A Controlled Before-and-After Evaluation of a Mobile Crisis Partnership between Mental Health and Police Services in Nova Scotia

Article excerpt

Objectives: Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional.

Methods: We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward.

Results: The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call-to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team (n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, χ^sup 2^ = 92.7, df = 1, P < 0.001). The service data findings were supported by the qualitative results of focus groups and interviews.

Conclusions: Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness.

Can J Psychiatry. 2010;55(10):662-668.

Clinical Implications

* The Introduction of an integrated mobile crisis service involving clinicians and police officers was associated with improved response times in spite of an increased use by patients, families, and service partners.

* Patients in contact with the mobile crisis service showed greater subsequent engagement with treatment than control subjects as measured by increased outpatient contacts.

* Partnerships between the police and mental health system can improve collaboration, efficiency, and the treatment of people with mental Illness.

Limitations

* We used routinely collected health and police administrative data for the quantitative analyses, which are subject to recording bias.

* Qualitative data add more depth and insight to quantitative findings but may not be generalizable, or applicable, to the larger population.

* We were unable to measure the effect on admissions to hospital.

Key Words: mixed-methods, integrated service, mobile crisis unit, police, mental health

Abbreviations used in this article

CDHA Capital District Health Authority

EHS Emergency Health Services

GAF Global Assessment of Functioning

HRP Halifax Regional Police

MHMCT Mental Health Mobile Crisis Team

PHRU Population Health Research Unit

Responding to mental health crises in the community has typically fallen to generic emergency response services, such as police, emergency medical services, and emergency departments. These services often do not have the knowledge and skills to respond to such crises, resulting in poor outcomes for all involved.13

Our study evaluated an integrated mobile crisis service of clinicians and police officers. A previous service had offered telephone support and mobile crisis intervention from an unaccompanied mental health professional, operating only from 1 PM to 1 AM. The new integrated service offered telephone support 24 hours a day backed by teams of mental health professionals and police partners. A clinician managed all incoming calls and, if unavailable or already on a call, returned the call within 30 minutes. …