Barriers and facilitators to implementing an urban co-responding police-mental health team

Abstract

BackgroundIn 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.ResultsFindings 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.ConclusionThe 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.

Knowledge and Skills for Social Workers on Mobile Crisis Intervention Teams

“…Those already in recovery may require an updated relapse prevention plan to keep focused on long-term goals. For clients wanting to discontinue substance use, knowledge of withdrawal management, outpatient services, and treatment options is essential (Bailey et al, 2018 ). Since March 2020, many rehabilitation programs have slowed or moved online to prevent the spread of COVID-19, requiring workers to maintain viable service partnerships and up-to-date awareness of referral processes to effectively connect marginalized clients with the programs they need to survive (Armstrong, 2020 ).…”

“…Outcome studies evaluating the efficacy of MCITs are scarce, though the few available studies show promising results (Bailey et al, 2018 ; Blais et al, 2020 ; Kirst et al, 2015 ; Kisely et al, 2010 ; Lamanna et al, 2015 ; Semple et al, 2020 ). A systematic review found co-responder crisis models can reduce the number of mental health act apprehensions and use of police custody for people with mental illness (Puntis et al, 2018 ).…”

“…The Sherbrooke, Quebec MCIT demonstrated effectiveness in reducing police use of force, connecting distressed individuals with community services, and avoiding unnecessary emergency department (ED) visits (Blais et al, 2020 ). A co-response team in Indianapolis was found to reduce short term incarceration risk (Bailey et al, 2018 ). Toronto’s MCIT was found to have lower rates of injury, arrest, and involuntary escort to hospital compared with police-only teams (Lamanna et al, 2018 ).…”

Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees

“…In addition to CIT, a number of jurisdictions have implemented mental health courts which aim to improve adherence to treatment as a means of avoiding incarceration (Kuehn, 2007); however, these courts are not able to serve all individuals with a mental illness who enter the justice system. More recently, jurisdictions have implemented diversion programs for individuals with mental health (Bailey et al, 2018) conditions or SUD (Collins, Lonczak, & Clifasefi, 2017) who commit low level, non-violent offenses; diversion is a way to link individuals to appropriate services and to medical professionals and has been shown to reduce repeat arrests. Programs like Seattle's Law Enforcement Assisted Diversion, which diverts individuals into supportive case management programs instead of jail, have reduced subsequent arrests by nearly 60% for individuals involved in low-level drug and prostitution activity (Collins et al, 2017).…”

“…Furthermore, prior research has relied on different definitions to identify individuals who have frequent contact with the justice system, taking into account only arrests for a protective hold (Akins et al, 2016), or only jail or incarcerated individuals (Baillargeon et al, 2009;Hwang et al, n.d.;Kopak, Guston, Maness, & Hoffmann, 2019;White et al, 2006), or only anecdotal evidence from police departments or news media (Santos & Goode, 2014). Given the limited samples used in prior studies, the true prevalence of mental illness and SUD among repeat arrestees is unknown (Bailey et al, 2018). This is problematic as repeat arrestees are typically presumed to be living with a mental illness (Akins et al, 2016).…”