In an emergency, police are often the first called to the scene. But they are rarely equipped to deal with complex mental health crises.

Following recent

parliamentary inquiries

and

royal commissions

there has been

a push

—led by researchers, advocates and some senior police officials—for a shift to a health-led and paramedic-first response.

South Australia is

one of a number of states

trialing a program based on a “co-responder” model. This means trained specialists accompany police to some mental health call-outs in the community.

So, how do co-responder programs work? And are they effective? Here’s what the evidence says.

The current situation

Mental health legislation in all states and

territories


gives police

the power

to use

“reasonable force” to transport people who “appear to have a mental illness” to hospital to prevent harm.

In

most cases

, this involves police taking people experiencing mental health crises to hospital emergency departments, without help from mental health clinicians or paramedics.

Overburdened emergency departments have

long wait times

for mental health and are often

inadequate at responding

to people experiencing distress.

Those who need mental health support may not need a hospital stay.


One study

found only 1 in 5 (23%) of those taken to emergency by police—usually after expressing intention to self-harm—were admitted.

The strain on police resources is also significant. For example, in New South Wales, police now respond to triple zero calls about mental health crises in the community

every nine minutes

(in Victoria it’s

every 10

).

Criminalizing mental health

The mere presence of police alone

can escalate

already heightened emotional situations.

Police frequently

lack training

in mental health, with combative

police culture

and the

militarization of police training

presenting significant problems.

Police often acknowledge they are

ill-equipped

to intervene in a mental health crisis.

Yet, about

1 in 10 people

who access mental health services have previously interacted with police.

These encounters can be risky and even deadly.

People who experience mental health issues are

over-represented

in incidents of police use of force and

fatal shootings

.

Police involvement can also lead to the

criminalization

of people with mental health issues and disability, as they are more likely to be issued with

charges and fines or be arrested

.

Yet the

main reason

police take people to hospital is for self-harm or suicidal distress, and most are not deemed to be of risk to others.

What do people with mental health issues want instead?

In

our research

, conducted in 2021–2022, we interviewed 20 people across Australia who’d had police intervene when they had a mental health crisis.

Those we spoke to often had multiple experiences of police call-outs over their lifetime.

They told us excessive use of force by police had traumatizing and long-term effects. Many were subject to pepper spray, tasers, police dogs, batons, handcuffs and restraints, despite not being accused of committing criminal offenses.

For example, Alex said, “I was having an anxiety attack, and they pepper sprayed me. I had bruises all over my hands from the handcuffs they put on really roughly, even though I wasn’t under arrest. Then they took me to hospital.”

In our study, people with mental health issues said they would prefer an ambulance-led response wherever possible, without police attending at all.

They also wanted to be linked to therapeutic and community-based services, including

mental health peer support

, housing, disability support and family violence services.

What are co-responder programs?

Co-responder programs aim to de-escalate mental health incidents, reduce the number of emergency department presentations and link people experiencing mental health crises with services.

These programs, such as the one

being trialed

in South Australia, mean mental health clinicians (for example, social workers, counselors or psychologists) attend some mental health incidents alongside police.


Peer-reviewed research

shows these kinds of responses can be effective when compared to traditional police-led interventions.

An

evaluation of a co-response program in Victoria

found the mental health response was quicker and higher quality than when police attended alone.

The success of programs in

the United States

and

Canada

shows many mental health crises can be safely managed without police involvement,

for example

by addressing issues such as homelessness and addiction with health workers, and reducing the number of arrests.

Limited by a lack of resources

While the evidence shows co-responder schemes are

valued by people with lived experience

, they are often limited by under-resourcing.

Co-responder programs are not universally available. Often, they do not operate

after usual business hours

or across regions.

There is also a

lack of long-term evaluations

of these programs. This means what we understand about their implementation, design and effectiveness over time can be

mixed

.

More broadly, the mental health sector is facing significant and ongoing

labor shortages

across Australia, posing another resourcing challenge.

How can responses to mental health crises be improved?

Last year, the

final report

from the Royal Commission into Victoria’s Mental Health System recommended paramedics should act as first responders in mental health crises wherever possible, instead of police, diverting triple zero calls to Ambulance Victoria.

However that reform has

been delayed

, with no indication of when it may be implemented.

A 2023 NSW

parliamentary inquiry

also remarked on the need to explore reducing police involvement.

Co-responder and ambulance-first models offer an improvement.

But our research suggests people with lived experience of mental health issues want more than ambulances replacing the police as crisis responders.

They need a mental health system that supports them and provides what they needed, when they need it: compassionate, timely and non-coercive responses.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Provided by The Conversation


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