Decriminalizing Mental Health: Partnering With Law Enforcement to Reduce Unwanted Outcomes

How can PMHNP consults with law enforcement reduce involuntary transfers and other unwanted outcomes?

CONFERENCE REPORTER

About 25% of individuals with mental health disorders in the US have been arrested at some point in their life, reported Andrew Currivan, PMHNP-BC; Sondra Leiggi Brandon, MPH, PMHNP-BC; and Christine Loui, PMHNP-BC at the American Psychiatric Nurses Association (APNA) 36th Annual Conference. Currivan and colleagues discussed the ways psychiatric clinicians can partner with law enforcement during emergency psychiatric evaluations in their presentation, “A PMHNP-Led Hospital-Based Team Supporting Law Enforcement to Reduce Involuntary Transfers to Emergency Departments.”

As few officers receive specialized training for crisis intervention, the trio explained PMHNPs can work as expert consultation and thus reduce the incident of law enforcement and emergency department overcrowding.

“The mental health emergency worker provides consultation to law enforcement officers with a person in crisis. We call them a person crisis because they might be having a mental health crisis, but the officer doesn’t know and neither do we, until we get the story. A lot of times we can provide real time education. We can provide advocacy. We also try to divert people who don’t need mental health care versus being arrested,” said Brandon.

In Hawaii, where the trio work, a statute dictates that a police officer must call a mental health worker to do an involuntary transfer to an emergency room, recognizing that they are unable to determine if an individual requires psychiatric care and must obtain a professional opinion. This process is called an MH-1. Between January of 2020 when the program started, to August of 2022, more than 6700 calls resulted in MH-1 in an effort to “decriminalize mental health.”

Crisis intervention team (CIT) training may be able to help police officers learn how best to handle these situations, said the trio. CIT training is a week-long intensive training program that police officers go through that does simulation work to teach them how to assess whether someone has a mental illness, rather than just assuming every angry individual on the street has mental illness. Part of that training, the trio explained, is helping them build rapport with an individual, rather than just getting facts. “It teaches them how to kind of go through an algorithm in their head to be able to approach people and how to talk to people with mental illness,” Brandon said further.

Furthermore, the trio strongly advocated for the use of community resources, so as to not overburden emergency departments. “We want them to have access to resources they don’t have coming into the emergency rooms.”

One of those resources is a homeless outreach project: a place that is safe, and staffed with police officers and social workers. This allows individuals to access trauma-informed community resources, the group explained, rather than medical services. “Our goal is to improve the continuity of care. We want to make sure that we not only can help these individuals in crisis, but that we can tap them into resources. We also want to do that in the least traumatic means available,” said Currivan. “The last thing we want to do is rough house them or manhandle them, throw them in handcuffs, throw them in the back of a squad car, and then strap them down to a gurney in the emergency department.”

To further understand the experience of their law enforcement peers, 2 of the speakers said they volunteered for the community police officer program. Understanding the “other side” helped them to be better partners in their ongoing relationship.

Currivan et al’s presentation was among many discussions at the APNA Annual Conference on improving mental health care for patients.

The meeting was held October 20 to 22, 2022, in Long Beach, California.