Case Register. RESULTS The police were called upon for mental health crisis situations 492 times within the study year, involving 336 individuals (i.e. 1.7 per 1000 inhabitants per year). Half of these individuals (N=162) were disengaged from mental health services, lacking regular care contact in the year prior to the crisis (apart from contact for crisis intervention). In the month following the crisis, 21% of those who were previously disengaged from services had regular care contact, and this was more frequent (49%) if the police had contacted the mental health services during the crisis. The influence of police referral to the services was still present the following year. However, for the majority (58%) of disengaged individuals police did not contact the mental health services at the time of crisis. CONCLUSIONS The police deal with a substantial number of individuals experiencing a mental health crisis, half of whom are out of contact with mental health services, and police play an important role in linking these individuals to services. Training police officers to recognise and handle mental health crises, and implementing practical models of cooperation between the police and mental health services in dealing with such crises may further improve police referral of individuals disengaged from mental health services.
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Affiliation(s)
- Rob HS van den Brink
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Broer
- Municipal Health Service Groningen, Groningen, The Netherlands
| | - Alfons J Tholen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim H Winthorst
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Lentis Mental Health Organisation (affiliation at time of study), Groningen, The Netherlands
| | - Ellen Visser
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Psychiatric Case Register North Netherlands, University Medical Center Groningen, Groningen, The Netherlands
| | - Durk Wiersma
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
BACKGROUND Crisis resolution and home treatment teams (CRTs) and home treatment teams have been established nationwide in the UK to reduce admissions to psychiatric hospitals. However, the evidence for CRTs was limited at the time of their introduction. AIMS Review of the literature accumulated since the national rollout of CRTs in 2000. METHOD Systematic narrative literature review utilising British Nursing Index, Cinahl, Embase, Medline and PsyINFO. RESULTS The search revealed one randomised controlled trial and a number of naturalistic studies. The balance of evidence suggests that CRTs can reduce hospital beds and costs with similar symptomatic outcome and service user satisfaction, but there is no evidence that CRTs are the only way to do so. There is no conclusive evidence that CRTs cause an increase in serious and untoward incidents (SUIs) or compulsory admissions. CONCLUSIONS Currently, there is no compelling evidence for the widespread implementation of CRTs. In the future, the incidence of compulsory admissions and SUIs needs to be studied at a national level, CRTs have to be compared with other methods to reduce hospital admissions and studies need to specify sample and treatment characteristics with greater detail.
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Affiliation(s)
- Dieneke Hubbeling
- Wandsworth Crisis and Home Treatment Team, Springfield Hospital, London SW17 7DJ, UK.
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Sjølie H, Karlsson B, Kim HS. Crisis resolution and home treatment: structure, process, and outcome - a literature review. J Psychiatr Ment Health Nurs 2010; 17:881-92. [PMID: 21078003 DOI: 10.1111/j.1365-2850.2010.01621.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY • During the last ten years there has been a major change in developing mental health services generally, and crisis resolution and home treatment (CRHT) services especially. Many Western countries have made a shift in perspective from in-hospital care to home treatment. The new approach is based on treating people who experience mental health crises in their homes instead of through hospitalization. • Most of the published articles on CRHT focus on structural issues pertaining to the development of home treatment services, and on macro-level outcomes such as cost-effectiveness and admission rates. These have political, economic, and practical implications. Few articles describe clinical intervention methods used in home treatment. • This paper explores how home treatment is described as an essential intervention method in crisis resolution at home in relation to three key characteristics of CRHT, which are being mobile, working in the service user's home, and working together with the person's family and network. • There remains a need for further research describing specific characteristics of home treatment, different clinical interventions that are used by CRHT teams, and the directions with which clinical interventions need to be developed further. It is critical to investigate what makes the interventions of the CRHT teams different from the hospital care, and how this affects the service users, the family and the networks, and the professionals. ABSTRACT The objective of this paper is to explore and systematize the existing knowledge regarding the structure, process, and outcome of crisis resolution and home treatment (CRHT) as a form of community mental health service. Data sources are published peer-reviewed articles. Our study selection is systematic search for peer-reviewed articles written in English and Norwegian published between January 2000 and December 2008. Data are extracted from review of published articles on the subject of CRHT team and home treatment. We identified 35 articles including 6 reviews, consisting of quantitative and qualitative studies. The knowledge regarding CRHT focuses on three areas: (1) structure in terms of the standards, organization, and development; (2) process in terms of clinical interventions; and (3) outcome in relation to cost-effectiveness and admission rates. While the structural issues were presented and discussed a great deal, there is a paucity of articles on clinical intervention methods in home treatment as well as a limited attention on outcomes at the micro-level. There is a need for further studies regarding the clinical work of CRHT teams from the home treatment perspective.
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Affiliation(s)
- H Sjølie
- Department of Health Sciences, The University College of Buskerud, Drammen, Norway.
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Kisely S, Campbell LA, Peddle S, Hare S, Pyche M, Spicer D, Moore B. A controlled before-and-after evaluation of a mobile crisis partnership between mental health and police services in Nova Scotia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:662-8. [PMID: 20964945 DOI: 10.1177/070674371005501005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional. METHODS We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward. RESULTS The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call-to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team (n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, chi square = 92.7, df = 1, P < 0.001). The service data findings were supported by the qualitative results of focus groups and interviews. CONCLUSIONS Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness.
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Affiliation(s)
- Stephen Kisely
- University of Queensland, Health LinQ, Brisbane, Australia
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40
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Coleman TG, Cotton DH. Reducing Risk and Improving Outcomes of Police Interactions with People with Mental Illness. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15332581003756950] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Winness MG, Borg M, Kim HS. Service users' experiences with help and support from crisis resolution teams. A literature review. J Ment Health 2010; 19:75-87. [PMID: 20380500 DOI: 10.3109/09638230903469178] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Services for crisis resolution provided by home treatment teams are recent developments in the mental health care scene. There is a lack of systematized reviews in the service users' responses to these services. AIM To systematize the existing knowledge regarding the service users' experiences with crisis resolution and home treatment (CR/HT) teams in order to explore ways to develop this form of service further. METHOD A systematic review of the periodical literature and research reports on CR/HT was carried out for the period from January 1995 to January 2009. RESULTS A total of 13 papers, one RCT review and two reports were identified, including both qualitative and quantitative studies. Although these studies provided few in-depth details, three major themes as the characteristics of CR/HT teams are extracted as: (a) access and availability, (b) being understood as "normal" human beings, and (c) dealing with crises in an everyday life context. CONCLUSIONS The findings suggest that the key positive characteristics of help in crisis situations are intrinsically tied to the values and principles undergirding CR/HT services. The commitment to community-based services, the philosophy of partnership, and user-empowerment seem to the base from which these three themes of positive experiences emerged.
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Currier GW, Fisher SG, Caine ED. Mobile crisis team intervention to enhance linkage of discharged suicidal emergency department patients to outpatient psychiatric services: a randomized controlled trial. Acad Emerg Med 2010; 17:36-43. [PMID: 20015106 DOI: 10.1111/j.1553-2712.2009.00619.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital-based clinic as a means of establishing near-term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. METHODS In a rater-blinded, randomized controlled trial, 120 participants who were evaluated for suicidal thoughts, plans, or behaviors, and who were subsequently discharged from an urban ED, were randomized to follow-up either in the community via a MCT or at an outpatient mental health clinic (OPC). Both MCTs and OPCs offered the same structured array of clinical services and referral options. RESULTS Successful first clinical contact after ED discharge (here described as "linkage" to care) occurred in 39 of 56 (69.6%) participants randomized to the MCT versus 19 of 64 (29.6%) to the OPC (relative risk = 2.35, 95% CI = 1.55-3.56, p < 0.001). However, we detected no significant differences between groups using intention-to-treat analyses in symptom or functional outcome measures, at either 2 weeks or 3 months after enrollment. We also found no significant differences in outcomes between participants who did attend their first prescribed appointment via MCT or OPC versus those who did not. However divided (MCT vs. OPC, present at first appointment vs. no show), groups showed significant improvements but maintained clinically significant levels of dysfunction and continued to rely on ED services at a similar rate in the 6 months after study enrollment. CONCLUSIONS Community-based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations.
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Affiliation(s)
- Glenn W Currier
- Center for Public Health and Population Interventions for Preventing Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
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Lee S, Brunero S, Fairbrother G, Cowan D. Profiling police presentations of mental health consumers to an emergency department. Int J Ment Health Nurs 2008; 17:311-6. [PMID: 18789040 DOI: 10.1111/j.1447-0349.2008.00553.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.
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Affiliation(s)
- Soung Lee
- Enhanced Hospital Drug Health Consultation Liaison Services, Liverpool Hospital, Sydney, New South Wales, Australia.
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Psarra V, Sestrini M, Santa Z, Petsas D, Gerontas A, Garnetas C, Kontis K. Greek police officers' attitudes towards the mentally ill. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2008; 31:77-85. [PMID: 18192017 DOI: 10.1016/j.ijlp.2007.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The deinstitutionalization of the mentally ill and their shift into the community lead the police to play an important role in the management of acute psychiatric states. This study examines the attitudes of the Greek police towards the mentally ill, and the problems that arise during the transfer of mentally ill people to psychiatric emergency departments. Results highlight policemen misperceptions, and the difficulties encountered during transport procedures, which may be attributed to insufficient knowledge about mental illness and lack of training, respectively. Furthermore, this article discusses the need for police educational intervention, and the formation of specialized teams to improve the handling of mentally ill in crisis situations.
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Ruggeri M, Salvi G, Perwanger V, Phelan M, Pellegrini N, Parabiaghi A. Satisfaction with community and hospital-based emergency services amongst severely mentally ill service users: a comparison study in South-Verona and South-London. Soc Psychiatry Psychiatr Epidemiol 2006; 41:302-9. [PMID: 16520886 DOI: 10.1007/s00127-006-0030-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2005] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study compares the satisfaction with emergency interventions among severely mentally ill (SMI) service users of a community-based and a hospital-based mental health service (South-Verona, Italy and Nunhead, South-London, UK). METHODS A measurement of the satisfaction with psychiatric emergency services was conducted among all those users in the two catchment areas who, in a 1-year period: (1) had at least two contacts with the service; (2) had a diagnosis of psychosis according to ICD10; (3) had not been living in hospital or sheltered apartment for most of the time. These users completed seven items belonging to the Verona Service Satisfaction Scale (VSSS) regarding their satisfaction with crisis response during and out of office hours and their satisfaction with the different interventions, which may be provided during emergencies, such as consultation for the user, consultation for the relative, day-centre attendance, informal and compulsory admission. RESULTS Users in South-Verona were generally more satisfied with emergency interventions. The main differences between the two samples were due to contacts outside the hospital setting, whilst satisfaction scores for informal admission were similar. The number of users who did not receive, but would have liked, different types of emergency intervention was smaller in South-Verona than in Nunhead. In South-Verona, users wishes mainly concerned consultation for the relatives during emergencies; in the Nunhead sample, the most requested types of intervention were consultation for the user and the possibility of day-centre attendance during crisis. CONCLUSIONS The findings suggest that users of a service with a well developed community-oriented approach and with crisis intervention outside the hospital setting are more satisfied of the emergency interventions than users of a mental health service relying mostly on hospital facilities during emergencies.
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Affiliation(s)
- Mirella Ruggeri
- Dept. of Medicine and Public Health Section of Psychiatry and Clinical Psychology, University of Verona, Ospedale Policlinico, Verona, Italy
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Bonsack C, Adam L, Haefliger T, Besson J, Conus P. Difficult-to-engage patients: a specific target for time-limited assertive outreach in a Swiss setting. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:845-50. [PMID: 16483119 DOI: 10.1177/070674370505001307] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT. METHODS We retrospectively assessed social, clinical, and functional outcomes and motivation for treatment in 75 consecutively seen subjects treated between 2000 and 2002. RESULTS With 70% of the interventions lasting less than 6 months, we observed significant improvement in most clinical and social problems, in collaboration, in motivation for treatment, and in social network support, despite high baseline levels of clinical and social problems. The number of hospitalizations decreased significantly. CONCLUSIONS Time-limited ACT is a useful treatment for difficult-to-engage patients with severe clinical and social problems, and it facilitates linkage to care. This narrower target for ACT may facilitate its implementation in Europe.
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Affiliation(s)
- Charles Bonsack
- Unité de Psychiatrie Communautaire, Département de Psychiatrie du CHUV, Faculté de Biologie et Médecine, Université de Lausanne, Switzerland.
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Abstract
To gain a better understanding of the scope of previous research on psychiatric emergency services (PES) and to identify areas of focus for future studies, the author reviews PES literature published between 1983 and 2003. PES literature was identified by performing a MEDLINE search. The author was interested in studies or reviews of all types of PES. The refereed research, consisting of 85 articles, is a representation of the existing literature as multiple studies were found to be similar in topic and methodology. This review is organized using Donabedian's structure, process, outcome framework to describe research that has examined 1) providers, clients, and services; 2) variations in access, utilization, evaluation, treatment, and continuity of care; and 3) outcomes of these services. The resulting report reveals methodological limitations that are pervasive throughout the PES literature, dimensions of psychiatric emergency services that remain unexplored, and a PES research agenda.
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Affiliation(s)
- Jennifer Field Brown
- Department of Health Administration, Virginia Commonwealth University, Virginia, USA.
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Landeen J, Pawlick J, Rolfe S, Cottee I, Holmes M. Delineating the population served by a mobile crisis team: organizing diversity. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:45-50. [PMID: 14763677 DOI: 10.1177/070674370404900107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE While mobile crisis teams have proliferated to address gaps in service for individuals with serious mental illness, research into their effectiveness is limited. This study identifies specific cohorts of individuals served by a single mobile crisis team so that appropriate program evaluation could be designed and conducted for each unique grouping. METHOD This retrospective study analyzes specific data from 4 sets of client records (n = 401) at 4 different time periods, using a qualitative, text-based approach. For the first 2 reviews (n = 69 and n = 40), only data related to referral source, sex, details of the reason for referral, and the mental status assessment were known to the researchers. The first 2 sets of records were used to identify the cohorts, the third set was used to confirm these cohorts, and the fourth set was used to determine the reliability of the classification tool. RESULTS All individual cases for the mobile crisis team could be classified into one of the following categories: Symptoms Disturbing Others, Symptoms Disturbing Self, Information Seeking, For Your Information, and Other. After the third review, the cluster, Symptoms Disturbing Others, was subdivided into Symptoms Disturbing Others-General and Symptoms Disturbing Others-Suicide. CONCLUSIONS This review was useful in identifying specific cohorts of individuals served by a single mobile crisis team. Clearly identifying who is served by a mobile crisis team is the first step in identifying practice guidelines and appropriate evaluation measures for each distinct group.
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Affiliation(s)
- Janet Landeen
- School of Nursing, McMaster University, Hamilton, Ontario
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Hugo M, Smout M, Bannister J. A comparison in hospitalization rates between a community-based mobile emergency service and a hospital-based emergency service. Aust N Z J Psychiatry 2002; 36:504-8. [PMID: 12169150 DOI: 10.1046/j.1440-1614.2002.01042.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aims of this study were to compare the rates of inpatient admission between a mobile community-based psychiatric emergency service and a hospital-based psychiatric emergency service, and to identify the clinical characteristics of consumers more likely to be admitted to hospital. METHODS A retrospective, quasi-experimental design was used with a 3-month cohort of all face-to-face emergency service contacts presenting at the mobile and hospital-based sites. The Health of the Nation Outcome Scales and details of the outcome following initial assessment were completed for all contacts, and each group was compared for differences in clinical characteristics and outcome. RESULTS Hospital-based emergency service contacts were found to be more than three times as likely to be admitted to a psychiatric inpatient unit when compared with those using a mobile community-based emergency service, regardless of their clinical characteristics. Those with severe mental health disorders such as schizophrenia and major affective disorder, and experiencing problems with aggression, non-accidental self-injury, hallucinations and delusions, problems with occupation, activities of daily living, and living conditions were more likely to be admitted to hospital. Nevertheless, after controlling for clinical characteristics, site of initial assessment accounted for a substantial proportion of the variance in decisions to admit to hospital. CONCLUSIONS Emergency psychiatric services which include a mobile component and provide a specialized multidisciplinary team approach appear to be most effective in providing services in the least restrictive environment and avoiding hospitalization.
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Affiliation(s)
- Malcolm Hugo
- 91 John Street, Salisbury 5108, South Australia, Australia.
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