The use of a brief mental health screener to enhance the ability of police officers to identify persons with serious mental disorders

Abstract

Police agencies in Canada and elsewhere have received much criticism over how they respond to persons with serious mental disorders. The adequacy of training provided to police officers on mental health issues and in particular on recognizing indicators of serious mental disorders has been a major concern. This paper describes the process that led to the development of a new brief mental health screener (interRAI Brief Mental Health Screener, BMHS) designed to assist police officers to better identify persons with serious mental disorders. The interRAI BMHS was developed in collaboration with interRAI, an international, not-for-profit consortium of researchers. The government of Ontario had previously partnered with interRAI to develop and implement the Resident Assessment Instrument for Mental Health (RAI-MH), the assessment system mandated for use on all persons admitted into inpatient psychiatric care in the province. Core items on the interRAI BMHS were obtained through analysis (N=41,019) of RAI-MH data together with input from representatives from health care, police services, and patient groups. Two police services in southwestern Ontario completed forms (N=235) on persons thought to have a mental disorder. Patient records were later accessed to determine patient disposition. The use of summary and inferential statistics revealed that the variables significantly associated with being taken to hospital by police included performing a self-injurious act in the past 30days, and others being concerned over the person's risk for self-injury. Variables significantly associated with being admitted included abnormal thought process, delusions, and hallucinations. The results of the study indicate that the 14-variable algorithm used to construct the interRAI BMHS is a good predictor of who was most likely to be taken to hospital by police officers and who was most likely to be admitted. The instrument is an effective means of capturing and standardizing police officer observations enabling them to provide more and better quality information to emergency department (ED) staff. Teaching police officers to use the form constitutes enhanced training on major indicators of serious mental disorders. Further, given that items on the interRAI BMHS are written in the language of the health system, language acts as common currency between police officers and ED staff laying the foundation for a more collaborative approach between the systems.

Review article: Clinical characteristics and outcomes of patient presentations to the emergency department via police: A scoping review

“…Supporting guidelines, clinical frameworks, policy and legislative requirements cited in the reviewed studies did not always appear to meet the needs of police and/or consumers or assist in the provision of quality care in the ED . Legislatively required documentation associated with presentations to ED that were BIBP was rarely mentioned or reported in studies. Actual or potential medico‐legal consequences/outcomes were sometimes, but not always referred to in the reviewed studies even though medico‐legal considerations were important factors that guided processes such as detention and restraint applied by police and clinical staff.…”

“…Interviews with 15 service users indicated an appreciation of specialised mental health response, use of de‐escalation skills, compassion, empowerment and non‐criminalising approach . A similar model, termed Police Ambulance Crisis Emergency Response, exists in Australia . With this model, the provision of mental health evaluations ‘in the field’ by mental health personnel and police meant that some consumers could be diverted away from the ED.…”

“…Although people BIBP were more likely to be referred to a mental health service, and other community services or resources, there was a noted lack of literature examining the uptake and outcomes of these referrals. This presents a critical opportunity for further research, especially in the context of national mental health and suicide prevention priority areas that include: coordinated treatment and support for people with severe and complex mental illness; improving physical health and reducing early mortality; and enabling effective system performance and system improvement strategies . By virtue of their presentation, people presenting to the ED by police are a vulnerable population who require co‐ordinated multi‐agency, multi‐sectoral responses.…”

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

“…The first interRAI instruments were designed to be used in a single sector at a time (142,143), and the release of interRAI's mental health instrument for in-patient psychiatry (144) represented its first effort to target the general adult population. In 2000, interRAI launched a major effort to redesign all of its assessment instruments to function as a fully integrated suite of measures (145)(146)(147)(148). The most recent developments by interRAI include the creation of a parallel suite of instruments for children and youth (149,150), screening systems for use by non-health professionals (151), and a set of self-report tools to measure patient experience (152)(153)(154) and patient reported outcome measures (155,156).…”

“…The first version of the instrument was released in 1999, with a major update in 2002. The most recent version 9.1.2 was published in 2012 (157) with revisions designed to make it fully compatible with the interRAI suite (147). The MH was pilot tested in Nordic countries and the US, but the primary implementation has been in two Canadian provinces (Ontario, Newfoundland and Labrador).…”