18 Dec 2017

Police to pilot change to 111 system for mental health calls

From Nine To Noon, 9:08 am on 18 December 2017

Sending mental health workers on relevant 111 callouts is a necessary first step, but will not work without a wider approach to things like homelessness and addiction, mental health advocates say. 

Police generic

Photo: RNZ / Claire Eastham-Farrelly

Last year police received over 46,000 calls related to mental health and attended nearly 33,000 of them. Over the past decade demand has increased by 9 percent each year and police expect it to continue.

However, police say they are not the most appropriate first responders, and last year secured $8 million from the previous government to trial a new service.

In their proposal, obtained under the Official Information Act, they called for a service where a mental health worker would attends all crisis calls along with police and ambulance staff.

"The Independent Police Conduct Authority is concerned that police are increasingly acting as first responders to people who should more appropriately receive a mental health response," the proposal said.

"As a result, mentally impaired people are not always dealt with by police in a manner that is conducive to their mental and physical wellbeing, increasing their distress and placing them at greater risk of harm while in police custody."

The proposal said the pilot would operate in three centres, seven days a week, 10 hours a day. It is expected to be up and running by September next year.

They want to trial the new system in some parts of the country, and were funded to do so by the previous government, but said the new administration had not confirmed that. 

Police manager of mental health Matthew Morris would not be interviewed, saying they were waiting to find out if the initiative would be progressed. 

However, Fiona Howard - from Christchurch-based mental health advocacy organisation Mhaps - and Auckland mental health lawyer Alex Steedman told Nine to Noon greater emphasis was needed to tackle the underlying problems that meant those with mental health concerns were being dealt with through the criminal justice system.

'People are looking for a genuine human connection'

Ms Howard agreed the police faced a huge task, and said there was a pressure on frontline services and the 111 emergency number was the standard number people would call in a crisis. 

"I think our system of response isn't as fine-grained as it could be, so we tend to have people are told 'go to your GP, talk to your neighbours, do what you can for yourself' and there's kind of a large gap before we hit 111.

"So in many ways we've been asking the police to be all things for all people and we need I think a more graded response along the way, and this proposal could fall into that basket so I think it could help. 

"Depending on what the crisis is, being able to put someone in first maybe who can work on de-escalation who isn't in a uniform - who understands something about where the person might be coming from in terms of their mental distress - that just may help to keep things calm." 

Where to get help:

Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason. Lifeline: 0800 543 354 
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
Depression Helpline: 0800 111 757 (24/7) 
Samaritans: 0800 726 666 (24/7)
Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email talk@youthline.co.nz
What's Up: online chat (7pm-10pm) or 0800 WHATSUP / 0800 9428 787 children's helpline (1pm-10pm weekdays, 3pm-10pm weekends)
Kidsline (ages 5-18): 0800 543 754 (24/7) 
Rural Support Trust Helpline: 0800 787 254
Healthline: 0800 611 116
Rainbow Youth: (09) 376 4155

If it is an emergency and you feel like you or someone else is at risk, call 111.

However, Ms Howard said there was more that was needed to tackle the underlying problems that mental health problems were often linked to. 

"I think rather than looking for responses where we try to lock people up or having more secure facilities, the part we're missing all the way along here and what people are desperately looking for when they're in distress ... people are looking for a genuine human connection. 

"So I would rather see more connections and less corrections."

"Financial things, things around housing, things around relationships: so, if we could get more coordination from places like MSD, Housing New Zealand, ACC." 

"We cannot solve these problems just by asking mental health services on their own and mental health dollars on their own to address all of society's issues."

Ms Howard said people struggling with their mental health often had long-term problems that would not easily be solved by crisis response. 

"The type of presentation that I think struggles the most are people who have often experienced what we refer to as complex interpersonal trauma," she said. 

"So these are people who have often had a very rough start in life, they might be growing up in a household where there's a fair bit of disruption or chaos, maybe there's someone struggling with a drug addiction, a parent struggling with mental illness ... it can be difficult for some people to grow up experiencing that. 

"Then you have the more direct problems people can experience, so there might be neglect, physical abuse or other forms of abuse." 

"Technically we're funded for mild to moderate distress and I'd say probably 80 percent or more of the people we see are in this complex interpersonal basket. 

"A very high proportion of people, sometimes even with just one or two sessions of people being asked to look at things in a different way, can find they've got more resources to draw on than they realise." 

Call for 'Mental Health Court'

Mr Steedman said he had clients who would ring police seeking help with mental health, and ended up getting arrested. He said the new pilot scheme was a reflection of that. 

"The police have obviously thrown their hands up here, and they're saying they need help, and of course that's appropriate." 

"How that interfaces with the criminal justice system and whether we're seeing a necessary expansion into including the health service and social welfare services, this could be the tip of the iceberg that we're witnessing." 

Mr Steedman said the current approach to mental health in criminal law - apart from the criminal procedure mentally impaired persons act for the most seriously affected people - was very ad hoc and depended largely on who those affected came into contact with in the courts system. 

"There will be different judicial approaches, differnt types of representation from council, police prosecutor views will be different." 

"Unfortunately to do something meaningful in a holistic way is not a cheap exercise, but then again keeping someone in jail by default that slips through the health system is not a cheap exercise either. 

"There's got to be a better way forward, there's no doubt about it." 

Mr Steedman said there was a gap in the courts system. 

He said there was already a pilot court system called the 'new beginnings court' which provides services for people who have substance abuse issues as well as suffering mental health problems so they can avoid the criminal justice system. 

"Ideally the overlap would be through a mental health court," he said. 

"We have many specialist courts ... they touch on the periphery or intersect with vulnerable clients with mental health issues, but they're not actually specifically set up for that purpose. 

Mr Steedman said the new beginnings pilot scheme in Auckland was underfunded but punching well above its weight. 

He saw as a very successful prototype for a mental health court, which could be rolled out to the district court system. 

Ms Howard however reiterated that wider services would have to be an important part of the system. 

"For the ones that do need the more serious ongoing support, having a response for them that is more nuanced than just what someone like Mary O'Hagan would call 'pills and pillows'. 

"There's no point in providing more hospitals, more doctors and nurses if people are not going to be able to get the time, care and attention they need ... in a way that will make a difference for people in the future.