The Specialized Crisis Nurse Program

Doug Sheppard
January 11, 2016
By Doug Sheppard
A collaboration between the Canadian Mental Health Association (CMHA), Local Health Integration Network (LHIN) and Waterloo Regional Police Service (WRPS) has significantly reduced mental health apprehensions and police wait-times at hospitals and improving service to patients within their own homes. WRPS and Waterloo Wellington LHIN struck a committee in late 2012 tasked with developing a model to address key factors relating to how police respond to mental health incidents. The goal was to educate officers on alternatives to apprehension and assist in identifying opportunities for practical intervention. WRPS officers were making apprehensions in 53 per cent of all MHA related incidents at the time, but only achieving admissions 20 per cent of the time. Spending hours waiting in hospital emergency departments for patient assessments was an inefficient use of officers' time. There was a clear need to better serve those in crisis and improve police response to mental health related incidents.

A collaboration between the Canadian Mental Health Association (CMHA), Local Health Integration Network (LHIN) and Waterloo Regional Police Service (WRPS) has significantly reduced mental health apprehensions and police wait-times at hospitals and improving service to patients within their own homes.

WRPS and Waterloo Wellington LHIN struck a committee in late 2012 tasked with developing a model to address key factors relating to how police respond to mental health incidents. The goal was to educate officers on alternatives to apprehension and assist in identifying opportunities for practical intervention.

WRPS officers were making apprehensions in 53 per cent of all MHA related incidents at the time, but only achieving admissions 20 per cent of the time. Spending hours waiting in hospital emergency departments for patient assessments was an inefficient use of officers' time. There was a clear need to better serve those in crisis and improve police response to mental health related incidents.

Waterloo Region covers an area of 1,369 square kilometers, comprised by three major cities (Kitchener, Waterloo and Cambridge) and four surrounding townships (Woolwich, Wellesley, Wilmot and North Dumfries), with a 2015 population of more than 560,000 people. The WRPS has three urban policing divisions as well as a rural patrol division. Having a mobile response across this vast geographical area was a challenge for the committee.

The new program received base funding from the LHIN, and involved a different approach from models adopted elsewhere, including a unique dispatch model. The local model hired Specialized Crisis Team (SCT) psychiatric nurses from the Canadian Mental Health Association to individually attend scenes of mental health crisis anywhere in the region on an 11 hour per day, 7 day a week basis.

Nurses were given police radios and trained how to use them. They were logged onto the police dispatch system and showed available for duty when working, just like any other police unit. Officers were trained in the partnership program and also given more specific overall mental health crisis training. When an officer assigned to a mental health related incident determined that the SCT nurse could assist, they were dispatched either via radio or cell phone.

Prior to being requested, the SCT nurse was usually briefed on the basic details of the incident by dispatch. In many cases nurses heard the call on the police radio and were already heading to the scene when their assistance was requested.

{Immediately successful}

The SCT Nurse program was an immediate success.

Upon attending an incident, the nurse provides mental health support for the person in crisis – and overall support for the officer – quickly assessing whether the subject's behaviours require enhanced crisis support or are better served by support at the scene.

The nurse has access to other supports available through CMHA. If the subject requires enhanced care, nurses provides their assessment to the officer; these observations contribute to the officer's grounds for apprehension. Once apprehended, the nurse accompanies the officer and person to the emergency department and shares their indicators with crisis staff. This professional sharing of information has led to a 77 per cent admission rate in 2015 (versus 20 per cent pre-program) and a significant drop in officer time spent at the hospital (75 minute average per apprehension in 2015 to the end of November).

A secondary benefit is that the SCT nurse often elects to stay with the person in crisis while the officer is free to clear the call. Early in the new program, officers would clear the call but remain a block or two away waiting for the nurse to call them back. Officers were only called back a handful (less than 10) times to a scene in the first year of the program, mainly because of other people showing up and interrupting the interaction between the person in crisis and the nurse.

Since the inception of the program, this assumption of incident responsibility has freed up several hundred officer hours. The nurses have cited a level of comfort in excusing officers from incidents because they have a police radio. Once the officer clears, the dispatch centre keeps track of the nurse as they would any other logged on member, periodically checking for an "all 10-4?"

Should a situation deteriorate, the nurse can either radio dispatch or activate the emergency button for rapid officer response. Since the inception of the program in February 2013, SCT nurses have attended 1,926 incidents and have yet to activate an emergency recall, in part due to their initial patient assessment, conducted in the presence of officers.

The SCT program also uses short-term support (30-60 days) from a mental health clinician who can provide counselling coordinators to assist individual access to community mental health resources. These CMHA staff are available to police officers through a fax referral when the SCT nurse does not respond. They are also used by the nurses as a follow-up to their intervention and assessment. If immediate consultation is required for a person in crisis, and the SCT is not available, officers can also contact the CMHA's "Here 24/7" crisis support line.

All WRPS officers who may respond to mental health related incidents have received enhanced training in crisis response. The Durham Regional Police Service allowed the WRPS to use its scenario-based e-learning training module, which walks officers through different mental health situations and guides them on the most effective response strategy in each situation. The focus: although officers need to be constantly diligent to protect safety and well-being, there are effective methods to appropriately resolve incidents of mental health crisis that do not involve apprehension or arrest.

CHART

{Statistical Results}

• Mental health related police incidents have shown a steady increase year over year, up 24 per cent since the end of 2011. This trend continued in 2014, with an 8.5 per cent increase in attempt suicide and mental health crisis incidents.

• Overall, significant media attention surrounding mental health may have positively contributed to the overall rise in incidents, as there is greater awareness of services available to those in crisis and more social acceptance to expressing a need for help (e.g. Bell's <Let's Talk> campaign).

{Overall Apprehensions}

Although the number of mental health incidents have risen, the apprehension percentile has not risen as high, proportionately. Overall, the apprehension frequency for all mental health calls for service in 2014 has fallen, even though there were 266 more incidents. This is a testament to the overall efficacy of the program, as officers have enhanced training in how to effectively address mental health issues while also getting nurse assistance.

As of November 2015, the overall frequency of apprehension for mental health crisis incidents fell by 25 per cent since the program was introduced. Although it would be ideal to have no apprehensions, a realistic target goal of 30 per cent has been set. While challenging, it is hoped that goal will eventually be met or exceeded through continued training and application of existing resources.

A lower apprehension rate will mean more people in crisis receive effective home-based mental health care. It will also result in a significant reduction in hospital wait times (and straining of hospital resources), with the ancillary benefit of officers released to attend to other policing needs.

{Nurse Assistance}

SCT nurses attended 699 incidents in 2014, an 82 per cent increase from 2013. The overall frequency of attendance at MHA related incidents went from 13.5 per cent in 2013 to 20 per cent in 2014 – impressive when you factor the overall increase of incidents (606 more in 2014). The eventual goal is to have the nurses attend to 30 per cent of all such incidents.

Despite increased SCT attendance, the apprehension frequency fell from 24 per cent of all incidents in 2013 to 18.5 per cent in 2014. More community members received mental health assistance in their own homes, while less officer time was spent in transport and waiting at the hospital.

In comparison, officers were 2.5 times more likely to apprehend a person in crisis as they would when the nurse was in attendance. This statistic shows the advantage to having professional psychiatric assistance directly in the field. Officer apprehension rate has dropped from the 53 per cent average before the program began but remains an area to improve on through expanded education and training.

When apprehensions were made by officers with nurse assistance, the admission rate increased to 72 per cent of all incidents in 2014, up from 62 per cent in 2013. That meant more people needing enhanced mental health assistance received it and fewer persons in crisis were taken to hospital when they did not require an admission.

WRPS divisional administrative staff sergeants now review all MHA related incidents daily to ensure SCT nurse attendance was considered, and to encourage increased use of the program for their officers.

{SCT Nurse Relief}

SCT nurses relieved officers from incidents involving people in mental health crisis 394 times (out of 512 incidents attended) for the period of May-December 2014. This is a 75 per cent relief rate, translating into several hundred hours of saved police time.

Results for 2015 to the end of October:

• Apprehension rate is 40 per cent overall, 33 per cent for non-suicide attempt mental health incidents.

• SCT nurses have attended 842 incidents – 28 per cent – of all mental health incidents (a 20 per cent increase over all of 2014).

• In calls for service where a SCT nurse participated, the admission rate for those apprehended is more than 77 per cent.

• The overall emergency department wait time for apprehended persons has dropped to a year to date average of 75 minutes, down from more than 120 minutes before the program began.

There are other models of mental health response in use across Canada. Waterloo Region chose the SCT nurse program because it involved enhanced mental health response education for all front-line members and a civilian specialized response to those in crisis, while leveraging the LHIN's investment in mental health response. It also provided the capacity needed to serve a large geographic area.

Results over the first 33 months of the program show that, while there are still areas for improvement, nurses are attending more incidents, resulting in better crisis care in the field and fewer (by frequency) persons being apprehended and taken to local hospitals for enhanced care. This is a strong example of an effective partnership among agencies for the betterment of those experiencing mental health crisis.

BIO

Contact the author at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 519-650-8531 for more information about the SCT nurse program.

Add comment


Security code
Refresh

Subscription Centre

 
New Subscription
 
Already a Subscriber
 
Customer Service
 
View Digital Magazine Renew

Most Popular

Latest Events

Blue Line Expo & Conference
Tue May 02, 2017 @ 8:00AM -
RCMP Synthetic Drug Awareness Workshop
Thu May 04, 2017 @ 8:00AM - 05:00PM
Serving with Pride - LGBT 101 education series
Tue May 09, 2017 @ 9:00AM - 03:00PM