Re‐examining mental health crisis intervention: A rapid review comparing outcomes across police, co‐responder and non‐police models

Abstract

Police are the default first responders in most mental health crisis intervention models worldwide, resulting in a heavy burden on police, perceived criminalization of individuals with complex mental health needs, and escalation of aggression that resort to violence. Models, such as crisis intervention teams (CIT), and co-response programmes aim to improve service user experiences and outcomes by providing mental health training to police, or pairing law enforcement officers with mental health clinicians, respectively. Despite these efforts, mental health-related calls continue to result in negative outcomes, and activists and policymakers are advocating for nonpolice models of crisis intervention. Evidence-based practice in mental health crisis intervention is urgently needed. The present review's main objective was to examine, synthesise and compare outcomes across police, co-responder and non-police models of mental health crisis intervention internationally using a rapid review framework. A systematic search of four electronic databases of studies published between 2010-2020 and a grey literature search was conducted, yielding (n = 1008) articles. A total of 62 articles were included in the present review. Studies were largely observational, lacking control groups and were of low-moderate quality with a high potential for bias. Overall, there is little evidence to suggest that the CIT model impacts crisis outcomes. Co-responder models evidenced improved outcomes compared to police only models, however, evidence was often mixed. Non-police models varied significantly, and studies tended to be too low quality to make comparisons or draw conclusions, however, research on youth models and crisis resolution home treatment suggested positive outcomes. Findings highlight the need for high-quality studies and policies to facilitate the implementation and evaluation of novel approaches not involving police.Cross-sectorial collaboration and service user input are urgently needed to inform, develop, test and disseminate effective models of crisis intervention acceptable to service users.

Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum

“…This is significant given evidence of service users’ preferences for the involvement of family members rather than police personnel in crisis situations [ 57 ] and carers’ reflections on the frightening and sometimes traumatising nature of mental health crises involving police intervention [ 58 , 59 ]. Evidence presented here supports the recommendation [ 56 ] for research into co-designed crisis models and subsequent large-scale evaluation to address this highly significant point in the care pathway for people experiencing mental health crises and their families.…”

“…Efforts have been made to embed mental health expertise within police responses to mental health crises, including as part of “co-response” teams comprising mental health professionals and law enforcement personnel. However, a recent systematic review [ 56 ] of related literature reported that while co-responder models show improvement in some crisis outcomes relative to police-only models, such as arrest rate, the current evidence base provides mixed support for their overall effectiveness and is limited to largely low-quality studies. The extent to which these models contribute to improved outcomes for families of people experiencing crisis is currently unclear.…”

Previous mental health care and help-seeking experiences: Perspectives from sexual and gender minority survivors of near-fatal suicide attempts.

“…SGM adults with high suicide risk should also be consulted in efforts to reduce police involvement in mental health crises. These discussions can occur individually with clients and providers to find appropriate, alternative methods to welfare checks with police while safety planning (see Drustrup et al, 2022, for practical recommendations) or as community stakeholders in development of nonpolice models of crisis intervention (Marcus & Stergiopoulos, 2022).…”

The spatial (in)stability of mental health calls for police service

“…Beyond CIT, police services have also established efforts broadly referred to as "co-response teams," which are commonly comprised of a specially trained police officer working together with a mental health practitioner who then respond to PwPMI calls as a team Shapiro et al, 2015). Although the evidence on co-response teams is not conclusive nor consistent across existing scholarship that has largely been limited to descriptive or quasi-experimental investigations (see e.g., Bird & Shemilt, 2019;Dewa et al, 2018;Ghelani et al, 2022;Huey et al, 2021;Marcus & Stergiopoulos, 2022;Puntis et al, 2018;Seo et al, 2021;Shapiro et al, 2015;Taheri, 2016;Watson et al, 2017;Watson et al, 2019), findings suggest that co-response teams may reduce use of force incidents, arrests, costs associated with PwPMI calls, and time spent at PwPMI calls, while also increasing referrals to community-based mental health services, PwPMI engagement with outpatient services, and PwPMI satisfaction when interacting with the police (Blais et al, 2020;Fahim et al, 2016;Kirst et al, 2015;Kisely et al, 2010;Lamanna et al, 2018;Semple et al, 2021).…”

“…This particular call for reform originates from the murder of George Floyd by the Minneapolis Police Department and the subsequent Defund the Police movement, which broadly sought to reimagine how policing and public safety is conducted, which in part questioned the role of the police in responding to PwPMI (Cummins, 2022; Koziarski & Huey, 2021; Lum et al., 2021). While most of our limited empirical knowledge on civilian‐based responses is currently contained within unpublished gray literature that has not been scrutinized by peer review (Marcus & Stergiopoulos, 2022), a number of North American jurisdictions are currently conducting pilot programs for these responses with the goal of reducing the footprint of the police in the lives of PwPMI (Dee & Pyne, 2022; Watson, Pope, et al., 2021; Yousif, 2022).…”