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The interRAI Brief Mental Health Screener


June 17, 2016
By Ron Hoffman

1118 words – MR

The interRAI brief mental health screener
A collaborative evidence-based approach to a mental health crisis

by Dr. Ron Hoffman & Dr. Greg Brown

The interRAI Brief Mental Health Screener (BMHS) was developed as a new screening system for police officers to complete when interacting with persons with serious mental disorders. It uses computerized logic rules based on scientific research to quickly flag risks in harm to self, others and self care.

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It was developed by Ron Hoffman PhD, a former instructor at the Ontario Police College (OPC), along with John Hirdes PhD and his research team at the University of Waterloo, Greg Brown PhD at Nipissing University and the interRAI International Network of Mental Health (iNMH).

While the initial reason for the system was to provide police officers with an evidence-based tool to standardize their observations and assist in articulating their reasonable grounds to believe a person has a mental disorder, it soon became apparent that there were other benefits.

One of the most important stems from the fact that items on the assessment form are written in language understood by both emergency department nurses/doctors and the officers completing the form. The language includes terms such as “hallucinations” and “delusions,” which have long ago been integrated into everyday language. Since the average age of recruits today is 27 and most have a college or university education, they often already understand these terms.

{InterRAI}

InterRAI (International Resident Assessment Instrument) is a not-for-profit organization comprised of researchers from around the world who spend most of their time developing instruments to help vulnerable persons like those with mental illness.

The Ontario government partnered with interRAI to develop a mental health assessment form (the “RAI Mental Health” or RAI-MH) currently used in every Ontario hospital with mental health beds and other jurisdictions around the world. The RAI-MH is a 10 page paper assessment form mandated in 2005 for use on every patient admitted into an Ontario psychiatric hospital.

There are more than 300 items on the form relating to socio-demographic, mental and physical health, service utilization and functional characteristics and practically every behaviour imaginable!

Among other things, the information is used to help hospital staff accurately identify the exact nature of the problem and formulate a treatment plan. It also standardizes assessment methodology and tools across the entire province, enabling information sharing and consistency in treatment in every facility.

The full-length RAI-MH would likely be too time consuming and complicated to be used by police, so in the spring of 2007 work began on a Brief Mental Health Screener (BMHS) form designed specifically for police use. The form development involved a number of methods and procedures including; a literature review, an analysis of the RAI-MH database and input from an expert panel and advisory committee consisting of police officers, hospital staff and researchers.

In collaboration with Dr. John Hirdes, Dr. Hoffman was able to analyze over 41,000 completed RAI-MH forms to identify items for the BMHS, so it is truly evidence-based and should stand up in court.

The BMHS was piloted in collaboration with one large and one medium Ontario police service. Several additional police services have since begun using the form and many others are in the process of implementation.

Of particular significance is that plans are underway to ensure the completed BMHS is forwarded to local mental health agencies regardless of whether the officer takes the person to hospital. This should further assist with ensuring persons in need of care receive it before ending up in crisis and a potentially dangerous interaction with the public or police.

Frontline officers report that once they get the hang of it, it takes only minutes to complete. As to its usefulness, one officer commented during an initial training session, “hey, this is great… it helps me put into words that really weird stuff [behaviour] I am looking at!”

Of course, teaching officers how to speak the language of the health system constitutes evidence-based training which we all know is on everyone’s minds today, in light of countless coroner’s inquest recommendations. It also re-enforces the advantages of police working more collaboratively with the mental health system.

The first step toward establishing a more collaborative relationship between hospitals (health/mental health system) and police agencies (criminal justice system) is to speak the same language. As Niagara Health System Project Management Specialist Barb Pizzingrilli noted, “prior to the use of the BMHS, the police officers and nursing staff were often confrontational. After using the new form, they are working more as colleagues than adversaries.”

While the BMHS form is intended to assist both police and mental health professionals, it ultimately benefits patients the most because they get the help they need in a much more accurate, appropriate and efficient manner. Data from the pilot sites appear to show that using the form does, in fact, speed up the whole process. Police personnel and their managers will also be pleased since the BMHS captures police time spent dealing with mental health calls, which can be translated into a monetary figure.

There is no easy answer to the problems associated with police responding to persons experiencing a mental health crisis. However, using the BMHS contributes to early identification of mental health issues and evidence-based training. Equally important, because police are talking the same language as their mental health care partners, it acts as the first step toward achieving a more collaborative approach, ensuring that vulnerable persons in our trust get the help they need when they need it most.

While the original BMHS process was paper-based, a new computerized version has been field tested since 2013 by the Brantford and Niagara Regional police services, offering a number of efficiencies to the process (See Tom Rataj’s Technology column for more details).

The HealthIM BMHS programs runs on mobile computers, allowing police officers to complete an assessment in three to six minutes while also allowing them to electronically share the completed assessment with hospitals, mental health support agencies and their own records management system.

Visit http://interrai.org for more on interRAI or https://healthim.com to learn more about the BMHS or app. Dr. Hoffman can be reached at ronhoffman@nipissingu.ca .

BIO

A former police officer, OPC trainer and expert witness in police use of force in responding to persons with serious mental health problems, Dr. Ron Hoffman is an Assistant Professor in the School of Criminology and Criminal Justice at Nipissing University and an interRAI Fellow.

Dr. Greg Brown is Associate Professor in the School of Criminology and Criminal Justice and the Department of Sociology, and Director of the Institute for Applied Research (IASR) at Nipissing University and former team leader of the OPC Research and Evaluation Unit.