Simple Form Helps Officers Expedite Mental Illness Calls

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A unique mental health assessment form that can help officers better communicate with medical personnel and may contribute to reduced wait times in hospital emergency rooms is becoming more widely used now after successful pilot studies.

The simple, one-page checklist of various “mental state indicators and behaviors” is designed to give street officers and hospital staffs a “common, descriptive but efficient language” to aid in determining whether a subject who appears to be mentally ill requires admission to a treatment facility in the interest of safety.

In the blunt explanation of one officer, “It helps me put into the right words the bizarre shit I’m looking at.”

The Brief Mental Health Screener (BMHS) was developed primarily by Ron Hoffman, PhD, a former Toronto constable who now serves as coordinator of mental health training at the Ontario (Canada) Police College.

Hoffman, who previously had a leading role in creating a template that helps Canadian officers articulate use-of-force decisions, designed the new screener with assistance from his academic advisor, Dr. John Hirdes, and other researchers as a project for his advanced degree in health studies.

We first described Hoffman’s project in a previous Force Science News when the checklist was being field-tested in a pilot study by two agencies in Ontario. Now it has been adopted throughout the jurisdiction of the Ontario Provincial Police (OPP), other agencies are also in line to begin using it, and it is being presented to medical conferences worldwide. Recently, for example, it received a very positive response from 10,000 delegates, mostly psychiatrists, attending the World Psychiatric Congress in Madrid, Spain.

SEEKING COMMONALITY

The BMHS grew from Hoffman’s realization that there is often a significant disconnect between LEOs and medical personnel when police bring subjects who seem mentally disturbed to the ER.

“Doctors and nurses use a different language and approach the situation from a different perspective than cops,” Hoffman says. “They are looking for specific cues that can give them quick insights into a subject’s mental state, but officers may not articulate what they’ve observed in the way that is most meaningful to them for making reasonable decisions.

“This tends to slow down the evaluation process, and officers end up spending a lot of time–expensive time–just waiting around for decisions to be made.”

In search of commonalities that might prove helpful in expediting things, Hoffman pored through a data base of more than 41,000 files of persons who had been admitted to psychiatric facilities for observation or treatment in Ontario.

From this he pinpointed “core elements of clinical significance”–statistically relevant behavioral indicators of potential danger to self or others that police might see during their interventions and that also appeared to be related to the admission decisions made by health professionals.

He then reduced the most common cues to terminology and checkpoints that both “capture the often bizarre-type behavior” officers encounter and are meaningfully descriptive to medical personnel. The checklist was fine-tuned across “many meetings” with input from both the health services and law enforcement communities, Hoffman says.

KEY COMPONENTS

The resulting evidence-based BMHS calls for officers to enter their observations regarding a suspected mentally disturbed person in two key sections:

  1. “Indicators of disordered thought” and
  2. “Indicators of risk of harm.”

In the “disordered thought” section, officers are asked to check off:

  • whether the person is subject to such disturbances as command hallucinations, hyper-arousal, pressured speech, disruptive behavior, or half a dozen other “mental state indicators”
  • the extent to which the person seems aware of his or her mental health problem
  • the degree to which the person’s skills for making decisions regarding the tasks of daily life, such as eating or getting dressed, seems to be impaired.

In the “risk” section, officers note such information as:

  • the person’s use or carrying of weapons
  • his or her ideation or use of violence toward others or self
  • conditions of the person’s home environment
  • compliance with taking prescribed meds.

The completed form is then sent ahead electronically or brought by the officer with the prospective patient when they arrive at the ER. The single-page summary gives the hospital staff a leg up in evaluating and processing the individual, Hoffman says.

ENTHUSIASTIC ACCEPTANCE

During the pilot studies and since the BMHS went province-wide last spring, both police and health staff alike have embraced it, Hoffman reports.

“While officers can be averse to additional paperwork, the fact that this screener is brief made buy-in easier,” says Insp. R. Scott Smith, a detachment commander with the OPP. “By using this standardized instrument, officers are able to clearly and concisely articulate their grounds for apprehending an individual and bringing them to a hospital for assessment.”

Also, he notes, the form has been helpful as “part of a broader mental health strategy,” allowing his agency “to track all calls for service where mental disorder is a factor. We have been able to observe changes in the behavior of those we have frequent contact with, and it has helped us mobilize community mental health services to engage with vulnerable individuals before a crisis situation develops.”

Barb Pizzingrilli, a mental health program manager with Ontario’s Niagara Health System, praises the BMHS as well. The fact that psychiatric emergency service staff “are now speaking a common language” with officers has “facilitated safe, risk-focused transfers” of mental patients to appropriate care facilities, she says.

In addition, she says, use of the new form as part of a “larger protocol” has helped reduce the average police wait time in one emergency department she’s familiar with from “3.2 hours to one hour,” while strengthening the “collegiality and collaborative dynamic” between medical personnel and LEOs.

YOURS FOR THE ASKING

The BMHS is a copyrighted document, but Hoffman wants it used as broadly as possible. If you would like a copy for your agency, along with permission to reproduce it for your personnel and an explanation of the related training necessary, contact him for the protocol at: Ron.Hoffman@ontario.ca

Our thanks to Chris Lawrence, a member of the Force Science Certification Course instructor team, for helping to facilitate this report.

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