Emergency departments have always served as a resource for the police in crisis situations for persons with mental illness. There are substantial barriers to using emergency services as a point of effective police referral to the mental health system. Transporting an individual in psychiatric crisis to an emergency department is often frustrating for both law enforcement and mental health professionals. Therefore, there is a need to facilitate effective collaboration between police and mental health professionals in crisis cases.
The current study assesses three prebooking jail diversion programs that participated in the Substance Abuse and Mental Health Services Administration jail diversion knowledge development application initiative.
The Multnomah County prebooking jail diversion program, established in 1997, has a crisis triage center and a police crisis intervention team program. The crisis triage center is located on the hospital campus of Providence Medical Center. Among the services at the triage center are a 24-hour crisis line; crisis intervention and stabilization; mobile outreach; voluntary subacute treatment, which includes chemical dependency; detoxification; mental health treatment; referral to outpatient community providers; medication management clinics; three holding rooms; and secure transport.
When a person is in crisis or someone is arrested who exhibits signs of mental illness or substance abuse, crisis intervention team officers are dispatched. The triage center is a one-stop centralized crisis service for law enforcement officers. The center has a no-refusal policy for police referrals. The police may transport individuals either voluntarily or in custody. The officer provides the necessary information to the center staff, fills out one form, and returns to duty within 30 minutes. In two years, 2,300 individuals visited the center, 20 percent of whom were referred by police.
Primary Research Question
Do specialized police responses to mental health emergencies increase the effectiveness of facilitating collaboration between police and mental health professionals in crisis cases?
The observations reported in this study have emerged from site visits and training sessions at each program by three of the authors, from operation of these programs by two of the authors, and from involvement in the SAMHSA evaluation by one of the authors.
No client outcome data are available to measure the impact of these specialized crisis response sites. The SAMHSA multisite study in which they are participating will provide some important data in the near future.
The authors conclude that the following elements contribute to successful prebooking jail diversion programs for individuals with serious mental illness and substance abuse problems: (1) an identifiable, central drop-off site; (2) the co-location of mental health and substance abuse services; (3) no-refusal policies for law enforcement referrals; (4) a streamlined intake process to minimize police officers’ time at the center; (5) appropriate legal foundations; (6) innovative and intensive cross-training between law enforcement and mental health staff; (7) 24-hour service; and (8) real linkages to community-based services.
The availability of a specialized crisis response site in prebooking jail diversion programs may help to surmount many of the problems previously experienced in law enforcement- mental health interactions.