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POLICE INTERVENTION IN EMERGENCY PSYCHIATRIC CARE A BLUEPRINT FOR CHANGE British Columbia Schizophrenia Society July 2006 BC Schizophrenia Society – Police Project ii CONTENTS Executive Summary - Blueprint for Change ............................................ 1 Report Recommendations…..................................................................... 5 Background........................................................................................... …7 The Current Dilemma Police Perspectives.............................................................................. 9 Psychiatry Perspectives..................................................................... 11 Shifting Patient Population: Medical Overview................................ 12 Justice Perspectives........................................................................... 15 Community Treatment Orders ..................................................... 17 Diversion from Criminal Justice System ..................................... 17 Concerns of Health Care Professionals................................................... 18 Hospital Fiscal Concerns........................................................................ 21 Confidentiality Issues ............................................................................. 22 Police/Mental Health Liaison Programs ................................................. 23 Effective Program Evaluation................................................................. 25 Generic Logic Model........................................................................ 26 Figure 1: Police/Mental Health Liaison Model Template ............... 27 Table 1: Underlying Assumptions of Goals, Objectives .................. 28 The AEIOU Approach..................................................................... 30 Table 2: AEIOU Questions .............................................................. 31 Importance of Evaluation: Victoria Example ......................................... 33 The Value of Written Protocols Montreal, Winnipeg, Cornwall, Vancouver................................... 35 Other Vancouver Initiatives ........................................................... 37 Next Steps............................................................................................... 39 APPENDICES Appendix A: Economic Burden of Schizophrenia........................ 41 Appendix B: Danish National Indicator Project ........................... 43 Appendix C: Danny’s Story.......................................................... 45 Appendix D: Hospital Emergency Triage Scale........................... 49 Appendix E: Victoria Evaluation (IMCRT Review) .................... 51 Appendix F: Police/Hospital Emergency Protocols Winnipeg Protocol ............................................. 53 Vancouver Protocol (St. Paul’s)......................... 59 Montreal Protocol ............................................. 61 Appendix G: List of Police Contacts in British Columbia BC Association of Chiefs of Police .................. 87 Royal Canadian Mounted Police in BC ............ 92 Endnotes.. ............................................................................................... 99 BC Schizophrenia Society – Police Project iii POLICE INTERVENTION IN EMERGENCY PSYCHIATRIC CARE: A BLUEPRINT FOR CHANGE EXECUTIVE SUMMARY The purpose of this project was to examine factors influencing long wait times for police accompanying psychiatric patients in emergency wards in British Columbia hospitals, and to propose possible solutions to alleviate the problem. To begin, it must be said that there is certainly hope to be found in some excellent police/mental health liaison programs that developed over the last few years through community initiatives. However, one of the major conclusions reached through our research and consultation is that systemic changes are required in the health care system and other systems that provide services for people with mental illness. Without such changes, it is unlikely that any specific recommendations for reducing police wait times can be wholly successful. There is growing recognition and acknowledgement of our failure as a society to provide basic care for people with serious and persistent mental illness. Police are acutely aware of this fact, since they have the ultimate responsibility of attending when individuals and families find themselves in crisis situations in the community. Most people consulted during this project noted that police duties to serve and protect people with mental illness have increased, contributing to resource shortages in other areas of police responsibility. Police data show that “street crime” offences and disorderly behaviour both represent a continual demand on police resources. There is a perceived lack of effective response to offences such as property theft and cars broken into, and there is an identified “capacity gap” for crime fighting and the prosecution of gang related crime in BC. In addition to a chronic shortage of mental health and police resources, consultations with BC police, health care providers and justice workers consistently articulate the same theme – lack of coordination between systems that deal with the mentally ill. In an attempt to overcome the numerous barriers caused by “stove pipe” budgets, overlapping jurisdictional authority, confidentiality concerns, plus a myriad of other challenges⎯clinicians and others have come together with the police to develop police/mental health liaison strategies within their own communities. In some areas, innovative approaches to helping people with mental illness and their families are becoming part of the fabric of the care system. It is evident that principles of contemporary community policing—prevention, community empowerment, partnership development and problem solving—fit well with the dedicated work of other agencies that support people with mental illness within the community. But despite innovative efforts by some police and other professionals in our communities, there is dissatisfaction everywhere at the large number of seriously ill individuals who continue to fall through the cracks. While resource limitations are an obvious concern, the lack of coordination and information sharing between government ministries, BC Schizophrenia Society – Police Project 1 regional authorities, and community agencies is just as often identified as the culprit. Everyone is aware that, to some extent, results are typical of a system that is bifurcated with so many separate lines of accountability. For many years, family and community advocacy groups have criticized “the mental health system” for its lack of resources and poor quality of care. Their complaints are finally now being echoed at the national and provincial levels of government, as well as by professional groups and policy, planning and administration officials. When considering specific things that can help us move forward in BC, one encouraging fact is that British Columbia is fortunate in having good mental health legislation⎯ although some professionals in the mental health field do not know the Mental Health Act well and therefore misinterpret it or underutilize it. The BC Mental Health Act for a type of conditional leave (extended leave) that should be helpful in dealing with the revolving door syndrome, whereby people with untreated mental illness continually rotate in and out of our health care and justice systems. In addition, the BC government provides concise guidelines that clarify the Freedom of Information and Protection of Privacy Act and specify how information may be shared for the purposes of continuity of care or if a person’s health or safety is at risk. Again, many professionals working in mental health are unaware of these provisions. Knowledge of both these tools – the BC Mental Health Act and the guidelines for sharing personal health information – should be essential for all professionals involved in service delivery to the mentally ill. A comprehensive provincial strategy is needed to (i) improve information-sharing between health, justice and social services; (ii) increase professional