Mental health emergency transport: the pot‐holed road to care

Abstract

Police have, historically, been the first point of contact for people experiencing a mental health crisis in the Australian community. Changes in the NSW Mental Health Act 2007 extended the powers and responsibilities for involuntary transport to paramedics and accredited mental health practitioners. The Mental Health Act also allows for police assistance to other agencies during transport of people living with mental illness if there are serious safety concerns. Involuntary intervention for people living with mental illness is based on risk-of-serious-harm criteria under the Mental Health Act, implying serious deterioration before the Act may be invoked. At the point of risk of serious harm, police involvement may be more frequently required according to the acuity of the situation. If the legal basis of non-consensual treatment under the Mental Health Act was lack of capacity, it would provide a more comprehensive legal and ethical basis for early intervention. Police contact is intensified in rural and remote regions, particularly after hours, where crisis assessments and intervention by health services are further stretched. Further reducing police involvement using strategies that increase access to consensual pathways of care for people living with mental illness, particularly for people in regional and remote areas, is desirable but not likely in the foreseeable future.

Lived experience of involuntary transport under mental health legislation

“…The current MHA effectively legislates against early intervention and inadvertently favours police interventions (Bradbury et al . ).…”

“…However, people with a mental illness are more likely to have force used against them by police (Kesic et al 2012) and are more likely to be fatally wounded by police use of force (Kesic et al 2010) than general community members. The current MHA effectively legislates against early intervention and inadvertently favours police interventions (Bradbury et al 2014).…”

“…This poses a number of challenges, particularly for those living outside metropolitan areas. A key concern of police and paramedics from a regional or remote community area is that the logistics of transporting a person with mental health challenges to an appropriate hospital (denoted as a declared facility by the MHA 2007) for psychiatric assessment is resource-intensive and disproportionately time-consuming, and critically, might leave whole communities without police or paramedic cover for hours at a time (Bradbury et al 2014). These issues are often confounded by difficult behaviours from people with mental health challenges towards police, paramedics, and nurses in ED (Fisher 2007).…”

The construction of people with mental health problems as risk objects: Findings of a case study inquiry

“…Rates of compulsory care are increasing, a concern which is not confined to the UK alone with enhanced use of Mental Health Legislation also identified within parts of Europe (Care Quality Commission, 2018;de Stefano & Ducci, 2008). Some countries have extended legislative powers despite challenges to the legitimacy of mental health law that enforces treatment (Bradbury, Ireland, & Stasa, 2014;Szmukler & Weich, 2017). High rates of compulsion have emerged in contrast to a social and political emphasis on community care, citizens' rights and the need for participation of service users in decision-making about their own care (DH, 2016, WHO, 2015.…”

Potentially incapable patients objecting to treatment: doctors' powers and duties

“…Competence as a criterion is a potential solution to much of this 2 but is problematic because of the level of sophistication required, particularly if the right to detain is extended — as it is in some jurisdictions — to all clinical staff. If in John's case competence criteria had been legally available to the caseworker, would she have felt comfortable exercising them just because he seemed psychotic, when there didn't seem to be any immediate danger?…”