Joining forces to aid in mental health crises

PACER TEAM: Senior nurse Claire Swanton and Constable Sheldon Robertson. Picture: ANDI YU
PACER TEAM: Senior nurse Claire Swanton and Constable Sheldon Robertson. Picture: ANDI YU

Police are often the first to respond to a mental health crisis, yet they're trained to fight crime rather than provide specialist clinical care.

But more and more, police officers are being asked to arrest people in crisis when that is the last thing the patient needs.

Until this year, Bendigo police's way of dealing with those under mental duress was no different to that of a criminal. 

Police would receive an emergency call, turn up at the scene to investigate and, if the person was unstable, place them in the back of a divvy van.

The person would then be transported to the emergency department at Bendigo Health or, if their behaviour was dangerous, they would be taken to the police station for a doctor to visit there. 

The method posed a dilemma to everyone involved. 

Sergeant Tony Commadeur said taking a person to hospital or the police station was "officially an arrest" - a stressful and humiliating experience. 

"More often than not those people were being placed in the back of divisional vans - a confined space. Not many people cope with that at the best of times," he said.

"People didn't like that of course - it was very intimidating for them, even if they were aggressive or their behaviour was such that it wasn't suitable for them to go anywhere else."

Aside from the distress to the patient, the process was a colossal waste of police resources, he said. 

"It took up staff from the hospital but also it took up our staff guarding them," Sergeant Commadeur said.

"There would be at least two police members there for up to five or six hours."

Those people were being placed in the back of divisional vans - a confined space. Not many people cope with that at the best of times.

Tony Commadeur

From the emergency department's perspective, physically well people were presenting at a service designed to prioritise life-threatening cases. They were turning these people away, leaving police feeling their efforts had been futile. 

Bendigo Health's head of nursing Victor Tripp said police and the health service were at odds with each other. 

"One of the complaints the police often had around us was, they'd say things like: 'The patient beats me home. We bring them up to the emergency department and your guys assess them and send them back home before we're back at the police station'," Mr Tripp said. Not only were police resources being wasted, but they were being squeezed, to the detriment of other emergency call-outs where officers were needed. 

Sergeant Commadeur said the status quo for dealing with mental health cases was "ridiculous" and had to change.

A solution was put into action in February this year when Bendigo police and Bendigo Health began a joint program - Operation PACER.

The acronym stands for Police Ambulance Clinician Early Response and had already been run with success through several hospitals in Melbourne. 

The program involves a Bendigo Health mental health clinician working out of Bendigo Police Station seven days a week from 2.30pm to 11pm. 

When the police receive a call-out where they believe a person is dealing with mental health issues, they send a first response team to assess the danger. 

Once under control, the first response team leaves to make way for the PACER team -  a mental health clinician and a police officer.

The team visits the unwell person - usually they are at home - and the clinician assesses their mental state. 

Rather than transporting the person to hospital, the patient can have a conversation with a trained mental health professional who then refers them to a support service. 

The PACER team is used across a broad range of cases including pre-existing psychiatric disorders, people under the influence of mind-altering drugs and domestic disputes.

Clinicians can make referrals to services such as age-appropriate mental health counselling and rehabilitation.

Bendigo Health senior nurse Claire Swanton works on the program and said assessing patients in their own environment made a remarkable difference.

"We're able to have frank and open dialogue that will help them to make some plans and empower them into their own management and care," Ms Swanton said. 

"Generally we try to keep people at home in the least restrictive environment. That is our job as community clinicians, to try to keep people out of hospital wherever possible," she said. 

Part of Ms Swanton's job is also to help educate police about mental health. 

"I think it's a to and fro situation with the police. We get a lot of resources about how they might manage things and then we can say, 'well perhaps we can try it this way, it may feel less threatening to the client'," she said. 

Sergeant Commadeur said the PACER clinicians were helping police understand mental health issues. 

"Our communication skill has improved, possibly even our body language has improved," he said.

He said the program was valuable because it gave patients personal attention.

"It's not just in the hospital ED where (the patients) are just one of 30 or 40 people," he said. 

While giving vulnerable people the one-on-one attention they need, the program has alleviated the pressure on police and health services.

From the total number of mental health-related call-outs to police, the number of people brought to the hospital with mental health issues has reduced by almost one third. 

"To us that's enormous," head of nursing Victor Tripp said. 

EMERGENCY DEPARTMENT: Bendigo Health's head of nursing Victor Tripp. Picture: PETER WEAVING

EMERGENCY DEPARTMENT: Bendigo Health's head of nursing Victor Tripp. Picture: PETER WEAVING

"In the emergency department, we have got what we call an enhanced crisis assessment service. They work there two shifts a day and they are saying to me that they're seeing a big reduction in their workload," he said.

Mr Tripp said police thought it was "absolutely fabulous" that the first response team was able to move on to other call-outs rather than spend their time transporting people to hospital. 

Mr Tripp said the PACER program would continue to evolve. 

Currently it reaches towns within about an hour radius of Bendigo, but that's not the full reach of Bendigo Health's district. 

"What I'm looking at is what we can do for areas like Swan Hill," Mr Tripp said. 

"There are areas that we won't go with PACER at the moment. It's just too far."

Mr Tripp said tele-health could provide answers.

"What we might do is have the PACER clinician available via video link to that assessment, which could avoid having to bring someone down to Bendigo." 

Earlier this week the state government's member for Northern Victoria Amanda Millar, announced a $909,000 injection of funding to the PACER program. 

Bendigo Health is among 12 services to be allocated the funding across the next four years.


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