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Evaluation case study: an evaluation of the Swindon Street Triage service

What was the aim of the service?

Swindon and Wiltshire Street Triage is a partnership service between Wiltshire Police and Avon and Wiltshire Mental Health Partnership NHS Trust. Mental health professionals offer advice and support to people who come to the attention of the police and may be experiencing mental health difficulties. In so doing they are reducing the number of people detained under section 136 who are not mentally ill.

The mental health professionals mainly provide advice, support liaison, information and may have direct telephone contact with a service user in crisis. The teams are able to triage and screen for assessment, support the police with any decision making and follow up plans and liaise, refer and / or signpost to other teams and organisations.

The aim of the service is to prevent offending and reduce re-offending by intervening at the earliest possible stage in the criminal justice pathway when someone is identified as having a mental illness, learning disability or dual diagnosis and is at risk of offending or re-offending.

Immediate access to a trained mental health team should reduce the need for members of the public to be taken into custody or to a place of safety.

The evaluation sought data on Swindon and Wiltshire’s Street Triage, as literature demonstrates that the use of police holding power has a detrimental effect on service user experience and workforce economics. Street triage marries healthcare provision between mental health and police services to reduce distress associated with a mental health crisis. Success of Street Triage is shown over various UK locations, whereby there has been reduction in uses of section 136 and diversion of mental health emergencies.

What resources and people were involved in the service?

The key stakeholders were the mental health team working and police officers working with / in the Swindon and Wiltshire Street Triage. The project was funded by the Avon and Wiltshire Mental Health Partnership and Swindon and Wiltshire Police.

What was the aim of the evaluation?

The aim of the evaluation was to find out how the service was working and the experiences of staff involved.

Who was involved in the evaluation?

The University of the West of England (UWE) evaluation team consisted of Professor Pam Moule – Professor of Health Services Research (Service Evaluation) and Senior Lecturers Emma Douglass, Kris Deering, Dr Lesley Lockyer and Anthony Lacny.

What did they do?

The evaluation team accessed audit data already being collected by Wiltshire Police on the number of incidents where individuals were brought to their attention where mental health was a point of concern. The data provided a record of time taken and service user journey. This data set included data captured between 2015 and 2016 related to 879 service users. These were analysed using descriptive statistics. The team collected data from 15 police officers through interview, and five members of the mental health team working with the Wiltshire police. The interviews were audio-recorded, transcribed and analysed using Designation Analysis.

What did they find?

The majority of service users; 593, were already known to mental health services. The police were involved for a number of reasons, most frequently due to concern about safety of the individual. A place of safety was considered by police on 126 occasions and 67 were detained. Those considered were significantly more likely to have had previous contact with the Swindon and Wiltshire Street Triage Team. These findings suggest that a minority of detentions took place when the Street Triage team was operational.

The analysis of interview data identified five themes:

  • expertise facilitating clinical recovery
  • freeing resources
  • awareness of street triage
  • suggested improvements and sharing information.

The Street Triage team provided a level of knowledge and expertise about mental health issues that was felt to benefit the police service and members of the public experiencing mental health and distress. There was consensus amongst the participants that police time was saved. However, the service had not been widely publicised. Sharing of information between the mental health service and the police was felt to be of significant benefit to the Street Triage service.

Who was the evaluation shared with and why?

The findings were shared with the funders and the participants to give access to the findings and recommendations for practice.

What next?

A report of the evaluation was provided to the service. This suggested that the service might be more widely advertised to the public. It was also suggested that Street Triage could provide more formal training for police officers and that an extension of the service hours might be considered.

What has changed as a result of this evaluation?

The funders have made some changes to practice as a result of the evaluation, acting on the recommendations to increase the training provision to the police officers and to more widely publicise the service. The funders are hoping to undertake further evaluation to look at the impact of these changes and undertake ongoing review of the service.

References

  • Cole, E. (2014) Street triage takes the heat out of mental health crises. Mental Health Practice. 18(3), pp. 8-10.
  • Gregory, M. J. and Thompson, A. (2013) From Here to Recovery: One Service User’s Journey through a Mental Health Crisis: Some Reflections on Experience, Policy and Practice. Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare and the Community. 27(4), pp. 455–470.
  • Krippendorff, K. (1980) Content analysis: an introduction to its methodology. Newbury Park: Sage.
  • MIND and Victim Support (2013). Police and Mental Health: How to Get it Right Locally. [online] Available at: http://www.mind.org.uk/media/618027/2013-12-03-Mind_police_final_web.pdf [Accessed 18th January 2016]
  • Riley, G., Freeman, E., Laidlaw, J. and Pugh, D. (2011) A Frightening Experience: Detainees’ and Carers’ Experiences of Being Detained under Section 136 of the Mental Health Act. Medicine, Science and the Law. 51(3), pp.164–169.
  • Wilson-Palmer, K. & Poole, R. (2015) Street triage for mental health crises. British Journal of Nursing. 24(20), pp. 1026-1027.