Lived experience of involuntary transport under mental health legislation

Abstract

Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales (NSW) Mental Health Act (MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most (n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports.

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

“…17 Of these, 50 focused on the experiences of solely patients and 6 focused on the experiences of both patients and carers. In total, 30 studies were conducted in the UK (including England and Scotland), 11,18–46 9 in Sweden, 13,47–54 5 in Australia, 55–59 5 in Ireland, 60–64 2 in Norway, 65,66 and a study each were identified from Austria, 67 Finland, 68 Greece, 14 Israel 12 and the USA. 69 All papers identified were reported in the English language.…”

Experiences and Perceptions of Police Officers Concerning Their Interactions With People With Serious Mental Disorders for Compulsory Treatment

“…This emotional bond with a person with a mental disorder has also been shown in research in other countries, such as with police officers in the United Kingdom (UK), where they express the desire to help and to have empathy and understanding of people with mental disorders (25). A gentle communicative style is required to gain trust, rapport and compliance from the person under compulsory admission (37). The strategy of using dialogue and giving time to patients to explain themselves is perceived by people with a serious mental disorder as a more humane treatment (38, 39).…”

“…The strategy of using dialogue and giving time to patients to explain themselves is perceived by people with a serious mental disorder as a more humane treatment (38, 39). For patients, being treated as humans is crucial to perceive the interaction as positive and for that, factors, such as communication style, being listened to, gentle handling, putting them at ease and not rushing things are key (37, 39). This procedural justice activity framework is crucial for the patient's cooperation and influences perceptions of police legitimacy.…”

Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis

“…1, 26 23 papers were selected: 12,16, 16 reported on the experiences of carers only, 12,16,[34][35][36][37][38][39][40][41][42][43][44][45][46][47] while seven reported on the experiences of patients, carers and other stakeholders. [27][28][29][30][31][32][33] Study characteristics are summarised in supplementary Table 1 including quality appraisal results that show that 20 of the 23 papers were rated as high-quality studies. Where studies were marked down during quality appraisal, this was often because of studies not having explicitly addressed the relationship between the researcher/s and participants (n = 19).…”

“…Twelve papers reported on studies conducted in the UK (6 in England, 16,29,30,32,34,35 1 in Wales, 36 2 in Northern Ireland, 28,31 1 in Scotland, 12 and 2 not specified 37,38 ), with the remaining studies conducted elsewhere in Europe (Germany, 39,40 Greece, 41 Norway, [42][43][44] and the Republic of Ireland 33 ), Canada, 45 the USA 46 and Australia. 27,47 Although most studies reported on detention in general psychiatric hospitals, three papersall conducted in the UKreported on carers' experiences of assessment and treatment units and forensic services. [36][37][38] At least 260 carers were included in the reviewed studies.…”