Girard V, Bonin J P, Tinland A, Farnarier C, Pelletier J F, Delphin M, Rowe M, Simeoni M C
Community Mental Health Outreach Team MARS (Movement and Action for Recovery Social) Assistance Public Hôpitaux de Marseille, France; Aix-Marseille Univ., Public Health Research Unit EA 3279, Marseille, France; Yale Program for Recovery and Community Health, New Haven, CT, United States.
Faculté des sciences infirmières, Université de Montréal et Centre de recherche Fernand-Seguin, Québec, Canada.
Int J Law Psychiatry. 2014 Jul-Aug;37(4):376-82. doi: 10.1016/j.ijlp.2014.02.008. Epub 2014 Apr 18.
Marseille, the second largest city in France, has a large population of homeless persons. A mental health outreach team was created in 2005 as a response to high rates of mental illness among this group. In a national political context where security is a government priority, a new central police station was created in Marseille in 2006 to address robberies, violence and illegal traffic in the downtown area of the city. While not directly related to such crimes, police also are responsible for public safety or behavioral issues related to the presence of individuals who are homeless in this area.
This report on a two-year pilot study (2009-2011) addresses collaborative work between a mental health outreach team and the police department responding to the clinical needs of persons who are homeless with serious psychiatric disorders. It also describes the homeless persons' interactions with, and perceptions of the presence of, police and mental health professionals on the streets.
Investigators adopted a mixed-methods approach. Data were collected on 40 interactions using brief standardized report for each interaction. Focus groups were conducted with police officers, outreach team members, peer workers, and service users. Minutes of partnership meetings between police officers and outreach workers also served as a source of qualitative data.
Outreach workers initiated just over half (n=21) of the encounters (n=40) between police and outreach workers. Interactions mainly involved persons with psychosis (77%), the vast majority (80%) of which involved persons in an acute phase of psychosis. Two key themes that emerged from data analysis included the violent nature of life on the streets and the high percentage of ethnic minorities among subjects of the interactions. In addition, it was found that the practices of the outreach workers are sometimes similar to those of the police, especially when outreach workers use coercive methods. "Users" (homeless persons) described police as sometimes using less coercion than the outreach team, and noted that they were more fearful of psychiatrists than police.
Formal initiatives between mental health outreach teams and police departments involve some common street practices. This study demonstrates the potential for closer working relationships between the two parties to help persons who are homeless with mental illnesses receive needed care, and to reduce inappropriate coercion including involuntary hospitalization and arrests.
法国第二大城市马赛有大量无家可归者。2005年成立了一个心理健康外展团队，以应对该群体中高发病率的精神疾病。在安全是政府优先事项的国家政治背景下，2006年在马赛设立了一个新的中央警察局，以处理该市市中心地区的抢劫、暴力和非法交通问题。虽然与此类犯罪没有直接关系，但警方也负责与该地区无家可归者的存在相关的公共安全或行为问题。
这份关于一项为期两年的试点研究（2009 - 2011年）的报告阐述了一个心理健康外展团队与警察部门之间的合作工作，以应对患有严重精神疾病的无家可归者的临床需求。它还描述了无家可归者与警察以及心理健康专业人员在街头的互动情况和他们对这些人员在场的看法。
研究人员采用了混合方法。使用针对每次互动的简短标准化报告收集了40次互动的数据。与警察、外展团队成员、同伴工作者和服务使用者进行了焦点小组讨论。警察与外展工作者之间伙伴关系会议的记录也作为定性数据的来源。
在外展工作者与警察之间的40次接触中，外展工作者发起了略超过一半（n = 21）的接触。互动主要涉及患有精神病的人（77%），其中绝大多数（80%）涉及处于精神病急性期的人。数据分析中出现的两个关键主题包括街头生活的暴力性质以及互动对象中少数民族的高比例。此外，发现外展工作者的做法有时与警察的做法相似，特别是当外展工作者使用强制手段时。“使用者”（无家可归者）描述警察有时比外展团队使用的强制手段少，并指出他们更害怕精神科医生而不是警察。
心理健康外展团队与警察部门之间的正式举措涉及一些常见的街头做法。这项研究表明，双方建立更紧密工作关系有潜力帮助患有精神疾病的无家可归者获得所需护理，并减少包括非自愿住院和逮捕在内的不适当强制行为。
