Study examines transfer policies for students with mental health emergencies from university to hospital

According to a new CAMH-led qualitative study published today in the journal, the odds of police becoming involved in the care of a student seeking help for their mental health at a health clinic campus university in Ontario depend on the university he attends. CMAJ Open.

The study is believed to be the first in the world to conduct in-depth interviews with physicians to examine policies and processes for transferring students in mental health emergencies from university clinics to hospitals. Investigators have found that some Ontario universities mandate the use of police restraints at all times when students need emergency hospital mental health care, while others have policies that handcuffs should only be used. in rare circumstances as a last resort.

“We wanted to identify university policies that facilitated the most dignified transfers to hospital from campus for students in need of emergency mental health care. We hoped these policies could serve as models for other universities” said lead author, family physician Dr. Andrea Chittle. who worked in a university health clinic. “We learned that in some universities, handcuffs are used every time. It is common practice to transport students in handcuffs to the hospital in all situations.”

This work is particularly timely as mental illness among Canadian post-secondary students is on the rise and mental health transfers ー when a student in mental health crisis is transferred from a university health clinic to a hospital for a evaluation and/or emergency psychiatric care ー are increasingly numerous. common.

The authors conducted interviews with 11 physicians at nine academic health clinics in Ontario between July 2018 and January 2019. Interviews were confidential and clinics were not identified to allow physicians to speak candidly about hospital transfer policies for students with mental health emergencies. In five of these clinics, the police were always called to help when a student needed to be transferred to hospital. In two of these clinics, it was police policy to routinely use handcuffs when transferring students to hospital.

Physicians interviewed at clinics where student handcuffing was common expressed concern that it was traumatic for students in a way that could deter them from seeking mental health supports in the future.

“Being handcuffed and loaded into a police car feels brutal and traumatic for the patient and sends all the wrong messages about a caring and supportive environment,” one interview participant said.

This study is the third collaboration of co-authors Drs. CAMH emergency department psychiatrist Andrea Chittle, Juveria Zaheer, and health clinic student physician Shane Neilson examine mental health transfer policies at Ontario universities.

Their first article identified the issue of police handcuffing of mentally distressed students as an area of ​​concern. The second paper examined policies and processes for transferring people in mental health crisis from community clinical settings to hospital. This latest study examined the decision to involve the police and use handcuffs during mental health transfers, as well as alternatives to this practice.

Researchers have found that police involvement and use of restraints when students need to be transferred to hospital for psychiatric evaluation is often due to non-clinical factors, such as understanding the staff roles and responsibilities, human resource constraints and staffing. consequences of long emergency room wait times.

“Before I was in the system, I hadn’t realized how closely policing was related to mental health,” said Gina Nicoll, undergraduate university student and study collaborator, who lived the experience of mental illness, including being transferred by the police to the hospital for evaluation. “It was really disheartening and I felt defeated and helpless. It made me feel like I was doing something wrong just by being sick and I felt like I was being criminalized for it.”

The authors conclude that routine police involvement in transfers of mental health students to hospital is detrimental. They suggest only engaging the police in rare circumstances when the risk of a student fleeing or becoming violent during transfer to hospital is deemed high. They recommend that provincial policies to minimize police use of restraints during mental health transfers from Ontario academic clinics be developed in collaboration with university administrations, municipal and provincial governments, hospitals , police services and people with lived experience of mental illness.

As an ER psychiatrist, I see people in the worst days of their lives. People with suicidal thoughts. People with psychosis. They may be afraid. They may have trauma. They may not want to be there. Similarly, in academia, we have people who come forward in distress and crisis in a myriad of different ways, including students who are racialized and who have had experiences of oppression and negative interactions with the police. . While we can’t say we never need to use restraints, they should be used infrequently and judiciously as a last resort. This should not be the default, as it is stigmatizing and scary. We need to be trauma informed and safe and minimize restraint, just as we need to do in all health care settings.”

Dr. Juveria Zaheer, lead study author and emergency department psychiatrist, Center for Addiction and Mental Health

Dr. Chittle added that she hopes a public debate about the role of police on campus will persuade universities to review their policies and processes for students in mental health crisis. She notes that following her and her co-authors’ previous work examining the practice of routinely engaging police and the routine use of handcuffs at the University of Guelph, a more flexible procedure for hospital transfers has been developed. At the same time, changes to police policies allowed for the discretionary use of restraint when police made transfers.

“I think we’re seeing society move more broadly away from police involvement in mental health care,” Dr Chittle said. “There are pilot projects underway that are non-policing models of mental health crisis care. I hope that’s where we’re headed.