Innovative Partnerships in Mental Health Care

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Innovative Partnerships

in Mental Health Care

QF 16

February 25, 2016

Why include Police in

Healthcare partnership?

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VCH/VPD Partnership

Programs • VCH has partnered with VPD to provide better

services to our clients

• Police Services have specific roles under the Mental

Health ACT

• Three current Community Mental Health and

Substance Use (MHSU) Programs have

partnerships with the Vancouver Police (ACT,

MHES, AOT)

• VCH has had partnership programs with VPD for

three decades.

Police Role as 1st Responders

• Respond to persons experiencing mental health

crises, including apprehensions under the

Mental Health Act;

• Calls in which the public is concerned about the

behavior of a person—who may not have

actually done anything wrong or illegal but is

making people uncomfortable;

• Situations in which the person has been

victimized by crime or social disorder;

Police Role as 1st responders

• Incidents in which a call is received by police for any reason—a crime in progress perhaps—and it turns out that the person involved is displaying signs of a mental illness;

• 236,960 calls for service in 2014 – 134,000 calls dispatched - 18% mental health related – 24% in DTES;

• 3,042 Sec. 28 apprehensions in 2015

• Social contacts (those situations in which mentally ill people with little in the way of social or community support come to rely on the police or the 911 line as “friends”).

Powers under the Mental Health

Act/Section 28 • Police are given certain powers directly related to

helping mental health clients in the community.

• If it looks like a person is acting in a manner likely to

endanger that person’s own safety or the safety of

others

• and is apparently a person with a mental disorder,

• the police can apprehend the person and immediately

take them to a physician for examination.

• This is not an arrest, but is a way to make sure that

someone has the opportunity for an evaluation and

treatment.

Where and how do we

use these partnerships?

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Vancouver Mental Health

Emergency Services

Car 87/88

• A Vancouver-wide mobile crisis response

program

• Longest running partnership of Vancouver

Police and VCH (1984)

• Police dedicate one car to the program,

known as Car 87 (day) Car 88 (night)

• Information sharing is for crisis management

Assertive Community Treatment

Team • Recent partnership program with VPD (January of 2012).

• Like MHES, this is a formal program, with defined parameters for the relationship.

• Came out of a shared concern between VCH and VPD for people that have mental health and addiction issues and are not able to access traditional services (like a Mental Health Team) – Frequent use of Emergency Departments, or come into frequent

contact with the criminal justice system.

– Problems maintaining housing and frequently have physical health problems as well.

– This group often does much better with a service like the ACT Team.


Team

• Information about this client group is

shared between VCH and VPD.

• There are legal documents in place that

outline the sharing of information.


Team

• This protects the clients, as well as the partners

providing services.

– ACT clients are identified in the police information

system (PRIME) as being attached to the ACT Team,

with the idea to keep the clients out of the criminal

justice system and emergency rooms, and into

community-based treatment.

– Under no circumstances will any of the shared

information be used for criminal investigation or

prosecution, or make up part of their VPD record.

Outline of the Officer’s work

• Currently the VPD Officer is at ACT five days/week, (Rob/Rudy)

• In the morning, the Officer provides us with updates from police databases for any of our clients that have come to the attention of the Police overnight. – gives us a better understanding of what goes on in

the lives of some of our clients outside of our contact with them.

– ACT clients are flagged in PRIME — a patrol officer who may have contact with a client then notes it in his/her report and/or emails Rudy or Rob.


• Averages 3 visits/day to our ACT clients.

• Accompanies our staff either in a supportive role

or if there are safety concerns.

• Accompanies staff on visits to clients that are not

doing well or that are otherwise more of a

concern for us.

• When no physician is available for certifications,

the officer is prepared to do a Section 28 for

clients meeting the criteria

.


• Well integrated as part of the Team

• Clients accept him like the other Team members. – Provides us with help navigating the criminal justice

system when our clients are incarcerated or before the courts including the Mental Health Program at Downtown Community Court.

– Facilitate access to North Fraser Pretrial Centre to treat our clients who have been incarcerated.

– Good connections have been made with individual clients.

– One fellow actually asked that the officer specifically accompany him to court for “emotional support”.

• Addresses health care & risk

• Focus: assessment for protection & need for treatment

• MHA s.20 - voluntary admissions

• Conduit for MHA s.22 - medical certification by doctor

• Assist with MHA s.39 & MHA s.41 (Form 21) apprehensions

• Assess other legislation needs (AGA, CFCSA)

• Refer to other agencies, liaise with treatment sources

Role

of

Health

Care

• Addresses public safety, peace-keeping, entry, containment

• Focus: apparent mental disorder & endangered safety

• Participate with assessment

• Apprehension: MHA s.28, MHA s.39 & MHA s.41 (Form 21)

• Take person to a doctor not an arrest nor criminal charge

Role

of

Police

Assertive Community

Treatment Teams (ACT) • Specialized service delivery model

• Multi-disciplinary team

• Small case load

• On-going care, not time-limited

• Intensive outreach

• Focus on psychosocial rehabilitation

• Goal of community re-integration

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Evidence for ACT

• ACT is an “evidence-based practice”

• Reviews of ACT research consistently

conclude that, compared with other

treatments (e.g., brokered or clinical case

management programs), ACT greatly

reduces psychiatric hospitalization and

leads to a higher level of housing stability

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ACT 1

Assertive Outreach Team (AOT)

• Newest partnership between Vancouver Coastal Health and the Vancouver Police Department (March 2014)

• Assertive Outreach Team provides time-limited outreach services

• Residents of Vancouver who are identified as difficult to engage

• Suspected or identified mental health issues along with substance use issues.

• Clients are seen by a team made up of one nurse and one VPD officer.

• Referrals from Police or Hospital

AOT

• Clients with high use of emergency departments (appropriate or inappropriate)

• Flagged by Police as potentially suffering from mental health or substance use issues

• Pose a potential risk to the community due to chaotic nature of substance use/misuse or mental health symptoms

• Documented history of poor follow-up and engagement in community health services.

AOT Goals

• Increased engagement

• Stabilization and improved health outcomes

• Connection to appropriate services

• Risk mitigation

• Prevention of mental health-related arrests and offenses

• Decrease use of emergency resources

How has the partnership

changed?

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VCH/VPD: An Evolving

Relationship • Started with responding to crisis situations

with Car87/88

• Moved to managing long-term clients

requiring assertive and intensive supports

with ACT

• Evolved to forecasting and early

interventions that prevent crises and

decline in client functioning with AOT

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Questions?