Barriers and enablers to implementing police mental health co-responder programs: A qualitative study using the consolidated framework for implementation research

O. Fisher, C. Donahoo, E. Bosley, R. du Cloux, S. Garner, S. Powell, J. Pickard, N. Grevis-James, M. Wyder
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Abstract

Police and mental health co-responder programs operate internationally and can be effective in providing timely and appropriate assessment, brief intervention, and referral services for people experiencing mental health crises. However, these models vary greatly, and little is known about how the design and implementation of these programs impacts their effectiveness. This study was a qualitative, post hoc implementation determinant evaluation of mental health co-responder units in Brisbane, Australia, comprising of verbal or written interviews with police and mental health staff with an on-road role in the co-responder units, and their managers. The Consolidated Framework for Implementation Research was used to identify barriers and enablers to the program's implementation and effectiveness. Participants ( n = 30) from all groups felt strongly that the co-responder units are a substantial improvement over the usual police management of mental health crisis cases, and lead to better outcomes for consumers and the service. Enablers included an information-sharing agreement; the Mental Health Co-Responder (MHCORE) program's compatibility with existing police and mental health services; and the learning opportunity for both organizations. Barriers included cultural differences between the organizations, particularly risk-aversion to suicidality for police and a focus on least-restrictive practices for health; extensive documentation requirements for health; and a lack of specific mental health training for police. Using an evidence-based implementation science framework enabled identification of a broad range of contextual barriers and enablers to implementation of police mental health co-responder programs. Adapting the program to address these barriers and enablers during the planning, implementation, monitoring, and evaluation phases increases the likelihood of the service's effectiveness. These findings will inform the spread and scale of the co-responder program across Queensland, and will be relevant to police districts internationally considering implementing a co-responder program.
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实施警察心理健康共同应对者计划的障碍和促进因素:使用实施研究综合框架的定性研究
警察和心理健康共同应对者项目在国际范围内开展,可以有效地为遭遇心理健康危机的人提供及时、适当的评估、简单干预和转介服务。然而,这些模式千差万别,人们对这些项目的设计和实施如何影响其有效性知之甚少。本研究是对澳大利亚布里斯班的心理健康共同应对单位进行的一项定性、事后实施决定因素评估,包括对在共同应对单位中担任路面角色的警察和心理健康工作人员及其管理人员进行口头或书面访谈。实施研究综合框架被用来确定计划实施和有效性的障碍和促进因素。来自所有小组的参与者(n = 30)都强烈地认为,与警方通常对心理健康危机案件的管理相比,共同应对单位是一个重大的改进,并能为消费者和服务带来更好的结果。促进因素包括:信息共享协议;心理健康共同应对者项目与现有的警察和心理健康服务的兼 容性;以及两个组织的学习机会。障碍包括两个组织之间的文化差异,尤其是警察对自杀风险的规避和医疗机构对最小限制措施的关注;医疗机构对大量文件的要求;以及警察缺乏专门的心理健康培训。利用循证实施科学框架,能够识别出实施警察心理健康共同应对者项目的广泛背景障碍和有利因素。在计划、实施、监督和评估阶段,调整项目以解决这些障碍和有利因素,就有可能提高服务的有效性。这些研究结果将为共同应对项目在昆士兰州的推广和规模化提供参考,并将对国际上考虑实施共同应对项目的警区具有借鉴意义。
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审稿时长
18 weeks
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