When police or paramedics attend an unfolding mental health crisis, often their only choice is to take the patient to hospital - regardless of whether it's the best option for their care.
But a new Canberra initiative, which from this week operates seven days a week, is trying to change that. As part of the Police, Ambulance, Clinician Emergency Response program - better known as PACER - an unmarked car can be dispatched to mental health incidents across the territory. On board is a paramedic, police officer and mental health clinician.
It's been operating since December last year and has already shown promising results, with about 80 per cent of the patients treated by the team not admitted to hospital and remaining in the community. And it's helping change perceptions of police and paramedics' responses to mental health emergencies along the way.
Like most police officers, leading senior constable Scott Vandervalk has attended more mental health incidents than he can count. It currently accounts for about 10 per cent of police jobs in the ACT.
Senior constable Vandervalk said he jumped at the chance to take part in the program because of its patient-centred approach. "Obviously there's an expectation when police show up that we deliver a certain approach. We bring a use of force option with us," he said.
He said the collaborative PACER approach allowed them to provide more thoughtful and clinical care in mental health crises. The team find they are more easily able to engage patients, meaning the situation is far less likely to escalate and it's less likely the patient will have to be admitted to hospital.
"[For example] we were called to a person who had made some suicidal statements. There were already police at the scene and this person did not want to come out of the house. She was fearful, she barricaded herself inside," senior constable Vandervalk said.
"Upon us starting to speak to her, basically because it was a new team she hadn't seen before, she was more engaged with us - she would talk to us. We decided she wasn't in acute crisis and she could remain in the community."
Paramedic Greg Tompos said you could almost see the relief flood through patients when they were told they did not have to go to hospital.
"There's an actual physical response that we can see as they realise the old model of just taking them to hospital isn't the approach that we're taking," he said.
"It's rewarding because one of the common things that people say when we walk in is 'I don't want to go to hospital, please don't take me to hospital'. It's rewarding to be able to go in a say, 'well that's actually what we're aiming to do - to keep you out of hospital today and keep you safe at home if we can do that'."
Mental health nurse Caroline Bain said the skillsets of the three different people combined well to de-escalate potentially critical situations.
"For a lot of people it's a surprise when we turn up," she said.
"When we can come to a situation and ... de-escalate the situation, it gives the person more of an opportunity to actually see what's going on. If there are heaps of coppers there, or they're expecting to be taken to hospital that's not necessarily [going to lead to] their best treatment outcomes."
Sergeant Craig McPherson helped spearhead the program, travelling across the country to look at various models.
But none were really fit for purpose, so the team headed overseas, visiting co-response models in the UK, USA and Canada.
"There were elements from them we liked ... so we came back and started to grow this thing called PACER," he said.
Government funding for the program beyond November is not locked in, but those involved believe it should not only continue but be expanded to a 24-hour model.
"If anything it upholds the principles of the mental health act - it has the patient at the centre of the decision-making, when historically often decisions were made about patients which were more for the organisational benefit," sergeant McPherson said.
The ACT's mental health minister Shane Rattenbury said a formal evaluation of the program still had to be done before more funding could be confirmed. But he said early indications were that the program would continue, and in fact expand.
"[These programs] are all designed to give people the experience of the mental health system rather than simply ending up in a crisis admission situation," he said.