Experts call for urgent ‘systemic change’ in police mental health crisis responding

Everyone knows to call 000 in an emergency. But there are calls for Australia to follow the US lead and introduce a second number. WARNING: Distressing

Aussies are sharing horror stories of dealing with police while in a mental health crisis, highlighting the need for urgent change. Picture: Quinn Rooney/Getty Images.

For Carla*, reflecting on one of the darkest points of her life conjures images of flashing police lights and wailing sirens, gruff voices and a violent physical struggle, culminating in her arrest and cold awakening in hospital the following morning.

These are the memories of a woman whose distressed state led her to the point of attempting suicide, but a welfare check from Tasmania Police intended to keep her safe from harm descended into terrifying scenes when her car was run off the road by three attending police vehicles, with one allegedly jumping in the back seat and grabbing her from behind.

“It triggered past traumas of abuse and captivity,” she explained to news.com.au of the moment that exacerbated her state of distress and led to her being handcuffed without charge.

Carla’s horrific experience could have been avoided with one simple change to first responding; an emergency mental health referral service for triple-000 callers where presence from uniformed police is not appropriate.

And we only need to look across the pond for a blueprint. In the US, ‘988’ was rolled out last year as the three-digit, nationwide phone number to connect directly to the Suicide and Crisis Lifeline, as a response to alarming suicide statistics.

Carla was going through a ‘very difficult phase’ in her life when a welfare check ended with her being run off the road by cops.

In Australia, first-responders dispatched through triple-000 are often ill-equipped to deal with mental health. In some situations, traumatic dealings with police can even inflame the situation.

In Carla’s case, while she was released from hospital the following day without charge, a week later, she was admitted to ICU after a suicide attempt left her in a critical condition.

“(The arrest) just reiterated to me that I just need to hurry up and get done with it because I’m just wasting all these resources and I’m not important to anybody,” she said.

“They made me feel absolutely worthless.”

Carla’s is just one of many similar stories across Australia.

Carla said the experience made her feel ‘worthless’.

While she says she has positive experiences from welfare checks — including one kind officer named Phil who kept in touch with regular coffee catch-ups — having her car run off the road after her phone was tracked by police responding to a concerned call from her social worker has stuck with her, and made her a passionate advocate for greater mental health awareness.

“It’s a very difficult dialectic, I’ve had so much trauma from police, but I’ve also had these odd ones who are actually decent,” she explained.

Carla says she is still “weary” of police, but there is a glimmer of hope as she remains active in the search for a solution, working with PACER — a pilot program implemented in some states where mental health clinicians respond to triple-000 call-outs with police and paramedics — to educate first-responders on appropriate mental health responding.

Carla is strongly in favour of mobilising peer support workers with “lived experience” to work hand-in-hand with police — a model which was recommended in the findings of the Victoria Mental Health Royal Commission, handed down in March 2021.

She’s one of many passionate voices leading the call to enact this change Australia-wide.

NSW community groups called to action

John Milham, who is chairman of Northern Beaches Cares, part of the national Suicide Prevention Network, says a change to triple-000 responding to mitigate the presence of uniformed, armed police is necessary in all mental health situations, declaring that we are currently in a “suicide crisis”.

“It’s not fair on anyone,” he said of the current operating system.

“I don’t want to trash the police, because they’re responding within their parameters of their understanding and their training and the rules that they operate under. But the consequence of that being completely inappropriate is massive.

“Almost 50 per cent of all police-related brutalities are people who are having a mental health episode, who are in the system as mentally ill. Every interaction that is not about a caring, patient, judgment-suspended conversation in a mental health space is the wrong one,” he said.

“You don’t bring a knife to a gun fight, you don’t bring a gun to a mental health episode. It’s just ridiculous.”

‘You don’t bring a gun to a mental health episode,” says John Milham.

Mr Milham’s passion in the mental health sector stemmed from tragedy in his own life. After losing his wife, he was “sent to the edge”, experiencing anxiety, complicated grief and suicidality.

Now, he uses his own lived experience to assist others, a tool he believes is under-utilised at a higher level.

“My belief is there are very few mental health interventions apart from a full psychotic break or a schizophrenic or manic episode, that can’t be assisted by a peer support worker with some training. We’re not talking four years in university, we’re talking about a few days here and there,” he said.

“It’s all about people with lived experience. This isn’t up for debate in terms of evidence informed. This is what all the reports coming through from the Victorian Royal Commission, the Australian Productivity Commission, the report to parliament, and Suicide Prevention Australia are saying.

“I’ve heard stories from situations where police are called and they’ve handled (a mental health episode) beautifully. They’re caring, considered and compassionate … It’s almost always the police who have a lived experience. Whether it’s themselves or someone close to them and it just opens up a whole different way of understanding what’s in front of you.”

He believes the plethora of peer-led community groups across Australia should be looked to for added support in setting up a similar system to what is being trialled in the US – a ‘988’ emergency line, supported by police and paramedics, in lieu of 911 for mental health incidents.

“We’ve got triple-000 – it could be ‘002’ or something, and it immediately goes through to a purpose group,” he suggested, adding that the bones of such a system already exist.

“There’s a lot of energy, just not a lot of direction,” he said of community groups and helplines already in existence.

“I believe that those people could easily fit into a community sponsored response, a fast reaction group, until the infrastructure comes in. A company can set up a call centre in days. All we need to do is resource the things that are working in communities.”

Priscilla Brice, the CEO of BEING, an independent NSW organisation supporting people living with mental health issues, agrees that there is a dire need for further integration between the police and mental health sectors.

“Just training police officers on mental health is not enough,” Ms Brice said.

“Of course, they need to know what a mental health crisis looks like and have a basic understanding of how to approach that situation, that’s a given. But there’s no substitute for lived experience.

“There are peer workers who work in hospitals, so I don’t think that the step between working in a hospital and working with police is very far, so I think it’s feasible. A mental health peer worker could easily support police when they’re out on patrol,” she argued.

Experts agree that 'there's no substitute for lived experience' when dealing with a mental health crisis.

In a statement to news.com.au about the recommendations, NSW Police responded: “The NSWPF Mental Health Intervention Team, implemented in 2020, continues to review education strategy and content in relation to mental health to ensure it is informed by current best practice with a view to equip police with the skills to de-escalate and diffuse potentially volatile situations, mitigating use of force to maintain the safety of the consumer, the public and police officers involved.

“The Mental Health Intervention Team will continue to work with organisations to ensure a collaborative approach to education, training and policy development while ensuring content experts are consulted to assist in the review and establishment of service agreements, policies, and education.”

‘Systemic change’: Vic Police Accountability Centre

Gregor Husper, the principal lawyer for Melbourne’s Police Accountability Project, is similarly damning of a police response in a mental health crisis, saying it is simply “not appropriate”.

Mr Husper says it can lead to adverse health and justice system outcomes, including the over-representation of people with mental health conditions in the justice system.

“A sizeable portion of complaints made to Inner Melbourne Community Legal’s Police Accountability Project are from people who experienced psychosocial distress and Victoria Police responded to their call for help with excessive force, including capsicum spray,” he tells news.com.au.

“According to the experiences of our clients, police can escalate from a welfare check to ‘we’re going to break down the door’ if the person is responding in a heightened state. This can lead to them being charged with resisting arrest or assaulting police, which can attract mandatory minimum sentences.

People with mental health issues can be ‘criminalised’ without an appropriate first response.

“Those clients then experience the added stress of criminal charges at a time when they should be able to focus on their mental health recovery.”

Mr Husper added that if a crisis response culminates in a person being placed in a prison cell, the situation goes from bad to worse.

“We have seen instances when people have also been placed in a prison cell without access to medication, including situations when police are aware someone needs medication and is not allowed access to it.

“Clients have also reported pressing the button for emergency help while in the cell and that the police do not respond or refer them to a medical team. There have also been instances of people suffering from heat sweats, vomiting, panic attacks or breathing problems and they report they are not taken seriously.”

So what is the answer?

Molly Williams, the managing lawyer from the Health Justice Partnerships arm of Inner Melbourne Community Legal, which provides free legal information and health referrals to clients, says “systemic change” is imperative, highlighting the findings of the Royal Commission.

“One of the recommendations that came out of the Royal Commission was that the mental health system should transition to Ambulance Victoria as the first response agency for mental health call outs,” she explained.

“The Victorian Government should progress this recommendation. There must be systemic change because the presence and expertise of specialised emergency mental health clinicians can help to ameliorate the trauma of a first responder interaction and prevent adverse outcomes.”

‘End of 2024’: Victoria Police ‘working towards’ system overhaul

A Victoria Police spokesperson told news.com.au that development is under way for a “specialist mental health education and training package for all frontline police” in recognition of the need for reform.

“Victoria Police data indicates the need for police intervention in mental health events is increasing,” it said in a statement.

“For many of these call-outs, a health-based intervention rather than a law enforcement one would have likely been the most beneficial response,” the statement continued, detailing that the recommendation from the Royal Commission supported this.

However, it is not as simple as flicking a switch when it comes to triple-000 calls.

Vic Police is working towards achieving recommendations from the Royal Commission. Picture: Quinn Rooney/Getty Images.

“To meet recommendations set out in the Royal Commission would require changes to triple-0 calls concerning mental health emergencies, diverting them to Ambulance Victoria rather than Victoria Police,” Vic Police explained.

“It will also mean mental health crises requiring both ambulance and police attendance will be led by paramedics where it is safe and possible to do so with support from mental health clinicians where required.”

The Royal Commission further recommended mental health clinical assistance be available to first responders via a combination of telehealth and in-person support, with secondary triage referral services for triple-000 callers who do not require police or ambulance dispatch.

According to Vic Police, transition to a full health-led response “will take time,” with implementation due to commence by the end of 2024.

In the meantime, Victoria Police works collaboratively with mental health clinicians through the Police, Ambulance and Clinical Early Response (PACER) initiative and Enhanced Critical Response Program. The service operates in “select areas at designated times”.

Woman ignored by cops ‘saved’ by SA Urgent Mental Health Care Centre

Ellie*, 26, attended the Urgent Mental Health Care Centre in Adelaide last year experiencing panic attacks and suicidal thoughts after she was turned away by SA police when she tried to report an incident.

The Adelaide woman said she was “aggressively” catcalled and followed by a man in the street while walking home from a night out in the early hours of the morning, recalling that she had to “sprint” to finally lose him.

She visited a nearby police station shortly afterwards to report the man because she was “worried about him doing it to other women,” but was turned away.

“I was really freaked out and just went to the closest station to feel safe. I don’t think they realised what I was going through because they just told me to calm down and go home and said there wasn’t anything they could do. I felt so dismissed and like I just didn’t matter to anyone,” she explained.

Ellie said she felt ‘dismissed’ by police.

“When I walked out, I started to feel so much worse … Suicidal. I was alone and I was worried about what I might do.”

She said she remembered hearing about the UMHCC through a friend, and credits the centre for saving her life.

“They welcomed me in and just listened and it really felt like they cared. They apologised for how I was treated by the cops and completely understood how I was feeling. I felt safe, not like I was just being dramatic.”

Run by Neami National, UMHCC puts peer support workers with lived experience in mental health, addiction and suicidal ideation to the forefront.

Opened in March 2021 to alleviate pressure on the Royal Adelaide Hospital and SA Police, the UMHCC operates as a safe space for people requiring urgent mental health assistance.

When a patient enters the facility in a heightened state of distress, a peer support worker is the first to greet them, staying with them until a nurse provides a triage assessment.

A UMHCC spokesperson said the centre works closely with SAPOL, and are aiming to better educate officers to identify the signs of a mental health crisis in order to streamline the referral process.

The Urgent Mental Health Care Centre on Grenfell Street, Adelaide. Picture: Keryn Stevens

“We partner closely with all the emergency services we work with, including South Australia Police (SAPOL) and the South Australian Ambulance Service (SAAS),” a centre spokesperson told news.com.au.

“Approximately 7 per cent of UMHCC consumers are referred by SAPOL (35 to 40 consumers per month).

“They are extremely respectful of our staff and consumers and support what we do, and, in turn, we support the workload of SAPOL officers as they are able to transfer consumers to the Urgent Mental Health Care Centre (UMHCC), knowing that they will receive timely and appropriate support.

“We meet fortnightly with SAPOL, and work together in partnership to make refinements to our referral process, when necessary. Overall, UMHCC and SAPOL have a very reciprocal relationship, where we can reach out to each other at any time.”

Since the UMHCC opened in 2021, it has supported more than 6,500 consumers.

“An average of 85 per cent of people who visit the UMHCC go back to their homes after their visit, with others requiring further immediate physical or mental health support,” the centre said in a statement.

While the centre was dubbed a “national blueprint” when it first opened, a Neami National spokesperson this week said they “aren’t aware” of plans to open others across Australia.

* Names have been changed

Originally published as Experts call for urgent ‘systemic change’ in police mental health crisis responding