Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study

Brian Mckenna,Trentham Furness,Mark Tacey,Andrew Hiam,Steve Brown,Morgan Wise

doi:10.1186/s12873-015-0040-7

Abstract

BackgroundThe Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.MethodsA retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.ResultsNPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16 % of people in crisis went to ED compared with 100 % for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.ConclusionsNPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.

Highlights

The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services
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
During the post NPACER period, there was a reduction in the frequency of people in mental health crisis who were without a primary diagnosis (p < 0.01)

Summary

Introduction

The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. Across five metropolitan EDs in the state of Victoria, 24 % of mental health related presentations required psychiatric inpatient admission [5]. Access to specialist mental health assessment in the ED may be delayed by long ED waiting periods [6, 7], In the state of Victoria, police officers are lawfully entitled under mental health legislation (section 10, Mental Health Act 1986) to detain people in community based mental health crisis, if deemed at risk to themselves or others, and transport them to an appropriate location for specialist mental health assessment [10, 12]. Of all mental health crisis arrivals to five different metropolitan Victorian EDs, presentation with police officers ranged between 14 and 26 % [10]

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