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You are here: Cabinet PapersReview of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System, Paper Two: The Police Setting

Paper 24: Effective Interventions: Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System, Paper Two: The Police Setting

PURPOSE

  1. The purpose of this paper is to provide Cabinet with background information on the situation Police face in detaining people in their watch-houses. It outlines the key issues, and outlines two proposals. One proposal is to review the mental health nurse initiative currently operating in the Rotorua watch-house, and the other is to set up two further pilots of a similar nature.
  1. The paper invites Cabinet to note the recommendations relating to the Police setting listed in Cabinet Paper One: Overview.

EXECUTIVE SUMMARY

  1. This is the second of five papers proposing initiatives that aim to:
  • enhance the social functioning and mental health of offenders
  • assist in reducing their rate of AOD addiction and AOD addiction-related harm
  • assist in reducing their re-offending.
  1. The Police interface with offenders with mental and AOD problems in the usual course of their work. However, the Police considered the most serious situations occur when they are holding people with mental health and/or AOD problems in their watch-houses. The main issues they identified were as follows.
  • While Police officers are trained in first aid and custodial management, the level of care required of intoxicated people and those with mental health conditions often exceeds the expertise of Police.
  • Despite the provision in section 37A of the Alcoholism and Drug Addiction Act 1966 for detoxification centres, none exist. Police are the only agency that presently provides a place for intoxicated people to be held under the Act.
  • Arrested or detained people with mental health problems are often difficult and time consuming for the Police to manage.
  • The Police cell environment can be detrimental to the wellbeing of people with mental health problems. International literature suggests that incarceration of people with mental health issues can result in an exacerbation of their problems.
  1. Police come into contact with more offenders than other agencies in the criminal justice system. An opportunity for providing access to mental health/AOD services arises when a person is held in Police cells. However, currently no consistent or comprehensive intervention exists in Police cells for people with mental health and/or AOD problems.
  1. We consider that many of the mental health and AOD issues confronting the Police could be alleviated by placing mental health nurses with AOD training in Police stations. By establishing such an initiative in the Police setting, detained people with mental health and/or AOD problems would have an opportunity to be referred and linked to agencies for the treatment they need. International literature indicates that providing treatment to offenders with mental health and/or AOD issues will also assist in reducing their re-offending and imprisonment rates.
  1. Over recent years the Rotorua Police Station has had a mental health nurse (without AOD expertise) in their watch-house to assist with the care of people held in their cells. We propose a review of this initiative. The review will provide information on how the nurse operates in a watch-house environment, whether the objectives of having a nurse at the station are being met, and, if so, how the initiative could be improved and extended.
  1. We also propose that a pilot, based on a more comprehensive version of the Rotorua initiative, be established in two other Police stations and subsequently reviewed.
  1. This initiative is primarily aimed at enhancing the social functioning and mental health of people held in the watch-houses by ensuring they are managed more safely during their time in the watch-house.

BACKGROUND

  1. The background to the interface review is detailed in Cabinet Paper One: Overview.

The Police Setting

  1. The Police complete a 'Custody Charge Sheet' for every arrested or otherwise detained person brought into the watch-house for processing through to the court if they have been arrested, or otherwise held for safety reasons. The Custody Charge Sheet includes a Health and Safety Risk Evaluation. The purpose of this evaluation is to ensure that people who have been identified as being "in need of care" or "in need of care and constant monitoring" receive the necessary attention.
  1. Medical interventions may also be required for a range of issues, including mental health and AOD matters, blood samples for Excessive Blood Alcohol offences, and first aid for cuts and bruises.
  1. People held in the watch-house also have to be segregated for safety reasons. For example, youth offenders have to be segregated from adult offenders; and women from men. Suicidal people are separated from other offenders, as are violent offenders.

Alcohol and Other Drugs

  1. Every year approximately 200,000 people are arrested in New Zealand. A significant number of people are under the influence of AOD at the time of their arrest. For example, 51% (496) of the participants in a Police research project[1] conducted in four watch-houses from June 2005 to June 2006, reported that they had been using at least one drug at the time of their arrest.[2] More than 50% of the users of all drugs (excluding cannabis) indicated that their drug use had contributed to their involvement in criminal activity.[3]
  1. Police are empowered under section 37A(2)(a) of the Alcoholism and Drug Addiction Act 1966 to take people found intoxicated in a public place to their home or to a temporary residence. However, if their address cannot be ascertained, or if it is not safe to leave the person, the officer may take, or cause that person to be taken, to any temporary shelter or detoxification centre under section 37A(2)(b). If neither course of action is practicable, the officer can detain, or cause that person to be detained, in a Police station for any period not exceeding 12 hours under section 37A(2)(c) or 37A(2A). Under section 37A(3) if after 12 hours the person is still so intoxicated that they are incapable of looking after themselves, the Police may take the person to a temporary shelter or a detoxification centre.[4]
  1. Despite the identification of potential "temporary shelters or detoxification centres" in the Act, such centres do not exist. Therefore, when Police find an intoxicated person in a public place, Police cells are the only place for these people to go to if they do not have a sober person who will take care of them.
  1. During 2005, Police recorded 15,358 instances where intoxicated people needed to be detained in Police custody, or where Police time was used to take people home. This volume of cases places a heavy demand on Police resources, usually at peak periods for crime and disorder (evenings and weekends). In 2005, it equated to 16,000 Police hours, or about $1.26 million of officer hours.

Mental Health

  1. Under section 109 of the Mental Health (Compulsory Assessment and Treatment) Act 1992, Police may apprehend a person appearing to be mentally disordered in a public place. Under this section, Police can take a person to a Police station, hospital, or surgery, or to some other appropriate place and arrange for a medical practitioner to examine the person at that place as soon as possible. Police can hold people under this section for up to six hours or until they are assessed, whichever occurs first.
  1. If the medical practitioner considers that there are reasonable grounds for believing that the person may be suffering from a mental disorder, the medical practitioner must, as soon as possible, issue a certificate under section 8(4)(b), and make an application for a full assessment under section 8A of the Act.
  1. If the medical practitioner decides that the person is not sufficiently ill for assessment or compulsory treatment under the Act, the person is left with the Police who must then release the person if they have not committed an offence. Generally, people detained by Police under section 109 of the Act have mental health problems, but not to the level to warrant further assessment and compulsory treatment. Treatment or support for the person is often the best option, but the Police do not always have the time or resources to link these people into mental health services and/or social services.[5]
  1. In the 2005/06 financial year the Police recorded 8,373 "mental health incidents". These people had not committed offences but nevertheless criminal justice resources were used to deal with such incidents.

Other - Suicide

  1. Police are also empowered to detain people to prevent suicide under section 41 of the Crimes Act 1961. There are no figures available on how often these people are detained in the Police watch-houses.

ISSUES

Alcohol and Other Drugs

  1. In December 2006, the Ministries of Health and Justice organised a Police focus group to discuss issues for Police when dealing with people with mental health and/or AOD problems. The attendees focussed on the situation in the watch-house noting that detaining intoxicated people raises a number of concerns, for example:
  • Intoxication may confound other serious health issues in arrestees/detainees. While Police are trained in first aid and custodial management, they are not clinically qualified to deal with high risk medical situations. Police have the ability to seek assistance from on-call GPs, but GPs can take some time to arrive at a Police station and are costly for the Police.
  • The availability of agencies with staff with medical training to provide appropriate support to Police do not typically match the times when intoxicated people are usually detained (weekends and evenings).
  • Crisis Assessment and Treatment (CAT) teams are reluctant to undertake mental health assessments of intoxicated people, so Police end up caring for intoxicated people who may also have serious mental health issues which are confounded by intoxication.[6]
  • The 12 hour limit for detaining people in the Alcoholism and Drug Addiction Act 1966 is not long enough for people under the influence of certain drugs (such as methamphetamine) to recover. Although Section 37A(2)(c) of the Act recognises that after 12 hours a person may be incapable of properly looking after themselves, the Act only authorises Police to take the person to a temporary shelter or detoxification centre. Because no such facilities exist, Police must release the person after the 12 hour time limit has elapsed unless the person can be held under some other statutory provision.
  • If a detained person is an alcoholic or a drug addict, forced detoxification in a medically unsupervised setting may cause serious health problems and could be fatal.
  • There are no specific AOD clinicians/teams Police can call upon for advice or an assessment of a person held in a Police cell.
  • Many of the people with AOD problems are socially needy and some are homeless. A high proportion of these people also have mental health problems. Police do not have the resources or time to link these people into other social services while they are in custody.

Review of the Alcoholism and Drug Addiction Act 1966

  1. The Ministry of Health is currently reviewing the Alcoholism and Drug Addiction (ADA) Act 1966. The review will examine:
  • the history of the ADA Act
  • details of past work undertaken to repeal or review the Act
  • current use of the Act, and problems with its use
  • similar legislation in other overseas jurisdictions
  • issues to be resolved before the Act can be repealed or amended.
  1. The Minister of Health will be provided with options for the repeal or amendment of the ADA Act by 30 June 2007.
  1. The Ministry of Health's review of the Act may have implications for the way Police and/or other social agencies manage intoxicated people. Although it is unlikely to change the responsibility Police have to respond and/or intervene when intoxicated or drug addicted people present in public places, it could provide some opportunities to involve other social agencies in the task of holding intoxicated persons in places other than the watch-house. It may be possible to consider establishing wet houses at least in the major metropolitan centres. The cost of such centres is unlikely to exceed the current costs of detaining intoxicated persons in police cells.

Mental Health

  1. The Police focus group noted the following concerns containing people in the watch-house with mental health problems, for example:
  • Arrestees/detainees with mental health problems are often difficult for the Police to manage, and Police lack clinical training/advice on the most appropriate ways to respond to the needs of people with mental health problems.
  • For arrestees/detainees with mental health problems, being held in Police cells can often exacerbate their problems. This can occur as a result of the potentially stressful situation of being in a cell.
  • The mental health problems and behaviour of some arrestees/detainees may have contributed to or exacerbated their offending. In some situations diverting these people to treatment rather than charging them with criminal offences may be more appropriate.
  • Some arrestees/detainees are too much of a risk for the Police to transport to a mental health service. Police often have to wait for several hours for busy CAT teams to come into stations and assess people.
  • Some CAT Teams want to provide advice on a diagnosis over the phone. In most instances this occurs when the person's illness is perceived as age-related (e.g. dementia if the person is over 60, or rebellious behaviour if the person is a teenager), or when they are intoxicated. However, the Police find that receiving advice in this manner does not help them understand or manage the person appropriately.

Other - Suicides

  1. Suicidal people need to be monitored closely when held in Police cells. Sometimes the Police employ security guards to monitor these people on a one-on-one basis. This creates a risk for Police as the security guards are not trained or qualified to provide medical care.

PROPOSALS

Review of the Rotorua Police Station Mental Health Initiative

  1. Since December 2001, a mental health nurse has been located at the Rotorua Police Station to assist Police with arrestees/detainees who present with mental health issues. When established, the objectives of the role were to:
  • improve liaison and communication between Rotorua Police and Lakeland Health Mental Health Services
  • educate Police staff about mental health issues
  • assist police when visiting mental health clients
  • ensure client and community safety is maintained.
  1. The nurse at the Rotorua Police station is contracted by Lakes District Health Board (DHB) to work with people with mental health problems during normal working hours. Back up for after hours work is undertaken by the local CAT team.
  1. If a person presents at the Police station with dual-diagnosis (i.e. mental health and AOD problems), the nurse will assist with both issues. However, the nurse is not contracted to assist people with only AOD problems.
  1. Officials from the Ministry of Justice and the New Zealand Police visited the Rotorua Police Station and Lakes DHB managers. Officials received anecdotal feedback that the service has been valuable to the Police and the DHB, and beneficial for arrestees/detainees. Although the service has been operating for six years and is being expanded to police stations at Taupo and Turangi, it has not yet been reviewed.
  1. We propose that the New Zealand Police, in consultation with the Ministries of Health and Justice, review the mental health initiative operating in the Rotorua Police Station, to provide an overview of how the scheme operates, the impact that it has had, and improvements that could be made. The New Zealand Police support this proposal. The review should be completed and a report referred to the Ministers of Police, Health and Justice by 31 December 2007.

Mental Health/AOD Nurse in Police Stations

  1. In interviews undertaken by the Ministries of Health and Justice, stakeholders noted the need for a mental health nurse with training in AOD to assist the Police in looking after people in the watch-house. We agree that the mental health and AOD issues confronting Police could be alleviated by placing nurses with relevant training in Police stations. For example, a nurse could:
  • screen arrestees/detainees for mental health and AOD problems
  • liaise between mental health and AOD service providers, the Police, the Courts, local iwi and families/whānau
  • connect people to other social services if possible and appropriate
  • monitor cells to ensure intoxicated detainees are not at risk
  • educate or provide advice to Police Officers about the needs of people with mental health problems and/or AOD problems and statutory requirements
  • assist the Police in the decision as to whether a person should be considered for diversion.
  1. The literature review[7] revealed that such models currently operate in England. These schemes involved having a psychiatric nurse based in Police stations to provide on-the-spot mental health assessments of detainees as well as providing liaison between Police officers and treatment service agencies. These models have not been evaluated.
  1. We consider that having a mental health/AOD nurse located at the Police Station will assist the Police to better manage the risks associated with those in the custody of the watch-house. It will reduce the risk of serious harm to detainees, and the exacerbation of mental illnesses. In regard to the aims of the interface review, this initiative is primarily about enhancing the social functioning and mental health of people held in the watch-houses.
  1. It is proposed that two pilot sites be established, based on a more comprehensive version of the Rotorua initiative. The pilots would test whether such a role would be useful to the Police, to local DHBs, and to people held in Police watch-houses. The New Zealand Police support this proposal.
  1. Further pilots are recommended, rather than extending the Rotorua initiative because:
  • the Rotorua scheme focuses on people with mental health problems, rather than people with mental health and/or AOD problems
  • the scheme needs to be tested in other Police stations with larger and/or different population mixes
  • considering mental health and AOD workforce constraints, the role needs to be properly reviewed and the benefits proven before roll-out to the rest of New Zealand is considered
  • to be certain that the initiative is successful in meeting its objectives, relevant baseline data needs to be collected before and after the initiative is commenced.
  1. It is proposed that the two pilots run for three years, and be reviewed six months after the first year. Baseline data must be gathered before the pilots are commenced for comparison purposes. The review of the pilots will require an assessment of the processes, and investigation of benefits to the Police and to the local DHB. A preliminary view of its benefits to detainees could also be undertaken at the same time.
  1. It is intended that this initiative be led by Police and funded by Health and Police. The review report should be referred to the Ministers of Police, Health and Justice. If successful, it is anticipated that the initiative would be extended to other major police stations in New Zealand, subject to workforce availability.

Population Group Considerations

  1. As part of the review, the Ministries of Health and Justice have examined the needs of Māori, Pacific peoples, youth and women with mental health and/or AOD issues in the criminal justice system. Paper Five: Population Groups examines the needs of special population groups across the criminal justice system. However, as the proposals in this paper cover all people in the watch-house it applies to all the above mentioned population groups.

Consultation

  1. The following agencies have been consulted on this paper: Department of Corrections, New Zealand Police, Treasury, Department of Prime Minister and Cabinet, Ministry of Social Development, Te Puni Kōkiri, Ministry of Pacific Island Affairs, and the Ministry of Women's Affairs. The Law Commission and DHB representatives have also been informed.

Financial Implications

  1. The following table outlines the financial implications of the proposals in this paper:

Item

2007/08

2008/09

Vote

Review of Rotorua Police Station Mental Health Initiative

s9(2)(j)

  

Police

Personnel costs for 4 full time mental health nurses with training in AOD (two nurses at each site, working shifts). This figure includes DHB administration and support costs.

s9(2)(j)

s9(2)(j)

Health

Accommodation at the Police Stations and operational costs.

s9(2)(j)

-

Police

Review of both pilot sites.

-

s9(2)(j)

Police

Legislative Implications

  1. This Cabinet paper has no legislative implications.

Regulatory Impact and Business Compliance Cost Statement

  1. A regulatory impact and business compliance cost statement is not necessary.

Human Rights Implications

  1. There are no human rights implications associated with these proposals.

Gender Implications

  1. The proposals will be of greater advantage to males as they compromise around 85% of those held in Police cells. However, female detainees present particular issues for the Police. For example, females are more likely than males to be on psychiatric medication and have higher rates of anxiety disorders, mood disorders, behaviours strongly associated with early-life abuse, and eating disorders. The proposals will help the Police provide a safe and medically supported environment for female detainees with mental health and/or AOD problems.

Disability Perspective

  1. The proposals will benefit people with disabilities who are also affected by mental illness or AOD needs, who are detained in Police watch-houses.

Publicity

  1. Cabinet decisions will be supported by a communications strategy.

RECOMMENDATION

  1. We recommend that the Committee:
  1. note that the recommendations that relate to this paper are contained in Paper One: Overview.
Hon Pete Hodgson
Minister of Health 		Hon Mark Burton
Minister of Justice

Footnotes

1 New Zealand Arrestee Drug Abuse Monitoring (NZ-ADAM) is a programme which seeks to measure AOD use among people who have recently been apprehended by Police. The New Zealand Police obtained funding for a one-year initial pilot of NZ-ADAM at four sites (Whangarei, Henderson, Hamilton and Dunedin), to be followed by a three-year extension should the pilot prove to be successful and useful. Data collection for the NZ-ADAM pilot programme commenced at Henderson and Whangarei in April 2005, and Dunedin and Hamilton in July 2005.

2 37.2% reported using alcohol; 20.6 were using cannabis; and 6.5% were using methamphetamines.

3 These figures are conservative because arrestees clearly under the influence of AOD had been excluded from being interviewed.

4 Note that detainees under section 37A (2) (a) have not committed an offence and not all of them fit the stereotype of chronic alcoholism.

5 It is important to note that mental health issues often co-occur with AOD misuse. For example, The National Study of Psychiatric Morbidity in New Zealand Prisons (1999) noted that 90% of those prisoners with major mental disorders also had a substance disorder. This co-morbidity is particularly difficult for the Police to manage.

6 ‘Intoxication’ or disturbed mental functioning as a result of AOD is a condition specifically excluded from the Mental Health (Compulsory Assessment and Treatment) Act 1992.

7 See Cabinet Paper One: Overview