Mental Health Frequent Presenters to

Police: who are they ?

Research Project

Presentation to the International Congress on Law and Mental Health

19th July 2011

Gina Andrews

Senior Policy Officer, Mental Health, NSW Police Force

andr1gin@police.nsw.gov.au

Mental Health Frequent Presenters to Police

Presentation outline:

1. Setting the scene: a case study

2. Goals of the research project

3. Project history

a) Research stages

b) Research method

c) Research findings

4. Research next steps and program options

5. Conclusion

• ‘Naomi’: female aged 18

• 35 apprehensions Mental Health Act in past year

• Total of 45 Police events

• Victim of sexual assault/incest

• History of aggressive behaviour & self harm

• Escalating behaviour

• Therapeutic response in place but inadequate

Scene Set: Mental Health Frequent Presenters Case Study

Goals:

1. To describe the characteristics of persons who have frequent emergency mental health contacts with Police, Ambulance and Health.

2. Developing appropriate care co-ordination model for this group.

3. Trial a care co-ordination model.

Research Goals: Mental Health Frequent Presenters

• 2007: One of 8 Mental Health projects developed

• Mid 2008 – 2009: Develop business case

• 2010: research contract awarded

• Jan 2011: Stage 1, Phase 1 Report completed

Project History: Mental Health Frequent PresentersVersion 9

DRAFT PROJECT PLAN

Identifying mental health frequent presenters to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Title: Identifying mental health frequent presenters (MHFP) to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Objective/s:

Goal: To determine the extent, characteristics and service implications of MHFP, as a basis to inform interagency service delivery

Objectives:

1. Develop an agreed definition of a “mental health frequent presenter”.

2. Describe the characteristics of this group and the prevalence of this problem.

3. Identify the implications of frequent service presenters for agencies.

4. Determine, (based on the analysis of the MHFP population group) whether a coordinated care intervention model is warranted, and if so develop a best practice interagency model for mental health frequent service presenters.

Version 9

DRAFT PROJECT PLAN

Identifying mental health frequent presenters to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Title: Identifying mental health frequent presenters (MHFP) to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Objective/s:

Goal: To determine the extent, characteristics and service implications of MHFP, as a basis to inform interagency service delivery

Objectives:

1. Develop an agreed definition of a “mental health frequent presenter”.

2. Describe the characteristics of this group and the prevalence of this problem.

3. Identify the implications of frequent service presenters for agencies.

4. Determine, (based on the analysis of the MHFP population group) whether a coordinated care intervention model is warranted, and if so develop a best practice interagency model for mental health frequent service presenters.

Version 9

DRAFT PROJECT PLAN

Identifying mental health frequent presenters to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Title: Identifying mental health frequent presenters (MHFP) to NSW Police Force, Ambulance Services NSW and NSW Health.

Project Objective/s:

Goal: To determine the extent, characteristics and service implications of MHFP, as a basis to inform interagency service delivery

Objectives:

1. Develop an agreed definition of a “mental health frequent presenter”.

2. Describe the characteristics of this group and the prevalence of this problem.

3. Identify the implications of frequent service presenters for agencies.

4. Determine, (based on the analysis of the MHFP population group) whether a coordinated care intervention model is warranted, and if so develop a best practice interagency model for mental health frequent service presenters.

• Individual agency datasets: persons presenting 3 or more times under the Mental Health Act in a year.

• 2005 as index year.

• NSW Statewide data identification used (except emergency departments).

• Frequent (i.e. individual presenting three or more times in given year under Mental Health Act) vs very high (i.e. top 10% of MHFPs at each agency).

Research Method: Mental Health Frequent Presenters

Stage 1: Examination of data on Mental Health Frequent Presenters

- Within agencies

Stage 2: Identify Develop and implement

service model/s

Phase 1 (completed): Within agencies

Research Stages: Mental Health Frequent Presenters

NSWPF

>3 presentations 1010 individuals

44%

14%

34

Female %

Aboriginal %

Avg Age (yrs)

Very High Frequency (top 10% of MHFP)

90th percentile contact cutoff Min nu events = 7

10Avg contacts top 10% FP

Research Findings: Mental Health Frequent Presenters

• Over 13, 500 with at least one mental health event. Total of 18, 672 mental health events in 2005.

• 7% (1010 persons) of overall population under the MH Act had at least three or more contacts per year therefore qualifying as Frequent Presenters.

• 7% of persons apprehended by Police under the Mental Health Act were responsible for 23% of all MH Act events.

• 33 people (3.3%) had 10 or more events per annum.

Research Findings NSWP: Mental Health Frequent Presenters

• 90% of MHFPs had contact other than MH Act that year:

– 82% as a “person of interest” (POI).

– 63% as victims of crime.

– The Mental Health Act contacts accounted for only around 25-30% of total contacts for frequent presenters.

• Frequent presentation was not stable over time – >50% did not continue pattern of MHFP in subsequent years

Research Findings NSWP: Mental Health Frequent Presenters

• Stage 1 : “Phase 2” (linked data):

– Awaiting ethics approval

– Time and resources required for data analysis & report 2

– Jostling for governance and hosting project.

• Stage 2 : Service model development:

– Clarification of scope (very high frequent presenters or frequent presenters)

– Case management approach (medical & psycho social)

– Modeling of costs, business case development.

Research Next Steps: Mental Health Frequent Presenters

Possible program response ?

MHFP =3 contacts with Police

= 1010 persons

Very High FP (top 10% of FP)

Approx 50 persons

Capacity-building across many

services

TARGET GROUP TYPE OF STRATEGY

New / targeted / specialised

services

Research Next Steps: Mental Health Frequent Presenters

• MHFP to Police are a small group who use a disproportionate amount of Police resources

• MHFP pattern of interaction with Police is diverse and includes: Mental Health Act, Person of Interest, and victim.

• MHFPs are likely to interact heavily with the wider criminal justice system and emergency services.

• Evidence base in favour of intensive case management of MHFP demonstrates that such an intervention results in a reduction of MHFPs interaction with emergency services.

Conclusion: Mental Health Frequent Presenters