Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis

Abstract

Background Police officers are often the first responders to mental health-related incidents and, consequently, can become a common gateway to care. The volume of such calls is an increasing challenge. Objective What is the evidence base for models of police-related mental health triage (often referred to as ‘street triage’) interventions? Design Rapid evidence synthesis. Participants Individuals perceived to be experiencing mental ill health or in a mental health crisis. Interventions Police officers responding to calls involving individuals experiencing perceived mental ill health or a mental health crisis, in the absence of suspected criminality or a criminal charge. Main outcome measures Inclusion was not restricted by outcome. Data sources Eleven bibliographic databases (i.e. Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, EMBASE, MEDLINE, PAIS® Index, PsycINFO, Scopus, Social Care Online, Social Policy & Practice, Social Sciences Citation Index and Social Services Abstracts) and multiple online sources were searched for relevant systematic reviews and qualitative studies from inception to November 2017. Additional primary studies reporting quantitative data published from January 2016 were also sought. Review methods The three-part rapid evidence synthesis incorporated metasynthesis of the effects of street triage-type intervention models, rapid synthesis of UK-relevant qualitative evidence on implementation and the overall synthesis. Results Five systematic reviews, eight primary studies reporting quantitative data and eight primary studies reporting qualitative data were included. Most interventions involved police officers working in partnership with mental health professionals. These interventions were generally valued by staff and showed some positive effects on procedures (such as rates of detention) and resources, although these results were not entirely consistent and not all important outcomes were measured. Most of the evidence was at risk of multiple biases caused by design flaws and/or a lack of reporting of methods, which might affect the results. Limitations All primary research was conducted in England, so may not be generalisable to the whole of the UK. Discussion of health equity issues was largely absent from the evidence. Conclusions Most published evidence that aims to describe and evaluate various models of street triage interventions is limited in scope and methodologically weak. Several systematic reviews and recent studies have called for a prospective, comprehensive and streamlined collection of a wider variety of data to evaluate the impact of these interventions. This rapid evidence synthesis expands on these recommendations to outline detailed implications for research, which includes clearer articulation of the intervention’s objectives, measurement of quantitative outcomes beyond section 136 of the Mental Health Act 1983 [Great Britain. Mental Health Act 1983. Section 136. London: The Stationery Office; 1983 URL: www.legislation.gov.uk/ukpga/1983/20/section/136 (accessed October 2017)] (i.e. rates, places of safety and processing data) and outcomes that are most important to the police, mental health and social care services and service users. Evaluations should take into consideration shorter-, medium- and longer-term effects. Whenever possible, study designs should have an appropriate concurrent comparator, for example by comparing the pragmatic implementation of collaborative street triage models with models that emphasise specialist training of police officers. The collection of qualitative data should capture dissenting views as well as the views of advocates. Any future cost-effectiveness analysis of these interventions should evaluate the impact across police, health and social services. Funding The National Institute for Health Research Health Services and Delivery Research programme.

The “disease” of violence against health-care workers is a wicked problem. Managing and preventing violence in health-care

“…The unique characteristics of people with mental health who perpetrate violent behaviour may necessitate a targeted mental health response. One specific challenge in psychiatric care settings is that workers are often required to develop and maintain ongoing therapeutic relationships with patients (Rodgers et al , 2019). When health-care workers are required to maintain long-term therapeutic relationships with patients who behave aggressively this can be particularly challenging for their emotional and mental health (Jacob et al , 2020).…”

“…Consistent with the idea of wicked problems, not all groups win together and small wins for certain groups can be overshadowed by damages to the aims of other groups (Termeer and Dewulf, 2019). As an example, a synthesis of evidence on police interventions for people with mental health challenges in the UK has shown that while having mental health professionals work with frontline police to attend to people in mental health crisis may increase the level of trust that people have in police, it may also have the potential to reduce the trust that is placed in those mental health professionals working with the police (Rodgers et al , 2019). There may be added difficulties when considering ways of managing wicked problems that are not politically expedient or in line with the broader ideological tenants of the government of the day (McConnell, 2018).…”

Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

“…5 Due to limited resources, the only options available to police have been force and detention. 9 Section 136 (S136) of the Mental Health Act 1983 gives police authority to detain PMI in a safe place, often a cell, which can worsen the crisis. 9 10 Concerns about police capability to make decisions about people's mental health has led to changes in legislation and policy.…”

“…However, there are concerns that FRs cannot provide expert support for PMI and report feeling ill-equipped 7 8. Limited training can result in inappropriate responses,5 9 for instance, tasers are more likely to be used during an MHC than a criminal arrest 5. Due to limited resources, the only options available to police have been force and detention 9.…”

“…Limited training can result in inappropriate responses,5 9 for instance, tasers are more likely to be used during an MHC than a criminal arrest 5. Due to limited resources, the only options available to police have been force and detention 9. Section 136 (S136) of the Mental Health Act 1983 gives police authority to detain PMI in a safe place, often a cell, which can worsen the crisis 9 10.…”