The Co-Response Team (CRT) initiative, devised and piloted in Wellington over 2020/2021, has the potential to be a gamechanger for frontline police teams that continue to struggle with the rise in mental health-related calls for service over the past decade.

The model, the first of its kind in New Zealand, combines the skills of a police officer, a paramedic and a DHB mental health specialist to respond to IM and IX callouts.

It has proved a resounding success, including endorsement from grateful frontline police and a tick of approval from a year-long Otago University evaluation that noted the value of accessing the knowledge of “three brains”.

CRT programme lead Senior Sergeant Matt Morris, who is a district shift commander at Wellington Central, says New Zealand police have for too long “been left holding the baby” when it comes to mental health.

“Our mental health response is several years behind police forces in other countries. We are playing catch-up now, but at least we can look to approaches taken overseas, including the CRT model.”

He has no doubt about its effectiveness. “Every single day, this team resolves incidents that no other team in New Zealand could do, multiple times a day.”

The Otago University evaluation reported that:

• During the days the CRT worked a shift in Wellington, fewer than a third of all “service users” (32%) attended the emergency department (ED), compared with close to half on days there was no CRT available (45%).
• On average, service users waited in the ED for 32.5 fewer minutes on days when the CRT was on duty.
• In the month after CRT interventions, people were significantly less likely to re-present to ED compared with the control group.
• Most CRT callouts resulted in the person remaining in the community with 75 per cent of these being referred to a crisis resolution service, mental health teams, GPs, Work and Income or NGOs.

In 2020/21, police attended more than 70,000 IM (mental health) and 1X (threat of suicide) incidents, a 10 per cent increase on the previous year. In its 2020/21 annual report, Police said staff were unable to keep up with demand and half of all such calls for service were cancelled in favour of higher priority emergency events. Mental health-related events had increased by 60 per cent over the past five years and were predicted to increase by a further 44 per cent by 2025.

It’s a situation that no one is happy about and an issue that Matt was acutely aware of back in 2011-2012 when he was managing the Wellington District Custody Unit where they dealt with about 700 mental health patients a year.

It was a drain on police resources, and often had poor outcomes for distressed people who were either detained in police cells or spent hours waiting in EDs, accompanied by a police officer, before they could be assessed and assisted.

Matt’s concerns led him to reach out to the DHB in search of solutions and eventually to joining the fledgling mental health team at PNHQ, where he and his team worked on a CRT model that was eventually accepted for the pilot in Wellington District, in conjunction with the DHB, in 2020.

Matt says the co-response team model is unique in terms of mental health because “for the first time in New Zealand Police’s history, we have employed multiple agencies on the scene as an emergency response”.

There are five people in the team. If everyone is available, the CRT is split into two sections. One is the three-person response arm – the police officer, the paramedic and the DHB mental health specialist (who is also a duly authorised officer, legally able to appropriately detain people under the Mental Health Act). The remaining team members provide support from the office.

Matt offers the following examples of the value of a wraparound service for dealing with complex mental health issues at the point of contact.

A woman suffering from chronic paranoia who believed she was being stalked by her neighbours went to a nearby property with a large kitchen knife sticking out of her pocket. PST attended and requested CRT attendance. They established that the woman had a long history of refusing to engage with mental health services and had never been properly
assessed.

CRT attended and, using the Mental Health Act, were able to take her, and her dog, to a local mental health service. She is now in a mental health ward for the first time and frontline staff and the woman’s family are grateful for an intervention that was long overdue.

A 42-year-old woman with an intellectual disability and chronic 1M behaviour called police from a bridge to say she was thinking about jumping. PST located her and requested an ambulance for a minor hand injury she had suffered. The CRT intervened, reviewed the situation and, coordinating directly with mental health services, arranged for her to be seen by her local mental health team instead. This saved an ambulance being dispatched or a long drive to ED.

“The issue for 1M and 1X calls,” says Matt, “is that the vast number of jobs we attend are in the ‘low to moderate’ category even through they come through the 111 system. We know from the CRT data that 75 per cent of our 111 mental health demand is from people who have been, or are being, managed by another agency, and those agencies have extensive information on them. This means better outcomes for those people.

“Outside of this model, you would deploy police officers whose only source of information is NIA.”

Matt says frontline police see huge value in a model that means they don’t have to spend long hours in ED and are therefore free to attend other jobs. “For the first time, staff have someone they can talk to within the Police who can operationally help them.”

It’s now considered such an integral part of frontline services in Wellington that the trial has been extended so as not to lose the experience the team have built up.

The Otago review noted that the “three brains” approach meant the CRT could offer more individualised solutions.

Other districts are getting on board, with trials under way in Southern and Counties Manukau. Taranaki is seeking funding for a trial from the Proceeds of Crime kitty.

Matt says the pressure is on to expand the service in Wellington as it is currently restricted to working day shifts to fit in with the availability of other agencies and services.

He notes the irony of the model’s success. “Ultimately, Police want to extract us out of the mental health space, but the big question is always how to do that. We know that unless police are willing to work in this space, we will always get calls from the high-needs users.

“Mental health services are based on a therapeutic model. They are not a behaviour management service, and much of the demand, in fact, is behaviour driven, which is often what needs addressing to reduce demand. The trick is to influence the mental health service, by using our skills, but not to get too drawn into it.”

Brett Calander, the current manager of mental health and community services for Police, says the balancing act is to provide the best service for people experiencing mental distress while at the same time lowering demand on police. “Police alone might provide a good service, but it’s not necessarily our role or the best use of police resources and police aren’t always the best people to respond.

“Working with partners widens our experience and options for a person in mental distress, and not revictimising them by having them in our cells. If they had a broken arm, there is no way we would take them to the cells, but that’s where they can end up if they are mentally unwell.”

This year, Brett says, Police and its partners are preparing a joint proposal for the Government in support of the CRT model being rolled out nationwide.

It’s a move that is backed by the Police Association. President Chris Cahill says the CRT initiative needs to be taken seriously by all political parties as part of the response to the mental health crisis the country is facing.

“A nationwide CRT approach would relieve police officers of situations they are rarely well equipped to deal with and, most importantly, will secure the right care for those who need it as quickly as possible.”
- ELLEN BROOK