The Government’s ‘street triage’ initiative – which sees mental health nurses accompany police officers to incidents where people need mental health support – could reduce police detentions without increasing cost to the public purse, a new study has suggested.
Street triage aims to provide faster and more effective assessment, support and access to appropriate mental health services, and to reduce the need for people to be detained under Section 136 of the Mental Health Act (MHA).
Section 136 is a piece of legislation that allows police officers to remove a person with an apparent mental health need from a public place and bring them to a place of safety – generally a hospital or, if no hospital beds are available, a police cell.
Published in BMJ Open, the study by researchers from King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN) examined street triage’s immediate impact on detentions under Section 136 of the MHA and the costs and savings generated for the NHS and criminal justice sectors.
Using data provided by a street triage service in Sussex, the researchers compared a 6-month period before the initiative was introduced to a 6-month period after its introduction.
The Sussex service involved a dedicated police officer and a mental health nurse who were available solely to attend and respond to mental health issues. It should be noted that some other triage services take a call-centre approach, providing police with mental health professional support by telephone, with others using something in between.
Researchers found that the number of Section 136 detentions to either hospital or police custody fell by 39%, from 194 to 118. Meanwhile, detentions in police custody fell by 53% from 119 to 56.
Study co-author, Professor Sarah Byford from the IoPPN, said: “It is particularly interesting to note that street triage was only available during set hours of peak need, at the weekend and some evenings, and of the 118 detentions that happened after street triage had been introduced, only about 6 of these detentions (5%) took place during these street triage hours.
“The other 94% were detained by the police during hours when support from the street triage service was not available to them or to the people subject to these detentions. This suggests that the impact of street triage on detentions could have been even greater if the service had been available on a more regular basis.”
The study also reported that the additional cost of providing street triage was offset by savings made as a result of reduced detentions, particularly those in police custody. In other words, the service paid for itself. But while the NHS was responsible for paying the greater proportion of the cost of the street triage service, it was the criminal justice system that benefited from most of the savings.
First author, Dr Margaret Heslin from the IoPPN, said: “This is a great example of how researchers can work with service commissioners or service managers to try to evaluate programmes that do not have an evidence base. This is incredibly important for making sure new programmes that have been implemented without prior evaluation are effective and are good value for money, but even more importantly – that they are not doing more harm than good.”
But Dr Heslin added a note of caution, saying the results of their research cannot be assumed to be relevant to other types of street triage. “Further evaluation is needed to see if these alternative models are effective and cost-effective, and to find out what model of service works best, in which contexts and for whom,” she said.
This research was funded by East Sussex Joint Commissioning Unit.