Augmenting Veterans Affairs Police Mental Health Response: Piloting Diversion to Health Care as Risk Reduction

The sequential intercept model (SIM) of mental health decriminalization describes five stages in the legal system at which people with mental illness can be diverted out of that system and into treatment. Law enforcement represents the first stage and that with the highest potential for diversion. A novel interpretation of the SIM is as a model of threat management and violence risk mitigation since crisis de-escalation can constitute primary prevention of violent behavior. Health care settings that treat substance abuse and mental illness represent excellent settings in which to optimize such prevention. The U.S. Department of Veteran Affairs is a nationwide system of such settings and also maintains its own internal federal police force. This study examined the pilot implementation of a 14-hr national “train-the-trainer” curriculum, focusing on mental health diagnoses, stressors, de-escalation techniques, and referral options. The goals of this study were to evaluate feasibility-of-implementation issues, recommend any changes for the full-scale project, and provide preliminary analysis of outcomes. Trainers (n = 35) exhibited significant pre- to posttest increases in the domains of (a) knowledge and (b) skill, but not in (c) attitudes or (d) perceived efficacy as a trainer. Police officers (n = 140) demonstrated significant gains in all three assessed domains of (a) knowledge, (b) attitudes, and (c) skill in identifying diversion resources. The results supported changes to the curriculum and procedure as well as progression to the full-scale implementation. The curriculum has the potential to systematically enhance officer management of violent behavior while simultaneously decriminalizing mental illness.