Implementing street triage: a qualitative study of collaboration between police and mental health services.

Kimberley Horspool,Alicia O'Cathain,Sarah J Drabble

doi:10.1186/s12888-016-1026-z

Abstract

BackgroundStreet Triage is a collaborative service between mental health workers and police which aims to improve the emergency response to individuals experiencing crisis, but peer reviewed evidence of the effectiveness of these services is limited. We examined the design and potential impact of two services, along with factors that hindered and facilitated the implementation of the services.MethodsWe conducted 14 semi-structured interviews with mental health and police stakeholders with experience of a Street Triage service in two locations of the UK. Framework analysis identified themes related to key aspects of the Street Triage service, perceived benefits of Street Triage, and ways in which the service could be developed in the future.ResultsStakeholders endorsed the Street Triage services which utilised different operating models. These models had several components including a joint response vehicle or a mental health worker in a police control room. Operating models were developed with consideration of the local geographical and population density. The ability to make referrals to the existing mental health service was perceived as key to the success of the service yet there was evidence to suggest Street Triage had the potential to increase pressure on already stretched mental health and police services. Identifying staff with skills and experience for Street Triage work was important, and their joint response resulted in shared decision making which was less risk averse for the police and regarded as in the interest of patient care by mental health professionals. Collaboration during Street Triage improved the understanding of roles and responsibilities in the ‘other’ agency and led to the development of local information sharing agreements. Views about the future direction of the service focused on expansion of Street Triage to address other shared priorities such as frequent users of police and mental health services, and a reduction in the police involvement in crisis response.ConclusionThe Street Triage service received strong support from stakeholders involved in it. Referral to existing health services is a key function of Street Triage, and its impact on referral behaviour requires rigorous evaluation. Street Triage may result in improvement to collaborative working but competing demands for resources within mental health and police services presented challenges for implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1026-z) contains supplementary material, which is available to authorized users.

Highlights

Street Triage is a collaborative service between mental health workers and police which aims to improve the emergency response to individuals experiencing crisis, but peer reviewed evidence of the effectiveness of these services is limited
The resulting operating models, which we use as an overarching term to describe characteristics of service design and the individual service components (Table 3) differed by location. Both locations involved a mental health worker responding to incidents in police cars, and held briefing sessions for relevant stakeholders to inform them about how the service worked, they differed in two ways
Street Triage services included a variety of components to address the initial response to mental health crisis, and developed further to include interventions targeted at service users who contact mental health and police services more frequently

Summary

Introduction

Street Triage is a collaborative service between mental health workers and police which aims to improve the emergency response to individuals experiencing crisis, but peer reviewed evidence of the effectiveness of these services is limited. Individuals who have experienced mental health crisis have voiced their dissatisfaction; 86 % of service users, surveyed between 2011–2014, felt they did not receive the right response to resolve their mental health crisis [4] This dissatisfaction with crisis services may be linked to the historically high and varied use of Section 136 (S136) of the Mental Health Act (1983) in some areas of the UK [5], whereby; “A police officer who finds a person in a place to which the public have access, who appears to be suffering from a mental health disorder and to be in immediate need of care or control, and if the constable thinks it necessary to do so in the interests of that person or for the protection of other persons, to remove that person to a place of safety”. The use of police custody as a place of safety, which has received unanimous condemnation due to the stigma, association of mental health crisis with criminality, and a lack of safety [6, 7], was common practice in some areas due to limited availability in health based places of safety or concerns regarding risk of violence or intoxication

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