Police Referral to Psychiatric Emergency Services and Its Effect on Disposition Decisions

Abstract

Objective: Some clinicians and researchers have questioned the appropriateness of police referrals to psychiatric emergency services and have suggested that police exercise undue influence on hospital admission decisions. The purpose of this study was to test these assertions. Methods:Research clinicians in nine emergency services in California observed staff evaluations of 112 cases and rated patients' symptom severity, danger to self or others, and grave disability. They also reviewed the criminal justice records of these patients both before and for 18 months after the index evaluation. A total of 186 patients referred by police were compared with 577 patients not referred by police.Results: Patients brought by police were more likely to be subsequently hospitalized, but they were also more psychiatrically disturbed. They were more dangerous to others and more gravely disabled. They were no more likely to have a criminal record than patients not referred by police. Conclusions:Police did not exercise undue influence on dispositions nor were the patients they brought in more "criminal" than others.Police officers have been called the primary referral source for psychiatric assistance in the community (1,2) and are among the most important providers of front-line crisis intervention, particularly for poor and underprivileged persons (3,4). To understand how emergency room personnel make decisions to hospitalize persons with psychiatric disorders, several authors have investigated referrals by police officers and have reported that a large proportion of such admissions are police referrals (5,6). Some authors have even suggested that police exercise undue influence over admission decisions (7). Psychiatric emergency service staff often view patients referred by police as "their most undesirable cases: hostile, aggressive young males" (8). Some authors have assumed that police referrals to emergency rooms represent an effort to hospitalize people who are really criminals (9,10). Steadman and associates (8,11

The use of a brief mental health screener to enhance the ability of police officers to identify persons with serious mental disorders

“…The results of the pilot study are consistent with the literature in that police officers tend to focus primarily on violence potential and issues of public safety (Broussard et al, 2010;Citrome & Volaka, 1999;Kneebone et al, 1995;Lee et al, 2008;Lyons et al, 1997;Marson et al, 1988;McNiel et al, 1991;Meadows et al, 1994;Mulder et al, 2005;Redondo & Currier, 2003;Reinish & Ciccone, 1995;Sales, 1991;Watson et al, 1993;Way et al, 1993). However, unlike previous research, which is based almost exclusively on hospital records of ED presentations and admissions, the current study used data obtained from police officers.…”

“…They are primarily concerned with potential for harm to self or others because their legislative authorities emphasize violence potential (see for example, S. 17, MHA, Ontario, 1990). A number of studies confirm that the most common characteristic associated with PSMD referred to hospital by police officers is violent or aggressive behavior toward self or others (Broussard, McGriff, Demir Neubert, D'Orio, & Compton, 2010;Citrome & Volaka, 1999;Kneebone, Rogers, & Hafner, 1995;Lee, Brunero, Fairbrother, & Cowan, 2008;McNiel, Hatcher, Zeiner, Wolfe, & Myers, 1991;Meadows, Calder, & Van Den Bos, 1994;Redondo & Currier, 2003;Reinish & Ciccone, 1995;Sales, 1991;Watson, Segal, & Newhill, 1993;Way et al, 1993).…”

Patient-Disease Characteristics and Coping Strategies Predict Hospitalization in Emergency Psychiatry

“…Overall, patient-disease characteristics allowed for correct classification of almost 70 percent of cases. So far, we had replicated the findings of earlier studies demonstrating the influence of previous hospitalizations and other aspects of the patient's psychiatric history [9,40], the way of referral [10,36,[41][42][43][44][45][46][47][48], and particularly diagnosis and the patient's current behavior [9,10,18,19,40,49]…”

Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness

“…In one large midwestern city, more than half of the ocers had responded to at least one of these calls in the preceding month (Gillig, Dumaine, Stammer, Hillard, & Grubb, 1990), and nationally, on average, medium and large police departments estimate that about 7% of their contacts involve people with mental illness (Deane, Steadman, Borum, Vesey, & Morrissey, 1998). Given the frequency of these encounters, it is not surprising that police are a primary referral source for psychiatric emergency departments, providing up to a third of all mental health referrals (Doyle & Delaney, 1994;McNiel, Hatcher, Zeiner, Wolfe, & Myers, 1991;Meadows, Calder, & Van den Bos, 1994;Sales, 1991;Watson, Segal, & Newhill, 1993;and Way, Evans, & Banks, 1993).…”