Methodological and practical challenges of undertaking a Randomised Controlled Trial in a non-clinical setting 11th annual Randomised Controlled Trials in the Social Sciences Conference 7-9 September 2016

Presentation Outline Background The CONNECT project Challenges of conducting a trial in the police setting The result: a pragmatic RCT

Background In the UK, 1 in 4 people suffer from mental health problems annually (MIND, 2016) The police are often the first contact for individuals with mental health problems (NPIA, 2010) Mental Health Crisis Care Concordat (DoH and Concordat signatories, 2014) Section 136 of the Mental Health Act (The Stationary Office UK)

Background Police officers are not and should not be experts in mental health However, they have to manage complex problems with insufficient training (Mental Health Cop, 2016) There are gaps in knowledge and variations in training received (Her Majesty’s Inspectorate of Constabulary, 2013) No high quality evidence evaluating mental health training within the police context exists

The CONNECT project Co-production of policing evidence, research and training: focus mental health The Police Knowledge Fund: encouraging collaboration between academia and police forces £1million project funded by the Higher Education Funding Council for England (HEFCE) and the Home Office through the College of Policing

The Connect Project North Yorkshire Police and the University of York Work streams: A series of systematic reviews Understanding inter-agency working Research methods training for North Yorkshire Police (NYP) officers An RCT to assess the effectiveness of a mental health training intervention for frontline police officers

Challenge 1: Population Understanding the geographical and operational structure of NYP – Spread and size of stations – Types, number and duties of frontline officers

Challenge 2: Intervention Understanding existing training provision at national, regional and local levels Collaborating with the College of Policing Delivering training to NYP

Challenge 3: Outcomes (1) Agreeing outcomes that were meaningful and achievable – Identify mental vulnerability – Record relevant information using available systems – Respond using appropriate internal and external resources – Refer vulnerable people into services to provide longer-term assistance – Review incidents to make sure that risks have been effectively managed

Outcomes (2) Issues with routinely collected data – Various IT systems, which are not integrated – Staff access to IT systems – ‘The Scarborough Pilot’ – ‘Frequent’ callers Terminology – Flags, tags and warning markers Vetting of York Trial Unit staff

A pragmatic RCT To assess the effectiveness of a face- to-face mental health training intervention delivered by mental health practitioners to frontline officers compared with routine training

A pragmatic RCT Pragmatic cluster RCT Clusters minimised contamination between police officers and stations Officers work in pairs Minimal interaction between officers at different stations

A pragmatic RCT Interventionn=6 Control n=6 Routinely collected trial data Online Survey Routinely collected trial data Online Survey Routinely collected data Online Survey Qualitative interviews Routinely collected data Online Survey Eligible Police Stations n=12 Randomisation of police stations (n=12) Specialised mental health training package Routine Training Baseline measures Intervention Post- intervention measures Eligibility: Two stations within each Safer Command Area with the largest number of frontline officers Not feasible to train 50% of NYP stations Greater movement of officers within smaller stations Smaller stations have fewer staff and irregular opening hours Randomisation: Statistician at YTU Minimisation to ensure balance Factors considered included: street triage, geographical area and cluster size Outcomes: Number of telephone calls which result in a police response received by the NYP control room Number of incidents with section 136 applied; number of incidents with mental health tags applied; number of incidents with a mental health flag applied from each call and number of frequent callers

References Department of Health and Concordat signatories. (2014). Mental Health Crisis Care Concordat Improving outcomes for people experiencing mental health crisis Her Majesty’s Inspectorate of Constabulary CQC, Her Majesty’s Inspectorate of Prisons, and Healthcare Inspectorate Wales. A criminal use of Police Cells? The use of police custody as a place of safety for people with mental health needs. June 2013 Mental Health Act 1983 Section 136. The Stationary Office. UK: Mental health cop: a venn diagram of policing, mental health and criminal justice. (2016). Available [online] roles-explained/ roles-explained/ MIND, for better mental health. (2016). Mental health facts and statistics. Available [online]: support/types-of-mental-health-problems/statistics-and-facts-about- mental-health/how-common-are-mental-health-problems/ support/types-of-mental-health-problems/statistics-and-facts-about- mental-health/how-common-are-mental-health-problems/ National Policing Improvement Agency on behalf of the Association of Chief Police Officers. (NPIA) (2010). Guidance on responding to people with mental ill health or learning disabilities

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