A Review of Quality Improvement [QI] Specialised Interventions in the USA and England to Reduce the Number of Police Mental Health Crisis Detentions and Provide Support to High Intensity Utilisers [HIUs]

Catherine B Matheson-Monnet1, *, Paul Jennings2
1 Centre for Implementation Science, Faculty of Health Sciences, University of Southampton, Southampton, Hampshire SO17 1BJ, UK
2 C/O Southern Support & Training Headquarters, Hampshire and Isle of Wight Constabulary, Hamble Lane, Hamble, Southampton, Hampshire, SO31 4TS, UK

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 4342
Abstract HTML Views: 1960
PDF Downloads: 901
ePub Downloads: 773
Total Views/Downloads: 7976
Unique Statistics:

Full-Text HTML Views: 1564
Abstract HTML Views: 1053
PDF Downloads: 496
ePub Downloads: 418
Total Views/Downloads: 3531

Creative Commons License
© 2017 Matheson-Monnet and Jennings.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Senior Research Fellow, Centre for Implementation Science, Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, SO17 1BJ, UK, Tel: (+) 44 23 8059 7041; E-mail:



Key issues in both the USA and England have been how to deal appropriately and effectively with the increasing number of mental health related incidents, in particular 1) the rising number of people with mental health issues detained in police custody until they can be clinically assessed and 2) the negative impact on public safety of the high intensity service users [HIUs] who draw a disproportionate amount of emergency and crisis services and are well known to both police and mental health services.

Aims and objectives:

To provide an overview of what is known about current quality improvement interventions undertaken to address these two key issues i.e. reducing both the number of police mental health crisis detention and the disproportionate amount of emergency and crisis service usage [police, ambulance, ED] from HIUs with complex mental health problems to help inform policy and practice decisions in a context of lack of best evidence and lack of evidence based studies.


PubMed and Google Scholar were searched to undertake a narrative synthesis of what is known of the various quality improvement interventions that have been introduced in both the USA and England to address these two key issues. Authors’ knowledge was also used to describe two quality improvement interventions not included/not yet listed in Google Scholar or PubMed.


In the USA, the dominant approach to reduce mental health police detentions is the CIT model, first introduced in 1988, now increasingly implemented with the addition of the older model of police and mental health co-responder (which go back several decades earlier) to increase its effectiveness. The CIT model has been adopted and spread worldwide despite methodological shortcomings in evaluations. Although a best evidence model with increasing data being gathered on effectiveness, it has yet to become an evidence based model. The Street Triage models introduced in England in 2012 were inspired by the older police and mental health co-responder model. Despite a primarily descriptive approach and methodological shortcomings in evaluations and only a handful of studies published, ST has also been widely adopted and spread within England. Only a handful of interventions have focussed on supporting HIUs with the implementation in England of a unique model but evolving model of integrating a police officer within a multi-disciplinary mentoring style intervention which has now adopted by other English police forces and could usefully be adopted by USA police forces.


More data need to be systematically gathered on effectiveness and analysed against a range of clear success criteria, including a cost benefit analysis of the relative merits of their different variations before and in order that they can be called evidence-based models.

Keywords: Jail diversion, police and community mental health partnerships, Mercy bookings, Section 136 detentions, Crisis intervention teams, Mental health and police co-responder, Street triage, High intensity utilisers of emergency and crisis services.