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Special Article
Published Online: 29 May 2024

Coercion During Psychiatric Ambulance Versus Police Transport in Mental Health Crises: A Pre- and Postimplementation Study

Jeroen B. Zoeteman, M.D. [email protected], Mathilde A. S. de Wit, Ph.D., Hans J. de Haas, Ph.D., Kate M. Borkent, M.D., Jaap Peen, Ph.D., Cornelis L. Mulder, M.D., Ph.D., and Jack Dekker, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Preprint
https://doi.org/10.1176/appi.ps.20230571
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Abstract

Objective:

Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel.

Methods:

A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort).

Results:

After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort.

Conclusions:

Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions.

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Supplementary Material

File (appi.ps.20230571.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
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Psychiatric Services
Preprint

History

Received: 19 November 2023
Revision received: 5 February 2024
Revision received: 14 March 2024
Accepted: 27 March 2024
Published online: 29 May 2024

Keywords

  1. Community mental health services
  2. Emergency psychiatry
  3. Nursing
  4. Police
  5. Program evaluation

Authors

Details

Jeroen B. Zoeteman, M.D. [email protected]
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Mathilde A. S. de Wit, Ph.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Hans J. de Haas, Ph.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Kate M. Borkent, M.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Jaap Peen, Ph.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Cornelis L. Mulder, M.D., Ph.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Jack Dekker, Ph.D.
Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder).
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Notes

Send correspondence to Dr. Zoeteman ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

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