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Mental Health Issues in Policing

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					Mental Health Issues in Policing
 Presentation to the Canadian Association of Police Boards
                      August 14, 2009

                   Dr. Linda Courey
                        Director
                Mental Health Services
          Cape Breton District Health Authority

             Constable Delton McDonald
          Cape Breton Regional Police Service
                    Outline
 Current challenges confronting Police and
  Mental Health Services in Cape Breton
 The Plan
    – MOU
    – Objectives
   Mental Health Liaison Officer
    – Orientation
 Plan for officer training
 Liaison functions
 Building a case?
   An officer was called by a store owner to
    complain about someone shoplifting
    merchandise. The officer apprehended the
    man who seemed quite agitated and was
    threatening to kill himself. The officer took
    him to hospital and waited several hours
    for a psychiatric assessment. As he was
    driving back to headquarters, he noticed
    the man trying to hitch a ride on the side
    of the road.
            Sample scenarios
   A police officer was called to a residence
    to deal with a family altercation. A young
    man was reported to be increasingly
    aggressive and psychotic and had just hit
    his mother. The officer, recognizing that
    the man was probably suffering from a
    mental illness, offered to take him to the
    ED for possible admission. The family
    requested instead that charges be laid so
    the man could be managed in the forensic
    system.
 Officerswere notified by an inpatient
 mental health unit that an
 involuntary patient was missing. The
 officers eventually located the
 patient and returned her to the unit.
 They were dumbfounded to learn
 that the unit was not only unlocked,
 but that the patient had privileges to
 leave the unit for short periods.
   A police officer who responded to a
    domestic dispute involving a schizophrenic
    man who died 30 hours after being
    Tasered acknowledged in a recent inquiry
    that he and his colleagues could use more
    training on how to deal with people who
    are mentally ill. The officer told a fatality
    inquiry into the man’s death that he
    received some instruction on dealing with
    such cases at a police academy but
    couldn’t recall what signs to look for.
       Types of interactions
 Apprehension    and other powers of
  police under mental health acts
 Arrests or minor disturbances in
  which the accused appears to be
  mentally ill
 Situations in which mentally ill
  person is a victim of crime
 Crisis situations in which the person
  threatens others
 Suicide   interventions
 Non-offense situations in which the
  person with mental illness requires
  assistance
 Requests for assistance by families

 Situations in which the person
  attempts to provoke police to harm
  or kill them
 “Suicide   by cop”
  – Frequency not well understood
  – Lack of standardized definition and
    reporting procedures
  – Removal of the suicidal individual to the
    mental health sector prevents further
    investigation by police
    Frequency of interactions
 AcrossNorth America, the UK and
 Australia there are reports of
 increasing interaction between police
 and individuals with mental illness.
 A Canadian Mental Health Association, BC
  Division study found that over 30% of
  persons with serious mental illness
  interviewed had contact with police while
  making, or trying to make, their first
  contact with the mental health system
 Vancouver Police Department recently
  reported that 49% of all calls involve
  interaction with a mentally ill person
   Police officers are becoming the first point of
    access to mental health services for persons with
    mental illness
   The vast majority of individuals with mental
    illness never come into contact with the criminal
    justice system (20% with some form of mental
    disorder, 2% with serious mental disorders)
   However, a subgroup of those with severe mental
    illness (psychotic, not taking prescribed meds
    and substance abusers) significantly more
    challenging for MH and the police
   Contributing factors
    – A shift from institutionalized care to
      community-based care (improved treatments)
    – Changes in mental health laws and in respect
      for individuals rights and freedoms
    – Insufficient funding for community mental
      health and social support systems
    – Fewer mental health hospital beds with
      reduced lengths of stay
    – Increased victimization of persons with mental
      illness especially in large inner cities
 What  are the impacts of this
 situation of increasing interactions–
 for persons with mental illness, for
 the police, for the public?
               Impacts
 Use  of force (injury, deaths, trauma)
 Criminalization of mental illness

 Inappropriate use of police resources

 Contribution to stigma and false
  perceptions about those with mental
  illness
Mental Health Services perspective
 Increasing violence (least restrictive,
  unlocked units) leading to requests
  to charge inpatients
 Increasing focus on community-
  based treatment resulting in
  occupational health and safety
  concerns
 Over-reliance on emergency services
 CTOs and COLs (in NS) using police to
  return patients to the hospital, police
  reluctance to enter homes, respond to
  requests to bring someone in who has not
  otherwise come to the attention of police
 New legislation and philosophy of least
  restraint
 Lack of understanding of how police
  services work (shifts, continuity,
  communication between police and
  Probation Services, laying charges, etc)
    Obstacles to Collaboration
 Different mandates (provision of
  treatment/support vs Protection of
  public/community safety)
 Different legislation and
  policies/procedures
 Confidentiality

 Disagreements on the decision to lay
  charges and other clashes of expectations
 Stigma, bias and lack of understanding by
  police (as part of general attitudes within
  the community)
               Guidelines
 Contemporary Policing Guidelines for
  Working with the Mental Health System
  (Police/Mental Health Subcommittee of the
  Canadian Association of Chiefs of Police
  Human Resources Committee, 2006)
 Central tenet and 10 principles to guide
  the development of systems for officers to
  use in dealing with individuals with mental
  illness
           Best practices
 Mobile  Crisis Teams
 Police training

 Adequate and accessible mental
  health and support services
 Transfer and referral protocols

 Use-of-force policy revisions

 (Psychiatrists in Blue as a catalyst)
          The Cape Breton Plan
   MOU
    – Three year agreement
    – Terms related to access, use and disclosure of
      information
    – Functions of the MH Liaison Officer
    – Supervision
    – Community Advisory Committee
    – Roles and Responsibilities
    – Evaluation
    – General (e.g. media)
Functions of the MH Liaison Officer
   TRAINING
    – Participates in an extensive orientation to Mental Health
      Services, CBDHA and receive whatever training is
      considered necessary by both Parties

    – Provides training to CBRM Police to improve
      identification of and intervention with individuals
      experiencing a mental disorder, and enhance their
      understanding of the mental health system

    – Provides training and education of mental health
      professionals with regards to legal processes.
   LIAISON
    – Provides liaison in order to assist in addressing systemic
      issues or in resolving particular situations involving
      individuals with mental disorders and the CBRM Police.

   OUTREACH
    – Participates in outreach activities to provide support to
      individuals exhibiting symptoms of mental illness that
      are at times disturbing to an individual or to others in
      the community where an assessment, intervention and
      referral might reduce the risk of escalation of the
      symptoms and behavior to the point of psychiatric
      emergency or involvement with justice services.
 COMMUNITY    EDUCATION

 – Participates in community education,
   committees and focus groups, attend
   meetings that address the issues of
   mental illness in the community and
   related topics, and perform formal
   presentations, consultation and
   advocacy
  Mental Health Liaison Officer
 Orientation
  – Emergency Crisis Program
  – Inpatient Services
  – Outpatient Adult Clinics and Day Centre
  – Child and Adolescent Services (main
    clinic and ICBTT)
  – Rehabilitation Services (case
    management, Crossroads Clubhouse)
  – Addition Services
 Orientation   activities
  – Shadowing staff
  – Reviewing protocols
  – Attending therapeutic groups
  – Participating in relevant meetings
  – Participating in training (non-violent
    crisis intervention training, Halifax-
    based CIT)
  – Providing information to staff on police
    procedures as required
  Plan for Training CBR Police
 Key   components
  – General classification of mental
    disorders
  – Skills in managing individuals with
    mental illness, including crisis
    intervention and de-escalation
  – How to access mental health services
    other than hospitalization
  – Relevant legislation
 Training:   Participants
  – Mental Health Services management
    and frontline staff (all major programs)
  – Psychiatry
  – Mental Health consumers
  – MH Liaison Officer
  – Addiction Services staff
  – Tour of an inpatient unit
   Expected Outcomes
    – Improvement in the treatment of individuals with mental
      illness by officers
    – Improved skills in verbal de-escalation techniques and
      decrease in need for use of force
    – Decrease in injuries during crisis events (officers and
      others)
    – Improved identification of underserved mental health
      consumers who are then provided with appropriate care
    – Less criminalization of mentally ill (fewer “victimless” or
      minor crime arrests)
    – Decrease in unnecessary use of EDs
    – Decrease in liability for health care issues in the jails
    – Decrease in inappropriate use of resources and
      associated cost savings
          Building a case?
 Datacollection (major challenge) to
 establish:
  – Need for a Mobile Crisis Team in Cape
    Breton
  – The importance of including dispatch
    staff in training
  – Expansion to include training and liaison
    with EHS personnel

				
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