The interaction of police officers with people experiencing community-based mental health crisis has involved the use of first responder police responses and/or co-responding approaches with mental health clinicians. Despite favourable outcomes, the consumer experience remains largely unknown. The aim of this study was to profile perceptions about the Northern Police and Clinician Response (NPACER) when the unit responded to mental health crisis compared with perceptions of a police only response. A total of 43 participants were recruited from an acute adult inpatient mental health unit and completed the Police Contact Experience Scale that quantifies perceptions of procedural justice and coercion. The major finding was that the NPACER model enabled greater perceptions of procedural justice and comparable perceptions of coercion. Although the NPACER facilitated clinical advantages, the nature of involuntary hospitalization may explain similar perceptions of coercion among the NPACER and a police officer only response.

Introduction

Law enforcement officers are often the first responders to people in community-based mental health crisis (Shapiro et al., 2014). Their interactions have been perceived by consumers to contrast between dignified and respectful engagement (Watson et al., 2008) to perceptions of threatening and over-reactive contact (Boscarato et al., 2014). Negative perception may be manifested by a punitive response involving pathways through the criminal justice system (Peterson et al., 2014). As such, models have emerged to improve police first responder efficiency and quality of care during mental health crises.

The Crisis Intervention Team (CIT), commonly called the Memphis Model, was established primarily to assist police redirect, when appropriate, people they suspect of having mental illness to treatment services rather than judicial systems (Steadman et al., 2000; Compton et al., 2008). A CIT consists of law enforcement officers with specialty training in acute mental health assessment and de-escalation. However, a limited body of evidence supports CIT models in connecting people during mental health crisis to appropriate mental health care after contact with police officers (Crompton et al., 2008). Another model involves police officers responding to a ‘call-out’ and initiating a specialist second responder Mental Evaluation Unit (MEU) which is a component of the System-wide Mental Assessment Response Team (LAPD, 2011). The MEU comprises of at least a law enforcement officer and a mental health clinician and has a focus on interagency collaboration (Donohue and Andrews, 2013). The goal of joint responses is to reduce the potential for violence, prevent unnecessary custodial incarceration, and provide alternate care in less restrictive environments (Lamb et al., 1995).

Iterations of CITs and co-responding interventions have improved efficiency and quality of care during mental health crises (Scott, 2000; Compton et al., 2008; Oliva and Crompton, 2008) and reduced custodial incarceration (Steadman et al., 2000). However, despite the ability of those models to divert to more appropriate care, the perceived experience of people in community-based mental health crisis interfacing with CIT and co-responding interventions remains largely unknown (Oliva and Crompton, 2008).

In the Australian state of Victoria, police officers are lawfully entitled under mental health legislation (section 10, Mental Health Act 1986; Section 351, Mental Health Act 2014) to detain people in community-based mental health crisis, if deemed at risk to themselves or others, and transport them to an appropriate location for specialist mental health assessment [e.g. an emergency department (ED)] (Victorian Government, 1986; Department of Human Services [DHS], 2005; Victorian Government, 2014). As many as 21% of police officers in the Australian state of Victoria report transporting people with mental illness for emergency mental health care at least weekly (Hollander et al., 2012). As such, people experiencing community-based mental health crisis who call for police service have predominantly been involuntarily transported to Victorian public hospital EDs (DHS, 2005; Al-Khafaji et al., 2014). However, for people in mental health crisis, involuntary transportation to an ED is associated with extended waiting time for mental health assessment (Knott et al., 2007; Al-Khafaji et al., 2014), the involvement of security staff (DHS, 2005), and the use of restrictive interventions (i.e. physical restraint or mechanical restraint) (Jelinek et al., 2013). Furthermore, given final disposition has predominantly been discharge to the community rather than inpatient admission (McKenna et al., 2015a), the journey of the individual in crisis needs constant evaluation and improvement (Morphet et al., 2012; Hall et al., 2016). Therefore, in 2014 an initiative to improve the journey of people in community-based mental health crisis was created by Victoria Police and an Area Mental Health Service. The initiative was identified as the Northern Police and Clinician Emergency Response (NPACER) unit and the current study presents finding regarding how consumers perceived their interaction with the service during community-based mental health crisis.

The setting

The Area Mental Health Service and Victoria Police division serve a combined population of ∼575,000 people in metropolitan Melbourne. The Area Mental Health Service is located in a major growth corridor of metropolitan Melbourne (Australian Bureau of Statistics [ABS], 2016a) and is characterized with high immigrant and ethnic diversity, and low socio-economic status compared with other areas of metropolitan Melbourne (ABS, 2013). In the state of Victoria, 17.5% of the population (∼1 million people) are reported to experience mental ill health and behavioural conditions, although this is comparable with the national rate (ABS, 2016b).

The NPACER

The collaborative initiative created by Victoria Police and the Area Mental Health Service was the NPACER. The single unit resembled a second responder (i.e. co-responder) model (Lamb et al., 1995) comprising a police officer and a senior mental health clinician attending to community-based mental health crises in a Victoria Police divisional van. A second responder model was chosen based on the context of service delivery and resource constraints among health and emergency services (Fisher and Grudzinskas, 2010). The goal of the co-responder is to reduce the potential for violence, prevent unnecessary custodial incarceration, and provide alternate care in less restrictive environments through interagency collaboration (Lamb et al., 1995). The NPACER unit is called to the scene after first responder police officers have assessed the scenario on a ‘safety first’ principle (i.e. siege or risk of unlawful activity) and when they suspect mental health crisis and enactment of mental health legislation (i.e. section 10, Mental Health Act 1986; Section 351, Mental Health Act 2014) which will involve involuntary transport for specialist mental health assessment. Additionally, the NPACER unit was tasked to reduce the risk of behavioural escalation and provide a better outcome for people with mental health needs through diversion to appropriate mental health or community mental health services. The model has a focus on ED diversion and direct admission to an acute 50-bed inpatient mental health service within the Area Mental Health Service (McKenna et al., 2015a,b). The operational components of the NPACER model has been comprehensively described elsewhere (see McKenna et al., 2015a).

Although a second responder model was chosen, evidence of effects of second responder models on consumers and services are barely known (Shapiro et al., 2014). It is important to describe experiences of people in community-based mental health crisis as their engagement with law enforcement officers can positively or negatively affect subsequent interventions (Tyler, 1990; Mazerolle et al., 2013). For people in mental health crisis, subsequent interventions may include involuntary transport (McKenna et al., 2015a) and inpatient mental health admission (McKenna et al., 2001). For instances where an individual perceives procedural justice, subsequent interventions can be perceived with less coercion (Watson and Angell, 2007) which may improve outcomes for the individual in crisis. Therefore, the aim of this study was to use the Police Contact Experience Scale (PCES) (Watson et al., 2010) to profile perceptions of procedural justice and coercion of people in community-based mental health crisis. Perceptions were profiled for people who interfaced with; (1) a first responder police response and NPACER which facilitated involuntary direct admission to an acute inpatient mental health unit compared and (2) a first responder police response leading to their involuntary transportation to an ED and involuntary admission onto an acute inpatient mental health unit.

Methods

Research design

This study was completed as exploratory research. Exploratory research is used when a problem has not clearly been defined (Stebbins, 2001). In the current study, the problem was the unknown perceptions of procedural justice and coercion of people in community-based mental health crisis. The focus of data was based on quantitative responses to the PCES (Watson et al., 2010). This study was approved by the Melbourne Health Office for Research (QA/LNR 2013140). Data were collected from April 2014 to February 2015.

Participants

Participants were purposively recruited from an acute adult inpatient mental health unit. The inclusion criteria were: (1) involuntary admission to the unit under Section 351 (i.e. Mental Health Act 2014), (2) 18 years of age or older, and (3) cognitively able to provide voluntary consent and data/research content. The 50-bed mental health inpatient unit has two 25-bed areas and average length of stay is 12 days. Participants were admitted to the unit via involuntary transportation to an ED or directly with a first responder police response and NPACER. In both instances, first responder police were the mode of transport and transportation was involuntary. The use of the NPACER unit was dependent on the availability of the unit and its operational period which was 7 days a week, every afternoon/evening (15:00–23:30 h).

Data collection

Data were collected with participants at a convenient time in the days after involuntary admission to the acute adult inpatient mental health unit. A convenient time was determined based on the current mental health state of the participant and their capacity to provide informed written voluntary consent. Participants provided informed voluntary consent and self-reported their age, gender, and diagnosis to an experienced research assistant with lived experience of mental illness. Quantitative data were collected with the PCES. The PCES is a validated tool that comprises the sub-scales of procedural justice (Cronbach’s alpha = 0.94) and coercion (Cronbach’s alpha = 0.85) (Watson et al., 2010). The PCES can be used to quantify the experience of people in mental health crisis when interacting with police officers. For participants that interfaced with police officers and NPACER ‘officer(s)’ was replaced with ‘officer(s) and NPACER’. Participants rated 5-items of coercion and 10-items of procedural justice on a four-point scale ranging from ‘strong disagreement’ (score of 1) to ‘strong agreement’ (score of 4) for their experiences with police officers and NPACER or the first responder police only response. An example of the procedural justice sub-scale was for participants to rate the degree to which ‘Police officer(s) treated me with respect.’ An example of the coercion sub-scale was for participants to rate the degree to which ‘I felt free to do what I wanted.’

Data analysis

The purposive sample was not randomly drawn from a population so an assumption for parametric statistical testing was violated (Portney and Watkins, 2014). Therefore, sample descriptors were compared with univariate and chi-square tests. Two Mann–Whitney U tests were computed for the sub-scales procedural justice and coercion of the PCES among the participants who interfaced with a first responder police officer and NPACER (NPACER + OFF) and the participants who experienced a first responder police response leading to their involuntary transportation to an ED and involuntary admission onto an acute inpatient mental health unit. This test is used for ordinal data when computing difference among rankings. The data were analysed with the Statistical Package for Social Scientists 20.0 for Windows (SPSS Inc., Chicago, IL, USA). Significance was accepted at P ≤ 0.05. Effect size (r) was computed to describe the magnitude of the change (Sullivan and Feinn, 2012) in ratings where 0.1 was considered small, 0.3 moderate, and 0.5 large effect (Cohen, 1988).

Results

A total of 43 participants were involved in the study (Table 1). There were 33 (77%) males and 10 (23%) females. There were more males that interfaced with police officers only and more females that interfaced with NPACER + OFF (P =0.03). Eleven (26%) participants self-reported a diagnosis of psychotic illness and 15 (34%) participants did not know their diagnosis (P =0.08).

Table 1:

Sample descriptors of the NPACER ± OFF response and police officers only response

  Total N (col %) NPACER+OFF n (col %) Police only n (col %) P value 
 Total (row %) 43 18 (42) 25 (58) 0.29 
Gender (%) Male 33 (77) 11 (61) 22 (88) 0.03 
 Female 10 (23) 7 (39) 3 (12)  
Age range 18–24 8 (19) 4 (22) 4 (16) 0.67 
 25–34 9 (21) 4 (22) 5 (20)  
 35–44 12 (28) 3 (17) 9 (36)  
 45–54 9 (21) 5 (28) 4 (16)  
 ≥55 5 (11) 2 (11) 3 (12)  
Diagnosis (%) Psychotic illnessa 11 (26) 6 (33) 5 (20) 0.08 
 Bipolar affective disorder 8 (19) 4 (22) 4 (16)  
 Other diagnosis 5 (12) 3 (17) 2 (8)  
 Major depressive disorder 4 (9) 3 (17) 1 (4)  
 Don’t know 15 (34) 2 (11) 13 (52)  
  Total N (col %) NPACER+OFF n (col %) Police only n (col %) P value 
 Total (row %) 43 18 (42) 25 (58) 0.29 
Gender (%) Male 33 (77) 11 (61) 22 (88) 0.03 
 Female 10 (23) 7 (39) 3 (12)  
Age range 18–24 8 (19) 4 (22) 4 (16) 0.67 
 25–34 9 (21) 4 (22) 5 (20)  
 35–44 12 (28) 3 (17) 9 (36)  
 45–54 9 (21) 5 (28) 4 (16)  
 ≥55 5 (11) 2 (11) 3 (12)  
Diagnosis (%) Psychotic illnessa 11 (26) 6 (33) 5 (20) 0.08 
 Bipolar affective disorder 8 (19) 4 (22) 4 (16)  
 Other diagnosis 5 (12) 3 (17) 2 (8)  
 Major depressive disorder 4 (9) 3 (17) 1 (4)  
 Don’t know 15 (34) 2 (11) 13 (52)  

aSchizophrenia, schizoaffective disorder, and psychotic disorder unspecified.

The interaction of participants who interfaced with NPACER + OFF was perceived with more procedural justice compared with participants who experienced a first responder police response leading to their involuntary transportation to an ED and involuntary admission onto an acute inpatient mental health unit (U = 18.50, z = −2.43, P = 0.02, r = 0.52) (Table 2). Within the 10-items of the perceived procedural justice sub-scale, for participants that interfaced with NPACER + OFF, the level of agreement was greater for nine-items compared with participants that interfaced with police officers only. For participants that interfaced with NPACER + OFF, 94% perceived they were treated humanely compared with 80% of participants that interfaced with police officers only. For participants that interfaced with NPACER + OFF, 83% perceived they were treated with respect compared with 64% of participants who interfaced with police officers only. For participants that interfaced with NPACER + OFF, 89% perceived the attendants to their community-based mental health crisis were just doing their job compared with 92% of participants who interfaced with police officers only.

Table 2:

Perceptions of a police officer and NPACER ± OFF response and a police officer only response with the PCES

 NPACER+OFF (N = 18)
 
Police only (N = 25)
 
 Mean (SD) Disagreea Agreeb Mean (SD) Disagreea Agreeb 
  n (Valid %) n (Valid %)  n (Valid %) n (Valid %) 
Perceived Procedural Justice (P = 0.02) 3.0 (0.1)   2.9 (0.1)   
The officer(s) seemed genuinely concerned about me as a person 3.1 (0.7) 4 (22) 14 (78) 2.9 (1.1) 8 (32) 17 (68) 
The officer(s) treated me respectfully 3.0 (0.8) 3 (17) 15 (83) 2.8 (1.2) 9 (36) 16 (64) 
The officer(s) treated me like a human being 3.2 (0.5) 1 (6) 17 (94) 2.9 (1.0) 5 (20) 20 (80) 
The officer(s) went out of his/her way to be helpful 2.9 (0.8) 4 (22) 14 (78) 2.8 (1.1) 7 (28) 18 (72) 
The officer(s) tried to do what they thought was best for me 3.1 (0.7) 3 (17) 15 (83) 2.9 (0.9) 7 (28) 18 (72) 
The officer(s) took the time to listen to me and understand my situation 3.1 (0.7) 4 (22) 14 (78) 2.9 (1.0) 8 (32) 17 (68) 
The officer(s) was concerned about understanding what I needed 3.1 (0.9) 6 (33) 12 (67) 2.7 (1.1) 10 (40) 15 (60) 
I am satisfied with the way the officer(s) dealt with the situation 2.7 (0.8) 4 (22) 14 (78) 2.8 (1.1) 9 (36) 16 (64) 
The officers were just doing their job 2.9 (0.6) 2 (11) 16 (89) 3.1 (0.8) 2 (8) 23 (92) 
The officers gave me enough time to do what they asked 3.2 (0.8) 3 (17) 15 (83) 2.7 (1.0) 9 (36) 16 (64) 
Perceived coercion (P = 0.07) 2.6 (0.2)   2.3 (0.21)   
I had a say in how the situation was resolved 2.6 (0.9) 7 (39) 11 (61) 2.3 (1.0) 16 (64) 9 (36) 
I had a lot of control over how the situation was resolved 2.4 (0.9) 12 (67) 6 (33) 2.2 (1.1) 16 (64) 9 (36) 
I felt free to say what I wanted to the officer(s) 2.9 (0.9) 4 (22) 14 (78) 2.7 (1.2) 9 (36) 16 (64) 
I felt free to do what I wanted 2.4 (0.9) 11 (61) 7 (39) 2.2 (1.0) 16 (64) 9 (36) 
I had more influence than anyone else on how the situation was resolved 2.5 (1.0) 11 (61) 7 (39) 2.3 (1.1) 15 (60) 10 (40) 
 NPACER+OFF (N = 18)
 
Police only (N = 25)
 
 Mean (SD) Disagreea Agreeb Mean (SD) Disagreea Agreeb 
  n (Valid %) n (Valid %)  n (Valid %) n (Valid %) 
Perceived Procedural Justice (P = 0.02) 3.0 (0.1)   2.9 (0.1)   
The officer(s) seemed genuinely concerned about me as a person 3.1 (0.7) 4 (22) 14 (78) 2.9 (1.1) 8 (32) 17 (68) 
The officer(s) treated me respectfully 3.0 (0.8) 3 (17) 15 (83) 2.8 (1.2) 9 (36) 16 (64) 
The officer(s) treated me like a human being 3.2 (0.5) 1 (6) 17 (94) 2.9 (1.0) 5 (20) 20 (80) 
The officer(s) went out of his/her way to be helpful 2.9 (0.8) 4 (22) 14 (78) 2.8 (1.1) 7 (28) 18 (72) 
The officer(s) tried to do what they thought was best for me 3.1 (0.7) 3 (17) 15 (83) 2.9 (0.9) 7 (28) 18 (72) 
The officer(s) took the time to listen to me and understand my situation 3.1 (0.7) 4 (22) 14 (78) 2.9 (1.0) 8 (32) 17 (68) 
The officer(s) was concerned about understanding what I needed 3.1 (0.9) 6 (33) 12 (67) 2.7 (1.1) 10 (40) 15 (60) 
I am satisfied with the way the officer(s) dealt with the situation 2.7 (0.8) 4 (22) 14 (78) 2.8 (1.1) 9 (36) 16 (64) 
The officers were just doing their job 2.9 (0.6) 2 (11) 16 (89) 3.1 (0.8) 2 (8) 23 (92) 
The officers gave me enough time to do what they asked 3.2 (0.8) 3 (17) 15 (83) 2.7 (1.0) 9 (36) 16 (64) 
Perceived coercion (P = 0.07) 2.6 (0.2)   2.3 (0.21)   
I had a say in how the situation was resolved 2.6 (0.9) 7 (39) 11 (61) 2.3 (1.0) 16 (64) 9 (36) 
I had a lot of control over how the situation was resolved 2.4 (0.9) 12 (67) 6 (33) 2.2 (1.1) 16 (64) 9 (36) 
I felt free to say what I wanted to the officer(s) 2.9 (0.9) 4 (22) 14 (78) 2.7 (1.2) 9 (36) 16 (64) 
I felt free to do what I wanted 2.4 (0.9) 11 (61) 7 (39) 2.2 (1.0) 16 (64) 9 (36) 
I had more influence than anyone else on how the situation was resolved 2.5 (1.0) 11 (61) 7 (39) 2.3 (1.1) 15 (60) 10 (40) 

Note: Coercion data are reverse coded. For participants that interfaced with NPACER + OFF ‘officer(s)’ was replaced with ‘NPACER’.

aRating ‘strongly disagree’ and ‘disagree’.

bRating ‘strongly agree’ and ‘agree’.

There was no difference for perceived coercion among the participants who interfaced with NPACER + OFF compared with the participants who experienced a first responder police response leading to their involuntary transportation to an ED and involuntary admission onto an acute inpatient mental health unit (U = 4.00, z = −1.79, P = 0.07, r = 0.57) (Table 2). Within the five-items of the perceived coercion sub-scale, for participants that interfaced with NPACER + OFF, the level of agreement was greater for three-items compared with participants that interfaced with police officers only. For participants that interfaced with NPACER + OFF, 78% perceived they were free to say what they wanted compared with 64% of participants that interfaced with police officers only. For participants that interfaced with NPACER + OFF, 61% perceived they had a say in how the situation was resolved compared with 36% of participants who interfaced with police officers only. For participants that interfaced with NPACER + OFF, 33% perceived they had a lot of control over how the situation was resolved compared with 36% of participants who interfaced with police officers only. For participants that interfaced with NPACER + OFF, 39% perceived they had more influence that anyone else on how the situation was resolved compared with 40% of participants who interfaced with police officers only.

With correlation computations of the PCES sub-scales, participant’s perception of procedural justice was negatively correlated with perceived coercion. For NPACER + OFF, a strong correlation was found (r = −0.867, r2 = −0.931, P = 0.06). For police officers only, a moderate/strong correlation was found (r = −0.616, r2 = −0.785, P = 0.27).

Discussion

The major finding of this study was that people in community-based mental health crisis perceived greater procedural justice when NPACER + OFF attended compared with people who experienced a first responder police officers response. However, there was no difference among the two groups for perceived coercion. Previously, police officers, medical, and mental health clinicians described the NPACER model to allow a better pathway of care (McKenna et al., 2015b), yet the results of the current study show that people in community-based mental health crisis perceive the model as coercive compared with people who interfaced with a police officer only response. This juxtaposition among those responding to community-based mental health crisis and those experiencing community-based mental health crises may be partly explained by the person’s immense distress at the time of engagement and difficulty understanding the concept of collaboration among emergency services and mental health clinicians (Boscarato et al., 2014). Although the pathway for people in community-based mental health crisis to an acute mental health inpatient unit was different among the NPACER model and the police officer only response, admission was involuntary. The results of the current study support the known perceptions of coercion and loss of autonomy (McKenna et al., 1999) associated with involuntary mental health hospitalization.

People in community-based mental health crisis perceived greater procedural justice when they felt they were treated fairly and with kindness and respect by police officers (Watson et al., 2010). Furthermore, perceived procedural justice was greater when police officers avoided threats, deception, physical force (Livingston et al., 2013), and aggression (Geller et al., 2014). As such, the NPACER model in the current study may have enhanced perceptions of procedural justice due to improved police officer engagement with consumers in mental health crisis compared with the police officer only response.

The difference among perceived procedural justice may also be explained by different contextual factors among the NPACER + OFF response and the police officer only response. The NPACER enabled collaboration among police officers and mental health clinicians through communication, information sharing, and knowledge/skill transfer (McKenna et al., 2015b). Furthermore, people with a mental illness believed that the co-responding model had the potential to dramatically improve the quality of crisis intervention (Boscarato et al., 2014). However, the results of the current study indicated that police officers acted in a manner that was perceived with procedural justice as people in mental health crisis tended to ‘agree’ to all items of the perceived procedural justice sub-scale of the PCES. The finding supports earlier work describing procedural just interaction of police officers and people with mental illness (Livingston et al., 2014). Therefore, in the current study both groups were found to be perceived as ‘just’ although NPACER + OFF was more so (P =0.02).

The data of the current study were collected soon after involuntary inpatient mental health admission (i.e. prior to discharge) compared with Livingston et al. (2014) who used the PCES for people with mental illness to describe their most recent interaction with police. For that study, the majority of data were collected with participants that recollected their interactions with police officers in the past year. Despite the different data collection methods, results of the current study are similar to Livingston et al. (2014) who reported a negative correlation of perceived procedural justice and coercion for people with mental illness and their most recent interaction with police using the PCES and also highlight that the police officer’s behaviour during mental health crisis may be the determining contextual factor in the perception of the interaction for people in mental health crisis (Livingston et al., 2013).

From a clinical perspective, the co-responding model was described by police officers, medical, and mental health clinicians (McKenna et al., 2015b) and quantified (Huppert and Griffiths, 2015; McKenna et al., 2015a) as a more appropriate response than just a police officer only response. However, in the current study, total agreement within the sub-scales of the PCES did not occur which indicated that a consumer’s perception of their community-based mental health crisis was highly individualized. More study is required to determine the effect of co-responding and police officer only response to people experiencing community-based mental health crisis. As such, we attempted a qualitative analysis of data collected about the cohort as they were offered the opportunity to comment further about their experience and encouraged to provide examples either written or transcribed verbatim by the research assistant with lived experience. A total of 33 (NPACER n = 11) participants provided comments after completing the PCES. However, data saturation did not occur to allow thorough representation of either group. As such, future iterations of co-responding police–mental health clinician models may deliver clinically desirable outcomes and be perceived as procedurally just. Yet, for people experiencing community-based mental health crisis the co-responding model may be no less coercive than a police officer only response.

Limitations

This study was limited as data were collected about a small purposive sample of people involuntarily admitted to an acute inpatient mental health unit after community-based mental health crisis. Therefore, findings may not represent other individuals admitted to the acute inpatient unit or individuals involuntarily admitted to acute inpatient units in general. Another limitation of this study was that saturation of the qualitative data did not occur to allow in-depth analysis. A further limitation was that the behaviour of police officers and NPACER unit members during mental health crisis was unknown. This study was also limited to one Area Mental Health Service of metropolitan Melbourne. Therefore, the perceptions of procedural justice and coercion may not be representative of other co-responding models in other metropolitan areas of Melbourne or rural areas of Victoria.

Implications for a police audience

The relationship of police officers and people affected by community-based mental health crisis (i.e. consumers and significant others) is central to perceptions of procedural justice and coercion. Results of the current study indicated that for both groups, the NPACER + OFF and first responder police officer only response, were perceived as procedurally just and with low perceptions of coercion. It is important to specifically document such police interactions to allow future development of resources to support police officers to work in a manner is that is perceived with procedural justice and low coercion.

For police officers actively policing and commonly encountering challenging situations where mental illness may be attributed to the community-based crisis, evidence suggests that education/support (e.g., the Memphis Model; Compton et al., 2008) can improve interactions. Rather than education, the NPACER in the current study allowed police officers greater access to specialist clinical mental health resources in an attempt to provide timely and quality mental health care in less restrictive environments. Despite this, participants in the current study were involuntarily admitted to an inpatient mental health unit and although this process provided greater perceived procedural justice, it was perceived as no less coercive than a police officer only response. Qualitative results of the current study indicated that responses to community-based mental health crisis can be highly individualized and that despite collaborative and clinical advantages, participants reported both positive and negative experiences with both a first responder police response and NPACER, and a first responder police officer only response.

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Author notes

The authors acknowledge and appreciate the work of Joanne Switserloot during the research project. This project was funded by NorthWestern Mental Health.