The association between the Police, Ambulance, Clinician Early Response model and involuntary detentions of people living with mental illness: A retrospective observational study

What is known on the subject?

• Involuntary detention is a legislative power that allows people to be taken against their will for a mandatory mental health assessment and is known to be a restrictive and traumatizing process for patients.
• While there is some literature examining police/ambulance and mental health worker co-response models, the conclusions are mixed as to whether they reduce rates of involuntary detentions in mentally ill people.
• The Police, Ambulance, Clinician Early Response (PACER) model is an example of a tri-response mental health crisis response team whose role is to respond and assess people thought to be experiencing a mental health crisis.
• There is little literature to determine whether PACER tri-response model reduces incidents of involuntary detention when compared with standard police and/or ambulance responses.

What this paper adds to existing knowledge?

• This paper describes the outcomes of patients assessed by a PACER team, compared with patients who were assessed by police or ambulance.
• It demonstrates that PACER may reduce unnecessary involuntary detentions through expert mental health assessment for patients coming to emergency services for assistance. It is one of only two published studies examining a tri-response model.

What are the implications for practice?

• The results of this study may support health and policing policymakers to implement PACER models as a means of reducing involuntary detentions, reducing demand for emergency departments, reducing time spent by emergency services responding to people experiencing mental health crisis and improving outcomes for people with mental illness.

Background

Involuntary detention is a common method of enforcing mental health assessment and treatment; however, it is associated with poor patient outcomes and high emergency service and hospital demand.

Aim

To examine the association between (1) Police, Ambulance, Clinician, Early Response (PACER) model, (2) police or (3) ambulance response and rates of involuntary detention of mentally ill people.

Methods

A retrospective observational study using routine administrative data in an Australian City, over a 12-month period (2019–2020).

Results

Over a 12-month period, 8577 people received crisis mental health intervention in the study setting. We observed an 18% increase in the relative risk of being involuntarily detained by police, and a 640% increase in the relative risk of being detained by ambulance. The PACER team detained 10% of their total presentations, as compared with 12% by police and 74% by ambulance. Involuntary detentions enacted by PACER were more likely to convert to a post-detention hospitalization (72%), when compared with police (27%) and ambulance (17%).

Discussion

PACER was associated with lower rates of involuntary detention and higher rates of post-detention hospitalization when compared to police and ambulance response.

Implications for Practice

PACER cohort experience more positive outcomes than with police or ambulance cohorts.