Background Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a ‘last line of support’ and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. Results Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For “vulnerable groups”, the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. Conclusions This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved.

With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings.

Background The impact of policing practices on the engagement of people who use drugs (PWUD) with harm reduction services is well evidenced. Although the police have traditionally taken an enforcement role in responding to drug use, it is increasingly clear that they can play an important part in multiagency delivery of harm reduction interventions. Despite this, there have been no studies exploring police officer perceptions of drug checking services (DCS), which provide analytical testing of client drug samples alongside harm reduction support and advice. Methods Semi-structured interviews were conducted with 10 police officers to explore the policing and legal challenges which could be encountered in the delivery of DCS in Scotland. Results Participants expressed general support for DCS and described this support as part of a wider organisational shift towards public health-oriented policing. Participants also discussed different potential approaches to the policing of areas surrounding DCS including: formal limits on police presence around the service and/or stop and search powers in relation to personal possession; the effective decriminalisation of personal possession within a specified boundary around the service; and informal agreements between local divisions and DCS outlining expected policing practices. Any formal limitation on the capacity of police officers to respond to community concerns was viewed as problematic and as having the potential to erode public confidence in policing. Participants also highlighted the potential for frontline officers to utilise discretion in ways which could undermine public health goals. Legislative change, or national strategic guidance from relevant stakeholders, was seen as a means of providing ‘cover’, enabling local divisions to support the operation of drug checking. Conclusions Despite a small sample of participants, this study summarises key challenges to be addressed in the implementation and operation of DCS in Scotland, and more widely. The paper concludes with suggested opportunities to develop approaches to policing that can facilitate rather than impede implementation and operation of these services.

In recent years, the scale, impact and legality of stop and search in Scotland has been subject to intense critical scrutiny, leading to major legal and policy reform in 2016. Based on these events, including an early unsuccessful attempt by Police Scotland to reform the tactic (the 'Fife Pilot'), this paper presents original theoretical and empirical insights into organizational change in policing. Building on the theoretical perspectives of Chan (1997) and Bradford and Quinton (2014) on organizational culture and justice respectively, the paper set out a dynamic model of organizational justice in policing. While Scotland has seen significant legislative reform apropos stop and search, we conclude that real change in police practice and culture will require effective leadership and a strong commitment to organizational justice. We also suggest how insights from the analysis might be applied to other jurisdictions and policing fields, with a view to securing more citizen-focused, democratic policing.

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