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A qualitative study exploring the challenges for a national police force as first responders to children and young people presenting with mental health crises: perspectives of emergency department professionals

Published online by Cambridge University Press:  04 June 2024

L. Bond*
Affiliation:
School of Medicine, University College Dublin, Dublin, Ireland Department of Psychiatry, Children’s Hospital Ireland at Crumlin, Dublin, Ireland
L. Rooney
Affiliation:
School of Medicine, University College Dublin, Dublin, Ireland
D. Healy
Affiliation:
University College Dublin, UCD Institute of Criminology and Criminal Justice, Dublin, Ireland
F. McNicholas
Affiliation:
School of Medicine, University College Dublin, Dublin, Ireland Department of Psychiatry, Children’s Hospital Ireland at Crumlin, Dublin, Ireland
*
Corresponding author: L. Bond; Email: [email protected]

Abstract

Introduction:

The difficulties in accessing Child and Adolescent Mental Health Services (CAMHS) and the lack of out-of-hours and crises services have resulted in Ireland’s national police force, An Garda Síochána (GS), becoming increasingly involved as first responders to children and young people (CYP) who are experiencing potential mental health crises.

Aims:

To outline challenges faced by members of GS and emergency department (ED) professionals in such cases.

Method:

Qualitative study design with semi-structured interviews conducted with a convenience sample of medical and mental health professionals (n = 11) from a paediatric ED who are frequently involved with the interface between GS and CYP experiencing potential mental health crises. Thematic analysis was conducted on transcribed interviews using the software package MaxQDA to systematically organise and code transcriptions.

Results:

Participants highlighted a lack of appropriate clinical settings within the ED for CYP who attend with a mental health crisis through GS. Whilst participants described positive rapport between GS and ED staff, interactions between GS and patients were identified as challenging. Knowledge gaps amongst members of GS in Mental Health Act (MHA) legislation and restraint were also identified as contributory stressors for GS and emergency department professionals.

Conclusion:

The increased prevalence of CYP mental health issues and psychosocial stressors in conjunction with difficulty in accessing CAMHS means that challenges faced by GS as first responders are likely to continue. Research is needed to quantify the adverse personal impacts on GS along with the potential negative impact on youth. Access to emergency mental health review for youth is essential to optimise the experience of both groups.

Type
Original Research
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of College of Psychiatrists of Ireland

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References

Barker, V, Taylor, M, Kader, I, Stewart, K, Le Fevre, P (2011). Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital. Psychiatrist 35, 106110.CrossRefGoogle Scholar
Bolton, J, Palmer, L, Cawdron, R (2016). Survey of psychiatric assessment rooms in UK emergency departments. BJPsych Bulletin 40, 6467.CrossRefGoogle ScholarPubMed
Brind’Amour K (2020). The new emergency department — for behavioural health. Paediatrics Nationwide (https://pediatricsnationwide.org/2020/10/01/the-new-emergency-department-for-behavioral-health/). Accessed July 2023.Google Scholar
Child Care Act (1991). Section 12: Power of Garda Síochána to take a child to safety. Child Care Act.Google Scholar
Clarke, V, Braun, V (2017). Thematic analysis. The Journal of Positive Psychology 12, 297298.CrossRefGoogle Scholar
Commission on the Future of Policing in Ireland (2018). The future of Policing in Ireland (http://www.policereform.ie/). Accessed July 2023.Google Scholar
Expert Group on Mental Health Policy (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy. The Stationery Office: Dublin.Google Scholar
Fairview Health (2023). New model of emergency mental healthcare designed to support people of all ages. Fairview Health (https://mhealthfairview.org/blog/behavioral-evaluation-center-offers-new-model-of-emergency-mental-healthcare). Accessed July 2023.Google Scholar
Government of Ireland (2020). Sharing the Vision. A Mental Health Policy for Everyone. Government of Ireland (https://assets.gov.ie/76770/b142b216-f2ca-48e6-a551-79c208f1a247.pdf). Accessed February 2024.Google Scholar
Griffin, E, McMahon, E, McNicholas, F, Corcoran, P, Perry, IJ, Arensman, E (2018). Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007-2016. Social Psychiatry and Psychiatric Epidemiology 53, 663671.CrossRefGoogle Scholar
Griffin, N (2023). Over 680 children waiting longer than a year for mental health services. Irish Examiner (https://www.irishexaminer.com/news/arid-41124391.html).Google Scholar
Health Service Executive (2019). Child and adolescent mental health services operational guidelines. Health Service Executive (https://www.hse.ie/eng/services/list/4/mental-health-services/camhs/operational-guideline/camhs-operational-guideline-2019.pdf). Accessed July 2023.Google Scholar
Health Service Executive. (2023). Crisis resolution services model of care. Health Service Executive (https://www.hse.ie/eng/services/list/4/mental-health-services/crs-moc.pdf). Accessed July 2023.Google Scholar
Healthy London Partnership (2017). Evaluation of South London and Maudsley NHS Foundation Trust’s Centralised Health Based Place of Safety. Healthy London Partnership: London.Google Scholar
House of the Oireachtas (2023). Mental Health Services Dáil Éireann Debate, Thursday -20 April 2023 (https://www.oireachtas.ie/en/debates/question/2023-04-20/21/). Accessed July 2023.Google Scholar
Irish College of General Practitioners (2023). PRESS RELEASE ICGP hopes CAMHS Review will lead to change in mental health services. Irish College of General Practitioners (https://www.icgpnews.ie/press-release-icgp-hopes-camhs-review-with-lead-to-change-in-mental-health-services/#:).Google Scholar
Irish Hospital Consultants Association (2021). Health budget 2022 is a critical moment for patients accessing mental health services (https://www.ihca.ie/news-and-publications/health-budget-2022-is-a-critical-moment-for-patients-accessing-mental-health-services). Accessed July 2023.Google Scholar
Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, McKenzie, N, White, IR, Thompson, M, Bebbington, P (2005). Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. British Medical Journal 331, 599.CrossRefGoogle Scholar
Kings Health Partners (2018). Success for Place of Safety Pilot. Kings Health Partners (https://www.kingshealthpartners.org/latest/1545-success-for-place-of-safety-pilot). Accessed July 2023.Google Scholar
Kubiak, S, Shamrova, D, Comartin, E (2019). Enhancing knowledge of adolescent mental health among law enforcement: implementing youth-focused crisis intervention team training. Evaluation and Program Planning 73, 4452.CrossRefGoogle ScholarPubMed
McCrone, P, Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, McKenzie, N, Thompson, M, Bebbington, P (2009). Economic evaluation of a crisis resolution service: a randomised controlled trial. Epidemiologia e Psichiatria Sociale 18, 5458.CrossRefGoogle Scholar
McNicholas, F (2018). Child & adolescent emergency mental health crisis: a neglected cohort. Irish Medical Journal 111, 841.Google ScholarPubMed
McNicholas, F, Moore, K (2022). Covid-19, Child & Adolescent Mental Health Services (CAMHS) and crises. Irish Medical Journal 115, 522.Google ScholarPubMed
Mental Health Act (1983). Mental Health Act 1983. HMSO: London.Google Scholar
Mental Health Act (2021). Section 12: Powers of Garda Síochána to take person believed to be suffering from mental disorder into custody. Government of Ireland.Google Scholar
Mental Health Commission (2023). Independent review of the provision of Child and Adolescent Mental Health Services (CAMHS) in the state by the inspector of mental health services. Mental Health Commission (https://www.mhcirl.ie/sites/default/files/2023-07/Mental%20Health%20Commission%20Independent%20Reviews%20of%20CAMHS%20services%20in%20the%20State.pdf).Google Scholar
National Alliance on Mental Illness (2009). Supporting Schools and Communities in Breaking the Prison Pipeline: A Guide to Emerging and Promising Crisis Intervention Programs for Youth. National Alliance on Mental Illness: Arlington, VA.Google Scholar
National Health Service (n.d.). Crisis and acute mental health services, National Health Service (https://www.england.nhs.uk/mental-health/adults/crisis-and-acute-care/). Accessed July 2023.Google Scholar
National Health Service Nottinghamshire Healthcare (n.d.). Child and Adolescent Mental Health Services (CAMHS) Crisis Resolution Home Treatment Team, National Health Service Nottinghamshire Healthcare (https://www.nottinghamshirehealthcare.nhs.uk/camhs-crisis-team). Accessed July 2023.Google Scholar
Nationwide Children’s (n.d.). A parent’s guide to the psychiatric crisis department. Nationwide Children’s (https://www.nationwidechildrens.org/specialties/behavioral-health/crisis-services/psychiatric-crisis-department/family-faq). Accessed July 2023.Google Scholar
O’Brien, BC, Harris, IB, Beckman, TJ, Reed, DA, Cook, DA (2014). Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine 89, 12451251. doi:10.1097/ACM.0000000000000388.CrossRefGoogle ScholarPubMed
Rooney, L, Healy, D, McNicholas, F (2021). The Garda Síochána and Child Mental Health: An Investigation of Pathways to Crisis Mental Health Care. Department of Child and Adolescent Psychiatry, UCD School of Medicine and UCD Institute of Criminology and Criminal Justice, Sutherland School of Law. University College Dublin (https://www.policingauthority.ie/assets/uploads/documents/The_Garda_S%C3%ADoch%C3%A1na_and_Child_Mental_Health_FINAL.pdf). Accessed February 2024.Google Scholar
Royal College of Paediatrics and Child Health. (2018). Facing the Future: Standards for Children in Emergency Care Settings. Royal College of Paediatrics and Child Health (https://www.rcpch.ac.uk/sites/default/files/2018-06/FTFEC%20Digital%20updated%20final.pdf). Accessed July 2023.Google Scholar
Staite, E, Howey, L, Anderson, C (2022). How well do children in the North East of England function after a mental health crisis during the COVID-19 pandemic: A service evaluation. Clinical Child Psychology and Psychiatry 27, 278290. doi:10.1177/13591045211037268.CrossRefGoogle Scholar
St. John of Gods Hospital. (2023). An Garda Síochána announces new mental health initiative with mental health first aid Ireland (https://www.stjohnofgodhospital.ie/news/280-03-07-2023-an-garda-siochana-announces-new-mental-health-initiative-with-mental-health-first-aid-ireland).Google Scholar
Tyrer, P, Gordon, F, Nourmand, S, Lawrence, M, Curran, C, Southgate, D, Oruganti, B, Tyler, M, Tottle, S, North, B, Kulinskaya, E, Kaleekal, JT, Morgan, J (2010). Controlled comparison of two crisis resolution and home treatment teams. The Psychiatrist Online 34, 5054.CrossRefGoogle Scholar
van Dijk, JJM, de Waard, J (1991). A two-dimensional typology of crime prevention projects: With a bibliography. Criminal Justice Abstracts. 483503.Google Scholar
Wan Mohd Yunus, WMA, Kauhanen, L, Sourander, A, Brown, YSL, Peltonen, K, Mishina, K, Lempinen, L, Bastola, K, Gilbert, S, Gyllenberg, D (2022). Registered psychiatric service use, self-harm and suicides of children and young people aged 0-24 before and during the COVID-19 pandemic: a systematic review. Child and Adolescent Psychiatry and Mental Health 16, 15.CrossRefGoogle Scholar
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