Liaising between the police and mental health: a ground-breaking mental health nursing role in Rotorua, liaising between the police and mental health services, has seen arrest rates drop, changed attitudes to those with mental illness, and treatment starting earlier.

Jeanette Knight had just the right combination of qualifications for the groundbreaking role she took on nearly three years ago. A psychiatric nurse with 20 years' experience, married to a policeman and with a son a policeman, she was well suited to become the country's first police liaison mental health nurse. Based at Rotorua police station, the role was developed after the then Rotorua Area Commander Roy Sutton and the service manager for mental health services at takes District Health Board (DHB) Christine Nolan recognised a gap in community based care. The police were having more contact with people with mental illness and many appeared to be falling through the gaps in the system.

After wide consultation and negotiation, the DHB provided money to fund a police liaison nurse on a pilot basis. Knight was attracted to the job for a number of reasons. She had the extensive psychiatric background, and skills required, having trained in the early 80s at Tokanui Hospital and worked in its acute wards until the hospital dosed in 1997. Living in Te Kuiti, where her husband was a policeman and she a resident psychiatric nurse, she was asked by a kaupapa Maori provider to establish level-three mental health accommodation in the King Country town. With family members in the police, she had a very good understanding of the difficulties police had when dealing with people who had mental illnesses and she was also very familiar with the police culture. "It certainly helped that I had an understanding of the police. I'd been in the business for 20 years so had credibility and having a husband and son who were cops also eased the way."

When she began the new role in December 2001, one of the biggest challenges was to break down barriers in the police attitude to mental health issues and vice versa. "The police had a sense of frustration that they didn't know what to do when confronted with a person with a mental illness and that they'd had no training in the new legislation [the Mental Health Act 1992]. On the other hand, mental health services thought the police could deal with many situations. The police have limited powers and no mental health training so I had to teach mental health staff that limitation." Education sessions for the police on mental health legislation and on ways of interacting with mentally ill people were, and still are, important aspects of her job. Since she began she has seen a heartening change in local police attitudes. "One of the big rewards of my job has been watching police attitudes change. Whereas once they might have driven past somebody with the 'look ups' [oculargyric crisis], they will now pick them up and take them to the unit. They are becoming more confident in their interactions with people who have a mental illness and are wanting to deal with situations. I'm getting positive feedback from the mental health teams about these changes." Another big reward is the fact she is able to get people into appropriate treatment quickly. "There's no time wasting. Getting that early intervention underway is a big buzz."

Learning the police language and gaining an understanding of the Crimes Act and its amendments and how it pertains to mental health, the Criminal Justice Act and other Legislation the police work under, have been other challenges in her role.

In her work Knight is literally saving Lives. She estimates that 30 percent of those she sees are at risk of suicide. "The one constant in those statistics is young Maori men."

She works with the police iwi Liaison officer, the Pou Te Atatu, the DHB's Maori mental health service and with Hau Ora Waikato, a kaupapa Maori forensic psychiatry service, when dealing with cultural issues.

She is also saving people from being charged unnecessarily. "If a mental health client has committed an offence, I can make an initial assessment of their mental stability at that point in time. I can refer them to the services they need, I liaise with the forensic psychiatric team if they are appearing in court."

Of the clients Knight sees--and she sees anything from one to seven a day--49 percent are existing mental health clients; 25 percent are new clients and 26 percent need no format mental health follow-up but may be referred to more appropriate services, eg addiction services or relationship services.

It can be "adrenalin pumping" work at times but always satisfying. Knight has a couple of "stand out" memories from her time so far. "Somebody reported a suicidal person to the police and I was able to get through to that person and get them the services they needed. Mobile phones are important tools of our trade, a way of making and keeping contact. That person subsequently contacted me and thanked me for saving their life. You can't get more satisfaction than that. It was realty humbling." Kinght is the only nurse in New Zealand working in this Liaison role but the Waikato District Health Board is currently looking at ways to improve collaboration between police and mental health services. She has presented on her role at the Australia New Zealand College of Mental Health Nurses' conference and will do so again in Canberra next month. Employed by Lakes DHB as part of the community mental health team, Knight does not feel professionally isolated. "I actively seek support and debrief with peers and management."

The role has been so successful in lowering arrest rates, improving collaboration between the police and mental health services, enhancing understanding on both sides, ensuring fewer people fall through the gaps, and getting people into appropriate treatment earlier that it has been made permanent. Knight is keen to stay. "I'm not indispensable but I have a useful mix of skills. Now I've established the credibility of mental health services with the police it will be easier for another nurse to step into the role. It needs to be a nursing position because we are doing clinical assessments, working with people and their medications, doing crisis interventions. It is definitely a nursing role."