5th March 2020

The Royal Commission findings on Mental Health in Victoria has been released, and within the initial report, there is one standout for Policing.

The Commission calls for all mental health calls to 000 emergency to be directed to Ambulance Victoria as primary responders rather than Victoria Police and is recommended to be implemented immediately.

This recommendation should be applauded as long overdue and ironically is only revisiting a successful pilot operated by Police many years ago where the Health Professionals were the first responders and the ubiquitous “Welfare Checks” requiring Police to visit patients were abolished during the trial period. Welfare checks were done by the clinicians.

Several positives came from that pilot; most significantly, people with expertise attended to distressed patients rather than untrained Police. Incidents escalating to violence between patients and Police ceased. Families were spared the indignity of their sick relative being bundled in a Police Van like a common criminal but instead treated with dignity in an ambulance.

A few voices wanted to improve the training of Police. Still, at the time, with push back from the Police, the consensus was that this was a Health responsibility and not a Police one, albeit Police and paramedics at times will be required to assist the health professionals.

In our view, having been involved and seeing firsthand how that pilot operated, it is grossly unfair for the Commission to make the paramedics the primary responders to mental health emergencies. It should be the clinicians.

The vast majority of these episodes requiring intervention are by patients under treatment. They are known to the Health practitioners who most often have critical knowledge concerning each patient and their medication. That is essential in managing a patient having an episode and cannot be adequately managed by an Ambulance paramedic, as good as they are.

The answer is in adequately resourced Crisis Assessment and Treatment Teams (CATT) and the teams having a good working relationship with Police and ambulance alike.

The secret of the pilot’s success was that these three arms shared a mutual respect. That respect translated to better outcomes for patients, their families and the community more generally and substantially reduced the risks to the first responders.

A CATT team is a group of people who work together and includes mental health professionals such as psychiatric nurses, social workers, psychiatrists and psychologists. They are usually based in major hospitals.

It seems that not a week passes without some significant incident involving a person with Mental Health issues in conflict with Police.

Using Police as the primary responders is like using an accountant to deal with a sewage issue instead of a plumber. An inevitable unpleasant outcome often escalated from the initial problem, and everybody ends up in the “schtook”.

We all should reflect on that well-publicised incident in Preston some little while back where some Police dealt inappropriately with a mental health patient.

The police response was inexcusable but what mitigated this Police behaviour to a degree is that they were not trained and had no practised skills in dealing with somebody that is having a mental episode.

Given media reports, it would seem that the health professionals treating this patient simply rang the police rather than getting out and doing their job. Probably a matter of priorities.

As a consequence of this inaction, the patient received inappropriate care subjected to untrained Police trying to do their job, albeit questionable on a humane basis.  However, there have been severe consequences for the patient and police involved, and all this could have been avoided if the Health professional had done their job. The patient and the police are the victims, and the health professionals responsible didn’t even have to leave the comfort of their office other than to go through their Pontius Pilate routine.

When these changes recommended by the Royal Commission are being considered, the Victoria Police must take leadership to ensure that mental patients’ welfare and safety are to the fore. The safety and welfare of first responders must also be considered of paramount importance.

To move mental health episodes to the responsibility of health, not first responders, will inevitably lead to a reduction in violent actions required to be adopted by police in dealing with psychotic perpetrators.

Police may not have to shoot as many.

There will be push back from the health professionals demanding more money and more resources, which is inevitable. There may be some justification; however, the overriding change has to be in the priority given to a mental health patient experiencing or suspected of experiencing a mental episode in the community.

These episodes must move to the top of the priority tree before the resource issue is addressed; it is urgent.

If the clinicians have to drop everything to deal with a patient in the community, then so be it. Clinicians will be welcomed to the real world of first responders – it was done previously it can be done again