Feature Article Police referrals to a psychiatric hospital: Experiences of nurses caring for police-referred admissions Reshin Maharaj, 1 Louise O’Brien, 2 Donna Gillies 1 and Sharon Andrew 3 1 Western Sydney Local Health District, Sydney, 2 Western New South Wales Local Health District and School of Nursing and Midwifery, University of Newcastle, New South Wales, Australia; and 3 Anglia Ruskin University, Chelmsford, UK ABSTRACT: Police are a major source of referral to psychiatric hospitals in industrialized countries with mental health legislation. However, little attention has been paid to nurses’ experience of caring for police-referred patients to psychiatric hospitals. This study utilized a Heideggerian phenomeno- logical framework to explore the experiences of nine nurses caring for patients referred by the police, through semistructured interviews. Two major themes emerged from the hermeneutic analyses of interviews conducted with nurse participants: (i) ‘expecting “the worst” ’; and (ii) ‘balancing thera- peutic care and forced treatment’. Expecting ‘the worst’ related to the perceptions nurse participants had about patients referred by the police. This included two sub-themes: (i) ‘we are here to care for whoever they bring in’; and (ii) ‘but who deserves care?’ The second theme balancing therapeutic care and forced treatment included the sub-themes: (i) ‘taking control, taking care’; and (ii) ‘managing power’. The study raises ethical and skill challenges for nursing including struggling with the notion of who deserves care, and balancing the imperatives of legislation with the need to work within a therapeutic framework. KEY WORDS: acute care, nurses, phenomenology, police, qualitative methodology. INTRODUCTION Police departments are considered one of the primary agencies for psychiatric referrals (Maharaj et al. 2011; Redondo & Currier 2003). The potential for danger to self or others has been identified as a major reason for police referral of people with mental distress (Citrome & Volaka 1999; Cordner 2006; Redondo & Currier 2003). In most developed countries, police have power under relevant legislation to apprehend and detain for psychiatric assess- ment any person they perceive to have mental distress. In Australia, for instance, under Section 22 of the 2007 New South Wales Mental Health Act (NSW Department of Health 2007), police can apprehend and refer a person for psychiatric assessment if the person ‘appears to be mentally ill or mentally disordered’ and ‘is committing or has committed an offence’, or is ‘imminently dangerous to self or others or is threatening or attempting suicide’ (p. 75) and would benefit from being dealt with under the Mental Health Act. Such mental health legislation has changed the profiles of patients and created nursing responsibilities in relation to the protection of the patient and others (Delaney et al. 2001; Fisher 2007). Furthermore, the criterion of danger- ousness for involuntary civil commitment has posed a challenge for nurses in the delivery of care with concern that mental health nurses are taking on the role of ‘de Correspondence: Reshin Maharaj, Cumberland Hospital, WS LHD, Locked Bag 7118 Parramatta, BC NSW 2124, Australia. Email: reshin.maharaj@swahs.health.nsw.gov.au Reshin Maharaj, PhD, MN, RN. Louise O’Brien, PhD, BA, RN. Donna Gillies, PhD, DipEd, BAppSc. Sharon Andrew, PhD, BAppSc, RN. Accepted August 2012. International Journal of Mental Health Nursing (2012) ••, ••–•• doi: 10.1111/j.1447-0349.2012.00881.x © 2012 The Authors International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.