What Works? Collaborative Police and Health interventions for mental health distress

Introduction

Background

It is becoming well recognised that the police are dealing with increasing numbers of people in mental health distress and that this is placing significant demand on their services and that of health services. In Scotland:

• 1 in 6 adults struggle with their mental health each year (Scottish Government, 2016)
• Only 1 in 3 people who would benefit from mental health treatment are receiving it (Scottish Government, 2017)
• Police Scotland estimate that they responded to around 57,000 incidents in 2015 which had a mental health aspect (Police Scotland, 2016)
• 1,133 people were detained in a Place of Safety as a result of mental health concerns (Mental Welfare Commission, 2017)

There are no definitive data on the nature and scale of individuals in mental health distress coming into contact with the police, but we can get some insight through looking at data on the use of Section 297 (s297) of the Mental Health (Care and Treatment) (Scotland) Act 2003 (the Act). This provides police with the power to detain people from a public place for reasons related to mental health and hold them in a place of safety for a mental health assessment (However, it must be noted that these findings only provide a general indication of the issue and do not provide a complete picture – there are a number of reasons why these statistics are not entirely representative ^[1] including that they only account for those people assessed in A&E, and do not account for those assessed by e.g. out of hours, GPs etc.):

• 41% of all referrals were between 2100 hours and 0100 hours identifying a peak time in which support is needed.
• Over half of the referrals were as a result of concerns of suicide or self-harm which identifies a key distress presentation that police are encountering.
• 96% were seen within 2 hours which is well within waiting time requirements to be seen by a doctor or in accident and emergency (A&E) departments but is a long time for police to be away from patrol duties.
• 62% of referrals were allowed to go home (Macaskill et al., 2011).

Policy context

There has been extensive interest in this area throughout 2017 and on-going into 2018. Key national strategies have been published and a formal, cross sector leadership network created:

• Scottish Government strategy, Justice in Scotland: Vision and Priorities: identifies the relatively poor physical and mental health and wellbeing of those in contact with the criminal justice system. Includes as a priority the need for collaborative working and a particular focus on addressing mental health and addictions.
• Scottish Government, Mental Health Strategy: includes an action to support the criminal justice system to work effectively with local partners to improve outcomes for those with mental health problems.
• Police Scotland, Policing 2026: highlights that supporting vulnerable people or people in crisis is a major demand on police resources: mental health issues are identified as the most common vulnerability.
• Scottish Government led, Health and Justice Collaboration Improvement Board: comprising leaders of a range of key organisations, and established to provide strategic leadership to accelerate progress on issues where the health and criminal justice system intersect. One of the themes of this group is specifically policing and distress.

In recognition and support of the need for more and better collaboration between policing and health, we need a robust evidence base upon which to base decisions and action. This review is an initial step to developing the evidence.

Research Aims and Overview

This evidence review looks at collaborative interventions which help to support people in distress. It aims to outline 'what works' when individuals present in 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.

Methods and Limitations

The Scottish Government Library Service conducted a literature search in October 2017. Snowball techniques were then used to identify further relevant articles. We also asked academic and practitioner contacts to share any relevant references with us. Parameters placed on the search were based on time (past 10 years) and geography (Western jurisdictions as likely to be similar in policing and culture).

This review does not purport to provide a comprehensive and definitive account of the evidence on collaborative police and mental health interventions across the world. Rather, it is an examination of material which could be identified and accessed within a relatively short space of time.

Terms and Definitions

The key focus of this report is Mental health distress. Distress is defined as "an emotional pain for which the person sought, or was referred for, help and which does not require (further) emergency service response" ( DBI, 2017a: 1). It therefore requires no further police, ambulance or fire assistance yet the individual will require some treatment, assessment or care for their distress which has fallen on police to navigate this.