Scarce community mental health resources have led to people in crisis (PIC) overusing the emergency department (ED) and encountering police more frequently. To divert PIC from the ED and criminal justice system, and support them in their community, police services have implemented crisis response teams (CRTs). CRTs refer to police, health and mental health crisis response. Evidence of CRTs’ effectiveness in achieving their desired outcomes is limited, mixed, and/or anecdotal. I completed three studies using various theoretical and methodological approaches, which included: (a) a critical interpretative synthesis (CIS) of the conditions under which CRTs are formed, their features, and their outcomes; (b) a policy analysis using a case study design to examine how and why a CRT model was adopted in Hamilton, Canada; and (c) a what’s the problem represented to be (WPR) critical policy analysis of why police are implicated in crisis response. The CIS presents a conceptual framework depicting how unresolved structural conditions produce system- and individual-level challenges. Second, the case study examines the mobile crisis rapid response team (MCRRT) development in Hamilton. The analysis shows that initiatives that incrementally expand on the boundaries of existing programs are likely to be adopted. Third, drawing on WPR, we excavate problem representations within policy and policy-related texts to understand why police-based CRTs are expanded in Ontario. When mental health is framed in terms of safety and implicated within discourses about risk and danger police intervention is legitimized. Collectively, these studies provide a theoretical framework connecting structural, system, and individual factors most relevant to CRTs; demonstrate that an incremental approach to CRT adoption did not disrupt existing system arrangements; and problematizations within government policies that legitimize police in mental health crisis response. / Thesis / Doctor of Philosophy (PhD) / Since deinstitutionalization, during which mental health patients were discharged into the community, this population has had more frequent encounters with police, contributing to criminalization and tragedies. They have also increasingly sought mental health crisis support in emergency departments. Police, health, and mental health crisis response teams (CRTs) have been implemented as an alternative response to people with mental health issues who are in crisis. To date, CRTs have been widely implemented but with little, mixed, and/or anecdotal evidence demonstrating their effectiveness. This dissertation contextualizes information about CRTs by presenting (a) a conceptual framework on CRTs, outlining the structural, system, and individual conditions under which CRTs are formed, their features, and outcomes; (b) a case study that examined under what conditions a CRT was developed and implemented in Hamilton, Canada; and (c) a critical discourse analysis of CRTs.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29705 |
| Date | January 2024 |
| Creators | Theuer, Ania |
| Contributors | Wilson, Michael G., Health Sciences |
| Source Sets | McMaster University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
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