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Canadian National Committee for Police/Mental Health Liaison |
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First Steps Toward Best Practices: Models for Working with the Mental Health System Report on the 2002 Montreal Conference Conference Committee 2002 front row: back row (this article, written by Dr. Dorothy Cotton, was originally published in the January, 2003 issue of Blueline Magazine) In retrospect, it seems perfectly obvious—as things so often do after the fact. Surely it should have been apparent to those responsible for the downsizing and closure of psychiatric hospitals across the country that as individuals with serious mental illnesses left the protective “custody” of institutions that the frequency of their contacts with the criminal justice system in general and the police in particular would increase. Again, as often is the case, what seems obvious in retrospect was not so obvious at the time. Are the mentally ill more dangerous and more likely to run afoul of the law than the rest of us? Did the mental health system release these individuals knowing full well that a significant additional burden would fall to the police? Did the political incorrectness of suggesting that people with mental illnesses were dangerous get in the way of setting up services that might benefit both them and the public as deinstitutionalization was in progress? Is this even a line of work that the police should be in? The answer to all of these questions is the same: hard to say, not clear, not sure. Perhaps the good news is that the answers are no longer particularly important because in the years since deinstitutionalization has been in progress, some things have become abundantly clear:
Catchy title, eh? We made it up. Who is “we” and where did this group come from? It came from the concerns of Toronto Police Service Constable Scott Maywood, who is responsible for overseeing the interactions between the TPS and the mental health system in Toronto; from Chief Jamie Graham, formerly of the RCMP and now Chief Constable of the Vancouver Police, who chaired British Columbia Association of Chiefs of Police (BCACP)’s Mental Health Committee; from A/Supt Sean Ryan’s involvement with the Newfoundland inquests into police shootings of mentally ill individuals; from the interest of Chief Terry Coleman of the Moose Jaw Police who simply thought this was an issue that needed attention; from Supt Pat Hayes of the Ottawa Police Service who holds responsibility for liaison with Ottawa hospitals; from Dr. Dorothy Cotton, a psychologist formerly employed in a psychiatric hospital and now with Correctional Service Canada—who couldn’t help noticing that the police were spending an inordinate amount of time with her patients; from an enthusiastic group in Montreal who called when they got wind of a conference and said “Please—we want to host this!” The Montreal gang included Inspector Mario Leclerc, Agent de concertation Sylvie Beauregard, Commander Benoit Duval, and Louise Riopel, the coordinator of the mental health team which provides joint response with the Montreal Police to crises involving the mentally ill (l’Urgence psychosociale–justice of the CLSC des Faubourgs) In late September, 2002, 90 interested police officers and mental health professionals from jurisdictions across the country met in Montreal to listen to the concerns of individuals who have mental illnesses and from their families; to hear from people in such places as Montreal, Hamilton, and Ottawa where they have developed cooperative programs with mental health agencies to co-respond to mental health crises; to learn about the issues and informal mechanisms that arise in smaller places like Repentigny and Rimouski, Quebec—places where the population base is too small to warrant a full time team but where the problems are similar to those in the Big Cities; to hear the lessons that can be learned from systematic data collection, as has taken place in Toronto and London, Ontario; and to hear thoughts, ideas, problems, and dilemmas that confront all jurisdictions regardless of size or location. The data from the London Police are sobering. The numbers are going up dramatically, the amount off police time and budget utilized is significant and the number of “repeat callers” is significant. Similarly, Constable Maywood of the Toronto Police, in conjunction with Dr. Greg Brown of Nipissing University presented an overview of data collected in Toronto which suggests that a significant number of calls take more than two hours for police to resolve, that the number of calls is staggering, and that working relationships with the many hospitals in Toronto vary from efficient to frustrating and that the individual requiring these services are largely experiencing psychotic disorders, although there are a fair number of suicidal and disoriented individuals as well. . Both the Toronto data and the London data suggest that most of the time, when mentally ill people come in contact with the police, it is not in situations which involve violence. There is no doubt that additional data in this area are needed. A review of the scant literature in this area clearly points to the need to know more about the people the police are dealing with, their progression through the legal system, and—more importantly—what works and what doesn’t in terms of interventions. Montreal, Hamilton and Ottawa Police Services have some ideas about what works. In Hamilton and Ottawa, there are joint mental health/police services that have police officers seconded to mental health agencies. These teams respond both to direct requests from “the field,” as well as from requests from other police officers. In Montreal, the model is slightly different. The police there have the option of calling a crisis team which is specially designated to respond to such calls. One of their major selling points is a fast response time, obviously a critical requirement for police work. A theme that ran through all sessions at the conference was the need for training—not just training for police but also for mental health personnel to develop the skills and knowledge to deal with the risk management issues that are inherent in this kind of work. All jurisdictions expressed concern about the difficulties encountered in dealing with the medical system and emergency room personnel in particular. Needless to say, the need for police training in understanding and relating to individuals with severe mental illnesses was also a prime concern. But training, while a necessary component, is not a sufficient one. Most jurisdictions lack the resources and the organization for police services and mental health systems to work together. There are signs of progress, however. Maureen Fedorus of the Cornwall (ON) General Hospital spoke briefly about the recently developed memorandum of agreement between that hospital and local police services which should facilitate their working relationships. But the overwhelming sense of the conference is that there is much work to be done in this area. Inspector Frank Trovato of the Toronto Police Service spoke about his own research which has looked at how police decide what kinds of action to take when dealing with individuals who appear to be mentally ill, and the picture is—needless to say—complex. We still know little about how specific situations unfold and why. The good news is that despite the picture portrayed by the media at times, Inspector Trovato’s research and similar research conducted by Dr. Cotton has shown that the problem is not one of “attitude.” In fact, the attitudes of the police toward the community integration of mentally ill are at least as benevolent as those of the general public, and somewhat less authoritarian. Perhaps Supt Sean Ryan and Chief Terry Coleman said it best when they spoke of the frustration, the questions, the glaring deficiencies that are evident in “the system.” What is often presented as a “police problem” which leads to suggestions about improved and increased training for police is really only the tip of the iceberg. The care of individuals with mental illnesses is the responsibility, in the narrow sense, of the health care system. But some of these individuals inevitably wind up in the criminal justice system. The responsibility is diffuse. The health care system, the criminal justice system including the police, and indeed those individuals who suffer from mental illnesses are all part of the problem as well as part of the solution. Where does that leave the National Committee? Growing and active. Planning for the second annual conference is underway. We were fortunate to have funding and support from the federal Solicitor General and the Regie regionale de la sante et des services sociaux Montreal-Centre for this first conference. Proceedings from the conference are being finalized and will be circulated to a variety of organizations with a vested interest in this area—CACP, CPA, the Solicitor General, mental health organizations. There is interest in making some contacts with organizations that represent psychiatrists and emergency room physicians. Many people expressed an interest in further developing training models. As for the conference, the biggest drawing card for most participants was the welcome opportunity to meet with and talk to other people working in this area. To keep the momentum going, a “listserv” has been initiated—an email forum for conversing with others from across the country who are doing similar work. One thing that was clear throughout the conference was that there are a lot of good people and a lot of good work going on in this area. It’s not enough, but it’s a start. |
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