Police Street Triage
People in the community having mental health crises and the police responding to them.
Police street triage services – these services give police officers on-the-spot advice from a mental health professional, such as a mental health nurse. This aims to ensure that the right decisions are made and people get the appropriate care they need.
Overall, such services have been warmly welcomed by all concerned and have achieved a marked reduction in people being temporarily detained by the police under mental health law. There is enormous variation in services however and they are often poorly described. Good quality evidence on how they work in practice and their effectiveness is very limited.
The CLAHRC is working with Thames Valley Police, Oxford Health NHS Foundation Trust, and local social care services on a programme of work to understand and evaluate these innovative services.
This collaboration, borne out of mutual interest, aims to improve the evidence base relating to these services, their components, and their outcomes in terms of ongoing health service use, self-harm, and other key issues.
Crucially, we want to understand the experiences of people who are in contact with street triage services and its impact on them. We will use a number of methods, such as surveys, questionnaires and interviews, to rigorously evaluate this.
We hope to identify what works best and for whom. We hope to use and share this knowledge to make triage services the best they can be.
Why this is important
The police are often the first resort for people who have a mental illness and are in extreme distress in the community (often called a ‘crisis’). At least 15% of police calls have a mental health component.
If the police believe someone to be a risk to themselves or others they have the power (Under section 136 of the Mental Health Act) to remove them from a public place and take them to ‘a place of safety’. This is usually a hospital or a police cell. However, understanding and appropriately managing people with mental health problems requires specialist training outside that of most police officers.
This presents two main challenges:
- The police might not be the most appropriate source of help, yet they could be accountable should they fail to act and something happens as they are ‘on the spot’.
- For the person in crisis, the police might (unintentionally and out of good intentions) take a course of action that does not help and could cause further distress, potentially exacerbating their condition or delaying their recovery.
How this could help patients/the public
Understanding what works best in street triage services will help people to get the appropriate care they need during what is always a time of extreme distress and when they are their most vulnerable.
This could help to speed up their recovery in the safest way possible for all involved, and could free up police time for other core duties.
The first step in this project is to understand how street triage is done in practice, how it is measured and how effective it is, to help guide future activities or research. A systematic review will be used to do this. A systematic review is a rigorous and transparent way of identifying, gathering and analysing all the available evidence on a topic to give a ‘state-of-the-art’ overview of what is known about it.
The next step is to use structured questionnaires to gather a large number of experiences and opinions on the implementation and effectiveness of street triage services from health and social care workers and from serving police officers.
Finally, and most importantly, we want to study and understand the experiences of the people who have been through street triage and what the outcomes (the ‘what happened next’) for them were. The first step is reviewing all documented evidence for cases of street triage in the Thames Valley and then contacting a sample of these people to interview them about their experiences with street triage and what happened after.
We will publish the systematic review as soon as it is available to add to the evidence base for these services. We will share our findings as soon as we can with police forces (they are also a key part of the project), service users, and social services departments. Depending on what we find, we would then use the information to try to ensure that these services can be the best they can be.
The programme is led by Stephen Puntis and Andrew Molodynski (Department of Psychiatry, University of Oxford) in collaboration with Chief Inspector Marc Tarbit of Thames Valley Police, Devon Perfect (Oxford Health NHS Foundation Trust), and others.