CDHB/ Police Watch-house Nurse Initiative.

Abstract

Introduction: Since June 2008 Mental Health Nurses have been based in the Christchurch Police Station Watch-house providing support to a vulnerable population of people in custody with Mental Health and/or Alcohol and Other drug problems. Description and timeline: Initially, in 2008, a two year pilot scheme funded by Ministry of Health in partnership with NZ Police with 2x nurses working alongside custody staff in the Watch-house, this was expanded to provide 24/7 cover in 2012. Aim: The aim of the of the original pilot was to improve access to mental health services and to help police manage at-risk behaviours of those held in custody. Objectives included reducing the risks of harm to detainees and staff, improving skills in custodial management of detainees, improving access to services and improving continuity of care for detainees. A further objective was to reduce repeat detention and imprisonment of people with mental illness and AoD issues reduction of AoD related harm and improving health status of detainees. The Pilot was formally evaluated and presented to Parliament in 2010. Target population and stakeholders: The target population were detainees in Police custody, stakeholders were the NZ Police and Canterbury District Health board. Highlights: In the 18 months prior to the initiative being introduced, there were three suicides in the Christchurch Police cells, there have been no deaths in custody since the initiative began. Key benefits identified by Police were, detainees receiving skilled assessment and support by Registered Nurses, reducing risk of harm in the custody unit. Formal and informal training received from the Nursing Team increased the knowledge and skills of police when dealing with people suffering from mental health issues. Nurses have assessed over 18.000 detainees since the scheme began. Detainees reported gains in having a skilled person to listen to them and provide reassurance, the support available to family/whanau, less risk of "falling through the gaps" and the availability of brief intervention and referral to specialist services or GPs. Advantages for Health services were, less duplication of services, more appropriate referrals, reduced reliance on Emergency Psychiatric Services, effective information transfer and provision of a more timely service to a very vulnerable population. Police and Canterbury DHB report that as a direct result of this programme, their organisational relationships have been transformed, characterised by high levels of trust that extend well beyond the Watch-house. Sustainability: The six nurses dedicated to this project have helped achieve significant savings for the health and justice system with significant financial savings for Police. Risks are identified earlier and lives are saved due to the nurses interventions. Transferability: In 2010 Parliament recommended the initiative be rolled out to other major custody units, however to date this has not occurred due to "DHB budgetary constraints" Conclusions: An integrated Police/Health response to meet the mental health, safety and custodial requirements of detainees has positive health outcomes for the detainees and benefits for the organisations. Learnings: Importance of co-location, shared focus and commitment to relationship building are critical to success.