Care on Wheels: Mobile crisis teams partner police with mental health workers

CrossCurrents

By Anita Dubey

Sandra* had been behaving strangely for a few weeks. She was living at the YMCA in Hamilton, Ontario, and had started spying on other residents in the bathroom or approaching them and chanting “Die, babe, die!” She was heard talking to herself at night. One evening, a doctor who had seen Sandra called YWCA staff and said she needed to be taken to the hospital. Sandra showed up at the YWCA and said she felt like killing herself or hurting someone else.

In this situation, a call to police would be natural. But Sandra obviously needed immediate attention for mental health issues as well. Fortunately, YWCA staff were able to access both these services through one phone call.

Hamilton is one of several Canadian cities with a mobile crisis intervention team. These teams consist of a non-uniformed police officer and a mental health worker who travel in an unmarked police car to individuals experiencing a mental health crisis in the community. They bring the expertise of both professions to decide which type of help is most appropriate.

Since the advent of deinstitutionalization and the exodus of persons with mental illness into the community, police have played an increasingly important role in managing people in crisis, says Terry Coleman, co-chair of the Canadian National Committee for Police/Mental Health Liaison, an organization of police officers and mental health professionals who provide information and support to police officers around mental health issues. Whether or not individuals are committing a criminal offence, it is often police who are called first and have to respond, without the training and expertise of a mental health professional.

The need for joint teams of police and mental health professionals is clear. Amnesty International has reported that police are increasingly called upon to deal with people experiencing a mental health crisis. A 2004 report by the British Columbia branch of the Canadian Mental Health Association (CMHA BC) found that between seven and 15 per cent of police contacts are with people with mental illness, and that the frequency of such interactions is increasing. A 1998 CMHA BC study found that more than 30 per cent of people came into contact with the police during their first experience trying to access mental health care in British Columbia.

In some cases, mobile crisis intervention teams developed in the aftermath of tragedy. Hamilton’s mobile team, which is part of a larger crisis management program, came into being after a woman died on the streets in 1995. “Mary* was well known to the police, hospital and social service providers,” says Terry McGurk, manager of Hamilton’s Crisis Outreach and Support Team (COAST). Service providers realized that an outreach service was needed for people like Mary, who was regularly brought to the hospital, stabilized and released with no follow-up.

In Toronto, a mobile team was launched based on recommendations from several coroner’s inquests, including that into the 1997 death of Edmund Yu, a man with schizophrenia who was shot and killed by police after he refused to drop a hammer he was waving over his head.

Given the high number of calls about mental health crises and the potential for tragic outcomes, partnerships between police and the mental health community make sense. One benefit of these teams is that a mental health worker is available to assess the situation. “One of the really important problems before our team existed was that an unfortunate number of patients were ending up in the criminal justice system,” says Dr. Ian Dawe, medical director of the Psychiatric Emergency Service at St. Michael’s Hospital in Toronto. Pairing police with mental health workers ensures that individuals experiencing mental health issues are not criminalized inappropriately, but rather, are directed toward the system that is most appropriate for them in their circumstances. This may mean entry into the criminal justice system if indeed a crime has been committed, explains Dawe. But more often, it means that individuals are directed to the mental health system, or, if it is their choice and they do not represent a danger, no system at all.

Teams can also free up police resources for other responses, says Dawe. If officers on general patrol turn cases over to the specialized team, they can go back to patrolling, rather than trying to manage the person’s mental health care, which a health professional will do more effectively.

But mobile crisis intervention teams aren’t without their critics. Several years ago, the Queen Street Patients Council at the Queen Street Mental Health Centre in Toronto (now the Empowerment Council at the Centre for Addiction and Mental Health) held a consultation with mental health consumers to discuss the idea of pairing police and mental health workers. “We heard that this is a good idea only if it facilitates the person in crisis in having a better dialogue with the crisis team or better access to the supports that person wants and needs,” says Jennifer Chambers, coordinator of the Empowerment Council. ‘For that reason, most people didn’t want a team of police and hospital-based workers. People didn’t want their only option in a crisis to be a fast track to the hospital, and they didn’t want the focus of the dialogue with crisis workers to be medical, such as whether or not they were taking medication.”

Chambers points out that many consumers had experienced police as being as good or better at responding to them in a crisis than mental health professionals. Many had found that police interacted with them as adults, presenting them with the facts and choices to make, whereas mental health workers spoke to them as children and disregarded what they were saying, telling them rather than asking them what they needed. Chambers adds that although people favoured avoiding police use of force, the idea that crisis intervention teams would prevent police use of force is largely a misconception, since crisis workers are replaced by an emergency task force if there is any perception of danger.

“Ultimately, whether or not mobile crisis intervention teams are a good idea depends on when and how the service is provided,” says Chambers.

These teams take on slightly different forms. In Vancouver, the mobile unit known as Car 87 is part of the citywide Mental Health Emergency Services (MHES). It includes a telephone line staffed 18 hours a day by a crisis line nurse. Calls come from anywhere in the community – emergency services, mental health agencies, families and even landlords. The nurse either connects the person with other services over the phone or decides whether the nurse-officer team needs to attend. The service is essentially a triage system, not a crisis counselling service, says Anne McNabb, manager of MHES. Since it has been running for 20 years, MHES is a well-known part of the system.

Police on general patrol also file a report with MHES if their case involves a non-urgent mental health problem. The mobile team reviews cases and determines how severe or acute the problem is, then makes a visit to do an assessment if needed. If a person requires hospitalization, the MHES arranges for an ambulance rather than a police car to transport the person. “This reduces stigma and respects that the person has a mental illness,” says McNabb.

Hamilton’s COAST service is similar to Vancouver’s. Its mandate is to cover the Hamilton-Wentworth region; like Vancouver’s service, it has a telephone crisis line. It is unique in having a multi-disciplinary team of social workers, nurses and occupational therapists. Where possible, the worker from the most appropriate discipline will attend.

“We want to see clients in their environment of choice,” says McGurk. “That could be on the street or at a coffee shop.” COAST also responds to alerts from mental health agencies with clients who need help to get through evenings when agencies are closed. Various service agreements are in place, so the COAST team can send its clients who need further care to these agencies.

COAST also has a mobile team serving children and teens, with two child and youth workers and a police officer. Its function is similar to that of the adult program. For example, a school liaison officer recently called COAST about a young girl who had brought a knife to school after being threatened by some older girls. COAST saw the girl and her family at home to investigate. She said she hadn’t planned on using the knife but wanted to scare the older girls. She said she had bursts of anger and often felt sad. With the help of her family doctor, the girl was referred to a youth agency to assess and address her depression and anger management issues.

In Toronto, the team is slightly different, as it responds to crisis immediately. Based out of St. Michael’s Hospital in the downtown core, the team pairs a crisis intervention nurse from the hospital with a specially trained police officer. The team serves two police divisions in the area. It may be alerted to the crisis by police who are at the scene, who will leave when the team arrives, or by 911 calls transferred to their service. The team also drives through the streets, looking for cases and listening to the police radio.

For several years, the team was the only system of its kind in Toronto, but the Ministry of Health and Long-Term Care and the Toronto Police Services (TPS) recommended in 2005 that there be widespread adoption of the model across the city. Recently, an identical team has been formed in Toronto’s west end between St. Joseph’s Health Care Centre and TPS Divisions 11 and 14.

“The model has a lot of efficiency built into the system,” says Dawe. “Because the mobile worker has done an assessment, it makes the process of handing over much easier.” The worker can simply pass the assessment to colleagues in hospital, saving the step of a long ER visit. A 2002 report notes that the team cleared the hospital in 30 minutes or less, on average. If hospital care is not needed, the crisis worker will find a case manager.

Despite their obvious benefits, mobile crisis teams will not necessarily work everywhere, says Dr. Dorothy Cotton, co-chair of Canadian National Committee for Police/Mental Health Liaison. “In order to have a dedicated team, you need a critical mass. They generally do best in higher density populations,” says Cotton, who is also a psychologist with Correctional Service Canada. In some communities, service agreements between police and emergency rooms or mental health agencies are enough to help (see “Other models” sidebar).

All these efforts are, however, part of a growing awareness that coordinated services are needed between police and mental health services. “The number of joint police-mental health initiatives is on the rise, and will continue to rise,” says Cotton.

*not their real names

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