Decision analytic model exploring the cost and cost-offset implications of street triage

Heslin, Margaret; Callaghan, Lynne; Packwood, Martin; Badu, Vincent; Byford, Sarah

doi:10.1136/bmjopen-2015-009670

Cited by 18 publications

(34 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The design of the Street Triage services in the current study is consistent with Street Triage design in other localities where a joint response in a dedicated shared vehicle and mental health practitioner support in the control room have been piloted together [27, 28] or separately [12]. This also identifies that a number of different collaborative operational models may be labelled as ‘Street Triage’ [10], but could also be argued as standalone collaborative interventions for example mental health training for police offers.…”

Section: Discussionmentioning

confidence: 84%

Implementing street triage: a qualitative study of collaboration between police and mental health services

2016

View full text Add to dashboard Cite

BackgroundStreet Triage is a collaborative service between mental health workers and police which aims to improve the emergency response to individuals experiencing crisis, but peer reviewed evidence of the effectiveness of these services is limited. We examined the design and potential impact of two services, along with factors that hindered and facilitated the implementation of the services.MethodsWe conducted 14 semi-structured interviews with mental health and police stakeholders with experience of a Street Triage service in two locations of the UK. Framework analysis identified themes related to key aspects of the Street Triage service, perceived benefits of Street Triage, and ways in which the service could be developed in the future.ResultsStakeholders endorsed the Street Triage services which utilised different operating models. These models had several components including a joint response vehicle or a mental health worker in a police control room. Operating models were developed with consideration of the local geographical and population density. The ability to make referrals to the existing mental health service was perceived as key to the success of the service yet there was evidence to suggest Street Triage had the potential to increase pressure on already stretched mental health and police services. Identifying staff with skills and experience for Street Triage work was important, and their joint response resulted in shared decision making which was less risk averse for the police and regarded as in the interest of patient care by mental health professionals. Collaboration during Street Triage improved the understanding of roles and responsibilities in the ‘other’ agency and led to the development of local information sharing agreements. Views about the future direction of the service focused on expansion of Street Triage to address other shared priorities such as frequent users of police and mental health services, and a reduction in the police involvement in crisis response.ConclusionThe Street Triage service received strong support from stakeholders involved in it. Referral to existing health services is a key function of Street Triage, and its impact on referral behaviour requires rigorous evaluation. Street Triage may result in improvement to collaborative working but competing demands for resources within mental health and police services presented challenges for implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1026-z) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 84%

Implementing street triage: a qualitative study of collaboration between police and mental health services

2016

View full text Add to dashboard Cite

show abstract

“…107 Unit costs of criminal justice staff were estimated based on the NOMS published pay scales, 111 with the exception of the hourly costs of a police officer, which was sourced from available literature. 112 Unit costs of medications prescribed were derived from the British National Formulary.…”

Section: Cost-effectiveness Methodologymentioning

confidence: 99%

The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

Forsyth

Archer-Power

Senior

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Older people are the fastest-growing group in prisons in England and Wales and have complex health and social care needs that often remain unmet. Objectives (1) Evaluate the efficacy of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) in improving (i) the ability to meet older male prisoners’ health and social care needs, (ii) health-related quality of life (HRQoL), (iii) depressive symptoms and (iv) functional health and well-being and activities of daily living; (2) assess the quality of care plans produced; (3) explore the experiences of older prisoners receiving, and staff conducting, the OHSCAP; and (4) evaluate the cost-effectiveness of the OHSCAP compared with treatment as usual (TAU). Design Multicentre, parallel-group randomised controlled trial (RCT) with follow-up at 3 months, with a nested qualitative study and quality audit of care plans (n = 150, 68%). Setting Ten English prisons. Participants Four hundred and ninety-seven newly arrived male prisoners aged ≥ 50 years with a discharge date at least 3 months from recruitment. A total of 14 prisoners and 11 staff participated in qualitative interviews. Intervention Randomisation to OHSCAP or TAU. The OHSCAP group had health and social needs assessed by a trained health-care worker or prison officer. Care plans were devised and subsequent actions included professional support and appropriate referrals. Main outcome measures Primary outcome measure – mean number of unmet health and social care needs as measured by the Camberwell Assessment of Need – Short Forensic Version. Secondary outcome measures – measures of functional health and well-being, depressive symptoms and HRQoL. A health economic evaluation was undertaken using service contact between baseline and follow-up and appropriate unit cost information. Results A total of 497 prisoners were recruited (248 to OHSCAP and 249 to TAU). The 404 completed follow-ups were split evenly between the trial arms. No significant differences were observed between the intervention and TAU groups in relation to the primary outcome measure. The OHSCAP did not demonstrate convincing benefits in HRQoL over TAU, and there were no significant differences in relation to costs. Audit and qualitative data suggest that the intervention was not implemented as planned. Limitations As a result of the limited follow-up period, potential long-term gains of the intervention were not measured. Some of the standardised tools had limited applicability in prison settings. Cost-effectiveness data were limited by unavailability of relevant unit cost data. Conclusions The OHSCAP failed in its primary objective but, fundamentally, was not implemented as planned. This appears to have been attributable, in some part, to wider difficulties currently affecting the prison landscape, including reduced levels of staffing, the loss of specialist support roles for such initiatives and increased prevalence of regime disruption. Future work Partnership working and information sharing across disciplines within prison settings require improvement. Research should explore the potential involvement of other prisoners and third-sector organisations in identifying and addressing older prisoners’ health and social care needs to better match community provision. Further examination should be undertaken of how the prison regime and system affects the well-being of older prisoners. Future prison-based RCTs should carefully balance the fidelity of initiatives being evaluated and testing in a ‘real-life’ setting. Trial registration Current Controlled Trials ISRCTN11841493. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 31. See the NIHR Journals Library website for further project information.

show abstract

“…Single studies used the following designs: a comparison of two different models of PRMHT interventions, 44 a largely single-group evaluation during a PRMHT intervention with some comparison data from a cost-benefit analysis, 46 an evaluation across multiple areas of PRMHT pilot interventions that reported comparative data only for some outcomes (e.g. S136 detentions), 9 a descriptive study comparing data before and after an intervention, 45 a pragmatic evaluation using a decision-analytic model exploring costs, 43 a non-comparative assessment and evaluation of two areas implementing a PRMHT intervention, 50 and a dissertation reporting data during the period of an intervention. 49…”

Section: Characteristics Of Primary Studiesmentioning

confidence: 99%

“…Eight studies (in nine articles) evaluated PRMHT interventions. 9,[43][44][45][46][47][48][49][50] Most studies evaluated variations of co-response or consultation models that were often referred to as street triage. The intervention characteristics varied across the studies, but all could be broadly classified in terms of the primary role of MHPs ( Table 5).…”

Section: Police-related Mental Health Triage Interventionsmentioning

confidence: 99%

“…Outside the hours of street triage operation, 'usual response' from police officers and access to mental health services continued. 9,43,45,46 One study reported a telephone line also being made available during peak hours to provide support to officers. 46 In one study, joint on-scene attendance of MHPs and police officers in one county in England was compared with telephone support only from a mental health nurse in another county.…”

Section: Police-related Mental Health Triage Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis

Rodgers

Thomas

Dalton

et al. 2019

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Police officers are often the first responders to mental health-related incidents and, consequently, can become a common gateway to care. The volume of such calls is an increasing challenge. Objective What is the evidence base for models of police-related mental health triage (often referred to as ‘street triage’) interventions? Design Rapid evidence synthesis. Participants Individuals perceived to be experiencing mental ill health or in a mental health crisis. Interventions Police officers responding to calls involving individuals experiencing perceived mental ill health or a mental health crisis, in the absence of suspected criminality or a criminal charge. Main outcome measures Inclusion was not restricted by outcome. Data sources Eleven bibliographic databases (i.e. Applied Social Sciences Index and Abstracts, Criminal Justice Abstracts, EMBASE, MEDLINE, PAIS® Index, PsycINFO, Scopus, Social Care Online, Social Policy & Practice, Social Sciences Citation Index and Social Services Abstracts) and multiple online sources were searched for relevant systematic reviews and qualitative studies from inception to November 2017. Additional primary studies reporting quantitative data published from January 2016 were also sought. Review methods The three-part rapid evidence synthesis incorporated metasynthesis of the effects of street triage-type intervention models, rapid synthesis of UK-relevant qualitative evidence on implementation and the overall synthesis. Results Five systematic reviews, eight primary studies reporting quantitative data and eight primary studies reporting qualitative data were included. Most interventions involved police officers working in partnership with mental health professionals. These interventions were generally valued by staff and showed some positive effects on procedures (such as rates of detention) and resources, although these results were not entirely consistent and not all important outcomes were measured. Most of the evidence was at risk of multiple biases caused by design flaws and/or a lack of reporting of methods, which might affect the results. Limitations All primary research was conducted in England, so may not be generalisable to the whole of the UK. Discussion of health equity issues was largely absent from the evidence. Conclusions Most published evidence that aims to describe and evaluate various models of street triage interventions is limited in scope and methodologically weak. Several systematic reviews and recent studies have called for a prospective, comprehensive and streamlined collection of a wider variety of data to evaluate the impact of these interventions. This rapid evidence synthesis expands on these recommendations to outline detailed implications for research, which includes clearer articulation of the intervention’s objectives, measurement of quantitative outcomes beyond section 136 of the Mental Health Act 1983 [Great Britain. Mental Health Act 1983. Section 136. London: The Stationery Office; 1983 URL: www.legislation.gov.uk/ukpga/1983/20/section/136 (accessed October 2017)] (i.e. rates, places of safety and processing data) and outcomes that are most important to the police, mental health and social care services and service users. Evaluations should take into consideration shorter-, medium- and longer-term effects. Whenever possible, study designs should have an appropriate concurrent comparator, for example by comparing the pragmatic implementation of collaborative street triage models with models that emphasise specialist training of police officers. The collection of qualitative data should capture dissenting views as well as the views of advocates. Any future cost-effectiveness analysis of these interventions should evaluate the impact across police, health and social services. Funding The National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Decision analytic model exploring the cost and cost-offset implications of street triage

Cited by 18 publications

References 3 publications

Implementing street triage: a qualitative study of collaboration between police and mental health services

Implementing street triage: a qualitative study of collaboration between police and mental health services

The effectiveness of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP): a randomised controlled trial

Police-related triage interventions for mental health-related incidents: a rapid evidence synthesis

Contact Info

Product

Resources

About