A Co-response Model Mental Health and Policing


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Presented by: Mary C. Pyche, MSW, RSW Health Service Manager
Mental Health Mobile Crisis Team (MHMCT)

Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program

Constable Angela Balcom, Halifax Regional
Police, MHMCT dedicated police officer

Published in: Education, Health & Medicine
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  • Often defaults to Emergency responders 911 and police front line to respond to mental health calls – speaks to the overlap of police and mental health
  • Key considerations for collaboration
  • Started offering CIT in Halifax in fall of 2008. We attended training in Winter of 2008 from Hamilton who had trained in the Memphis Model of CIT. We had a consultation trip to Memphis in April 2009 as quality assurance that we were consistent with Memphis model. We offer CIT to Halifax Police Force twice a year and are building capacity to have CIT as a model of response in HRM.
  • A Co-response Model Mental Health and Policing

    1. 1. A Co-response Model Mental Health and Policing Mary C. Pyche, MSW, RSW Health Service Manager Mental Health Mobile Crisis Team (MHMCT) Susan Hare, BScOT, Program Leader, Crisis Supports, Capital District Mental Health Program Constable Angela Balcom, Halifax Regional Police, MHMCT dedicated police officer
    2. 2. Mental Health Mobile Crisis Team
    3. 3. MHMCT is a partnered crisis support service of Capital District Health Authority, IWK Children’s Health Centre, Halifax Regional Police and Department of Health Emergency Health Services . MHMCT services population base of 450,000 people
    4. 6. 2010 Demographics <ul><li>The province has a population of 940,000 people, of which 450,000 live in the Regional Municipality of Halifax </li></ul><ul><li>Halifax Regional Police have a patrol division of approximately 700. </li></ul>
    5. 7. Prevalence of Mental Illness <ul><li>One in five people experience a mental illness every year. That's roughly 200,000 Nova Scotians. </li></ul><ul><li>Less than 5% of the health care budget in Nova Scotia goes towards the treatment of all forms of mental illness, including depression and substance abuse. </li></ul>
    6. 8. Police Calls <ul><li>Halifax Police responded to 1081 mental health/suicide calls in 2003. </li></ul><ul><li>Average dispatched/cleared time for mental health/suicide police calls went from 92 minutes in 1999 to 214 minutes in 2003 </li></ul><ul><li>3400 police hours were utilized on mental health/suicide calls in 2003 – equivalent to almost 2 full time officers </li></ul>Even though police are receiving more mental health calls since partnering with MHMCT, the average total time spent on scene for a mental health call had decreased by 49.07 minutes in year two
    7. 9. EHSNS <ul><li>Reported that compared to their other calls Mental Health calls were not as receptive to paramedic intervention and higher percentage refused service or police intervention was required. </li></ul><ul><li>Paramedics were also spending increasing hours at ED waiting for transfer of care </li></ul><ul><li>Post MHMCT – fewer calls from police to respond </li></ul>
    8. 10. IWK Mental Health Program <ul><li>Reported that the response of referral to the outpatient follow up clinics was not always approp. Or effective following a visit to the ED Crisis Team </li></ul><ul><li>Felt that there was a significant population of at risk youth who would not use IWK ED but would benefit from a community based crisis response. </li></ul><ul><li>20 – 25 % of all callers are youth or youth related </li></ul>
    9. 11. Capital Health <ul><li>Long Frustrating waits at ED for individuals experiencing a crisis – often with unsatisfactory results </li></ul><ul><li>Referrals to existing crisis service were typically help seeking </li></ul><ul><li>Lack of consistent approach from HRP officers when needed </li></ul><ul><li>First full year of expanded service June 2006-June 2007 1377 new clients who had never used the service before and 1786 total callers </li></ul>
    10. 12. Why we came together <ul><li>To improve access to Mental Health Service beyond the emergency department </li></ul><ul><li>To provide improved training and support in identification of mental health disorders for other service providers and in particular other emergency responders </li></ul>
    11. 13. Collaboration is a process defined by the recursive interaction of knowledge and mutual learning between two or more people working together toward a common goal typically creative in nature . Wikipedia
    12. 14. True interdisciplinary collaboration requires crossing professional boundaries into what is often unfamiliar territory. Interdisciplinary collaboration also challenges us to drop preconceived notions of other professions, learn new languages, and also see a problem through a new lens . Playing Well With Others — Interdisciplinary Collaboration By Lenard W. Kaye, DSW, and Jennifer A. Crittenden, 2005 Social Work Today Vol. No. Page 34
    13. 15. Key Considerations Memorandum of Understanding Ministerial Authorization Steering/Operations Committee EDP’s referral form and process Police Training in Mental Health
    14. 16. It is all about context!
    15. 17. HRP: Time Spent on Scene <ul><li>Time Volume </li></ul><ul><li>Total time spent on scene for a MH call: </li></ul><ul><li>1 year pre (n=798): 185.24 </li></ul><ul><li>1 year post (n= 1058): 161.23 </li></ul><ul><li>2 years post (n=1184): 136.17 </li></ul>
    16. 18. Health Outcomes <ul><li>Connection to MH Services </li></ul><ul><li>Attending ED’s less often </li></ul><ul><li>MHMCT referrals to ED result in 74.7% admission rates to hospital </li></ul>
    17. 19. Monthly average for 12 months 816 919 16.0% 84.0% JANUARY/10 854 22.2% 77.8% DECEMBER/09 898 23.8% 76.2% NOVEMER/09 740 16.2% 83.8% OCTOBER/09 842 14.2% 85.8% SEPTEMBER/09 852 10.5% 89.5% AUGUST/09 884 16.3% 83.7 % JULY/09 794 11.9% 88.1% JUNE/09 785 18.3% 81.7% MAY/09 815 23.0% 77.0% APRIL/09 799 23.0% 77.0% MARCH/O9 610 22.9% 71.1% FEBRUARY/09 TOTAL # INTERVENTIONS YOUTH ADULT MONTH
    18. 21. Volume and Locations of Interventions 100 7553 100 5926 100 2806 Total 91.4% 6934 92.1% 5455 94.2% 2643 Telephone 8.6% 619 7.9% 469 5.8% 163 Community % N % N % N 2 yrs Post-MHMCT 1 yr Post-MHMCT 1 yr Pre-MHMCT Location
    19. 22. Complement of 4 Halifax Regional Police (HRP) Officers dedicated to MHMCT on a minimum 2 year posting. This allows a schedule rotation that guarantees an officer with the team from 1pm to 1 am 365 days a year and a second officer from for an overlap mobile time of 8 hrs. These officers work in plain clothes and HRP also provides 2 unmarked cars to the service. An HRP constable goes out on all calls with a mental health clinician.
    20. 23. Clinicians with MHMCT are called crisis intervenors and have a discipline background in either nursing, social work or occupational therapy with a minimum of two years mental health experience. They work 12 hr shifts with an overlap of staff between the mobile hours of 1-1 so that there is always a clinician answering the phone and triaging calls and the potential for mobile response in the community from 1pm -1 am
    21. 24. MHMCT Goals <ul><li>To enable individuals experiencing mental health crisis or distress to access a range of crisis intervention services in a timely and effective manner in their own environment or the environment of their choice . </li></ul><ul><li>“ the right service, in the right place at the right time” </li></ul><ul><li>Provide a consistent integrated response to mental health crisis in the community regardless of which service identifies the individual in crisis (CH, IWK, HRP, EHS or the community at large) </li></ul><ul><li>“ any door is the right door” </li></ul><ul><li>To improve overall capacity of the HRM community to address concerns related to individuals experiencing acute psychiatric symptoms and psychiatric crisis through provision of support, information and education to caregivers, community organizations and services and the community at large. In particular, to support the training needs of the identified service partners through both formal and informal processes . </li></ul><ul><li>“ informed and trained responders result in better outcomes for all” </li></ul>
    22. 25. MHMCT <ul><li>MHMCT provides intervention, and short term crisis management for children, youth and adults experiencing a mental health crisis. </li></ul><ul><li>We offer telephone intervention throughout the Capital District 24/7 and 12 hr. mobile response in most communities of HRM from 1pm to 1am </li></ul><ul><li>MHMCT also supports families, friends, community agencies and others to manage mental health crisis through education, outreach and consultation </li></ul>
    23. 26. Youth and Youth related calls are generally initiated by parents and are largely around parent/adolescent conflict. Initial objective (least intrusive first approach) is to support the parent/guardian to get settled in the moment so they can remain engaged in de-escalating the presenting crisis. First line of action is to support agency and autonomy and to support the parent to remain in charge. Clinical approach is to not undermine the parent’s authority or replace the parent’s role
    24. 27. Telephone crisis intervention response 24 hours a day within Capital Health District
    25. 28. Telephone crisis intervention response 24 hours a day within Capital Health District <ul><ul><li>A Mobile Team where a dedicated MHMCT police </li></ul></ul><ul><ul><li>officer and a Mental Health clinician as a team </li></ul></ul><ul><ul><li>offer a mobile response to most communities in HRM </li></ul></ul>
    26. 29. <ul><li>Two Models of Community Response to Mental Illness </li></ul><ul><li>Co-Response Model (mental health and police) example MHMCT </li></ul><ul><li>CIT – Police response – first responder – officers with enhanced training in mental health to respond to mental health calls </li></ul>
    27. 30. A combination of both these models provides the most comprehensive service for building capacity for a community response to mental illness (Study in Blue and Grey –BC CMHA- 2003) Mobile Crisis Teams partnered with Police Plus CIT trained law enforcement Equals Improved Responses and Outcomes to People with Mental Illness in the Community
    28. 31. Initiative in our Home Province Capital Health Innovation Grant Project – Police Mental Health Collaboration Across Nova Scotia Purpose of Project: To facilitate the development of Police/Mental Health Collaborative Partnerships within the health districts and law enforcement agencies throughout Nova Scotia
    29. 32. Mental Health Mobile Crisis Team Questions ?????