Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review

Abstract

Background Historically, police departments focused solely on criminal justice issues. Recently, there has been a dynamic shift in focus, with Law Enforcement professional groups assuming more responsibility for tackling mental health and distress-related issues (that may arise because of mental health related problems and learning disabilities) alongside Public Health departments. While Law Enforcement has become a ‘last line of support’ and an increasing partner in mental health support, there is partnership working between law enforcement, psychology, and health professions in training and mental health service delivery. The term vulnerability is frequently used across Law Enforcement and Public Health (LEPH) to identify those in need of these services. Effective vulnerability assessment is therefore expected to prevent unintentional harmful health and criminal justice consequences and manage the negative impact of such in cases where prevention is not possible. This scoping review aimed to identify how vulnerability is defined and assessed across LEPH organisations. Results Vulnerability is context-specific from a Law Enforcement perspective, and person-specific from a Public Health perspective. Definitions of vulnerability are at best fragmented, while models for assessing vulnerability lack uniformity across LEPH. The implications are two-fold. For “vulnerable groups”, the lack of an evidence-based definition and assessment model could prevent access to relevant LEPH services, exacerbating issues of multiple vulnerabilities, co-morbidity, and/or dual diagnosis. All could inadvertently enable social exclusion of vulnerable groups from political discourse and policy interventions. The lack of consistency regarding vulnerability may result in reactive crisis responses as opposed to proactive preventative measures. Conclusions This scoping review exposes the complexities associated with defining and assessing vulnerability from a LEPH perspective, which are perceived and prioritised differently across the organizations. Future research must bridge this gap. Building on the establishment of a definition of vulnerability within the empirical literature, researchers ought to engage with service users, LEPH staff, and those engaged in policy making to craft effective vulnerability definitions and assessment models. Only through evidence based, co-produced definitions and assessment models for vulnerability can we ensure that best-practice, but also meaningful and feasible practice, in vulnerability assessment can be achieved.

Co‐creation of five key research priorities across law enforcement and public health: A methodological example and outcomes

“…Considering LEPH practice, there has been recognition of need for partnership working (Christmas & Srivastava, 2019). However, few studies have explored partnership working from a LEPH theoretical lens (Enang et al., 2019; Shepherd & Sumner, 2017), and so there is relatively little empirical evidence about combined public health and policing interventions. This paper adds to the scant empirical evidence in this area, by extending the discussion on the imperative for partnership working across LEPH, as reported by Heyman and McGeough (2018) and Martin and Thomas (2015) in the Journal of Psychiatric and Mental Health Nursing.…”

“…This will be followed by an overview of vulnerability research across LEPH. Vulnerability has no shared definition in the LEPH literature (Enang et al., 2019), and for the purposes of this paper, a broad definition will be adopted: everyone can be vulnerable and this will vary depending on the context, the situation and across the person's lifespan.…”

“…Despite vulnerability appearing within a myriad of policy documents, directives and being noted as a priority area for LEPH professions, as detailed above, there is, as yet, no shared definition of vulnerability across LEPH research or practice (Enang et al., 2019). This, at best, means that shared understandings will be muddied and a loss in meaning may occur.…”

“…In a recent scoping review, Enang et al. (2019) identified that there was no clear or shared definition of “vulnerability” used across LEPH. They noted that the definition of vulnerability and operationalization of processes, assessment and policy using the adopted definition varies depending on the different LEPH professional perspectives.…”

“…While this difference is expected upon considering the approaches and academic literature underpinning their evidence base, that is, law enforcement professions (traditionally sociologically/criminological based) and health professions (traditionally person‐centred care/psychological focus), there are important implications for working practice between the groups and the lack of shared operational definitions. Poor understandings of and assessment of vulnerability inhibit shared understandings of what vulnerability means at the intersect of policing and public health, and makes the identification, assessment and management of vulnerable people challenging between LEPH professionals (Enang et al., 2019). Having such a shared understanding of vulnerability has the potential to improve communication, decision‐making and management of vulnerable people with complex needs throughout the criminal justice and health systems.…”