title: Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study.
abstract: BACKGROUND
  The Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.
  
  
  METHODS
  A retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.
  
  
  RESULTS
  NPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16% of people in crisis went to ED compared with 100% for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.
  
  
  CONCLUSIONS
  NPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, 3065, Fitzroy, Australia. brian.mckenna@mh.org.au.|NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, 3050, Parkville, Victoria, Australia. brian.mckenna@mh.org.au.
authors.forename: Brian
authors.initials: B
authors.lastname: McKenna
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, 3065, Fitzroy, Australia. trentham.furness@acu.edu.au.|NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, 3050, Parkville, Victoria, Australia. trentham.furness@acu.edu.au.
authors.forename: Trentham
authors.initials: T
authors.lastname: Furness
authors.affiliation: Northern Area Mental Health Service, NorthWestern Mental Health, The Northern Hospital, 185 Cooper Street, 3076, Epping, Australia. steve.brown@mh.org.au.
authors.forename: Steve
authors.initials: S
authors.lastname: Brown
authors.affiliation: Melbourne EpiCentre, The Royal Melbourne Hospital and Department of Medicine, The University of Melbourne, Grattan Street, 3050, Parkville, Australia. mark.tacey@mh.org.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Tacey
authors.affiliation: Epping Police Station, Victoria Police, Police Station, 785 High Street, 3076, Epping, Australia. andrew.hiam@police.vic.gov.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hiam
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, 3065, Fitzroy, Australia. morgan.wise@acu.edu.au.
authors.forename: Morgan
authors.initials: M
authors.lastname: Wise
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data* / Q000639:trends; D003419:Crisis Intervention / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D016495:Police; D012189:Retrospective Studies; D014739:Victoria