Evidence Base Camp: Day 3 Sifting Sessions Mark Abram – Research Unit Charmian Werren – Research Unit Graham Cline – National Police Library

Research question Interventions that have been shown to be effective in supporting individuals during an acute mental health crisis

Today… 1.Present outcomes of initial searches What happened while you were away… 2.Collaboratively develop sift criteria 3.Collaborative sifting Get a view of what our search has returned Refine sift criteria if required 4.Individual sifting

From there… 18/10/2013 – ProQuest 180 Title or Abstract Tier 1 – Mental Health Crisis ("Mental ill health" OR "Mental illness" OR "Mental breakdown" OR "Nervous Breakdown" OR "Psychotic crisis" OR "Psychotic episode" OR "Mental* *capacity" OR "Depressive episode" OR Suicid* OR "Mental medical condition" OR "Unsound mind" OR "Mental disorder" OR "Psychiatric disorder" OR "Psychiatric condition" OR "Mental condition " OR Depress* OR Anxi* OR PTSD OR Panic OR Bipolar OR "Excited delirium") AND Tier 2 – Interventions (intervention* OR tactic* OR strateg* OR initiative* OR procedure* or approach*) AND Tier 3 – Acute (acute OR Major OR Serious OR Severe OR Severity OR Violent OR Intense OR Emergency OR Distress OR Inpatient OR Detain OR critical OR Event OR Incident OR Trauma OR Mani*) AND Tier 4 – Police (police OR policing OR "law enforcement") AND Tier 5 – What Works ("systematic review" OR "literature review*" OR trial* OR "RCT" OR “randomi?ed controlled trial” or experiment* OR evaluat* OR "best practice*" OR "good practice*" OR effective* OR assess* OR "What Works" OR impact* OR success*) AND Tier 6 – Crisis (crisis OR crises OR emergency OR hysteria OR acute OR attack* OR episode*)

Search development process Results with all 6 tiers in previous slide were low but not particularly relevant. So re-started the search using terms developed in camp. Initially two tiers were used: T1-Mental Health; T2-Crisis but this produced far too many hits due to the crisis terms not being associated with mental health. T1 terms were then developed as "quoted phrases" including the T1 and T2 terms (e.g. "suicid* intent*" OR "Schizophren* episode*"... etc). This was combined with an tier for Intervention and the standard tier for What Works, but we were still getting several thousand hits. Finally an additional tier for Crisis was also included to increase the relevancy of results. The search was run on Web of Knowledge (Web of Science; Medline) and EBSCO (Psychology and Behavioural Sciences Collection; PychINFO; Criminal Justice Abstracts) in addition to ProQuest, and these databases produced a greater proportion of the results than ProQuest. Results from all three platforms were combined in Reference Manager and duplicates found were removed using the de-duplication function in Reference Manger. Via

… to here 30/10/2013 – ProQuest, Web of Knowledge, EBSCO 1975 (actual 1408) Title or Abstract Tier 1 - Mental Health Crisis (("excited delirium" OR "mental health cris?s" OR "suicid* intent*" OR "suicid* behavi*r" OR "bipolar episode*" OR "manic episod*" OR "Psychotic episode*" OR "paranoid episode*" OR "paranoid attack*" OR "Schizophren* episode*" OR "Schizophren* attack*" OR "acute panic attack*") AND Tier 2 - Crisis (attack* OR event* OR episode* OR cris?s OR emergency OR hysteri*) AND Tier 3 - Interventions (tactic* OR intervention* OR strateg* OR initiative* OR procedure* OR approach* OR respond* OR reponse*) AND Tier 4 – What Works ("systematic review" OR "literature review*" OR trial* OR RCT OR experiment* OR evaluat* OR "best practice*" OR "good practice*" OR effective* OR assess* OR "What Works" OR impact* OR success*))

Group work Building our inclusion criteria

Sift criteria - recap Sift criteria are a series of questions that help you decide if the abstract you are reading is useful to the research question and should be ‘called’ (the full paper requested). Questions in your sift criteria will often map across to the key elements or tiers of your search. The same set of questions are applied to all abstracts to attempt to remove bias/ overt ‘judgement calls’. Typically, a lot of papers identified by the search are excluded at this stage of the process.

Research question Interventions that have been shown to be effective in supporting individuals during an acute mental health crisis

Factors in our question Acute Mental health problems crisis management/response/support Interventions Effectiveness/What Works So our sift criteria needs to address each of these points… …and we may need to be careful about how we phrase our questions… …and remember – we can refine our criteria as long as changes are consistently applied across the sift

Inclusion Criteria QuestionAnswerAction Q1.NoExclude YesGo to Q2 UnclearExclude Q2.NoExclude YesGo to Q3 UnclearExclude Q3.NoExclude YesInclude UnclearCan’t exclude Flag: Other exclusions:

Inclusion Criteria QuestionAnswerAction Q1. Is the study about acute mental health episodes, events or crises NoExclude YesGo to Q2 UnclearExclude Q2. Does the paper address interventions or approaches to manage, support or respond to individuals during an acute mental health crisis NoExclude YesGo to Q3 UnclearExclude Q3.Does the paper include: Empirical data/ methods NoExclude YesInclude UnclearCan’t exclude Flag: Analysis or review or trial or quantitative or qualitative study etc Other exclusions: Entirely medical or preventative measures, discussion or theory papers

1 st abstract Stephen Kisely et al. A Controlled Before-and-After Evaluation of a Mobile Crisis Partnership Between Mental Health and Police Services in Nova Scotia, 55 CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE.662, (2010). Keywords: Access/Assessment/Collaboration/contact/Crises/crisis/Crisis Management/Design/engagement/Evaluation/family/Health/Health services/Illness/Illnesses/Intervention/Interventions/Interviews/Management/Mental health/mental health crises/mental health service/Mental Health Services/Mental Illness/NOVA Scotia/Police/police officers/Studies/time/Treatment Abstract: Objectives: Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional. Methods: We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward. Results: The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call- to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team (n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, chi(2) = 92.7, df = 1, P < 0.001). The service data findings were supported by the qualitative results of focus groups and interviews. Conclusions: Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness

2 nd abstract M. Ekramul Hoque et al. Stakeholders' perspective: injury behaviour and attitude of young Asians in New Zealand, 7 INTERNATIONAL JOURNAL OF MIGRATION, HEALTH, AND SOCIAL CARE.106, (2011). Keywords: Adolescent/Attitudes/Child/Ethnic minorities/Hospitals/Intervention/Medical research/Medical Sciences/Mental health/Mortality/New Zealand/Perceptions/Prevalence/Prevention/Psychology/Risk factors/Selfregulation/Students/Studies/Suicidal behaviour/Suicide/Suicides & suicide attempts/Traffic accidents & safety Abstract: Purpose - Of the unintentional injuries sustained by year old Asians, one-third have been attributed to road traffic crashes. This study seeks to examine stakeholders' perceptions of Asian youth injury prevention behaviours in Auckland, New Zealand. Design/methodology/approach - Information was collected through face-to-face individual interviews, with key stakeholders who were aware of youth injury prevention and road traffic safety issues. Analysis used the statements of the discussants as the basis of describing the findings. Findings - Risk-taking behaviours, environment, and individual variations in attitudes influence the occurrence of injuries among Asian migrant students. Domestic injuries of students from affluent backgrounds were linked to their inexperience in domestic or kitchen work. Injuries also resulted from unprovoked race-related street assaults by locals. Road traffic injuries may be attributed to the driving quality of some Asian youths and are influenced by traffic orientations of their country of origin. Migrant youths are often reluctant to seek medical help for their injuries due to precarious employment situations. Asian youths are reactive to minor injuries and expect robust medical procedures. Mental health and suicidal status is hard to assess due to stigma. Family pressure and limited involvement with alcohol and drugs have a protective effect against injuries. Research limitations/implications - While some Asian family values are protective against youth injury risk behaviours, negative parental attitudes may have the opposite effect. This has implications for community-based prevention programmes. Under-reporting of injuries and unprovoked racial attacks on Asian youths are of great concern. Further research on mental health and suicidal behaviour of Asian students and culturally appropriate injury prevention programmes are advocated.

3 rd abstract Michael Levin Epstein,. First responding agencies grapple with situations involving mental illness crises, 29 LAW ENFORCEMENT EMPLOYMENT BULLETIN.1, 1 (2012). Keywords: Criminology And Law Enforcement/Law enforcement/Mental health/Prisoners/Quality of service/Training Abstract: Law enforcement agencies often are the first responders to be called in situations involving mental health crises, although the officers responding to such calls may not know that the person or persons involved are mentally ill. Studies indicate that approximately 30% of jail inmates have a diagnosis for a mental health condition. The issue of training officers to recognize and respond effectively to those events has received increased attention in recent years, and departments nationwide are looking at how to better prepare their personnel

4 th abstract S. Yen et al. Prospective predictors of adolescent suicidality: 6-month post- hospitalization follow-up, 43 PSYCHOLOGICAL MEDICINE.983, (2013). Keywords: Adolescents/Aggression/article/Borderline personality disorder/Positive affect/Psychiatric disorders/Psychiatry/Suicidal behaviour/Suicide Abstract: The aim of this study was to examine prospective predictors of suicide events, defined as suicide attempts or emergency interventions to reduce suicide risk, in 119 adolescents admitted to an in-patient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Structured diagnostic interviews and self-report instruments were administered to adolescent participants and their parent(s) to assess demographic variables, history of suicidal behavior, psychiatric disorders, family environment and personality/temperament. Baseline variables that significantly predicted time to a suicide event during follow-up were Black race, high suicidal ideation in the past month, post-traumatic stress disorder (PTSD), childhood sexual abuse (CSA), borderline personality disorder (BPD), low scores on positive affectivity, and high scores on aggression. In a multivariate Cox regression analysis, only Black race, CSA, positive affect intensity and high aggression scores remained significant. Our findings suggest the following for adolescent populations: (1) in a very high-risk population, risk factors for future attempts may be more difficult to ascertain and some established risk factors (e.g. past suicide attempt) may not distinguish as well; and (2) cross-cutting constructs (e.g. affective and behavioral dysregulation) that underlie multiple psychiatric disorders may be stronger predictors of recurrent suicide events than psychiatric diagnoses. Our finding with respect to positive affect intensity is novel and may have practical implications for the assessment and treatment of adolescent suicide attempters. Adapted from the source document

5 th abstract Gary G. Dickstein,. Student Discipline Intervention Strategies: A Case Study of Two Institutions' Processes Utilized to Resolve Misconduct of Students Who Concomitantly Experience a Mental Health Crisis Keywords: Administrators/Case Studies/Cognitive Processes Abstract: This study contributes to the research regarding processes and procedures utilized by two institutions of higher education to respond to students who participate in inappropriate behavior and who are concomitantly experiencing a mental health crisis. A case study analysis of two institutions of higher education was used to examine this issue. The institutions studied were located within the Midwest and Southern regions of the United States. Qualitative methodologies including document review, observation and interviews were conducted on each campus studied. Interviews with four professional staff members were conducted from each campus and transcribed. The data obtained was first separated by institution and then using a cross case analysis approach, similarities and dissimilarities were identified and discussed. Multiple common themes were discovered during this study. There is a need for institutions to have available a comprehensive set of processes and procedures that can withstand a legal challenge as well as provide multiple options for addressing student misbehavior. The positive impact of a multidisciplinary crisis response team that is well trained, trusting and collaborative was also realized. Furthermore, the necessity for administrators to be keenly aware of legal renderings such as student privacy issues and under what circumstances it is appropriate to release information to others was also identified in this study. Finally, the need to commit the time and resources necessary to developing a systemic approach to resolving incidents where students misbehave and are also concomitantly experiencing a mental health crisis was verified. Recommendations for practice and areas for future research are also included.

Issues 1.Need to avoid interventions entirely clinical/medical/pharmaceutical in nature 2.Measures that are preventative, assess risk factors or focused on long term care should be excluded 3.Need to focus on measures that support individuals immediately during an acute mental crisis

Inclusion Criteria QuestionAnswerAction Q1. Is the study about acute mental health episodes, events or crises NoExclude YesGo to Q2 UnclearExclude Q2. Does the paper address interventions or approaches to manage, support or respond to individuals during an acute mental health crisis NoExclude YesGo to Q3 UnclearExclude Q3.Does the paper include: Empirical data/ methods NoExclude YesInclude UnclearCan’t exclude Flag: Analysis or review or trial or quantitative or qualitative study etc Other exclusions: Entirely medical or preventative measures, discussion or theory papers

Individual sifting (handouts)

Individual sifting (the real thing!) We are sifting hard copies of the abstracts Highlighters are provided – highlight the reference number: – Green for ‘include’ – Orange for ‘unsure’ – Leave ‘excluded’ abstracts blank Fill in your sift template to keep track of what you have sifted Please return all of the abstracts, sift templates and highlighters at the end of the day!

Recording our sifting… Each abstract is numbered Pages are numbered Some abstracts overlap from one page to another – if you don’t have the whole of an abstract in your pile, make a note of this on your sift template… Any questions, just ask!