Embedded police officers in assertive community treatment: Impacts on service delivery and health-related outcomes

Background: The deinstitutionalization of patients from psychiatric institutions and deficiencies in community treatment have been linked to a mental health “crisis” in Canadian cities. Municipal police departments have vocalized concerns that they have become 24-hour responders to this crisis, that it is taxing their resources beyond capacity, and that it is fostering a criminal justice response to mental illness. To address these concerns, some municipal police departments have advocated for the creation of Assertive Community Treatment (ACT) teams with embedded officers. Although the ACT model has been the focus of rigorous scientific scrutiny, modification with the presence of embedded officers remains largely unevaluated. This study seeks to address this knowledge gap through research focusing on the experiences of service providers and consumers. Methods: This research is informed by grounded theory ethnographic methods. Data collection included 47 in-depth qualitative interviews with both service providers (N = 23) and consumers (N = 24) as well as over 90 hours of focused observational fieldwork and informal interviews. Findings: Results reveal that embedding police officers in the ACT model shapes the experiences of service providers and consumers in multiple domains of their treatment interactions. Findings demonstrate the significance of relationships in the ACT model, the importance of secure housing as a component of treatment, service-provider struggles between identities as agents of social control and agents of change, and the impacts of systemic pressures for “flow” in and out of ACT teams. Conclusions: Police-embedded ACT offers a unique adaptation with the potential to address psychiatric, psychosocial, and criminogenic needs. However, findings of this study raise concerns, including coercion, lack of consumer autonomy, and potential blurring between treatment and social control. Police-embedded ACT and the potential power imbalances the model can create call for independent and transparent oversight as well as consumer involvement in future research and evaluation.