The police coming into contact with those in mental health distress has been identified as a key issue in the Mental Health Strategy 2017-2027, Policing 2026, and Justice in Scotland: Vision and Priorities 2017. It is also a main theme for the newly established Health and Justice Collaboration Improvement Board.
Research Aims and Overview
This evidence review looks at collaborative interventions which help support people in mental health distress. It aims to outline 'what works' when individuals present in mental health distress to the police. The key objective is to examine interventions that have been utilised internationally and, where evaluations are available, identify what aspects of the approach work well/not so well.
Types of Intervention and What Works
Many collaborative interventions have been developed and piloted across the world. Interventions tend to fall into one of three categories:
- Increased training on mental health and distress for police officers
- Mental health staff working with the police service to triage, give advice or support over the phone or face-to-face if necessary
- 'Ride along' models where police and health practitioners work together in the response of mental health emergencies.
Increased police training and liaison
This type of intervention provides dedicated training to police on mental health. Evaluations found that:
- Evidence suggested that training is best delivered by mental health staff
- Role-playing is beneficial for real life experience
- Important to dedicate enough hours to training
- Interventions were more effective when the training was combined with some form of increased liaison with mental health practitioners.
Mental Health practitioner Embedded as a Contact for Police
A mental health nurse is embedded in control room, custody suite or provides a direct line of contact for officers. Evaluations found that this approach:
- Improved communication and information sharing
- Reached more service users than face-to-face interventions
- Was best for rural areas
- Was more costly overall but less expensive by case.
Team of one mental health nurse and one police officer. Evaluations found that:
- The teams were less likely to detain, hospitalise or charge individuals unnecessarily
- Some evidence of improved service-user experience
- Co-response teams did not provide as much geographical coverage or respond to as many incidents as other models
- Teams must be truly mobile to be efficient
- The teams were reliant on the nurses knowledge of the local area and health services.
There are two Scottish interventions currently being piloted or rolled out, with some evaluative evidence available. The Community Triage model piloted in a number of areas by Police Scotland provided a mental health nurse to conduct telephone assessments. This has been found to greatly reduce the length of time police spend on calls.
Distress Brief Interventions ( DBI) are more in line with the first model. DBIs provide training to front line staff to improve compassionate response and referrals for onward care. The pilot is still in its infancy but a complete evaluation is being carried out.
Other types of promising interventions
There are a range of other promising interventions that can improve outcomes for mentally distresed individuals. These include those that are focused on prevention and early intervention - in other words, those aimed at preventing a crisis from occuring in the first place. These preventative or 'upstream' interventions can be used alongside the other types of interventions that will be discussed here. There are also interventions which involve assessing individuals remotely via a 'telehealth' assessment.
There are many examples of innovative and succesful collaborations for improving processes and outcomes for those in mental health distress presenting to the police. There are three main types of intervention approach and each can lead to different outcomes for the services or the individual. Therefore, it is clearly important to consider what the desired outcome of a planned intervention is. For example, reduced time spent by the police dealing with incidents, provide support to more individuals, smoother process and resolutions for the individuals, cost savings, better use of place of safety etc.
Overall, the evidence points to the most successful approaches being those which are well co-ordinated between policing and health, involve a high degree of information sharing and clear communications and consider the needs of local areas. There is also scope for innovation. One area that appears particularly untapped through our examination of the evidence is technological innovation. For example, remote assessments. It may also be valuable to look into more preventative interventions, intevening before a crisis point is reached.
The recent establishment of the Health and Justice Collaboration Improvement Board could be a real facilitator in overcoming some of the structural and cultural barriers. The Board is ideally placed to direct a strong co-ordinated approach, which could lead to improved outcomes for both sectors and for individuals.