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

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 have been discussed here. There are also interventions which involve assessing individuals remotely via a 'telehealth' assessment.

Early intervention/prevention approaches

As was noted earlier, the Norfolk pilot aims to intervene at an early stage in order to prevent a crisis point. However, there are interventions and approaches which intervene at an even earlier stage and aim to prevent an individual from reaching a crisis point. These are referred to as 'upstream' interventions, and they aim to be proactive rather than reactive to individuals experiencing mental health distress. To put this into context, these interventions are part of a 'second generation' approach to support those experiencing mental distress; the 'first generation' of reform focused on improving the capabilities of police and law enforcement to respond to crises (Wood and Beierschmitt, 2014).

It is important to bear in mind that preventative interventions in this context sit in a broader area of early intervention and prevention work that spans a range of areas, including health and justice. 'Hot spot policing' has developed as an approach to help prevent individuals experiencing mental health distress from presenting to the police in crisis (Wood and Beirschmitt, 2014). A growing body of evidence suggests that mental health related calls and transportations are not evenly distributed across geographic areas; rather, there are clusters or hotspots (termed also as 'hotspots of vulnerability') where calls and transportations are disproportionately high. Other research evidence suggests that these hot spots are also those streets and areas where crime and disorder are also concentrated (White and Weisburd, 2017). Broadly, hot spot policing involves applying the same interventions and approaches explored- for example, the co-response model and CIT- but applying them in a more targeted way to these particular geographic locations. This is supported by criminological evidence- police knowledge and resources are best utilised when they are focused (as opposed to being applied in a uniform way) (White and Weisburd, 2017).

A recent study in the US applied a co-response model to a crime hot spot, and findings from this pilot suggest that a more targeted application of this model would maximise its effectiveness. Firstly, the process evalaution of this pilot intervention found that a pro-active (rather than reactive) approach was feasible. Secondly, despite some initial scepticism that local citizens would be guarded when interacting with police and mental health workers, there was in actual fact considerable openess. The evaluation also found that professionals were able to help citizens with other problems, in addition to mental health issues. This would potentially be of significant value when considering the co-morbidity of mental health issues with other issues, including those that commonly co-occur, such as problem substance use. Furthermore, the evaluation found that community relationships with the police had improved as a result of this longer term engagement. Lastly, there was a sense that the more frequent police presence had contributed to reductions in the level of crime and disorder, although this was not quantifiable (all White and Weisburd, 2017). These findings are echoed by a study from Wood and Beierschmitt (2014) who call for a move from 'case management' to 'place management'; that is, shifting from looking at individuals, to looking at communities where mental health calls and transportations (and related issues) are experienced disproportionately.

Further research and evaluation is required, as well as careful consideration of how hot spot policing could apply to Scotland with its distinct geographic and structural context (as outlined earlier). However, available evidence suggests this is a promising approach.

Tele-health assessments

Tele-health "involves the remote exchange of electronic information between patients and health care professionals" (Steventon and Bardsley, 2012). Tele-health is used throughout the world and applied to a range of health issues, including those which are related to mental health (Saurman et al., 2011). It has the overall aim of improving the quality of health-care while reducing budgetary pressures (Steventon and Bardsley, 2012). In the context of mental health, telecommunication technologies (such as video link) can be used to assess an individual from a geographical distance. In this particular context, tele-health is often referred to as 'telemental health', 'tele psychiatry or 'tele psychological services'.

As with other interventions and approaches in this field, a greater number and/or more in depth evaluations of tele-health interventions would be welcome. However, a comprehensive review of telemental health interventions concluded that they were effective in diagnosing and assessing across the general population, as well as across different population sub groups (such as adults, children, and the elderly); in terms of the effectiveness of these, they were comparable to face to face consultations (Hilty et al., 2013). As has been raised already, satisfaction with a service, from the perspective of both patients and health-care providers, is of course very important. Another comprehensive review found both groups to be satisfied with the service offered by telepsychiatry (Khalifa et al., 2008).

Key benefits to telemental health include savings in time, money and travel (Khalifa et al., 2008). These benefits may be particularly felt in rural or remote locations where the time and financial costs associated with patient transportation to facilities are typically higher than in urban areas; this was borne out in an Australian study which piloted an effective service to provide 24 hour access to mental health specialists via video-link (Saurman et al., 2011).

There are a number of drawbacks and concerns associated with telemental health assessments. For example upfront costs will be incurred when the technology is installed, though the evidence suggests that this may be offset by reducing costs overall (Hilty et al., 2013). There are concerns around the availability and reliability ( e.g. technical issues) of technology (Khalifa et al., 2008). There are potential diagnostic issues in the sense that some symptoms are more likely to be obscured in a video encounter than in a face to face interaction- for example, restless legs beneath a desk (Khalifa et al., 2008). However, for such cases, a video assessment could be used as a initial assessment, before a follow up face to face assessment; an approach that developed in an the Australian study (Saurman et al., 2011). Another concern relates to patient privacy- for example, a private discussion could be overheard by a non clinical member of staff; local arrangements would have to be made to minimise the risk of this.

Further research is needed into the use of tele-health for mental health, and the practical and ethical considerations that tele-health raises must be fully addressed. However, the available evidence suggests that tele-health assessments in the context of mental health distress are a valuable tool, either as stand-alone or initial assessments. Moreover, while mental health issues are unique and raise particular patient needs, it is important to reiterate that tele-health is widely (and increasingly) used internationally, and successfully responds to and treats a range of health issues.