Police, Ambulance, Clinician Early Response (PACER) model and involuntary detentions

Background: Involuntary detention is a common method of enforcing mandatory mental health assessment for people experiencing mental health crisis in the community. However, it is associated with poor patient outcomes, high emergency service and emergency department demand, and restrictive practice which can cause trauma and distress. The primary aim of this study was to examine the association between a novel Police, Ambulance, Clinician, Early Response (PACER) model and involuntary detentions when compared with standard police and ambulance response to mental health crisis.

Methods: We used a retrospective observational study design using three cohorts (PACER, police, ambulance). Our sample included all mental health crisis presentations in an Australian metropolitan city from December 2019 to December 2020 that were responded to by PACER, police or ambulance services (n = 8577). Risk of involuntary detention was examined using Relative Risk (RR) in each cohort. We used logistic regression to estimate the probability of being involuntarily detained or diverted from hospital using an odds ratio (OR) using Gender, Age and primary presenting condition as independent variables.

Results: Over a 12-month period 8,577 people received crisis mental health intervention in the ACT. 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%).

Conclusion: PACER was associated with lower rates of involuntary detention of people experiencing mental health crisis when compared to police and ambulance response.