Police and mental health clinician partnership improves crisis response

Feature Article Police and mental health clinician partnership in
response to mental health crisis: A qualitative study Brian
McKenna,1,2 Trentham Furness,1,2 Jane Oakes1,2 and Steve
Brown3 1 School of Nursing, Midwifery and Paramedicine,
Australian Catholic University, 2 NorthWestern Mental Health,
The Royal Melbourne Hospital, and 3 The Northern Hospital,
Northern Health, Melbourne, Victoria, Australia
ABSTRACT: Police officers as first responders to acute mental
health crisis in the community, commonly transport people in
mental health crisis to a hospital emergency department.
However, emergency departments are not the optimal
environments to provide assessment and care to those
experiencing mental health crises. In 2012, the Northern Police
and Clinician Emergency Response (NPACER) team combining
police and mental health clinicians was created to reduce
behavioural escalation and provide better outcomes for people
with mental health needs through diversion to appropriate
mental health and community services. The aim of this study
was to describe the perceptions of major stakeholders on the
ability of the team to reduce behavioural escalation and improve
the service utilization of people in mental health crisis.
Responses of a purposive sample of 17 people (carer or
consumer advisors, mental health or emergency department
staff, and police or ambulance officers) who had knowledge of,
or had interfaced with, the NPACER were thematically analyzed
after one-to-one semistructured interviews. Themes emerged
about the challenge created by a stand-alone police response,
with the collaborative strengths of the NPACER
(communication, information sharing, and knowledge/skill
development) seen as the solution. Themes on improvements in
service utilization were revealed at the point of community
contact, in police stations, transition through the emergency
department, and admission to acute inpatient units. The
NPACER enabled emergency department diversion, direct

access to inpatient mental health services, reduced police
officer ‘downtime’, improved interagency collaboration and
knowledge transfer, and improvements in service utilization and
transition. KEY WORDS: crisis intervention, mental health
nurses, mental health, police.
INTRODUCTION
Police officers are often the first responders to acute mental
health crisis in the community. In metropolitan Melbourne,
Australia, within one police division, 41% of police officers
reported they responded to calls involving people with mental
illness at least weekly (Hollander et al. 2012). Furthermore,
21% of police officers reported transporting people with mental
illness for emergency mental health care at least weekly
(Hollander et al. 2012). The transportation by police officers of
people experiencing a mental health crisis for mental health
assessment is supported in Victoria by mental health legislation,
if risk is apparent to the individual or others (State Government
of Victoria 1986; 2014).
As such, people experiencing a mental health crisis have
predominantly been transported to Victorian hospital emergency
departments (ED) (State Government of Victoria 2005).
Unfortunately, the processing of people experiencing mental
health crises through the ED for the purposes of mental health
assessment is problematic on several counts, such as long length
of stay (Kalucy et al. 2005; Knott et al. 2007; Shafiei et al.
2011) and the use of restrictive interventions such as physical
restraint (Al-Khafaji et al. 2014; Knott et al. 2007). Nationally,
the number of people in mental health crises presenting to the
ED is rising to nearly a quarter of a million in 2010– 2011, of
which two-thirds were sent home at discharge from the ED
(Australian Institute of Health and Welfare 2012).
Internationally, efforts to improve first responder police
officers’ efficiency and quality of care during mental health
crises have been attempted with mental health education and
training models (Compton et al. 2008; Steadman et al. 2000).
However, a limited body of evidence supports such police

education and training interventions to connect people in mental
health crisis to appropriate mental health care after contact with
police officers (Compton et al. 2008). An alternate is for first
responder police officers attending to a mental health crisis in
the community to then call/initiate a specialist second responder
team (Lamb et al. 1995). The second responder comprises at
least a law enforcement officer and a mental health clinician,
usually a mental health nurse (Lamb et al. 1995). The goal of
the second response team is to reduce the potential for violence,
prevent unnecessary custodial incarceration, and provide
alternate care in less restrictive environments through
interagency collaboration (Lamb et al. 1995). However, the
effectiveness of such interventions is barely known (Shapiro et
al. 2014). The selection and implementation of a first or second
responder intervention/model has been left to decisions based
about the context of service delivery and resource constraints
among health and emergency services (Fisher & Grudzinskas,
2010). As such, in late 2012, the Victoria Police along with
Northern Area Mental Health, which serves a combined
population of 575 000 people (Australian Bureau of Statistics
2014) in metropolitan Melbourne, established the Northern
Police and Clinician Emergency Response (NPACER) team. The
team resembles a second response model (Lamb et al. 1995)
comprising a police officer and a senior mental health clinician
attending to a mental health crisis in the community, after an
initial police response requires the person to be assessed by a
mental health practitioner under mental health legislation. First
responder police ensure the incident is resolved or contained on
a safety first basis, prior to the introduction of the NPACER
unit. The NPACER team is tasked to provide mental health
assessment, reduce the risk of behavioural escalation, and
provide a better outcome for those people with mental health
needs through diversion to appropriate mental health and
community services. The model has a focus on ED diversion
with the capacity to directly admit people to acute inpatient
services. The NPACER team consists of a mental health nurse

and a police officer. Clinicians are drawn from a limited pool of
senior emergency mental health nurses in the service, while the
police officers are drawn from a wider pool of rostered staff,
cognisant of experience and support for the NPACER initiative.
The NPACER team operates 7 days a week, every
afternoon/evening (15.00–23.30 hours). The aim of this study
was to describe the perceptions of major stakeholders on the
ability of the NPACER model to reduce behavioural escalation
and improve the service utilization of people in mental health
crisis. METHODS Research design An exploratory research
design, which is used when a problem is not clearly defined
(Stebbins 2001), was used to meet the descriptive research aims.
This research was approved by the Melbourne Health Office for
Research (QA2013141). Participants A purposive sample of key
stakeholders interfacing with people in mental health crisis and
who had broad knowledge of the NPACER (consumer advisors
as the voice of consumers, carer advisors as the voice of carers,
mental health staff, ED staff, police officers, and ambulance
officers) were recruited and provided informed voluntary
consent to participate in one-to-one semistructured interviews
from January to July, 2014. Procedures The literature-informed
interview schedule enquired about perceptions of the NPACER:
(i) benefits; (ii) limitations; (iii) outcomes; and (iv) the impact
on the work environment including job satisfaction and
collegial relationships. Prompts were levelled at perceptions of
the ability of the NPACER to manage mental health crisis,
collaboration between agencies present during the crisis, and
communication between all those involved. For example,
‘Discuss how NPACER has impacted on col laboration between
police officers and inpatient or ED mental health staff’.
Respondents were asked to provide specific pragmatic examples
from their experience. The interview schedule was identical
across all participants. The same researcher (B. M.) conducted
all one-to-one interviews. Responses were recorded to an audio-
digital recorder (ICD-PX333M; Sony, Tokyo, Japan). Data
analysis A thematic analysis of the qualitative data was

undertaken using a general inductive approach. This approach
allows defensible analysis of qualitative data that may initially
be varied raw text and allows it to be condensed into brief
summaries (Thomas 2006). Data were transcribed verbatim and
organized using colour coding. The codes were developed
through continuous independent reading and agreement among
the researchers (B. M. and J. O.). As necessary during analysis,
codes were either collapsed or split into developing themes,
until central relationships began to emerge (Patton 2002). Each
theme was examined for supporting quotes from the data. Rigor
was further enhanced by collective agreement among the
research team on the thematic analytic framework, emergent
patterns, and supporting evidence (Guba & Lincoln 2005; Mays
& Pope 1995). RESULTS Sample description A total of 17
participants who interfaced with the NPACER provided
informed voluntary consent to participate in this research. The
sample included three consumer advisors and three carer
advisors (who had spoken with consumers/carers with
experience of the NPACER); the manager of the acute mental
health inpatient service and two senior staff nurses from the
unit all with direct experience of the NPACER (as the voice of
inpatient mental health staff); the associate unit manager,
clinical director, the manager of mental health staff, and a
mental health crisis nurse, all stationed in the ED with direct
experience of the NPACER (as the voice of ED staff); two
police officers and the police station commander all with direct
experience (as the voice of police staff); and a manager of the
ambulance service with direct experience of the NPACER.
Major themes The participants in this study readily discussed
their perceptions of how the NPACER functioned to reduce
behavioural escalation, improve consumer outcomes, and
improve access to appropriate mental health care. A major
theme emerged about the challenge created by a stand-alone
police response that existed prior to the NPACER. A theme then
emerged as a solution to this challenge focused on the
collaborative strength of the NPACER. This collaboration was

exemplified in the subthemes of communication, information
sharing, and knowledge/skill development. The third theme
focused on improvements in the person’s pathway through
service utilization towards resolution of the crisis. Four areas
along this pathway were highlighted as subthemes; at the point
of community contact, the use of police stations, progress
through the ED, and admission to acute mental health inpatient
services. Finally, the means of enhancing the NPACER arose as
a distinct theme from the data. The challenge: A stand-alone
police response The discussions of the NPACER compared the
model with a stand-alone police response which involved
practices which were perceived by consumer and carer advisors
as traumatic and distressing. Incidents were described involving
the use of restrictive interventions including handcuffs: I’ve had
quite a few people talk about how terrible that is and to have to
see your loved one be handcuffed, being put in a van. . . . (Carer
advisor) The use of restrictive interventions by the police was
perceived as stemming from a lack of understanding and a
limited repertoire of strategies to manage people in mental
health crisis. This limited repertoire was perceived as leaving
people in crisis disempowered in their time of need: Police
don’t have an understanding of people living with mental illness
and often the procedures of even putting people in handcuffs, if
somebody’s not aggressive. . . . Handcuffing somebody is
absolutely re-traumatizing them . . . they (the consumers) don’t
feel like they’ve got any control. (Consumer advisor) The
default local practice of a stand-alone police response at a
mental health crisis was the transportation under mental health
legislation of people to the ED for mental health assessment.
This was perceived as causing congestion in the ED. The
associated ‘bottleneck’ was frustrating for both staff and the
person in crisis. For the ED staff, there was an
acknowledgement that a lot of the people eventually returned
home, which led them to question whether they should be there
in the first instance. The congestion led to increased waiting
time which elevated psychological distress for the person in

crisis: A lot of patients who present (under police custody
mandated by mental health legislation) do get discharged home
and when they were presenting in high numbers there isn’t a
resource to actually see them in a timely manner, which then
escalates their behaviour. (Voice of ED staff) A statutory
requirement is for the police to remain in the ED with the
person until the mental health assessment has taken place.
However, the ‘bottleneck’ created in the ED was perceived as
having ramifications for the police, in that time spent in the ED
awaiting mental health assessment delayed return to the
community, to focus on other law enforcement requirements: At
the end of the day, if our police are tied up with assessments
and/or we’re waiting at a hospital environment for a clinician to
conduct that assessment, that’s problematic for us. (Voice of
police staff) The volume of people in mental health crisis
processed through the ED was reflected in communication
breakdown between the police and the ED staff, whereby people
were escorted by police into the ED without any prior
notification to the service: They (the police) don’t tell us that
they’re coming, they just walk the patient in, who’s screaming,
carrying on, you know. It’s a really dangerous situation. (Voice
of ED staff) The solution: Collaboration through the NPACER
The challenges posed through a stand-alone police response to
mental health crises were seen as being addressed through the
collaborative endeavour of police and mental health nurse
expertise embodied in the NPACER. This collaborative working
relationship was developed by the parties working side-by-side
from the same location, over shifts that extended to each day of
the week: The simple model is this: You get people working
together for a sustained period of time, they start to learn each
other’s strengths and weaknesses and appreciate their strengths
and weaknesses. So it’s a ‘no-brainer’ to me that the
collaboration model has yielded fruit. (Voice of police staff)
Such collaboration enabled the development of a clearly
understood modus operandi in managing safety associated with
the crisis and then facilitating the pathway through services to

address the crisis. Joint decisionmaking was at the heart of the
management: There’s some very clear protocols in respect to
when the NPACER can activate. Now, if a clinician’s not
comfortable they will make it very clear, ‘I’m not comfortable
with this’ and unless both parties agree they don’t enter that
arena. (Voice of police staff) The strength of the collaboration
was exemplified through the subthemes of communication,
information sharing, and knowledge/skill development.
Communication Collaboration was exemplified in the trust
arising from direct face-to-face communication between the
police officer and the mental health nurse as part of an
integrated team response. This circumvented communication
from a distance with agencies such as the dispatch authority and
the ED, who may have a limited ability to impact on the actual
management of the crisis: Yeah, what it does, it cuts out people
from that communication loop who aren’t really necessary to it
as well. (Voice of police staff) This improved communication
resulted in each partner having a greater appreciation of the
attributes of the other: Just being able to go out on the road
with them and see and be a part of the assessments and listen to
the sorts of questions that they ask, what they’re looking for . . .
the relationship building, networking, lines of communication .
. . it’s just made a world of difference. (Voice of police staff)
Information sharing Collaboration enabled information sharing
between the police and mental health nurses. Accurate
information enabled each role to function to its potential in
maintaining safety: The benefit that has been provided to police
when they’re entering critical incident areas has really been
quite phenomenal and that benefit of information sharing, you
just can’t put a value to that. (Voice of police staff) Accurate
information sharing was also extended to the service receiving
the person in crisis. Information sharing was achieved by the
police officer and mental health clinician both having access to
real-time secure databases and sharing that information as
appropriate and permitted by law. The process enabled more
timely and improved decision-making via a synthesis of clinical

and criminal justice information that provided a holistic picture
of risk, safety, and disposition options. This also enabled prior
planning to safely transition the person along the pathway of
engagement toward eventual resolution of the crisis:
That information, accurate information, relayed for instance to
the inpatient unit, so they understand the seriousness or the
gravity of the situation, so they’re able to then more effectively
manage the person. (Voice of police staff) Knowledge/skill
development Close collaboration enabled both parties to acquire
and develop new knowledge and skills to refine their roles. For
the police, the starting point was an increased understanding of
the relationship between symptoms of mental illness and the
person’s presenting behaviour. This increased understanding
enabled a more tolerant and effective management of people in
crisis, which resulted in the police avoiding the use of force.
The presence of a mental health nurse trained in de-escalation
enabled a modification of the approach resulting in a less
traumatic experience for the consumers and their carers: I think
it can boost their (police) confidence so that they feel like
they’ve got the knowledge that they need. . . . I think if people
have a better understanding and they build up some skills
they’re less likely to respond in an inappropriate way to
consumers. Hopefully it builds confidence, knowledge, and
skills for (police) to be able to do their jobs. (Consumer
advisor) Improvements in the person’s pathway Contact
between the person in crisis and the police initiated a pathway
of service utilization toward eventual resolution of the crisis.
This can involve a number of services, but primarily the ED and
mental health services. The NPACER was seen as effective in
streamlining this pathway by diverting people to less restrictive
alternatives (i.e. to their home, to a GP, or to another
community service) and by creating ‘smoothness’ by easing the
transition along the pathway when the journey required
engagement with multiple services (e.g. the NPACER clinician
contacting en route the receiving ED to prepare for arrival). At

the point of community contact The intent of the NPACER was
initial assessment followed by the diversion of people to have
their needs met, away from the ED, by referral to appropriate
community options. Those interviewed perceived this to be the
case: They may decide to refer that person back to a private
psychiatrist, or a GP for a mental health plan, or drug and
alcohol services or contact one of those multitude of services
that are available out there in the community, in which case
they would then do follow-up phone calls to whoever it was
who was going to be following that person up and linking them
back into that service. (Voice of police staff) Subsequently,
consumers were managed in the least restrictive environment
(i.e. their own homes or the community in which they lived).
This alternative was perceived as a more dignified process for
people than transporting them to the ED, which was dislocated
from their social reality: The person isn’t displaced and . . .
having to go to an emergency department. They can be seen in
their own environment. (Voice of inpatient mental health staff)
There were clinical advantages for this approach in that it
facilitated a holistic assessment of the person in the social and
environmental context within which the person functioned: The
clinician is seeing them in that environment, in that context as
well, and so they’re actually able to make a much more accurate
assessment. (Voice of police staff) Use of police stations There
were examples described of the use of police stations in the
pathway toward crisis resolution. This followed circumstances
whereby a person was transported to police holding facilities
following alleged serious offending. Concern about the persons
mental health status at this point then led to involvement of the
NPACER and potential diversion to address mental health
needs: The (police) can take somebody who they might arrest,
somebody who they believe is performing a criminal act and
then they take them back to the police station and during the
course of the interview they might have concerns that that
person’s actually mentally unwell and then they may say ‘look,
I’m holding you here under Section 10 and we’re going to get

the NPACER’. (Voice of police staff) Progress through the ED
The impact of the NPACER on the ED was viewed positively.
Improved communication between police officers, mental health
clinicians, and ED staff was cited as aiding the smooth pathway
of people in crisis through the ED. Diversion of those not
requiring ED assessment was viewed as enabling those
presenting with physical healthcare needs to receive optimal
care: If you’re in the ED of an evening shift and you’ve come
there with a physical complaint, now you’ However, those in
mental health crisis with co-existing physical health-care needs
were still appropriately prioritized to the ED: There might be
queries about the person’s physical health-care needs as well as
mental health-care needs. . . . If my crew assess and find
anything physical then that’s the priority, they must go through
the ED for that. (Voice of police staff) When situations arose
for people in mental health crisis who required the services of
the ED to address physical needs, there was prior
communication between the NPACER and the ED staff, which
allowed preparation before arrival to ease the person through
the ED experience. Furthermore, faster turnaround for people in
the ED was facilitated by mental health assessments being
completed in the community by the NPACER team: You get the
phone call that you know when they arrive in the ambulance
bay. They don’t just walk the patient into a chaotic situation.
You assess the patient outside; you bring them in. It’s all very
planned and well set up and the resources are there. You know
what to expect. (Voice of ED staff) Admission to acute mental
health inpatient services A role of NPACER is to divert acutely
unwell people in crisis directly to acute mental health inpatient
services for admission. This timely and efficient diversion was
positively reported: You take the right patient to the right place
at the right time. (Voice of ED staff) Timely admission to the
acute mental health inpatient services was also viewed as
advantageous for the police: The ED is probably going to be a
minimum of 3 hours. Now that’s 3 hours we can commit to the
community. So in terms of a win for us, if we can have direct

admissions and stay out of the ED environment, then we can get
back on the road. (Voice of police staff) Means for improving
the NPACER In considering improvements, there were one-off
comments regarding: (i) the need for more on-call support from
a psychiatrist; and (ii) the need for professional development to
manage people in crisis from culturally and linguistically
diverse communities. However, there were more consistent calls
from participants for additional resources to expand the
NPACER from more than one work shift throughout the day:
Maybe the possibility of increased hours. (Voice of police staff)
Extending the hours and, of course, increasing the resource.
(Voice of ED staff) A cautionary note emerged that the
perceived success of the NPACER did not necessarily mean that
it was a model that could be easily translated to mental health
services in other areas. The high volume of mental health crises
attended by the police was singled out as a defining reason for
the model working in this particular area: We have a high need
for the NPACER. If that need’s not there, I don’t think the
collaboration model would be very effective at all. . . . I believe
it works well because of the high demand we have in that
mental health space. (Voice of police staff) DISCUSSION The
major finding of this study was the perceived ability of the
NPACER, a specialist second responder team to people in
mental health crisis, to reduce behavioural escalation, improve
consumer outcomes, and improve access to appropriate mental
health care. Specifically, participants described the important
role the NPACER played in: (i) diverting consumers from the
ED to more appropriate and timely mental health care; (ii)
allowing direct access to inpatient mental health services; (iii)
releasing police officers to other non-mental health-related
tasks; (iv) increasing knowledge transfer and building rapport
among interagency teams; and (v) reducing adverse events that
may be associated with a stand-alone police response.
Emergency department clinicians have expressed concern about
the safety of people in mental health crisis and a lack of
resource to support mental health crisis presentations to the ED

(Al-Khafaji et al. 2014; Jelinek et al. 2013; Kerrison &
Chapman, 2007). The results of the current study support such
sentiments about the challenge created by a stand-alone police
response that existed prior to the NPACER. Furthermore, as
collaboration across services is fundamental to the consumer’s
pathway through mental health crisis (Boscarato et al. 2014;
Morphet et al. 2012) and to provide appropriate care (Lamb et
al. 1995), the results of the current study highlight the benefit
of interagency collaboration due to a specialist second
responder team and the resulting improvements in service
utilization. Interestingly, as staff occasionally do not respect
professional abilities of staff from interfacing services
(Hollander et al. 2012), there much more likely to get a better
service than you would preNPACER. (Voice of police staff)
results of the current study highlight the knowledge and skill
development a specialist second responder team was able to
foster. Police have reported that reducing ‘down-time’ in
hospital EDs is important for improving police morale and
efficiency (Borum et al. 1998; Shapiro et al. 2014). Responses
of police in the current study indicate the ability of a specialist
second responder team to achieve such ends by quickly
releasing police to respond to other jobs and resolving crises in
the community without the need for the ED transportation. This
study also indicated the use of police station holding facilities
as part of improving the pathway of service utilization for
people in mental health crisis. Given the difficulties of police
detecting people with mental illness in police holding cells
(Baksheev et al. 2012), there is potential for responses such as
the NPACER to assist in this regard. However, this study tells
us little about the experience of people transported to police
stations or the appropriateness of this diversion. As such, there
remains the need for further research regarding police
interaction with people with mental health crisis in such
facilities (Chappell & O’Brien 2014). Limitations This study
attempted to access the views of a large number of stakeholders
interfacing with a combined police and mental health nurse

team responding to people in mental health crisis. However, this
was a single second response team in metropolitan Melbourne.
Furthermore, representatives of the stakeholder groups were
purposively selected for interview. Finally, consumer and carer
advisors were interviewed, who had spoken to their peers about
their experience of the NPACER, rather than those directly
involved. As such, data may not represent all the experiences or
perspectives of consumers who were responded to by the
NPACER, and data may also not generalize to joint police and
clinical specialist second responder teams that may operate
under different models of care either in Australia or
internationally. CONCLUSION The aim of this study was to
describe the perceptions of major stakeholders on the ability of
the NPACER model to reduce behavioural escalation and
improve the service utilization of people in mental health crisis.
This specialist second responder team enabled the ED diversion,
direct access to inpatient mental health services, reduced police
officer ‘down-time’, improved interagency collaboration and
knowledge transfer, and improvements in service utilization and
transition through such services, compared with a typical stand-
alone police response to people experiencing mental health
crisis in the community. ACKNOWLEDGEMENTS The authors
acknowledge Sergeant Andrew Hiam (Epping Police Station),
Mr Peter Kelly (Operations Manager, NorthWestern Mental
Health), Robynne Cook (Acting CEO, the Northern Hospital),
and those people interviewed for their support of this project.
AUTHOR CONTRIBUTIONS All authors contributed to the
conceptualization and conduct of the research. All authors
contributed to and approved the final version of the manuscript.
B. M. collected data, and B. M. and J. O. analyzed data.
REFERENCES
Al-Khafaji, K., Loy, J. & Kelly, A.-M. (2014). Characteristics
and outcomes of patients brought to an emergency department
by police under the provisions (Section 10) of the Mental
Health Act in Victoria, Australia. International Journal of Law
and Psychiatry, 37, 415–419. Australian Bureau of Statistics

(2014). Data by region. [Cited 1 Aug 2014]. Available from:
URL: http://stat.abs.gov.au/itt/ r.jsp?databyregion Australian
Institute of Health and Welfare (2012). Mental health services
provided in emergency departments. [Cited 1 Aug 2014].
Available from: URL: http://mhsa.aihw.gov.au/
services/emergency-departments/ Baksheev, G., Ogloff, J. &
Thomas, S. (2012). Identification of mental illness in police
cells. Psychology, Crime and Law, 18 (6), 529–542. Borum, R.,
Deane, M., Steadman, H. & Morrissey, J. (1998). Police
perspectives on responding to mentally ill people in crisis:
Perceptions of program effectiveness. Behavioral Sciences &
the Law, 16 (4), 393–405. Boscarato, K., Lee, S., Kroschel, J.,
Hollander, Y., Brennan, A. & Warren, N. (2014). Consumer
experience of formal crisisresponse services and preferred
methods of crisis intervention. International Journal of Mental
Health Nursing, 23, 287–295. Chappell, D. & O’Brien, A.
(2014). Police responses to persons with a mental illness:
International perspectives. International Journal of Law and
Psychiatry, 37, 321–324. Compton, M., Bahora, M., Watson, A.
& Oliva, J. (2008). A comprehensive review of extant research
on Crisis Intervention Team (CIT) programs. The Journal of the
American Academy of Psychiatry and the Law, 36, 47–55.
Fisher, W. & Grudzinskas, A. Jr (2010). Crisis intervention
teams as the solution to managing crisis involving persons with
serious psychiatric illnesses: Does one size fit all? Journal of
Police Crisis Negotiations, 10, 58–71. Guba, E. & Lincoln, Y.
(2005). Paradigmatic controversies, contradictions, and
emerging confluences. In: N. Denzin & Y. Lincoln (Eds). The
Sage Handbook of Qualitative Research. (pp. 191–216).
Thousand Oaks, CA: Sage. Hollander, Y., Lee, S., Tahtalian, S.,
Young, D. & Kulkarni, J. (2012). Challenges relating to the
interface between crisis mental health clinicians and police
when engaging with people with a mental illness. Psychiatry,
Psychology and Law, 19 (3), 402–411. Jelinek, G., Weiland, T.,
Mackinlay, C., Gerdtz, M. & Hill, N. (2013). Knowledge and
confidence of Australian emergency department clinicians in

managing patients with mental health-related presentations:
Findings from a national qualitative study. International Journal
of Emergency Medicine, 6, 2. Kalucy, R., Thomas, L. & King,
D. (2005). Changing demand for mental health services in the
emergency department of a public hospital. Australian and New
Zealand Journal of Psychiatry, 39, 74–80. Kerrison, S. &
Chapman, R. (2007). What general emergency nurses want to
know about mental health patients presenting to their emergency
department. Accident and Emergency Nursing, 15, 48–55.
Knott, J., Pleban, A., Taylor, D. & Castle, D. (2007).
Management of mental health patients attending Victorian
emergency department. Australian and New Zealand Journal of
Psychiatry, 41, 759–767. Lamb, H., Shaner, R., Elliott, D.,
DeCuir, W. & Foltz, J. (1995). Outcomes for psychiatric
emergency patients seen by an outreach police-mental health
team. Psychiatric Services, 46, 1267–1271. Mays, N. & Pope, C.
(1995). Rigour and qualitative research. British Medical
Journal, 311, 109–112. Morphet, J., Innes, K., Munro, I. et al.
(2012). Managing people with mental health presentations in
emergency departments – a service exploration of the issues
surrounding responsiveness from a mental health care consumer
and carer perspective. Australian Emergency Nursing Journal,
15, 148–155. Patton, M. (2002). Qualitative Research and
Evaluation Methods, 3rd edn. Thousand Oaks, CA: Sage
Publications. Shafiei, T., Gaynor, N. & Farrell, G. (2011). The
characteristics, management and outcomes of people identified
with mental health issues in an emergency department,
Melbourne, Australia. Journal of Psychiatric and Mental Health
Nursing, 18 (1), 9–16. Shapiro, G., Cusi, A., Kirst, M.,
O’Campo, P., Nakhost, A. & Stergiopoulos, V. (2014). Co-
responding police-mental health programs: A review.
Administration and Policy in Mental Health and Mental Health
Services Research, doi: 10.1007/s10488-014-0594-9. State
Government of Victoria (1986). Mental Health Act 1986.
Melbourne, Vic.: Department of Health. State Government of
Victoria (2005). Mental Health Presentations to the Emergency

Department. Melbourne, Vic.: Department of Human Services.
State Government of Victoria (2014). Mental Health Act 2014.
Melbourne, Vic.: Department of Health. Steadman, H., Deane,
M., Borum, R. & Morrissey, J. (2000). Comparing outcomes of
major models of police responses to mental health emergencies.
Psychiatric Services, 51, 645– 649. Stebbins, R. (2001).
Exploratory Research in the Social Sciences. Sage University
Paper Series on Qualitative Research Methods, Vol. 48.
Thousand Oaks, CA: Sage. Thomas, D. (2006). A general
inductive approach for analysing qualitative evaluation data.
American Journal of Evaluation, 27, 237–246.
Name __________________________________
Problem Set 4
1. John Taylor has suggested the following rule as a policy
guide for the Federal Reserve
*0.5()0.5
federal funds rate
* real rate
expected inflation rate
target inflation rate
Okun's law 2(*)
unemployment rate
* natural rate of unemploment
ttttart
t
t
tar

tt
t
RRRY
R
RR
YUU
U
U
ppp
p
p
=++-+
=
=
=
=
=--
=
=
Suppose that the real rate is 2%, expected rate of
inflation is 1.5 %, current unemployment rate is 5.5%, and the
natural rate of unemployment is estimate to be 6%. According
to the Taylor model, what federal funds rate would achieve a
target inflation rate of 2%? Suppose with a global savings glut
we assume a real rate of zero, what the nominal federal funds
rate associated with a 2% inflation target? Still assuming a zero
real rate, what happens to the nominal federal funds rate if the
Fed tries to achieve a target inflation rate of 3%?
2. Suppose the Fed does an overnight repo in the
amount of $20 million with a primary dealer. Illustrate this
transaction with the T-accounts below.
3. Arrange the items listed below into a correct

Federal Reserve balance sheet; i.e., lists the assets and
liabilities.
Net portfolio holdings of Maiden Lane LLC
Deferred availability cash items
Reverse repurchase agreements
Mortgage-backed securities
Gold certificate account
Federal Reserve notes
Central bank liquidity swaps
Items in process of collection
Term deposits held by depository institutions
Net portfolio holdings of TALF LLC
Treasury Bills
Federal agency debt securities
U.S. Treasury, General Account
Capital paid in
Foreign currency
Bank premises
Treasury Notes and Bonds

Coins
Foreign deposits
Surplus
Federal Reserve notes
Special drawing rights (SDRs)
Repurchase agreements
Loans
4. Indicate the effect of each of the following changes
on bank reserves (+ = increase and - = decrease).
Increase in Federal Reserve Notes Outstanding
Decrease in foreign deposits
Increase in Treasury cash holdings
Decrease in primary credit
Decrease in Treasury bills
Increase in agency securities
Increase reverse repos
Increase in secondary credit
Increase in Treasury deposits
5. Suppose the Federal Reserve instructs the Trading

Desk to purchase $1 billion of securities. Show the result of this
transaction on the balance sheets of the Federal Reserve System
and commercial banks. What happens to the liquidity of the
banking system?
6. Suppose the Federal Reserve instructs the Trading
Desk to sell $850 million of securities. Show the result of this
transaction on the balance sheets of the Federal Reserve System
and commercial banks. What happens to the liquidity of the
banking system?
7. A recent headline in Reuter’s read as follows:
China's central bank on Sunday cut the amount of cash that
banks must hold as reserves, the second industry-wide cut in
two months …
The People's Bank of China (PBOC) lowered the reserve
requirement ratio (RRR) for all banks by 100 basis points to
18.5 percent, ….
Explain what impact this policy change would have
on the balance sheet of PBOC and the commercial banks.
8. Using the Federal Reserve Statistical Release
(H.4.1) classify the sources of reserves, uses of reserves and the
net change in reserves.
Federal Reserve
Primary Dealer
Money-Center Bank
If the reserve requirement is 10%, by how much will deposits

increase as a result of this transaction? If the demand for money
was assumed to be constant, what is your prediction about the
level of interest rates?
4
_1497687830.unknown

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