Augmenting Veterans Affairs police mental health response: Piloting diversion to health care as risk reduction.

Abstract

The sequential intercept model (SIM) of mental health decriminalization describes five stages in the legal system at which people with mental illness can be diverted out of that system and into treatment. Law enforcement represents the first stage and that with the highest potential for diversion. A novel interpretation of the SIM is as a model of threat management and violence risk mitigation since crisis de-escalation can constitute primary prevention of violent behavior. Health care settings that treat substance abuse and mental illness represent excellent settings in which to optimize such prevention. The U.S. Department of Veteran Affairs is a nationwide system of such settings and also maintains its own internal federal police force. This study examined the pilot implementation of a 14-hr national "train-the-trainer" curriculum, focusing on mental health diagnoses, stressors, de-escalation techniques, and referral options. The goals of this study were to evaluate feasibility-of-implementation issues, recommend any changes for the full-scale project, and provide preliminary analysis of outcomes. Trainers (n ϭ 35) exhibited significant pre-to posttest increases in the domains of (a) knowledge and (b) skill, but not in (c) attitudes or (d) perceived efficacy as a trainer. Police officers (n ϭ 140) demonstrated significant gains in all three assessed domains of (a) knowledge, (b) attitudes, and (c) skill in identifying diversion resources. The results supported changes to the curriculum and procedure as well as progression to the full-scale implementation. The curriculum has the potential to systematically enhance officer management of violent behavior while simultaneously decriminalizing mental illness. Public Significance StatementInterpreting the sequential intercept model as a novel model for threat or violence mitigation invokes law enforcement officers as the group with the highest potential to effect primary prevention of violence through use of de-escalation techniques. The initial feasibility and preliminary effectiveness of a nationwide (United States) train-the-trainer program designed to enhance federal police officers' response to

A national train-the-trainer program to enhance police response to veterans with mental health issues: Primary officer and trainer outcomes and material dissemination.

“…For a particularly vulnerable and underserved subset of individuals experiencing mental health problems, LEOs effectively broker the earliest stages of routing them into either care or custody, treatment or criminalization. This process is formalized in the Sequential Intercept Model (SIM; Munetz & Griffin, 2006), wherein is demonstrated LEOs’ unique potential to decriminalize mental health issues, as well as to prevent or manage resulting violence risk (Mok et al, 2018). Unless and until this role is replaced by an equally responsive alternative, enhancing officers’ response to relevant situations remains a desirable goal.…”

“…Several elements of the curriculum development process and resulting innovative approach required feasibility demonstration prior to full-scale launch, and were previously reported (Mok et al, 2018). Briefly, that effort demonstrated general content support by trainers and trainees, feasibility of the multi-tier train-the-trainer model with multidisciplinary teams, and outcome assessment via multiple randomized forms.…”

Community-based participatory research with police: Development of a tech-enhanced structured suicide risk assessment and communication smartphone application.

“…The expected roles that police officers may play with regard to suicide risk assessment and management parallel those of health and mental health providers. Although suicide is not specifically a mental health phenomenon from the standpoint of the Diagnostic and Statistical Manual of Mental Disorders or medical models (e.g., Mościcki, 1997), police officers' training on suicide risk is often enhanced through their gold-standard mental health crisis intervention team training model (Cochran et al, 2000;Dupont & Cochran, 2000) and derivations thereof (e.g., Mok et al, 2018;Steadman et al, 2001;Weaver et al, 2013Weaver et al, , 2021. The crisis intervention team model also identifies systemic stressors that increase the need to provide police with effective and efficient means of evaluating and documenting suicide risk.…”

Evaluating Veterans Response Teams and Police Interventions on Veterans' Health Care Utilization

“…community partners have called for veteran-specific approaches and resources to improve outcomes for criminal justice-involved veterans. 5,6 In 2012, the VA began requiring training of VA's own police force on mental health identification, crisis de-escalation, referral to treatment resources, and collaboration between police and health care providers. 5 A national curriculum was developed and this training began to be offered to local police departments as well, which began the formation of Veterans Response Teams (VRTs).…”

“…For example, a national train-the-trainer program, led by the VA, helped train more than 1000 trainers who were mostly law enforcement officers on veteran issues and the VA mental health resources and services 5. Although the training was not formalized to create VRTs, the project showed that there was community interest and it was feasible to implement veteran-specific training for law enforcement 6. Based on a literature search in major databases (eg, PubMed, Google Scholar), we could find no empirical study of clinical outcomes of VRTs.…”