Week 9 Flashcards
Why does terminology matter in mental health? (4)
There are a variety of terms that are commonly used when discussing police interactions in mental health situations and we need to understand what interactions we are actually talking about to understand what is happening
Language also shapes our actions and perceptions (labeling theory)
People-first language creates dignity and respect
Reflective language encourages positive interactions and outcomes
What are the 3 terms used by police and in literature/research?
Emotional Disturbed Person (EDP)
Person with a Mental Illness (PMI)
Person in Crisis (PIC)
What is an Emotional Disturbed Person (EDP)? (3)
Any person who appears to be in a state of crisis or any person who is mentally disordered
Historically a commonly used term but we have moved away from it because it is quite negative
Viewed as pejorative, not person-first
What is a Person with a Mental Illness (PMI)? (2)
Individual with a diagnosable mental illness, using person-first language
Issues with the term in policing are that police are not MH pros and cannot know and not everyone they encounter suffers from a MI
What is a Person in Crisis (PIC)? (3)
An individual whose behavior results in police contact due to an apparent need for urgent care within the mental health system
Or they are otherwise experiencing a mental or emotional crisis involving behavior that is sufficiently erratic, threatening or dangerous that the police are called in order to protect the person and/or those around them
More common term
What terminology is used? (3) Why?
Most common in literature is PMI
Sometimes EDP is still used in policing
PIC seems to capture everything however
Choosing respectful and accurate terms encourages better research as well as empathy and support
What factors result in the high number of police interactions with PICs? (3)
De-institutionalization of asylums and mental health institutions, throwing them back into the world without support
Lack of community resources (especially after COVID)
Mental Health Act that requires police be involved in certain situations
What are the 3 conditions under which a police response is likely to be necessary for a mental health crisis?
Violence or weapons (against self or others)
Criminal activity
Involuntary apprehension under relevant legislation
What are the 4 ways the Mental Health Act creates police interactions with PICs?
Form 1: Application for Psychiatric Assessment
Form 2: Justice of the Peace Order
Form 47: Community Treatment Order
Section 17 apprehension
What is a Form 1: Application for Psychiatric Assessment? (2)
Given by a physician, requiring an officer to apprehend that person and bring them to the hospital as they believe they are in immediate crisis and need an assessment
Only valid for 7 days and need to have seen them within the last 7 days
What is a Form 2: Justice of the Peace Order? (3)
Anyone can get this for a loved one or someone you know
Officer has to go get that person and bring them to the hospital for a psychiatric assessment
Valid for 7 days
What is a Form 47: Community Treatment Order? (2)
Physicians can issue a form to get a person picked up by an officer and brought to the hospital for assessment as they haven’t seen them in a while and are worried
Good for 30 days
What is a Section 17 apprehension? (2)
Immediate apprehension by an officer to bring them into the hospital
The individual is in immediate danger to themselves or somebody else to such an extent that it would be dangerous to wait for a Form 2
What are the stats regarding police interactions with PMIs/PICs? (4)
PMIs are more likely to interact with police than non-PMIs
25% of PMIs are arrested at some point in their lifetime and 10% encounter police during their intro to the mental health system
Mental health related calls ranged from 1-17% of all calls for service in Canada and they are increasing
There are a variety of reasons for contact - 20% for violent criminal act, 40% each for non-violent criminal act and situation unrelated to crime
What are the challenges with police responses to mental health? (6)
Consumes a lot of police resources (take longer, they have to wait with them at the hospital)
Lack of expertise (not enough training, experience is not enough)
Criminalization of PMIs (more likely to be arrested, overrepresentation, mercy bookings)
Issues with the MH system (limited resources, fragmented system)
Stigmatization and traumatization (labeled as unpredictable and dangerous, involuntary apprehensions can be traumatizing and stigmatizing)
Over-representation in UofF incidents, including deadly force
What are PMI perceptions of the police? (5)
Research suggests they are mixed and influenced by a variety of factors (identity, background, previous experience, family, etc. of officers and PMIs)
Can vary between individuals, interactions and within a single interaction
One survey of homeless individuals in Alberta found significantly more negative evaluations of the police if they had been handcuffed
Interviews conducted with PMIs in Vancouver found the majority believed the police treated them humanely and with respect
Another study found some people thought the interactions had a positive impact on their lives, others had a negative, but PMI perceptions of their more recent contacts were positive
What are common police interventions to interactions with PMIs? (5)
Mental health screening tools
Situation tables
Mental health and de-escalation training
Crisis intervention teams
Co-response teams
What are mental health screening tools? (2)
Increasingly, police services are adopting mental health screening tools to better identify individuals with mental health issues and facilitates an appropriate response
In Canada, the only research on these tools has been on the IntraRAI Brief Mental Health Screener
What is the IntraRAI Brief Mental Health Screener (BMHS)? What are the goals? (2) What does it asks officers? What does the research suggest? (3)
Mobile online form created by academics for use by officers when they encounter someone exhibiting signs of a potential mental illness to determine if someone needs to go to the hospital for evaluation
Goal is to help officers identity indicators of serious mental disorder and facilitate a collaborative relationship between frontline staff in the CJS and health system
Asks about characteristics, evidence of disordered thinking, risk of harm, time spent on the call, etc.
Research suggests that it may be predictive of hospital admissions, screener is not intuitive for officers, and it can be unrealistic in an operational setting (takes to long)
What are situation tables? (3)
Involve frequent meetings between police and mental health services to facilitate communication regarding individuals in the community at risk for criminalization and victimization
Shares responsibility and resources to make everyone better equipped to handle PMIs
There is a lack of literature devoted to evaluating the effects on PMIs, police and the system
What is mental health training? (2) What does the research show? (3)
Many officers in Canada receive at least some training but it varies by amount, goals, content and delivery
Often focuses on relevant policies and legislation, symptoms, strategies, and available resources
Research is mixed
Generally suggests increased officer confidence in interacting with PMIs and reduces stigma but doesn’t really examine behavioral outcomes
One study found that officers were more empathic, communicated better and used more de-escalation rather than force in the 6 months after training
What is de-escalation training? (3)
Focuses on techniques aimed at reducing the tension during an escalated situation (rapport, active listening, paraphrasing)
Lack of consensus around de-escalation as it varies across jurisdiction by amount, content and delivery
A more popular de-escalation training in Canada is Crisis Intervention and De-Escalation (CID) training
What does the research of de-escalation training show? (4)
There is limited evaluations of this training and most have never been evaluated
The evaluations that do exist demonstrate they are generally effective at improving officer knowledge and attitudes
Results are mixed when considering behavioral outcomes
More promising results came from an evaluation of the US Integrating Communications, Assessment and Tactics (ICAT) training that found reductions in UofF and injuries
What is the Mental Health Crisis Response Training? (2) What did the evaluation do? (2) What did it find?
Developed by a team of over 40 people from a variety of disciplines and people with lived experiences
Co-developed to enhance de-escalation competencies while managing safety
Evaluated the effects of the training in live action and VR formats compared to a control group
Used 63 officers from Ontario with varying levels of experience and training
Found evaluation scenario de-escalation scores increased following the training compared to the control group (but no differences between live action and VR)
What is the Crisis Intervention Team (CIT) Model? What are the 4 components? What are the goals? (3)
40-hour training on crisis intervention and mental health provided to frontline officers
There is a classroom component aimed at increasing officer knowledge
Simulations that teach de-escalation and situational assessment
Mental health facility component where officers to go these places and interact with who they’ll be working with (clients and workers)
There is also dispatcher training on when to call police and when to call the CIT
Divert PMIs away from the CJS to MH supports
Enhance collabs between police and MHS to make services more accessible
Increase officer and client safety
What are the impacts of the CIT model on the system (4), officers (2) and clients (3)?
System:
- fewer involuntary transports to MH facilities for CIT and non-CIT officers
- faster responses from CIT officers
- less time spent on scene for CIT
- modest cost savings
Officers:
- enhanced MH knowledge on resources, de-escalation skills, self-efficacy
- less stigmatizing beliefs and adherence to stereotypes
Clients:
- mixed evidence regarding influence of arrest rates
- more voluntary treatment referrals
- diversion from jail and hospital resources
What are Co-Response Teams (CRTs)? (4)
Pairs specially trained officers with mental health professionals (psychiatric nurse, social services, paramedic)
They respond to mental health calls for service, sometimes on their own or with other frontline officers until the scene is determined safe
Typically act as a secondary response unit
Dominant response in Canada and the UK
What are the objectives of CRTs? (4)
De-escalation
Reducing or preventing injuries
Connecting to community resources
Reducing pressures on the CJS and healthcare system by using informed discretion
What is the effectiveness of Canadian CRTs? (3)
Research is growing in Canada
The teams vary by jurisdiction, making more research necessary as small changes like uniform can impact how people perceive and experience the program
Generally, research suggests a positive impact
What are the system (2), professional (2) and client (2) impacts of CRTs?
System:
- generally positive (less time spent, cost savings)
- some negative/mixed findings (takes longer to arrive on scene, some transport more others less)
Professional
- generally positive (enhanced collab and info sharing, feel safer, knowledge and expertise)
- several challenges identified (lack of coverage, funding, wait times, meshing)
Client:
- generally positive (referred to resources, less force and involuntary transports, more compassionate)
- mixed negative findings (negligible effect on arrests, some clients unhappy)
What are the challenges with CRTs? (5)
Inter-agency collaboration (practical and systemic differences)
Information sharing
A lot of calls for service
Hours of operations (not 24/7, rarely at night when they are most needed)
Large jurisdiction
Are police responses to mental health necessary? (2)
One study shows that only half the calls included violence and it was mostly towards themselves, rarely included weapons, but half still included MHA apprehension
Another study shows that about 30% of cases involve criteria requiring policing presence, the rest indicating that there is no criminal activity and therefore no need to police presence
What are alternative response models? (2) What is the difference between a police centric model and a healthcare centric model? (2)
Responses that don’t involve police at all
Need more research on alternative response models
A police centric model uses 911 to send a police or CRT response to address a PIC
A healthcare centric model sends training police or CRT only if there is violence, criminal activity or apprehensions, otherwise a civilian crisis team responds with the option to call the police if things change to address the PIC
What research is there on civilian-led teams? What did it find? (5)
Researchers at St. Mary’s have identified 220+ civilian-led crisis response teams globally, mostly located in Canada, US, Australia and Sweden
60% were launched in the last 2 decades, under half operate 24/7, they make up paramedics/clinicians/social service workers and 2/3 serve individuals of all ages
Unspecified police involvement ranged from 2% to 50.8% but calls for police backup were only up to 3% of cases
Most common calls were MH, situational and medical crises
Most common outcomes were hospitalization, conversations/checkups and diversions from the hospital
Service users largely reported positive feedback while providers and police reported mixed feedback
