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How co-locating with the police can reduce avoidable ED use

June 23, 2017

    One in eight emergency department (ED) visits is associated with a behavioral health issue. These visits are not only costly to the system, they are often unnecessary and preventable.

    A key driver of many of these visits is the shift away from providing services in psychiatric institutions to providing them in community-based settings—but limited funding for community-based programs has left individuals with behavioral health problems struggling to access care.

    Police lack knowledge of care options beyond ED

    While the ED is not the right site of care for individuals in mental health crisis, it is often the only option available. Sometimes, the decision of where to go for care is not even in the patients own hands. Police responding to behavioral health calls frequently select the ED as what they perceive to be the safest and most straightforward site of care for individuals in crisis because of limited knowledge about and access to behavioral health expertise and alternative care options.

    When the Australian state of Victoria realized that many of their patients in psychological distress were brought to the ED unnecessarily by the police, they set up a partnership between their hospitals, police departments, ambulance services, and mental health services. They call it the Police, Ambulance and Clinical Early Response program (PACER).

    Behavioral health-police dyads improve access to care

    In the PACER program, a behavioral health clinician partners with a police team to support individuals with behavioral health needs. The clinician is either based in the police department or remains in the hospital on call.

    When the police respond to a behavioral health call, the clinician accompanies the PACER police team. Once on scene, the clinician is able to assess the person and determine the best course of care. In many cases, the clinician is able to de-escalate the situation and connect patients to available services in the community, thereby avoiding a trip to the ED.

    If the clinician determines that hospitalization is necessary, the patient is fast-tracked to the mental health unit, space permitting, again bypassing the ED.

    Partnership reduced unnecessary ED utilization among individuals in psychological distress

    The PACER model has seen tremendous success. Only 18.8% of patients identified via the PACER police unit are transported to the ED, compared to 81.5% of patients identified via regular police units.

    Partnering with the police is just one example of how hospitals can collaborate with other entities to improve care for vulnerable patients, engage consumers, and improve quality. Check out our new briefing, Building the Business Case for Community Partnership, to learn about four steps for building effective community partnerships.

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