Health workers concerned about violence as police back down on mental health calls

Health New Zealand is trying to introduce new ways of dealing with people suffering from mental health problems from Monday Police are withdrawing from non-urgent mental health calls.

A few days ago, it issued new procedures for medical staff, aimed primarily at the safety of patients and employees. Then on Friday there was an update that said you would “share it urgently,” just 72 hours before the untested changes went live.

Healthcare workers have expressed concerns that they – and patients – they will be exposed to more violence with less police support.

Police say they have no choice but to withdraw as mental health calls limit their crime-fighting duties.

The government said Monday’s first phase had been carefully planned to “recruit the workforce” and fill the gap left by police who began phasing out of work in recent weeks at the same time as they tested a new way of prioritizing non-emergency calls .

Health NZ has made available to employees three new mechanisms, called standard operating procedures (SOPs), which will come into force from Monday.

These include the actions of medical staff in response to police restricting the transfer of people in vulnerable situations – for example from a family home to a clinic or from a small hospital to a large hospital with better treatment facilities – spending less time transferring people such as emergency department nurses (ED) and narrowing the scope of when officers will respond to calls from a mental health or addiction treatment center.

The first phase of the changes involved interactions with voluntary patients that were “largely considered low risk”, he told RNZ Health NZ.

For involuntary detainees who may be more agitated or aggressive, other changes are scheduled to start in March after being delayed by two months.

“The police advised that they will always intervene when there is an immediate threat to life or safety or when a crime has occurred,” the SOP stated.

Health New Zealand was unable to obtain all the information it wanted to use in its plans, when a project to analyze mental health 111 and other police calls ran into privacy and ethical issues.

Public Service Association health sector leader Ashok Shankar said there was uncertainty whether standard procedures would address the additional risk and frontline workers had little input.

“It was rushed,” he said, adding that PSA received a copy on October 15 and asked Health NZ for a postponement, but was told the standard operating procedures were only temporary.

“It was distributed to our members just last week or so. And we had no involvement…from what we heard from our members, none of them were involved.”

The procedures did not take into account the different risks present in large urban and small rural hospitals and the different roles such as security guards and nurses, he added.

In an email on Friday, Health NZ’s chief security officer included “an important update on some of the improved processes police have implemented to support the first phase of change. Information on this topic was published late yesterday evening.

The government talked about police wasting valuable time on transfers or transportation.

The new standard operating procedures for transport state that healthcare workers are only to call the police when “there is an urgent need for transport and there is an immediate risk to the safety of the patient, staff or others”; and after having first explored all other options and the situation has become “high risk or emergency.”

Police say other agencies need to fill the gap. But the ambulance association said its people did they were putting themselves at greater risk and needed stab-resistant vests.

The standard operating procedures emphasize that in the event of “person-to-person physical aggression” or “the risk and likelihood of person-to-person aggression is imminent”, medical staff must call 111.

The highest priority 111 calls were not part of a police pilot program to reprioritize less urgent calls.

RNZ has copies of three standard operating procedures, discussed below.

Transport

From Monday, the police will introduce a higher threshold for transporting people suffering from mental illness.

“Before considering police assistance in non-urgent situations, ensure that all other options have been exhausted,” the SOP reads.

Options included calling an ambulance or “security support if necessary.” Police will only be able to transport mental health professionals if they are accompanied by a mental health professional.

The standard states that its aim is to ensure safe, timely and coordinated transfers, while ensuring the safety of staff, “including where police are unable or refuse to provide assistance.” This was intended to ensure there was a national and common understanding of when to call the police if there was a sufficiently high risk.

“There are situations that are not urgent, but police will be on site, but not immediately.”

Handovers

Police intend to spend less time handing over workers to health care workers. SOP says they will leave as soon as the triage nurse checks for any warnings regarding the person’s safety.

“Police will conduct a safety assessment and contact ED staff or security prior to departure to consider whether the patient poses a risk to himself or others.”

If there are safety concerns, officers will refer the matter to the District Command Center for further review.

The SOP stipulates that police will call mental health professionals to discuss the situation before referring the person to the emergency department for assessment, including considering alternative options “where appropriate”.

“If police raise any concerns regarding aggression or safety and/or the patient’s reluctance to remain in the ED, this will not be considered a voluntary transfer of the patient.”

Health NZ has told hospital staff to check the system for “warnings” about people brought in by police before leaving hospital.

Hospital security may also get involved.

Attendance

The police do not intend to respond to calls from the psychiatric hospital that often.

“Before police assistance is called and a person is hospitalized or brought to an inpatient mental health unit for admission, all other health processes and procedures will be considered and, where appropriate, implemented,” the new SOPs read.

Other processes may include behavioral efforts, medical or drug intervention, or the involvement of security at the facility or the person’s whānau.

Provides guidance on calling the police in emergencies, if violence occurs or if staff are unable to control the situation.

“Before considering police assistance in non-urgent situations, please ensure all options above have been exhausted.”

Oversight

The agency said Health NZ has established a national operational working group made up of staff from mental health, emergency departments and safety teams to adapt new practices and procedures.

“We are focused on ensuring people get the right care at the right time, while maintaining the safety of staff and the integrity of our services,” interim national clinical lead for mental health and addictions Murray Patton told RNZ.

“Each district is working with affected teams to ensure these changes are implemented to meet local needs, and is also working with local police.

“We will be monitoring the first phase of changes closely to ensure our plans for subsequent phases are appropriate.”

Sign up for Ngā Pitopito Kōrero’s daily newsletter curated by our editors and delivered straight to your inbox every weekday.