How can PMHNP consult with law enforcement to reduce involuntary transfers and other undesirable outcomes?
About 25% of people with mental disorders in the US have been arrested at some point in their lives, reported Andrew Currivan, PMHNP-BC; Sondra Leiggy Brandon, MPH, PMHNP-BC; and Christine Lui, PMHNP-BC at the 36th Annual Conference of the American Psychiatric Nurses Association (APNA). Currivan and colleagues discussed ways psychiatric clinicians can partner with law enforcement during emergency psychiatric evaluations in their presentation, “A Hospital-Based PMHNP-Led Team Supporting Law Enforcement to Reduce Involuntary Transfers to Emergency Departments.”
Because few officers receive specialized training in crisis intervention, the trio explained that PMHNPs can work as expert consults and thereby reduce overcrowding in law enforcement and emergency departments.
“The emergency mental health worker provides counseling to law enforcement officers with a person in crisis. We call them a personality crisis because they may have a mental health crisis, but the employee doesn’t know, and neither do we, until we know the story. Many times we can provide education in real time. We can provide advocacy. We also try to divert people who don’t need mental health care instead of arresting them,” Brandon said.
In Hawaii, where the trio work, the law dictates that a police officer must call a mental health professional to perform an involuntary transfer to an emergency room, recognizing that they cannot determine whether a person needs psychiatric help and must obtain a professional opinion . This process is called MH-1. Between January 2020, when the program launched, and August 2022, more than 6,700 calls were made to MH-1 in an effort to “decriminalize mental health.”
Crisis Intervention Team (CIT) training can help police officers learn how to best handle these situations, the trio said. CIT training is a week-long intensive training program that police officers go through that does simulation work to teach them how to judge if someone has a mental illness, rather than just assuming that every angry person on the street has a mental illness. Part of that training, the trio explained, is helping them build a relationship with the individual rather than just getting facts. “It teaches them how to go through an algorithm in their head to be able to approach people and how to talk to people with mental illness,” Brandon added.
In addition, the trio strongly advocated for the use of community resources so as not to overburden emergency departments. “We want them to have access to resources that they don’t have in emergency rooms.”
One of those resources is the Homeless Work Project: a place that is safe and staffed by police and social workers. This allows people to access trauma-informed community resources, the group explained, rather than medical services. “Our goal is to improve the continuum of care. We want to make sure that not only can we help these people in crisis, but that we can provide them with resources. We also want to do this by the least traumatic means possible,” Kurivan said. “The last thing we want to do is rough house them or manhandle them, handcuff them, throw them in the back of a police car and then strap them to the gurney in the emergency room.”
To better understand the experiences of their law enforcement colleagues, 2 of the speakers said they volunteered for the community police officer program. Understanding the “other side” helped them be better partners in their ongoing relationship.
Currivan et al’s presentation was among many discussions at the APNA Annual Conference on Improving Patient Mental Health Care.
The meeting was held October 20-22, 2022 in Long Beach, California.