About this presentation

1. 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 excludedfrom our synthesis sessions. The findings have not been peer reviewedor 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.

2. 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

3. 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 How did we answer the question?

4. Draft search terms Draft sift criteria Sift received abstracts Request relevant papers Read and ‘grade’ papers Write it up (‘synthesis’) The process (in a nutshell)

5. Developing search terms What interventions have been shown to be effective in supporting individuals during an acute mental health crisis?

6. Search outcomes 1408 potentiallyrelevant studies identified. Mental Health Events or crises Intervention What Works Our search identifies studies that mention all four of our areas: Mental Health, Events or crises, Interventions and ‘What Works’…

7. Searches find all potentially relevant studies… 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, 662-668 (2010). Returned by the mental health search… 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.

8. Sifting – inclusion criteria

9. Sifting – flow of papers Abstract and title screened N=1408 Full text screened N=55 Searches of online databases and library catalogue N=1408 Reports meeting inclusion criteria & mapped N=18 • Papers excluded: Total N=55/38 • Reasons for exclusion: • Publication not available n=16 • Duplicates n=1 • Papers sifted out: N=1353 • Reasons for exclusion: • Did not meet sift criteria. • 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

10. Synthesis – Mapping the evidence

11. Synthesis – Mapping the evidence

12. Synthesis – Mapping the evidence

13. What does ‘good’ or ‘robust’ evidence look like? Statements about ‘what works’ Statements about ‘what’s promising’ Study designs increasingly rule out potential alternative causes Study designs cannot rule out potential alternative causes Statements about possible impact

14. Synthesis – Quality of evidence

15. Synthesis

16. Key messages 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. What interventions have been shown to be effective in supporting individuals during an acute mental health crisis?

17. 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 Key measures