State of emergency

Every day, police around the country spend about 280 hours dealing with mental health-related incidents. Nikki Macdonald asks how police have become our default crisis mental health service.

Upset and drained, Kelly sat in the emergency department with her police escort, waiting to get help for her mental health crisis.

‘Has she come straight from prison?’ she imagined her fellow patients wondering. ‘Was it safe to sit next to her?’

After two hours of waiting, exhaustion set in and she sank to the floor. ‘‘Stand up,’’ the policeman said brusquely. ‘‘Or we’ll take you to the cells.’’ Her only crime was being sick.

In Wellington, Constable Sally Wiffen spent five days out of a sixday shift in Wellington Hospital’s emergency department watching over people in crisis, waiting alongside the kitchen cuts and broken toes. She forced a toilet door to prevent one patient selfharming. They didn’t put that in the new police recruiting video.

In Waikato, a mother still can’t shake the searing look of betrayal as police took her son away. She’d tried to get help from the crisis mental health team, but they couldn’t make it. It was one of the worst moments of her life.

These are the stories behind the statistics. With mental health services struggling to handle unprecedented numbers of desperate people, the sick and their loved ones are increasingly calling 111.

Police officers attended almost 35,000 mental health callouts this past year; 14,491 mental health incidents and 19,672 attempted or threatened suicides. That’s about

94 jobs every day, lasting an average of three hours. But the implications are much greater than simply taking frontline cops off the crime-fighting beat.

Kelly, 26, counts off eight encounters with police while experiencing a mental health crisis. There was the time she had a panic attack on a flight and they escorted her from the airport to mental health crisis services. She asked them to turn down the music, and open the window, as sensory overload increases her distress. They were wilfully antagonistic, pumping up the sounds and winding up the window. Then there was the ‘‘amazing’’ cop who sat and cried with her after she lost it, screaming and crying, when she saw a car hit a brood of ducklings.

The time she put her hand through a window at the home she owns with her partner. If she’d been badly injured, an ambulance would have come. Instead, police turned up. She had only tried to hurt herself, but any destruction of joint property counts as family violence.

Unlike 164 others slapped with offences after calling for mental health help, Kelly was not charged. But the information stays on her record and could restrict her ability to work with children.

And then there’s the stigma of having a cop car repeatedly pulling up to your home.

‘‘You can get a sense that there’s gossip in the neighbourhood. That people think maybe there’s family violence, maybe there’s drugs and alcohol, maybe these people aren’t people you want to spend time with or are dodgy in some way.

‘‘It’s not a reflection of that at all, it’s a reflection that people’s health isn’t great.

‘‘But outside looking in, when you’re the neighbour across the road, you’re seeing the police car pull up every few weeks for a couple of months, you get a very different picture.’’

The statistics are clear. Police suicide callouts are increasing by about 9 per cent every year, while 111 calls for the next tier of mental distress rose by 77 per cent between 2009 and 2016. Canterbury experienced the lowest call increase, at 29 per cent, while in the Tasman region the number of mentally distressed (but not threatening or attempting suicide) callers rose more than 250 per cent.

Police set up a mental health team in 2014, and in 2017 they included mental health for the first time as one of six official drivers of demand. But trying to pin down exactly who is calling police, and why there are so many more of them, is more vexed.

Police mental health manager Matthew Morris says mental health is a sneaky demand on emergency services.

‘‘It’s been creeping up on us for a long time and I think we’re all in a process of trying to catch up ... Nothing is being increased to meet that. There’s not more mental health services available. The demand is increasing, but the response is not.’’

Police split mental health callouts into two categories: 1X (suicide attempts or threats) and 1M (mental health events, including psychosis).

A 2017 analysis of 1M calls found mental health crisis calls peaked on Thursday and Friday evenings, and in November, December and January. Almost two-thirds of callers were the distressed person themselves and more than half (56.9 per cent) of calls involved no criminal offence or serious emergency.

And while call numbers soared, police actually attended in a smaller proportion of cases in 2016 than they did in 2010, suggesting many calls were for lower level mental distress.

There’s no question police have a role in mental health crises, Morris says. But that should be at the most acute end – where there’s a risk to the person or others, or a suggestion of weapons or violence.

‘‘When you introduce police, who are not mental health professionals, and they are seeing someone who is maybe behaving erratically, there is always potential for escalation.

‘‘Police spend about 280 hours every 24 hours, as total police time, dealing with mental health-related incidents. I’m not saying we shouldn’t be doing any of that. I’m saying we probably shouldn’t be doing all of it.’’

The day police took Nicky Stevens away was one of the worst of his mother Jane’s life. It was 4am and he was comatose in her truck. She couldn’t move him. He’d been suicidal the night before but there was no threat of violence. He needed someone to sit with him, talk to him and take him somewhere safe, so she rang the crisis team. She ended up with police instead.

‘‘I think it’s kind of the default, because there’s no effective psychiatric emergency service in this country ... In the end, police talked him out and they decided he needed to go to psychiatric services so they ended up taking him there, which actually wasn’t their job.

‘‘The look on his face – I will never forget it. I had totally betrayed him. And I don’t blame him for feeling like that – who wouldn’t? There’s a big difference between an ambulance arriving, to being taken away by the police when you’re ill.’’

Kelly says people often try mental health crisis teams first, but are told to get police to bring them in.

Of the 1M police calls analysed, 7 per cent of callers had already contacted mental health services. That had increased from 4.5 per cent in 2010 and is probably an underestimate, as there’s no requirement for call takers to record that information. For those experiencing a mental health episode, that number rose to 22 per cent from 17.1 per cent in 2010.

Our attempt to measure every DHB’s crisis response highlighted the difficulties police face dealing with 20 autonomous health boards. Some DHBs have crisis lines; some don’t. Some measure call response time; some don’t.

Ian Soosay, Health Ministry Deputy-Director of Mental Health, is a clinical psychiatrist currently working for Auckland DHB’s crisis team. He admits mental health services are under pressure, with

169,454 people using mental health services in 2016, compared with

154,523 in 2013. But he stops short of calling it a crisis.

‘‘Crisis teams are the mental health equivalent of emergency departments, so when the whole system is under pressure, the particular pinch points are things like crisis teams.’’

New Zealand’s dispersed population and geography mean trying to match crisis team staffing to demand is probably uneconomic, Soosay says. At present, police might have to wait with a person in crisis in Timaru, while the region’s entire afterhours mental health team spends four hours undertaking a Mental Health Act assessment on a suicidal farmer 90 minutes away in rural South Canterbury. But to avoid that scenario would require massive community investment.

He’s more interested in finding better ways of doing things. ‘‘When people are feeling ill, they want a quick response. And if you’re on the front line, you want to provide a quick response. The question is, how do we organise it?’’

Canterbury’s Mental Health Advocacy and Peer Support Trust runs a drop-in centre from 10am to 1.30pm, for people to walk in off the street and get support within half an hour.

Increasingly, police are bringing distressed people to manager Sue Ricketts for help. These are often the people who don’t tick the right boxes, Ricketts says.

Crisis mental health services are only set up to deal with the 3 per cent of the population who have the most serious mental health problems, such as severe depression, bipolar disorder, psychosis, and drug and alcohol addictions. But more people are now experiencing psychosocial distress.

They call crisis lines, get told they’re not mentally ill, so phone police. Police say that’s not really our issue. And round and round they go.

Often a small problem spins out of control, Ricketts says. Something causes relationship stress, they can’t afford counselling, the kids suffer, the schools get on their backs, they turn to alcohol and drugs to numb the pain, they can’t find accommodation ... and so it goes until the tether snaps.

‘‘What started off as quite a small issue can spiral into a family completely breaking down. We do see this fairly regularly – it’s not just a myth. So the difficulty is if the help isn’t there at the beginning, when things aren’t too complicated, they can actually turn into something enormous. And that’s when people start to get suicidal, because they don’t know what else to do.

‘‘Everyone is really aware of this problem, but the question is how to deal with it when it’s not actually a heath issue and it’s not actually a justice issue and it’s not actually a social issue. It’s come up through the centre of all our silos, so there’s nobody who is taking responsibility for addressing it.’’

Soosay says the wave of mental health problems is this generation’s new pattern of illness, like infection in the 40s and 50s and cardiovascular disease in the 70s and 80s. And like heart disease, it needs a whole-society response.

If you had a heart attack in the 70s you were sent to a medical ward for two weeks of bed rest. Emergency departments didn’t want to know – they were for road accidents and gory trauma. Now, GPs undertake routine cardiovascular risk assessments and recommend healthy lifestyle changes; legislation and millions of public health dollars have helped slash smoking rates; school canteens have cut fatty fast foods and EDs are set up to treat heart attacks.

‘‘With that wide-ranging approach, we’ve seen a reduction in mortality and morbidity associated with cardiovascular disease ... With mental health we’re not quite there yet.’’

‘Something major needs to change," says police mental health boss Matthew Morris. "We really need to think about this issue. We need to think outside the square, be innovative."

Police have invested in mental health training – though so far only for new recruits, not serving officers. But Morris says that’s not enough. Two things would make all the difference, he says: 1) Better call filtering so police only attend the most serious or threatening incidents and 2) A place to take people to.

A new early mental health response service rolled out nationwide in November 2017 should help with Morris’s first plea. Run by Healthline operator HomecareMedical and staffed 24/7 by 25 mental health nurses, it aims to divert and assess 111 mental health calls, and to link people to local mental health services where possible.

Manager and mental health nurse Liz Hosking says it’s early days but so far her team is seeing anxiety; psychosis – such as people hearing voices telling them the Mongrel Mob is coming to get

‘‘What started off as quite a small issue can spiral into a family completely breaking down.’’ Sue Ricketts manager, Canterbury’s Mental Health Advocacy and Peer Support Trust

‘‘... there’s no effective psychiatric emergency service in this country.’’ Jane Stevens

them; drug and alcohol issues, and problems following on from growing homelessness and social deprivation. The biggest age groups are 25-39-year-olds and

45-49-year-olds.

‘‘People call police because they’re in distress and they don’t know who to call.’’

About 15 per cent of calls are referred to local crisis teams for an urgent face-to-face follow-up, about

11 per cent are referred back to police to dispatch an officer, but the rest are managed over the phone.

‘‘We don’t want everybody in this situation to get a police officer,’’ Hosking says. ‘‘We want them to get a personalised plan of support that actually suits them for where they live.’’

Morris’s second request – a place to take distressed people – is more difficult. Police have made a huge push to avoid detaining people in police cells while they await a mental health assessment, taking them instead to emergency departments. But that has its own problems, as Kelly’s experiences showed. Capital & Coast DHB figures show a quarter of people seeing the crisis resolution team in ED wait more than six hours for help.

Wellington policewoman Sally Wiffen thinks emergency departments are the wrong place for people suffering extreme mental distress, and would like to see a dedicated facility. Crisis nurse Fran Gibb would set up a six-bed unit next to ED. Wellington regional mental health boss Nigel Fairley thinks emergency departments are the right place for people suffering a mental health crisis, but agrees police shouldn’t have to wait with patients.

One innovation that seems to have universal approval is the previous government’s plan to set up an $8m co-response unit, which would bring together police, ambulance and mental health staff to respond to crisis calls. That’s top of Fairley’s spending list, alongside more community and school support.

‘‘That will reduce pressure on emergency departments significantly,’’ he says. ‘‘And I reckon it would be a pretty popular job.’’

Overseas experience in places such as Perth has shown the system can cut costs and reduce the number of people left waiting in emergency departments.

The initiative, announced in August 2017, was to be trialled in two cities and one provincial or rural site. Police briefing papers say the project is due to be up and running by September 2018, but new Health Minister David Clark is still considering all new initiatives.

Morris says a joint response team would solve the current problem of mental health staff turning up and realising they need police, or vice versa.

‘‘The biggest problem we have is the unco-ordinated nature of the response. It is co-ordinated, but it’s not together.’’

Kelly also likes the joint response idea – care without the stigma. She’d also like to see better crisis team resourcing to enable longer phone chats to devise crisis plans. She got on to a long-term therapy programme and has been crisis-free for two years, highlighting the importance of having the right support to prevent total meltdowns.

‘‘I kind of consider myself out the other side. But it could happen again – it could happen to anyone – so you want the system to be working in a way that can help.’’