About this presentation
• These slides present interim findings from a review of the
evidence undertaken in workshop conditions at Evidence Base
Camp 2013/14.
• The findings from the review are not exhaustive. Due to time
constraints not all available bibliographic databases have been
searched, and books and longer reports were excluded from our
synthesis sessions.
• The findings have not been peer reviewed or quality assured
in the same way as a formal research publication.
• The College of Policing Research Analysis and Information Unit
(RAI) plans to turn this review of the evidence into a full Rapid
Evidence Assessment Report in due course.
What interventions have been
shown to be effective in supporting
individuals during an acute mental
health crisis
Delegates:
Jane Birkett
NCA
Steve Bussey
Wiltshire Police
Paul Clarke
Dyfed-Powys Police
Clare Gollop
Devon & Cornwall Police
Maria Kerr
NCA
Julie Miller
College of Policing
James O'Dwyer NCA
Stephen Precious College of Policing
Shaun Pyke
Cheshire Police
Claire Smith
College of Policing
Timothy Young
Leicestershire Police
College of Policing:
Mark Abram - RAI
Rory McKenna - RAI
Graham Cline – National
Police Library
Anna Akerman - PIU
How did we answer the question?
• Using a Rapid Evidence
Assessment (REA)
• REAs follow a systematic
process to identify and
appraise evidence…
• …but make compromises
given available time and
resources
• Pragmatic and transparent
approach
• Ensure best possible
coverage of literature in
the time available
The process
(in a nutshell)
1. Draft search terms
2. Draft sift criteria
3. Sift received abstracts
4. Request relevant papers
5. Read and ‘grade’ papers
6. Write it up (‘synthesis’)
Developing search terms
What interventions have been shown to be effective in
supporting individuals during an acute mental health crisis ?
Tier Area
Synonyms include…
1
Is the study about acute
mental health episodes,
Mental health; suicide; bipolar;
schizophrenic; manic; psychotic; paranoid
or acute panic.
2
Events or crises
Attack; event; episode; crisis; emergency.
3
Intervention
Tactic; intervention; strategy; initiative;
procedure; approach; response.
4
What Works
Systematic review; rapid evidence
assessment; trial; RCT; experiment;
evaluation; effective; assessment; “What
works”; impact; success.
Search outcomes
Mental
Health
Events or
Intervention
Our search
identifies studies
that mention all
four of our areas:
Mental Health,
Events or crises,
Interventions and
‘What Works’…
crises
What Works
1408 potentially
relevant studies
identified.
Searches find all potentially relevant studies…
Returned by the mental health search…
Stephen Kisely et al. A Controlled Before-and-After Evaluation of
a Mobile Crisis Partnership Between Mental Health and Police
Services in Nova Scotia, 55 CANADIAN JOURNAL OF
PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE.662, 662668 (2010).
Abstract: This study examined the impact of an integrated mobile
crisis team formed in partnership between mental health services,
municipal police, and emergency health services. We used a
controlled before-and-after quantitative comparison of the
intervention area with a control area without access to such a
service, for 1 year before and 2 years after program implementation.
The integrated service resulted in increased use by people in crisis,
families, and service partners (for example, from 464 to 1666
service recipients per year).
Sifting our abstracts identifies the truly relevant
literature. Sift criteria is used so that we are
consistent and transparent in our sifting.
Sifting – inclusion criteria
Q1.
Q2.
Q3.
Question
Answer
Action
Is the study about acute mental
health episodes, events or
crises
No
Exclude
Yes
Go to Q2
Unclear
Exclude
Does the paper address
interventions or approaches to
manage, support or respond to
individuals during an acute
mental health crisis
No
Exclude
Yes
Go to Q3
Unclear
Exclude
Does the paper include:
No
Exclude
Empirical data/ methods
Yes
Include
Unclear
Can’t exclude
Sifting – flow of papers
Searches of online
databases and
library catalogue
N=1408
Abstrac
t and
title
screene
d
N=140
8
Full
text
screene
d
N=55
Reports meeting
inclusion criteria &
mapped
N=18
Papers excluded: Total N=55/38
Papers sifted out: N=1353
Reasons for exclusion:
• Did not meet sift criteria.
Reasons for exclusion:
• Publication not available
• Duplicates
n=16
n=1
Our initial search identified 1408 papers, but only 38 available papers (3%) were actually
relevant to our research question. Our findings are drawn from these 38 studies that we
have reviewed over the last two days.
• We searched the main databases available to the National Police Library
• Around 30% (n=16) of the screened studies were not available
Synthesis – Mapping the evidence
Publication Date
10
9
8
7
6
5
4
3
2
1
0
1970-1979
1980-1989
1990-1999
2000-2009
2010+
Synthesis – Mapping the evidence
Country of focus
10
9
8
7
6
5
4
3
2
1
0
UK
USA
Australia
Canada
Norway
Synthesis – Mapping the evidence
Intervention Type
10
9
8
7
6
5
4
3
2
1
0
Community
Care
Crisis
Intervention
Team (CIT)
training
Crisis
Partnerships
Caregivers
Community
Safety Officer
What does ‘good’ or ‘robust’ evidence look like?
Statements about
‘what works’
Systematic Reviews
(Based on level 3-5 studies)
5
Statements about
‘what’s promising’
Statements about
possible impact
Randomised controlled trials
4
Before/after measures
Multiple site comparisons
3
Before/after measures
Two site comparisons
2
Before/after measures
No comparison site
1
One-off measure
No comparison site
Study designs
increasingly rule
out potential
alternative
causes
Study designs
cannot rule
out potential
alternative
causes
- im
5
4
3
2
1
re
Re
vi
ew
Q
ua
lit
at
iv
e
Le
ve
l
Le
ve
l
Le
ve
l
Le
ve
l
Le
ve
l
di
es
pa
ct
st
u
Li
te
ra
tu
No
n
Synthesis – Quality of evidence
Number of studies
8
7
6
5
4
3
2
1
0
Synthesis
What Works
There is evidence from one RCT to show that a community-based 24
hour Crisis Resolution Team (CRT) is able to significantly reduce hospital
admissions within eight weeks of an acute MH crisis.
What’s Promising
There is promising evidence to suggest that a mobile crisis service team
involving clinicians and police officers was associated with reduced
time-on-scene despite increased service use across a 2-year period.
There is also promising evidence that Crisis Intervention Team (CIT)
training improves linkages to mental health services and reduces
officers’ use of force with people experiencing mental health crises.
What’s Unknown
The majority of studies did not assess treatment outcomes for people
experiencing mental health crises (i.e. referral rates were focused on as
opposed to mental well-being at follow up).
The impact of CIT training on arrest rates is unclear however one level
three study found no effect.
What Doesn’t Work
What’s Harmful
There was no evidence to identify harmful approaches to intervene
with individuals experience mental health crises.
Non-impact studies
suggest
None identified
Key messages
What interventions have been shown to be effective in
supporting individuals during an acute mental health crisis?
• Most studies were published in the last 3 years and the majority were
undertaken in the US.
• The overall quality of evidence in low.
• There are 5 types of interventions including measures to provide
alternate referral routes, officer training, and partnerships with
healthcare specialists
• The most promising approach appears to be crisis intervention team
training and mobile crisis partnerships but the supporting evidence is
limited.
• More research is needed and could focus on experimental trials of
CIT training in the context of call handling, first responding and
custody. Research could also focus on crisis partnership working
within the UK. Outcomes relating to appropriate use of force,
appropriate referral rates and outcomes for individuals who have
experienced an acute mental health crisis could be assessed, e.g.
satisfaction, mental well-being.
Key measures
• Research design should be informed by a
feasibility study which takes account of the
following; current practice and local
interventions amongst forces, availability and
quality of data, profile requirements by force,
emerging findings from the MPS
implementation of the Vulnerability
Assessment Framework (VAF).
• Clarity of appropriate outcomes and measures