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

Mental Health Mobile Crisis Team

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

2010 Demographics• The province has a population of

940,000 people, of which 450,000 live in the Regional Municipality of Halifax

• Halifax Regional Police have a patrol division of approximately 700.

Prevalence of Mental Illness

• One in five people experience a mental illness every year. That's roughly 200,000 Nova Scotians.

• 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.

Police Calls• Halifax Police responded to

1081 mental health/suicide calls in 2003.

• Average dispatched/cleared time for mental health/suicide police calls went from 92 minutes in 1999 to 214 minutes in 2003

• 3400 police hours were utilized on mental health/suicide calls in 2003 – equivalent to almost 2 full time officers

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

EHSNS• 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.

• Paramedics were also spending increasing hours at ED waiting for transfer of care

Post MHMCT – fewer calls from police to respond

IWK Mental Health Program

• 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

• 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.

20 – 25 % of all callers are youth or youth related

Capital Health• Long Frustrating waits at ED for individuals

experiencing a crisis – often with unsatisfactory results

• Referrals to existing crisis service were typically help seeking

• Lack of consistent approach from HRP officers when needed

First full year of expanded service June 2006-June 2007 1377 new clients who had never used the service before and 1786 total callers

Why we came together

To improve access to Mental Health Service beyond the emergency department

To provide improved training and support in identification of mental health disorders for other service providers and in particular other emergency responders

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

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 TodayVol. No. Page 34

Key Considerations

Memorandum of Understanding

Ministerial Authorization

Steering/Operations Committee

EDP’s referral form and process

Police Training in Mental Health

It is all about context!

HRP: Time Spent on Scene

Time Volume

Total time spent on scene for a MH call:

1 year pre (n=798): 185.24 1 year post (n= 1058): 161.232 years post (n=1184): 136.17

Health Outcomes

• Connection to MH Services

• Attending ED’s less often

• MHMCT referrals to ED result in 74.7% admission rates to hospital

MONTH ADULT YOUTH TOTAL # INTERVENTIO

NS

FEBRUARY/09

71.1% 22.9% 610

MARCH/O9 77.0% 23.0% 799

APRIL/09 77.0% 23.0% 815

MAY/09 81.7% 18.3% 785

JUNE/09 88.1% 11.9% 794

JULY/09 83.7 % 16.3% 884

AUGUST/09 89.5% 10.5% 852

SEPTEMBER/09

85.8% 14.2% 842

OCTOBER/09

83.8% 16.2% 740

NOVEMER/09 76.2% 23.8% 898

DECEMBER/09 77.8% 22.2% 854

JANUARY/10 84.0% 16.0% 919

Monthly average for 12 months 816

0

20

40

60

80

100

May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr

Adult

Youth

Volume and Locations of Interventions

Location

1 yr Pre-MHMCT 1 yr Post-MHMCT 2 yrs Post-MHMCT

N % N % N %

Community 163 5.8% 469 7.9% 619 8.6%

Telephone 2643 94.2% 5455 92.1% 6934 91.4%

Total 2806 100 5926 100 7553 100

# of clients

# new clients # new & not seen > 60 days

N N % N %

1 yr Pre-MHMCT 468 349 74.6% 428 91.4%

1 yr Post-MHMCT 1419 1213 85.5% 1353 95.3%

2 yrs Post-MHMCT

1674 1277 76.3% 1577 94.2%

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.

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

MHMCT Goals • 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.

“the right service, in the right place at the right time”

• 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)

“any door is the right door”

• 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. “informed and trained responders result in better

outcomes for all”

MHMCT

• MHMCT provides intervention, and short term crisis management for children, youth and adults experiencing a mental health crisis.

• We offer telephone intervention throughout the Capital District 24/7 and 12 hr. mobile response in most communities of HRM from 1pm to 1am

• MHMCT also supports families, friends, community agencies and others to manage mental health crisis through education, outreach and consultation

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

Telephone crisis intervention response 24 hours a day within Capital Health District

Telephone crisis intervention response 24 hours a day within Capital Health District

A Mobile Team where a dedicated MHMCT policeofficer and a Mental Health clinician as a team offer a mobile response to most communities in HRMto most communities in HRM

Two Models of Community Response to Mental Illness

1.Co-Response Model (mental health and police) example MHMCT

2.CIT – Police response – first responder – officers with enhanced training in mental health to respond to mental health calls

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

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

Mental Health Mobile Crisis Team

Questions ?????