New nurse on the beat: the nurses swapping wards for police stations

Paula’s regular shift is 2pm to 10pm, she tells me. It’s only ten past and today a police officer has already come to her desk to fill her in on a domestic violence-related incident with mental health implications.

The incident involved a female health worker who police believe is suicidal, which is why the officer comes her way. This is a regular day for Paula O’Brien, who is one of the 36 specialist mental health nurses deployed across NSW and embedded in police stations as part of the expanded PACER program.

The program was announced in June by the Berejiklian government after positive results from a pilot program that saw a 15 per cent reduction in mental health cases dealt with by police in some areas and a reduction in hospital presentations due to mental health issues by 9 per cent – according to NSW Police.

Paula has a spot in the Gosford Police Station on the Central Coast and she thinks the police are certainly feeling the benefits of her expertise already, although it keeps her busy. The mental health team were six weeks into their work at Gosford when I spoke to Paula and an average shift sees at least two or three calls. And the close relationship with police has given her a new insight into the other side of mental health care.

“Well, between corridor chats and then call outs… with my first Saturday night, I had five calls, which was ridiculous. But two or three a night, yes. And then on top of that lots of corridor chats and then meetings with people that present to Triple 0 often,” she says.

“The police do an incredible job. They do so much more than I was aware of in terms of after hours, taking care of people with mental illness and very vulnerable people. We never knew about that. We never knew that some of our chronic clients would be calling the police three or four times a week because we never had that open communication.”

That communication and relationship with police is key for Sam Johnstone too. I catch her on her day off; she’s off to brunch with the family. And I can see how she can quickly bond with strangers. We joke about some shared misconceptions and stereotypes about our homelands (Scotland for her, Ireland for me) but she also uses that to her advantage.

“I'll ethnic it up a bit to incite a reaction. After being in nursing for 30 years you just kind of know how to pick your audience. And I find that you can use it in a self-depreciating way,” she says of her soft Scottish lilt.

“You can get patients on your side because of the accent. They'll maybe want to talk to me rather than an Australian sounding person. It's quite handy at times.

“It's has been my ticket to actually get in with some of the senior police officers, because our station officer has a Scottish heritage... And that's actually paid in dividends; it's kind of got him on one our side a bit. So, it's has been very helpful.”

Sam is one of the mental health nurses embedded in Wyong Police Station, about 30 minutes north of Gosford, still on the Central Coast. And like any other work environment it took a while for the new people to settle in. Sam says it was challenging at first, that perhaps there was a perception that the nursing staff were there to spy on the police officers or there to critique the way they dealt with mental health.

“But I think once they realised the value of having mental health clinicians that they could call on between the hours of 2pm and 10pm, it's been very helpful for them. It's taken away some of the pressure,” she says.

“They're extremely busy. We can hear the jobs going down all the time. And on the surface, it looks like they're not paying attention to the radio which goes constantly from a speaker in the ceiling above them.

“And then there'll be a phrase or a word that will come the radio, they stop doing everything and they just run. And they're out that door in a matter of moments. The room will clear, and it actually leaves you with goosebumps. They are very much attuned to what's going on around them even though, on the surface, it doesn't look like it. They do a fantastic job.”

Much like Paula, Sam’s day is chock full. Most days she doesn’t have time to put her bag down before the officers have questions for her. “It's like they're waiting for you to come in,” she says.

Even if she doesn’t physically leave the station, Sam and her team will have meetings and field multiple calls from different officers about real time issues.

Police Minister David Elliott said in June that police in NSW currently deal with mental health related incidents 1000 times a week and attended 55,000 incidents in 2019. Elliot said that the time an officer dealt with a case involving mental health was reduced by 45 minutes with the pilot program, so an expansion of the program “makes good economic sense”.

Having people like Paula and Sam around frees officers up to do other things and, more than anything, can often deescalate scary situations for people when they are at their most vulnerable.

“So, the police get that job and then hopefully we’re there very soon at the address if mental health [issues] have been identified. Often they are clients that are known to us, but my last two weeks have been all people that I've never seen. They have no mental health history,” Paula says.

“It's very traumatic for people if they're having a mental health crisis and they have two, four, six police officers, an ambulance. And when they see a mental health nurse and we are able to identify ourselves and what our role is and use de-escalation skills, you obviously build a little bit of rapport and often find that the person doesn't need the police.

"They don't need to come into an emergency department. They need someone to listen to them there and then, and they can be referred to a community team and be followed up in the community in their home rather than the traumatic event of being taken by police or ambulance to an emergency department where they may have to wait for many hours.”

The nurses can also act as a liaison between the police, community health or emergency departments, smoothing the way for successful and safe transitions for the consumer.

“[Sometimes] we contact the emergency department and say that the police have already Section 22'd this person, or the ambulance services Section 20’d them, and they're coming in, regardless of our involvement. We just kind of smooth that pathway to make it more of a seamless transition between the community and the hospital. We do a pre-arrival notification, basically, to ED mental health and our afterhours nurse manager,” Sam tells me.

“One of the jobs we did the first week we were on board, and we had been called out to a man in his forties. I think he was one of the consumers of our Community Mental Health. He phoned in a state of distress. So, we attended with the police at the same time. They made sure it was safe for us to go in. And we were in, assessed the situation, had this fellow in the car with us, me driving, rather large police officer in the back with the consumer, and my colleague in the front seat. And we had him up at the hospital, handed over to the ED mental health team and back on station within the hour.

“So that meant that we didn't have to involve the paramedics. We could get him timely assessment. No waiting for hours on end for an ambulance crew or the indignity of being put into the back of police wagon, because that's really not good for anybody's mental wellbeing.”

Paula recalls an incident involving a man who was previously homeless and with a history of drug abuse who got in an altercation with his new neighbours.

“He apparently was suicidal and the police were going to take him up to the emergency department. He was terrified of the police. He had a long history of living on the streets. But when they were able to speak to him, it was an altercation with a neighbour. They had had a couple of drinks, but not in excess. The story got blown out of proportion,” she says.

“He needed a bit of time to talk about what had gone on. And he needed a referral back to his GP. But he would've been headed for quite a traumatic evening.”

Both Sam and Paula are glad that mental health is being recognised in this way. Both of their police districts have many issues often associated with low socioeconomic areas. Adding to that the strain and aftermath of last year’s bushfire season and this year’s economy-crushing pandemic, mental health will be more important than ever in the coming year.

Along with the expansion of the PACER program, the NSW government also pledged $73 million will be invested into mental health and part of that package will see 180 mental health workers deployed across the state.

This will also increase capacity for an extra 60,000 calls in the next 12 months to the 1800 NSW Mental Health Line and see the creation of pop-up mental health Safe Space sites to reduce pressure on emergency departments.

Bronnie Taylor, NSW Minister for Mental Health, told Nursing Review that the program is about navigating a pathway to recovery, not incarceration, hopefully saving lives and changing them for the better.

“The PACER program is about getting the best outcome for a person on potentially their worst day.

“This is a great example of practical collaboration between police, first responders and NSW Health as we work together to find innovative ways to deliver supports to meet the unique needs of individual communities across regional and rural NSW.

“We have had an overwhelmingly positive response from all parties, and several Police Area Commands have reached out to me to say they want to see it rolled out in their areas too,” she said.

For Sam, it’s about helping the police, the consumers and ultimately the local community.

“[Police are] swamped and they need extra support. Mental health is a growing trade basically. It's not a problem that's going to go away and they need help supporting them to deal with it so that there's better patient outcomes,” she says.

“We are crucial,” Paula tells me. “But I think we've got a lot to learn too. By sitting here, you can certainly see that there's a whole lot of different organisations, police in health being one, and we need to work a little bit better together.

“And because we're able to exchange information freely, the police are able to give us a lot of information that we would never ever have had and vice versa we're able to exchange information with the police. So, it's been incredible what's come out of that partnership just in the short period of time.”

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