• A study looks into policies for transferring students with mental health conflicts from university to hospital

    International

    This research is especially timely because mental illness is on the rise among Canadian postsecondary students, and mental health transfers (when a student in a mental health crisis is transferred from a university health clinic to a hospital for emergency psychiatric assessment and/or care) are becoming more common.

    Digital Desk: According to a new CAMH-led qualitative study published today in the journal CMAJ Open, the likelihood that police will become involved in the care of a student who seeks help for their mental health on campus at an Ontario university health clinic depends on which university they attend.

    The study is thought to be the first of its kind in the world to conduct in-depth interviews with physicians in order to examine policies and processes for transferring students experiencing mental health emergencies from university clinics to hospitals. Investigators discovered that some Ontario universities require the use of police restraints in all circumstances when students require emergency mental health hospital care, whereas others have policies stating that handcuffs are only used as a last resort in rare circumstances.

    "We sought university policies that would allow students in need of emergency mental health care to be transferred to a hospital in the most dignified manner possible." We hoped that such policies would serve as models for other universities." The study's lead author is Dr. Andrea Chittle, a family physician who previously worked in a university health clinic. "We discovered that handcuffs are routinely used at some universities." Students are always transported to the hospital in handcuffs."

    This research is especially timely because mental illness is on the rise among Canadian postsecondary students, and mental health transfers (when a student in a mental health crisis is transferred from a university health clinic to a hospital for emergency psychiatric assessment and/or care) are becoming more common.

    Between July 2018 and January 2019, the authors interviewed 11 physicians at nine university health clinics in Ontario. To allow physicians to speak candidly about hospital transfer policies for students with mental health emergencies, the interviews were kept confidential and the clinics were not identified. When a student needed to be transferred to the hospital, police were always called at five of those clinics. The police policy at two of those clinics was to routinely use handcuffs during student transfers to hospitals.

    Surveyed physicians at clinics where student handcuffing was common expressed concerns that it was traumatising for students, potentially discouraging them from seeking mental health services in the future.

    "Being handcuffed and loaded into a police cruiser appears brutal and traumatic for the patient, and sends all the wrong messages about a caring, supportive environment," said one interviewee.

    Dr. Andrea Chittle, CAMH Emergency Department Psychiatrist Juveria Zaheer, and Shane Neilson, a student health clinic physician, worked together on three studies that looked at mental health transfer policies at Ontario universities.

    In their first paper, they raised the issue of police handcuffing of students in mental distress. The second paper looked at the policies and procedures for transferring people in mental health crisis from community-based clinical settings to hospitals. The most recent study investigated the decision to involve the police and use handcuffs during mental health transfers, as well as alternatives.

    The researchers discovered that non-clinical factors such as a lack of understanding of staff roles and responsibilities, human resource constraints, and the staffing implications of long emergency department wait times frequently lead to the involvement of police and the use of restraints when students require a transfer to hospital for psychiatric assessment.

    "Before I was in the system, I had no idea how intertwined policing and mental health were," said Gina Nicoll, an undergraduate university student and study contributor who has lived experience with mental illness, including being transferred to hospital for assessment by police. "It was simply depressing, and I felt helpless and defeated. It made me feel as if I was doing something wrong just by being sick, and that I was being prosecuted for it."

    Routine police involvement in student mental health transfers to hospitals, according to the authors, is harmful. They recommend involving police only in extreme cases where there is a high risk of a student fleeing or becoming violent during the hospital transfer. They advocate for the development of province-wide policies in collaboration with university administrations, municipal and provincial governments, hospitals, police departments, and people with lived experience of mental illness in order to reduce police use of restraints during mental health transfers from Ontario university clinics.

    Dr. Chittle continued, "I hope that a public debate about the role of police on campus will persuade universities to reconsider their policies and procedures for students in mental health crisis." A more flexible procedure for hospital transfers was developed as a result of her and her co-authors' previous work at the University of Guelph examining the practise of routinely engaging police and routine use of handcuffs. Simultaneously, changes in police policies permitted the use of restraints at the discretion of officers transferring. "I believe society is moving away from police involvement in mental health care," said Dr. Chittle. "Pilot projects are being conducted to test non-policing models of mental health crisis care. My hope is that we will go in this direction."

    ccc

    Weather Forecast