America

CAHOOTS, EUGENE OREGON

In Eugene, Oregon, Glen worked alongside Whitebird Clinic staff in their CAHOOTS program - Crisis Assistance Helping Out On The Streets which was founded in 1989 by the city of Eugene and is funded out of the Eugene Police Department & public safety budget.

The program assembles two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field.

“Their data shows that the program is beneficial. They are sending out a vehicle with a licensed clinical social worker and emergency medical staff - no police presence in the vehicle – and are dispatched by their call centres who identify the risk assessment,” Glen told Police News

“They have police radios with them and can acquire backup at any time if the job escalates. I went out on several jobs with the team where in every case no police were needed, and the situation was resolved in the home or with transport to a facility care centre.”

“All those jobs add up, so that’s people that aren’t seeing a police officer or people that aren’t going into the judicial system. It’s a great diversion system freeing up police resources.”

A November 2016 study published in the American Journal of Preventative Medicine estimated that 20 percent to 50 percent of fatal encounters with law enforcement involved an individual with a mental illness.

LOS ANGELES, CALIFORNIA

Glen’s next stop was Los Angeles to ride alongside the Los Angeles Police Department’s Mental Evaluation Unit.

“This was an incredible experience. They have had a mental health division for around 40 years and also run a Co-Response model. They have a triage centre, detectives investigations team and a proactive case management team who I also spent a day with tasking out and seeing how they engage their High Utilisers,” he said.

In his second week in LA, Glen participated as a student on their 40-hour mental health training – a program called Mental Health Intervention Team (MHIT) which was undertaken at the LAPD Academy.

“The Western Australia Police Force have no training available to officers in this scope and certainly none that is mandatory. This is one of my recommendations out of my studies and something I would love to see implemented more in the field and in our police academy,” he said.

A standout policy Glen observed in LA was their disengagement policy.

“If officers get to a job and the person is only posing a risk to themselves and no one is there, it could be assessed to potentially allow for disengagement. If someone is barricading in and it looks like it could even escalate to a suicide by cop, or if police think their engagement will make it worse or if they can confirm there is no risk to others, they will make the call to disengage and possibly go back or have a mental health clinician respond.”

“WAPOL don’t have a disengagement policy and officers are required to stay on the scene. If someone is threatening harm – we will more than likely have to force a door and force an encounter of some sort which does not always have a positive result, we need to be prepared to absorb some risk as an agency around these types of calls” he said.

“I was lucky enough to be at an active job in LA– where they engaged this policy. The person was very paranoid and known to mental health services. On site we had SWAT teams and lots of police presence. He disengaged with the mental health practitioner and the negotiator, so it was clear that talking was not going to work,” he said.

“In traditional policing mode, officers would force some sort of conduct which more than likely would have ended in force and maybe fatal force. He was the perfect candidate for this policy as he was only threatening himself. Hours later officers were able to go back to him and engage with him when he had come out of that heightened crisis.”

PITTSBURGH, CRISIS INTERVENTION TEAM INTERNATIONAL – NATIONAL CONFERENCE

Whilst in America, Glen attended a Crisis Intervention Team Conference in Pittsburgh – a forum that brings together crisis teams from all around America looking into how everyone’s crisis intervention programs work.

Glen said he heard from several jurisdictions who had developed behavioural health receival units, designed so police officers aren’t having to transport people to emergency departments in hospitals, instead they are 24/7 mental health centres. Behavioural health receival centres is the new push forward in the USA.

“So as an example, in WA if an officer has apprehended someone under the mental health act, instead of taking them to Charlie Gardiner ED – off to the side of that there would be another ward which is purely designed for behavioural health crisis patients, and they would take them there. This in turn frees up emergency rooms and police resources who aren’t waiting around at a hospital for hours,” he said.

“The flow-on effect would be huge. Police aren’t stuck at emergency departments for hours, St John ambulance isn’t ramped. Overseas, these centres have a half hour turnaround time.

“In WA we still really only have one option if we think a person is in a mental health crisis and needs some sort of behavioural health crisis management and that is to apprehend under the mental health act and convey them to hospital for an assessment. This extends wait times and is quite often not necessarily the best outcome for the person involved,” he said.

“There is a lot of research showing that emergency departments heighten the crisis the person is experiencing –the activity, the noise and even the police presence. It could be established earlier that police presence is not needed.”

Glen said a prominent theme across several agencies was around diversion which even extended to diversion from the onset with call diversion.

“I was there in September and in July they were launching the national 988 number. They did run on a system of a 10 digit number for behavioural health crisis, like the one we have now. But they identified that if you aren’t in the right state of mind, you’re not going to remember a long number for your mental health crisis so created a secondary triple number.”

“One of my recommendations from my research is that we could have something similar to ensure the calls that come through are getting the appropriate responder not always a police officer responding to a job that a clinician could attend,” he said.

“We all know that police respond to a vast majority of 000 calls – but often police aren’t necessarily required. Yet if the public are in crisis and trying to remember complex numbers, inevitably a simply 3 digit number like 000 is the fall back effect.”

United Kingdom

LIVERPOOL AND EXETER

Concluding his trip, Glen spent 10 days with Merseyside Police, and a week with the Devon and Cornwall Police.

Glen’s highlight was being able to spend time with the team at First Response which is the National Health Services diversion system for behavioural health crisis and similar to the USA’s 988 alternate call number operates from the 111 alternate 3 digit number to 999.

“They have really great proactive programs in this space as well,” he said.

“They have a fantastic first response program working out of their triple 1 call centre where they send out a non-police response. Their triage systems work well. 111 calls only result in a need to call on police 2 percent of the time which shows again there is capacity to divert some of these types of calls away from police.” ▷