对受试者有什么了解?:非自愿拘留是一项立法权,允许人们违背自己的意愿进行强制性的心理健康评估,并且对患者来说是限制性和创伤性的过程。虽然有一些文献研究了警察/救护车和精神卫生工作者的共同反应模型,关于是否降低精神病患者非自愿拘留率的结论好坏参半。警察,救护车,临床医生早期响应(PACER)模型是三响应心理健康危机响应小组的一个例子,其作用是响应和评估被认为正在经历心理健康危机的人。与标准的警察和/或救护车响应相比,几乎没有文献可以确定PACER三响应模型是否减少了非自愿拘留事件。这篇论文对现有知识有什么帮助?:这篇论文描述了由PACER团队评估的患者的结果,与由警察或救护车评估的患者进行比较。它表明,PACER可以通过专家心理健康评估来减少不必要的非自愿拘留,以帮助来急救服务的患者。这是研究三响应模型的仅有的两项已发表的研究之一。实践的含义是什么?:这项研究的结果可能会支持卫生和警务政策制定者实施PACER模型作为减少非自愿拘留的手段,减少对急诊科的需求,减少紧急服务对经历心理健康危机的人的反应所花费的时间,并改善患有精神疾病的人的结果。
■背景:非自愿拘留是实施心理健康评估和治疗的一种常见方法;然而,这与不良的患者预后以及高的急诊服务和医院需求有关。
目的:研究(1)警察、救护车,临床医生,早期反应(PACER)模型,(2)警察或(3)救护车反应和非自愿拘留精神病患者的比率。
方法:一项回顾性观察研究,使用澳大利亚城市的常规管理数据,在12个月内(2019-2020年)。
结果:在12个月的时间内,8577人在研究环境中接受了危机心理健康干预。我们观察到被警察非自愿拘留的相对风险增加了18%,被救护车扣留的相对风险增加了640%。PACER团队拘留了他们总演讲的10%,相比之下,警察和救护车分别占12%和74%。PACER颁布的非自愿拘留更有可能转换为拘留后住院(72%),与警察(27%)和救护车(17%)相比。
结论:与警察和救护车的反应相比,PACER与较低的非自愿拘留率和较高的拘留后住院率相关。
结论:PACER队列比警察或救护车队列更积极。
WHAT IS KNOWN ON THE SUBJECT?: Involuntary detention is a legislative power that allows people to be taken against their will for a mandatory mental health assessment and is known to be a restrictive and traumatizing process for patients. While there is some literature examining police/ambulance and mental health worker co-response models, the conclusions are mixed as to whether they reduce rates of involuntary detentions in mentally ill people. The Police, Ambulance, Clinician Early Response (
PACER) model is an example of a tri-response mental health crisis response team whose role is to respond and assess people thought to be experiencing a mental health crisis. There is little literature to determine whether
PACER tri-response model reduces incidents of involuntary detention when compared with standard police and/or ambulance responses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes the outcomes of patients assessed by a
PACER team, compared with patients who were assessed by police or ambulance. It demonstrates that
PACER may reduce unnecessary involuntary detentions through expert mental health assessment for patients coming to emergency services for assistance. It is one of only two published studies examining a tri-response model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this study may support health and policing policymakers to implement
PACER models as a means of reducing involuntary detentions, reducing demand for emergency departments, reducing time spent by emergency services responding to people experiencing mental health crisis and improving outcomes for people with mental illness.
UNASSIGNED: BACKGROUND: Involuntary detention is a common method of enforcing mental health assessment and treatment; however, it is associated with poor patient outcomes and high emergency service and hospital demand.
OBJECTIVE: To examine the association between (1) Police, Ambulance, Clinician, Early Response (PACER) model, (2) police or (3) ambulance response and rates of involuntary detention of mentally ill people.
METHODS: A retrospective observational study using routine administrative data in an Australian City, over a 12-month period (2019-2020).
RESULTS: Over a 12-month period, 8577 people received crisis mental health intervention in the study setting. We observed an 18% increase in the relative risk of being involuntarily detained by police, and a 640% increase in the relative risk of being detained by ambulance. The PACER team detained 10% of their total presentations, as compared with 12% by police and 74% by ambulance. Involuntary detentions enacted by PACER were more likely to convert to a post-detention hospitalization (72%), when compared with police (27%) and ambulance (17%).
CONCLUSIONS: PACER was associated with lower rates of involuntary detention and higher rates of post-detention hospitalization when compared to police and ambulance response.
CONCLUSIONS: PACER cohort experience more positive outcomes than with police or ambulance cohorts.