How do we effectively utilise co-response teams in healthcare across New Zealand?
Worldwide and in New Zealand, the number of people accessing services for mental health and addiction issues has risen exponentially. The large increase in numbers to mental health and addiction services and EDs has created immense pressure. Meanwhile, people struggle with accessing appropriate and timely mental health services, they have long waiting times for publicly funded treatments and sometimes while waiting, their health deteriorates to the point of crisis.
An article by Steadman et al, in 2000 recommended that collaboration between Police, mental health services and the advocacy community would lower inappropriate arrests in the USA, also known as Co-Response Teams (CRT). More recently, other countries such as the UK, Canada and Australia published overall positive evaluations of CRTs. Co-responder models vary in practice, but generally involve law enforcement and clinicians working together in response to call for service involving a person experiencing a behavioral health crisis. The model provides law enforcement with appropriate alternatives to arrest as well as additional options to respond to non-criminal calls. Communities and local leaders can use the model to develop a crisis continuum of care that results in the reduction of harm, arrests, and use of jails and emergency departments and that promotes the development of and access to quality mental and substance use disorder treatment and services.
An evaluation of a year-long project in Wellington concluded the CRT initiative (a first of its kind in New Zealand) was a success.The trial was run by a new inter-agency team led by Wellington District Police in partnership with Wellington Free Ambulance and Capital and Coast District Health Board to respond to emergency mental health calls in Wellington city.
The volume of mental health-related calls to emergency services has been increasing in recent years. From 2018 to 2019 alone, the total volume of mental health-related calls for service to police increased by 12%. While emergency services do the best they can when dispatched to mental health-related events, the CRT partners have recognised an opportunity to improve the emergency response provided to people in mental health distress.
Despite favourable evidence, the implementation of such teams has also been criticised. A systematic review of CRTs found a lack of evidence to evaluate their effectiveness; they found wide variation in the implementation of these teams, differences in hours of operation, staffing, and incident responses. Another criticism of CRTs includes a possible increase of the pressure on already stretched police and mental health services, making adequate resourcing crucial.
Where does this leave the co-responder model and the future of such inter-agency initiatives?