Methodological Challenges in Conducting a Pragmatic Randomised Controlled Trial in a Non-Clinical Police Setting

1. Methodological and practical challenges of undertaking a Randomised Controlled Trial in a non-clinical setting 11th annual  Randomised Controlled Trials in the Social Sciences Conference 7-9 September 2016

2. Presentation Outline • Background • The CONNECT project • Challenges of conducting a trial in the police setting • The result: a pragmatic RCT

3. Background • In the UK, 1 in 4 people suffer from mental health problems annually (MIND, 2016) • The police are often the first contact for individuals with mental health problems (NPIA, 2010) • Mental Health Crisis Care Concordat (DoH and Concordat signatories, 2014) • Section 136 of the Mental Health Act (The Stationary Office UK)

4. Background • Police officers are not and should not be experts in mental health • However, they have to manage complex problems with insufficient training (Mental Health Cop, 2016) • There are gaps in knowledge and variations in training received (Her Majesty’s Inspectorate of Constabulary, 2013) • No high quality evidence evaluating mental health training within the police context exists

5. The CONNECT project Co-production of policing evidence, research and training: focus mental health • The Police Knowledge Fund: encouraging collaboration between academia and police forces • £1million project funded by the Higher Education Funding Council for England (HEFCE) and the Home Office through the College of Policing

6. www.connectebp.org

7. The Connect Project • North Yorkshire Police and the University of York • Work streams: • A series of systematic reviews • Understanding inter-agency working • Research methods training for North Yorkshire Police (NYP) officers • An RCT to assess the effectiveness of a mental health training intervention for frontline police officers

8. Challenge 1: Population Understanding the geographical and operational structure of NYP • Spread and size of stations • Types, number and duties of frontline officers

9. Challenge 2: Intervention • Understanding existing training provision at national, regional and local levels • Collaborating with the College of Policing • Delivering training to NYP

10. Challenge 3: Outcomes (1) Agreeing outcomes that were meaningful and achievable • Identifymental vulnerability • Record relevant information using available systems • Respond using appropriate internal and external resources • Refer vulnerable people into services to provide longer-term assistance • Review incidents to make sure that risks have been effectively managed

11. Outcomes (2) • Issues with routinely collected data • Various IT systems, which are not integrated • Staff access to IT systems • ‘The Scarborough Pilot’ • ‘Frequent’ callers • Terminology • Flags, tags and warning markers • Vetting of York Trial Unit staff

12. A pragmatic RCT To assess the effectiveness of a face-to-face mental health training intervention delivered by mental health practitioners to frontline officers compared with routine training

13. A pragmatic RCT • Pragmatic cluster RCT • Clusters minimised contamination between police officers and stations • Officers work in pairs • Minimal interaction between officers at different stations

14. Eligible Police Stations n=12 A pragmatic RCT Randomisation of police stations (n=12) • Eligibility: • Two stations within each Safer Command Area with the largest number of frontline officers • Not feasible to train 50% of NYP stations • Greater movement of officers within smaller stations • Smaller stations have fewer staff and irregular opening hours Intervention n=6 Control n=6 Baseline measures Routinely collected trial data Online Survey Routinely collected trial data Online Survey • Randomisation: • Statistician at YTU • Minimisation to ensure balance • Factors considered included: street triage, geographical area and cluster size Intervention Specialised mental health training package Routine Training • Outcomes: • Number of telephone calls which result in a police response received by the NYP control room • Number of incidents with section 136 applied; number of incidents with mental health tags applied; number of incidents with a mental health flag applied from each call and number of frequent callers Post-intervention measures Routinely collected data Online Survey Qualitative interviews Routinely collected data Online Survey

15. References • Department of Health and Concordat signatories. (2014). Mental Health Crisis Care Concordat Improving outcomes for people experiencing mental health crisis • Her Majesty’s Inspectorate of Constabulary CQC, Her Majesty’s Inspectorate of Prisons, and Healthcare Inspectorate Wales. A criminal use of Police Cells? The use of police custody as a place of safety for people with mental health needs. June 2013 • Mental Health Act 1983 Section 136. The Stationary Office. UK: http://www.legislation.gov.uk/ukpga/1983/20/section/136 • Mental health cop: a venn diagram of policing, mental health and criminal justice. (2016). Available [online] https://mentalhealthcop.wordpress.com/2012/03/26/police-rank-and-roles-explained/ • MIND, for better mental health. (2016). Mental health facts and statistics. Available [online]: http://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/ • National Policing Improvement Agency on behalf of the Association of Chief Police Officers. (NPIA) (2010). Guidance on responding to people with mental ill health or learning disabilities

16. Thank you http://connectebp.org/ Arabella.clarke@york.ac.uk @ConnectEBP @ArabellaLClarke