People in mental distress, police and out-of-hours health services: a qualitative exploratory case study of experiences and the intersect of safeguarding services.

The aim of this study was to explore the experiences of people in mental distress, who come to the attention of police and healthcare professionals outwith routine hours. Some people in the community call on police officers to help manage their self-harm behaviour, with the intention of preventing serious harm. As conduits to healthcare and in keeping with police safeguarding policies, officers will seek healthcare practitioner assessment and support. This can be problematic when an individual's needs are not associated with a severe mental disorder or time-critical medical emergency, or when the person is intoxicated. Consequently, police officers may feel unable or insufficiently confident to discharge safeguarding responsibilities when they or the individual perceive that needs are unmet. This can find some people, police officers and healthcare practitioners exposed to lengthy wait times and repetitive distress presentations. This thesis addresses a gap in existing literature through the exploration of the relationships and experiences of people in mental distress, and police and health care professionals involved in their safeguarding during out of hours. It also provides an in-depth account of those factors and features of police and health care professional processes that facilitate or impede safeguarding journeys. An in-depth, qualitative case study was conducted in three phases. This study was underpinned by broadly social constructionist perspectives, with each phase building on the in-depth understanding and interpretation of data. Phase one featured semi-structured interviews (n = 12) with police and health managers, providing a landscape of the police / health care intersect when supporting people in mental distress. Phase two featured further semi-structured interviews (n = 15) that critically explored three clinical cases, in which police and healthcare practitioners responded to people in mental distress. Phase three featured three focus group interviews with operational police officers and healthcare practitioners (n = 18), exploring front-line perspectives of supporting people in mental distress, and helping contextualise and enhance findings from phases one and two. Template analysis supported the thematic analysis of findings, which elaborated on and were interpreted through the inter-related theoretical lens of Defeat and Entrapment Theory (Gilbert and Allan, 1998), Cry of Pain Model (Williams and Pollock, 2001) and the Conceptual Model of Suicide (Stark et al., 2011). The study found that health and police systems and human responses can influence individuals' experiences and undermine safeguarding journeys. A predominantly medicalised model of unscheduled care, gaps in inter-agency safeguarding policies and legislation, inconsistencies in levels of sobriety to conduct mental health assessment and availability of appropriate safeguarding environments can find people displaced between criminal justice and health services. Police and healthcare practitioners' organisational cultural and professional perspectives of peoples' needs find those practitioners working in conflicting ways and the individual inadvertently overlooked. These factors were particularly problematic when people were distressed, intoxicated or aggressive. This study identifies a relationship between feelings of entrapment, intoxication, aggression and inter-agency safeguarding. Police officers encounter situations where an individual is distressed, intoxicated and aggressive and who cannot be assessed by health services. Collectively, these factors can create situations exposing people to additional stressors such as inappropriate safeguarding environments, such as police custody as a safeguarding space, police-escorted transportations, and coercive processes like using handcuffs and strip-searching. This leads to a lack of dignity and re-traumatisation, therefore reinforcing cyclical distress journeys. This study concludes that there exists a gap in environments, policies and processes to safeguard people in mental distress, which impacts upon safeguarding journeys. Police and health system shortcomings may result in a person in mental distress being managed in the criminal justice system, if no other options are available. This is due predominantly to a medicalised model of emergency care, which is further complicated if the person in mental distress is intoxicated. For the person in mental distress, their reality is a safeguarding journey that may be convoluted and cyclical, and which reinforces rather than supports their distress needs. Although unintended, police and healthcare professionals' responses reinforce a cyclical safeguarding journey that does not meet the needs of the person in mental distress, and can place pressure on police and out-of-hours health services. These findings have important implications for trauma-informed Police and health care professional practice. The issue of how police and health care professionals respond to people who are distressed, intoxicated and aggressive should be explored in further research

Black, white and grey: investigating the pathways and interface between police, those in mental health distress and emergency health services.

People who experience mental health distress (PWEMHD) often come to the attention of police through direct contact when help seeking or through concern by others in the community. Frequently officers are required to seek safe-keeping advice through mental health assessment from health services to support decision making. At times the individual may not be considered to be at risk by health staff or clinical involvement can be compromised due to intoxication, with PWEMHD returned to police officers for onward management. Officers can find this challenging and may believe the individual may still require safeguarding yet feel ill- equipped and under resourced to do so. Anecdotally, although officers understand their roles in keeping communities safe, they frequently find their policing roles compromised in caretaking people whom they believe are the responsibility of health services

Collaborative Outcomes Learning Tool (COLT) – A Multi-agency Educational Resource to Support Complex Public Protection Understanding and Practice

Multi-agency public protection practice has received significant media and government scrutiny in recent years, in response tofailings to protect those most vulnerable people in society. Despite an appreciation by agencies that there are resource and outcome benefits to collaborative practice, how safeguarding public protection policy may be integrated into practice andeducation is often challenging.Public protection legislation directs core agencies to co-operate and work together with governmental direction setting out key shared safeguarding responsibilities and arrangements for individuals, professional groups and teams. Despite this there still remain difficulties between organisations to understand each other’s priorities and responsibilities. This can then transpose to anindividual level where entrenched professional divisions can compromise joint working.Many health and social care curricula invest in inter-professional education to encourage exploration of information sharing,reporting and case management. However, when public protection issues are considered, uni-professional and inter-professionaleducation tends to focus on single silos of harm, for example child and adult protection, radicalisation or domestic abuse.This paper discusses the development, application and future possibilities for innovation of a unique educational tool to addressthis gap in public protection multi-agency education. The tool aims to support understanding of key public protection issues inScotland by encouraging learners within undergraduate and practice environments to recognise risk, explore overlapping and ‘grey areas’ of harm and understand partner agency best practice and response whilst encouraging cross-sector working, appreciation and support. Through gaining insight into other agencies safeguarding roles the learner has the opportunity to gain a deeper insight and broader perspective of the complexities of interventions beyond their own discipline whilst recognising opportunities for joint resource management

Interagency adult support and protection practice of police and health and social care professionals: a realistic evaluation approach.

The purpose of this project was to investigate the interagency Adult Support and Protection practices of police, health and social care professionals in Scotland by means of a Realistic Evaluation Approach. The study comprised of two specific phases. The first phase sought to establish the 'state of play' for cross boundary working by: identifying the gaps in interagency practice; evaluating the education and training needs of professionals working in the area of adult support and protection, and identifying information sharing practices. Focus groups with members of the police and health and social care professionals were conducted in each of the three Police Scotland Command areas. Thirteen focus groups were conducted, with 101 professionals participating. Nine key themes were identified: Information sharing; relationships; people and processes; lessons from child protection; environment; implementation of the act; regional variations and training; rights of the service users. The second phase will inform the development and evaluation of future interprofessional training resources and identify key performance indicators (KPIs). These KPIs will enable subsequent evaluation and monitoring of practice for all professionals involved in adult support and protection

Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review

Background Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a ‘last line of support’ and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. Results Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For “vulnerable groups”, the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. Conclusions This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved

Co-creation of five key research priorities across Law Enforcement and Public Health: A methodological example

IntroductionLaw enforcement professions now assume more responsibility for tackling mental health issues alongside public health colleagues than ever before. The term ‘vulnerability’ is frequently used within Law Enforcement and Public Health (LEPH) to identify those requiring emergency mental health care. However, there are ongoing challenges within LEPH to determine whose responsibility this is.AimTo co-create the most important priorities for LEPH research in Scotland.MethodThe paper describes a collaborative workshop which brought together an Expert Advisory Group (EAG) of 26 senior stakeholders, from academia, policing, mental health nursing, psychiatry, paramedics, emergency medicine, people with lived experience, policy makers, and third sector.ResultsThe five key priorities included: vulnerability; mental health crisis; decision making around assessment and triage across professional groups and professional roles; peer support and organisational well-being; and information and data sharing.DiscussionThe paper discusses the EAG group event as a co-production process, focusing on how key LEPH research priorities were derived.Implications for PracticeThis paper demonstrates the inextricable link between co-production and co-creation of value via EAG group consensus on LEPH research priorities. Shared vision and professional will is not enough to ensure progress: there must also be shared policy, knowledge, and access

Defining and Assessing vulnerability within law enforcement and public health organisations: A scoping review.

Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (encompassing for example, mental disabilities, learning disabilities and other mental health related problems) alongside Public Health departments. While Law Enforcement has become a ‘last line of support’ and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations