Key Points

The Study:
  • A study compared communities with 3 different models of crisis service: 1. police as part of a specialised mental health team; 2. a mental health worker as part of a specialized police team; and, 3. an informal relationship between police and mental health crisis service
  • Both rural and urban areas were included
  • Focus groups were held with key stakeholders in each community: consumers, family members, service providers including police. Administrative data was reviewed. Job shadowing was conducted
The Findings:
  • While all communities valued their crisis services all identified limitations related to responsiveness during peak periods and transportation concerns.
  • Rural communities were most disadvantaged by transportation issues which at times created safety issues
  • Consumers in all settings wanted more peer support as part of the crisis services. They discussed the need for "warm lines" as well as "hot lines"
  • Access to beds was a major issue. The lack of access created a bottleneck in emergency rooms, and tied up police as well as crisis workers
  • Gaps in the continuum of care in each community will be reflected in the nature of and frequency of crises seen
The Recommendations:
  1. Crisis programs require the capacity of mobility, particularly in rural areas. For this reason and because of the wide geographic spread of rural areas, the use of police teams with a mental health worker best address the needs in rural areas. This strategy requires attention to impact on police checks.
  2. Crisis programs require staff members that are educated and sufficiently experienced to handle the full range of psychiatric crises including suicidal behavior, adolescent issues, family violence, psychogeriatrics and addiction issues. With sufficient volume, as in urban centres, specialized teams can be used to address this range, but in rural areas the individual mental health worker must have the skills to address the full range of crises. The volume and specialization issues in urban areas suggests that specialized mental health teams with attached police officers are most appropriate for urban centres.
  3. A system for easier access to psychiatric beds is required such as a regional and provincial roster system.
  4. No one calling a psychiatric crisis line should get a busy signal or have to leave a message. Since all crisis lines will experience peak periods, regional back-up phone systems need to be established.
  5. Crisis services need to include peer support.
  6. All police officers require extensive training and education on mental health matters, including addictions.
  7. Common minimum data sets for crisis service need to be developed and adopted.
  8. Local communities should regularly evaluate the types of crisis situations typically encountered to identify existing gaps in psychiatric services that need to be filled.
  9. Psychiatric crisis and emergency services need to provide or address transportation.