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Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study.

McKenna B, Furness T, Brown S, Tacey M, Hiam A, Wise M - BMC Emerg Med (2015)

Bottom Line: NPACER reduced the number of mental health crisis presentations to the ED.When the NPACER team was operational, 16% of people in crisis went to ED compared with 100% for all other times of the day, over a six-month period.NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, 3065, Fitzroy, Australia. brian.mckenna@mh.org.au.

ABSTRACT

Background: The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.

Methods: A retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.

Results: NPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16% of people in crisis went to ED compared with 100% for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.

Conclusions: NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.

Show MeSH
Operational flow of the NPACER model
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Fig1: Operational flow of the NPACER model

Mentions: The NPACER team is collaboratively supported by NorthWestern Mental Health, Melbourne Health, Northern Health, and Victoria Police. A senior mental health clinician and a member of Victoria Police act as second response to acute mental health crisis in the community. Clinicians are drawn from a limited pool of senior emergency mental health nurses in the service, while the police officers are drawn from a wider pool of rostered staff, cognisant of experience and support for the NPACER initiative. The NPACER unit attends call-outs in a marked Victoria Police vehicle and allows mental health assessment in situ (Fig. 1). Based on the perceived need for section 10 events, the NPACER team operates seven days a week, every afternoon/evening (15:00–23:30 h), across two Victoria Police Divisions growth corridors (approximately 600,000 people) [15] characterised with low socio-economic status, high immigrant, and ethnic diversity compared with the remainder of the state of Victoria [16]. To assist with ED diversion for the acutely unwell requiring hospitalisation, three inpatient beds are made available to NPACER to allow direct admission.Fig. 1


Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study.

McKenna B, Furness T, Brown S, Tacey M, Hiam A, Wise M - BMC Emerg Med (2015)

Operational flow of the NPACER model
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4496862&req=5

Fig1: Operational flow of the NPACER model
Mentions: The NPACER team is collaboratively supported by NorthWestern Mental Health, Melbourne Health, Northern Health, and Victoria Police. A senior mental health clinician and a member of Victoria Police act as second response to acute mental health crisis in the community. Clinicians are drawn from a limited pool of senior emergency mental health nurses in the service, while the police officers are drawn from a wider pool of rostered staff, cognisant of experience and support for the NPACER initiative. The NPACER unit attends call-outs in a marked Victoria Police vehicle and allows mental health assessment in situ (Fig. 1). Based on the perceived need for section 10 events, the NPACER team operates seven days a week, every afternoon/evening (15:00–23:30 h), across two Victoria Police Divisions growth corridors (approximately 600,000 people) [15] characterised with low socio-economic status, high immigrant, and ethnic diversity compared with the remainder of the state of Victoria [16]. To assist with ED diversion for the acutely unwell requiring hospitalisation, three inpatient beds are made available to NPACER to allow direct admission.Fig. 1

Bottom Line: NPACER reduced the number of mental health crisis presentations to the ED.When the NPACER team was operational, 16% of people in crisis went to ED compared with 100% for all other times of the day, over a six-month period.NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, 3065, Fitzroy, Australia. brian.mckenna@mh.org.au.

ABSTRACT

Background: The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.

Methods: A retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.

Results: NPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16% of people in crisis went to ED compared with 100% for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.

Conclusions: NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.

Show MeSH