期刊论文详细信息
BMC Emergency Medicine
Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study
Morgan Wise4  Andrew Hiam2  Mark Tacey5  Steve Brown3  Trentham Furness1  Brian McKenna1 
[1] NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, Parkville, 3050, Victoria, Australia;Epping Police Station, Victoria Police, Police Station, 785 High Street, Epping, 3076, Australia;Northern Area Mental Health Service, NorthWestern Mental Health, The Northern Hospital, 185 Cooper Street, Epping, 3076, Australia;School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, Fitzroy, 3065, Australia;Melbourne EpiCentre, The Royal Melbourne Hospital and Department of Medicine, The University of Melbourne, Grattan Street, Parkville, 3050, Australia
关键词: Crisis management;    Mental health;    Police;    Emergency department;   
Others  :  1231106
DOI  :  10.1186/s12873-015-0040-7
 received in 2015-01-28, accepted in 2015-06-29,  发布年份 2015
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【 摘 要 】

Background

The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.

Methods

A retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.

Results

NPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16 % of people in crisis went to ED compared with 100 % for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.

Conclusions

NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.

【 授权许可】

   
2015 McKenna et al.

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【 参考文献 】
  • [1]Lowthian J, Curtis A, Jolley D, Stoelwinder J, McNeil J, Cameron P. Demand at the emergency department front door: 10-year trends in presentations. MJA. 2012; 196(2):128-32.
  • [2]Australian Institute of Health and Welfare. Australian hospital statistics 2009-10. Canberra: AIHW, 2011. http://www.aihw.gov.au/publication-detail/?id=10737418863> (accessed Oct 2014).
  • [3]Australian Institute of Health and Welfare. Australian hospital statistics 2010-11. Health services series no. 43. Cat. no. HSE 117. Canberra: AIHW; 2012.
  • [4]Australian Institute of Health and Welfare. Mental health services provided in emergency departments. Canberra: AIHW, 2012. http://mhsa.aihw.gov.au/services/emergency-departments// (accessed Oct 2014).
  • [5]Knott J, Pieban A, Taylor D, Castle D. Management of mental health patients attending Victorian emergency departments. ANZJP. 2007; 41(9):759-67.
  • [6]Fatovich D, Hirsch R. Entry overload, emergency department overcrowding, and ambulance bypass. EMJ. 2003; 20(5):406-9.
  • [7]Kalucy R, Thomas L, King D. Changing demand for mental health services in the emergency department of a public hospital. ANZJP. 2005; 39(1-2):74-80.
  • [8]Morphet J, Innes K, Munro I, O'Brien A, Gaskin C, Reed F et al.. Managing people with mental health presentations in emergency departments – a service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective. AENJ. 2012; 15(3):148-55.
  • [9]Improving the patient experience for older people in the emergency department. Department of Health, Melbourne; 2010.
  • [10]Mental health presentations to the emergency department. Victorian Government, Melbourne; 2005.
  • [11]Jelinek G, Weiland T, Mackinaly C, Gerdtz M, Hill N. Knowledge and confidence of Australian emergency department clinicians managing patients with mental health-related presentations: findings from a national qualitative study. Int J Emerg Med. 2013; 6(1):2. BioMed Central Full Text
  • [12]Mental Health Act 1986. Victorian Government, Melbourne; 1986.
  • [13]Short T, MacDonald C, Luebbers S, Ogloff J, Thomas S. The nature of police involvement in mental health transfers. Police Pract Res. 2014; 15(4):336-48.
  • [14]Lamb H, Shaner R, Elliott D, DeCuir WJ, Foltz J. Outcomes for psychiatric emergency patients seen by an outreach police-mental health team. Psych Serv. 1995; 46(12):1267-71.
  • [15]Metropolitan Planning Authority. North Growth Corridor Plan. Melbourne: Victorian Government 2014. http://www.mpa.vic.gov.au/wp-content/uploads/2012/11/North-Growth-Corridor-Plan.pdf (accessed Oct 2014).
  • [16]McKenna B, Furness T, Wallace E, Happell B, Stanton R, Platania-Phung C et al.. The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study. BMC Psych. 2014; 14:234. BioMed Central Full Text
  • [17]Al-Khafaji K, Loy J, Kelly A-M. Characteristics and outcomes of patients brought to an emergency department by police under the provisions (Section 10) of the Mental Health Act in Victoria, Australia. Int J Law Psychiatry. 2014; 37(4):415-9.
  • [18]Dean E. Nurses work with police to cut unnecessary arrests. Ment Health Prac. 2013; 17(1):8-9.
  • [19]Cordner G. People with mental illness: problem oriented guides for the police. Office of Community Oriented Policing Services, Washington; 2006.
  • [20]Fisher W, Grudzinskas A. Crisis intervention teams as the solution to managing crisis involving persons with serious psychiatric illnesses: does one size fit all? J Police Crisis Negot. 2010; 10(1-2):58-71.
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