Police are often first to respond to people experiencing a mental health crisis. There are four commonly used mental health interventions associated with policing.
Four Intervention Models
The four commonly, internationally used interventions are Liaison and Diversion (L&D), Street Triage with mental health specialists, embedded mental health specialists in Police Contact Control Rooms (CCRs) and Crisis Intervention Teams (CITs).
Liaison and Diversion services aim to divert individuals with vulnerabilities, including mental health problems, at their earliest possible contact with the justice system.
Street Triage is a joint mental health service and policing approach to crisis care. Based on locally agreed protocols, the aim is to support access to appropriate crisis care and to provide more timely access to other health, social care and third sector services.
Embedded Staff in Contact Control Rooms (CCRs). Mental health specialists are embedded in the CCR team, advising call handlers and dealing with individual callers.
Crisis Intervention Teams (CIT). Police call center dispatchers are trained to identify mental disturbance calls and assign them to CIT trained officers; they have access to a designated psychiatric emergency drop-off site which operates a no refusal policy, reducing officer time with an individual.
Overall, research studies show a positive impact of the various interventions for those with mental illness or in a mental health crisis where police are involved. This is variously reported as decreasing arrests, reducing jail time, providing a route into mental health treatment services and the identification of other unmet needs.
Wide Interest in CIT
Among the four models, the intervention that stands out is the crisis intervention team (CIT). The key to its effectiveness is that it offers an integrated service combining initial call and response triage with specialist trained officer and mental health professional interventions.
The CIT model involves teams of mental health professionals (e.g., psychiatric nurses or social workers) and police officers trained to respond to calls involving a mental health crisis.
The joint team responds to situations in which a police response has been requested and it is suspected that a mental health issue is an influencing factor.
There is not a standardized implementation and protocol for CIT, though.
In a 2012 pilot CIT program (Lee et al. 2015), when a case description fit the response criteria, the team was mobilized. The clinician would be picked up from the hospital to proceed to the call-out site.
Services that could be requested included mental health assessment, assistance with de-escalation, advice on mental health referral options or appropriate transport options, and treatment plans to assist frequent users of emergency services.
Four types of the CIT benefits were reported in this pilot program:
enhanced outcomes for consumers (e.g. more sensitive and timely response to health issue for consumer)
more efficient use of police resources (e.g. can free up police to respond to other jobs)
enhanced outcomes for police (e.g. get help from a mental health expert or unit)
improved collaboration between services (e.g. better communication, feedback and access to information)
Challenges in CIT Implementation
Differences in police and health system cultures. Often, this has to do with differences in goals. While police are seen to be responsible for public safety, nurses are viewed as accountable for the well-being of individual consumers, frequently acting as health advocates.
Lack of awareness of CIT mandate and varying organizational buy-in in police divisions. There is a lack of awareness of the CIT program mandate among the community, and particularly the primary response unit.
Training. For example, more training is suggested on effective consumer engagement, crisis de-escalation, and general mental health system information was needed for officers. For nurses, more training on safety issues and police culture is recommended.
Role clarity. Some people view marked police cars as helpful in identifying the team and assisting in quick response times; others argue the cars could be stigmatizing and physically uncomfortable for consumers.
Transfer of program consumers. The long wait times in the emergency department is a major challenge to service delivery when the decision has been made to bring a consumer to the hospital.
Lack of a coordinated mental health system. A more coordinated, integrated mental health service system is needed to ensure effective program partnerships, appropriate consumer referrals, and care for individuals with mental health issues.
Sources consulted:
Kane, Eddie, et al. "Effectiveness of current policing- related mental health interventions: A systematic review." Criminal Behaviour and Mental Health, vol. 28, 2018, pp. 108-119.
Kirst, Maritt, et al. "Examining implementation of mobile, police-mental health crisis intervention teams in a large urban center." Journal of Mental Health, vol. 24, no. 6, 2015, pp. 369–374.
Lee, Stuart J., et al. "Outcomes achieved by and police and clinician perspectives on a joint police officer and mental health clinician mobile response unit." International Journal of Mental Health Nursing, vol. 24, 2015, pp. 538–546.
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