If you think you’re having a heart attack, you know exactly what to do: Call 911 and get yourself to a police station, or at least under a police officer’s care, as soon as possible.
Wait, that’s not quite right. Call 911, yes, but a police station is the wrong place to be, and a police officer is the wrong person to consult. Health care ought to be managed by health care professionals, and in a health crisis, you need to visit a hospital.
Except if you’re experiencing a mental health crisis. Then our entire system is founded on the belief that police officers are always the appropriate first responders to handle the crisis. Mental health crisis calls typically result in an officer being sent to the scene, whether you ask for one or not.
That might finally be changing, however, as last week’s report from the all-party special committee on reforming the police act expressed support for a continuum of responses to mental health crises, including using teams of mental health experts without any police accompaniment.
The reasons for this are acutely obvious: From 2013-2017, there were 127 deaths among people within 24 hours of police contact, and according to a report from the B.C. Coroner’s Service death panel, seven in 10 of the incidents involved a mental health issue. Although shocking, that finding isn’t surprising given that police are not trained to deal with what is essentially a complex health problem rather than a criminal one.
Indeed, the belief that police ought to attend such incidents is both the cause and consequence of the stigmatization and criminalization of mental illness. No one worries that a heart patient might be dangerous, but in a mental health crisis, we — and our current system — assume that violence is sufficiently inevitable as to require the presence of police.
As the death statistics reveal, violence often does occur, but it is the patients who pay the greatest price. And that violence is frequently at least partly the result of police presence, since it often creates fear, heightens tensions and ultimately escalates the situation.
Given this, police in Vancouver and B.C. have improved how they address mental health incidents, including through implementation of programs like Vancouver’s Car 87, which pairs plainclothes police officers with psychiatric nurses, and Assertive Community Treatment (ACT) teams, which embed police officers in multidisciplinary groups that provide treatment to those with complex mental health needs.
But the embedding of police remains the problem. Public health researcher Craig Norris, the first social worker to participate in the Car 87 program and a veteran of the ACT teams, told the committee that while ACT programs have existed around the world for 40 years, only B.C. chose to add police officers to the teams.
And since the composition of a team often dictates its complexion, the presence of police can have deleterious effects on everyone involved. Norris’s research reveals that many consumers of mental health services see the ACT program as essentially an element of the criminal justice system, and believe it results in a lack of autonomy and personal choice in their health care.
Similarly, service providers in police-embedded ACT teams expressed concerns that they’re used as agents of social control, thereby clashing with their health care values and interfering with their ability to develop trust with clients.
In contrast to this quasi-criminal justice approach to dealing with mental health care, several programs in the U.S. and Canada, including Toronto’s recently implemented Community Crisis Support Service pilot program and North and West Vancouver’s Peer Assisted Crisis Team, hire civilian teams of experts and peer supporters to attend at the sight of mental health incidents.
Rather than assuming at the outset that police are necessary, team members are responsible for assessing the incident, and if the situation involves a threat to safety, members can then call police. This therefore provides for a continuum of responses to incidents, but presumes that a health issue requires a health care response.
And that’s as it should be given that mental health care is just another form of health care. Which is why only health care workers ought to provide it.