Once my interest in policing and mental health really got going, it seemed sensible to look at other countries to see the nature of challenges facing their police services and to see if responses differed and could offer something from which I could learn. It didn’t take long to focus more on Canada and Australia than anywhere else, because both countries had experienced high-profile policing events connected to mental ill-health and when I began reading about them, it all sounded a quite familiar in tone. I want to focus on Canada in this post and give a UK perspective about the last few years of following news events.
Firstly, Canada being a federation of individual provinces and territories, legislation on mental health, policing and the governance of health and policing is done at that level, although there is a Federal criminal code. So there are many different Mental Health Acts, for British Columbia, Ontario, Quebec and all the other areas. What I first noticed about the Acts I’ve read, is that none of the powers equivalent to s136 Mental Health Act (England / Wales) allow detention in police custody and all them may be exercised in private places as well as public places, if the criteria are satisfied.
This immediately puts the Canadian police at an advantage - at least theoretically! - in terms of being able to access care for those detained, although reports about the usage of these powers suggest that they have quadrupled in just the last ten years. When you look at the numbers of detentions made, was stands out to me, is that for a country with just over half the population of the UK, the use of Mental Health Act emergency detentions seems very high. In the UK, recent figures suggest around 25,000 uses per annum, where as in Vancouver and Ontario alone, it is used over 10,000 times for populations that are about fifth of the size. I would love to know whether this is because the Canadian police can use MHA powers in private places; and I would love to know whether a theory from the police themselves that mental health intervention is now about crisis intervention rather than crisis prevention is driving this?
These facts and others have prompted questions across the Canadian debate about the extent of “de-institutionalisation” and the role of police officers as “front line mental health professionals.”
LOST IN TRANSITION
In 2008, Detective Fiona WILSON-BATES of the Vancouver Police Department (VPD) wrote a report for Chief Constable Jim CHU about “how a Lack of Capacity in the Mental Health System is Failing Vancouver’s Mentally Ill and Draining Police Resources.” This caught my attention and as I read through the document it all seemed depressingly familiar: deinstitutionalised healthcare, underfunded community care, crisis services that are not able to absorb the nature and variety of mental health demand which is generated and a consequential knock-on for the VPD who found that 31% of calls in a sample period involved at least one person experiencing mental distress and in more deprived areas of the city, this figure rose to 49% – all at a cost of $9 million. In 2010, Inspector Scott THOMPSON wrote a second report, which adds weight to those original findings and a summary is available.
We have seen the UK begin to talk recently about Street Triage: Vancouver Police have been operating “Car 87” in the city for some years, pairing a police officer and a psychiatric nurse to make earlier health interventions in policing related situations and the Lost in Transition reports, which became the officially endorsed position of the Vancouver Police Department and the Vancouver Police Board, made recommendations for their health partners about improved services.
This report should be set against a background of third-sector questions about the expanding role of the police, for example from the Canadian Mental Health Association in British Columbia; and it is clear that questions are asked against a background of concerns about the operations of the health and social care system. Chief Constable Jim CHU, as the chair of all Canadian Police Chiefs, recently called directly upon the federal Government of Canada to “step up” and to “do more” to resource the mental health system, pointing out that his officers are detaining four times as many vulnerable people now as they were just 10 years ago. His point was recently echoed by the Mayor of Vancouver, Gregor ROBERTSON.
CRISIS INTERVENTION TRAINING
In reaction to these trends, the Canadian police in several areas started to look to the US model of Crisis Intervention Training to provide at least some solutions, and investing in new models of working. CIT is an operational model where a certain percentage of front line police officers undergo what is usually a one-week course in mental health and crisis intervention, aimed at increasing their knowledge of mental distress and improving their skills to de-escalate situations without resort to the use of force.
Various studies suggest that this training leads to reductions in the use of force by officers, reductions in injuries to both patients and officers and to improved “diversionary decisions” by the police who better identify where the root cause of an incident could be unmet mental health need. (Some of those studies have wondered whether these improved outcomes are the consequence of the training or the consequence of certain officers volunteering for the training who were less inclined to use force.)
Of course, none of that necessarily matters if those better trained officers are still experiencing difficulty in accessing mental health services and in several areas mental health professionals have deployed with CIT officers to develop what the UK have started calling “Street Triage” schemes. Again, doing the wrong thing righter, but potentially better than nothing at all. But something in particular keeps raising it’s head when you look at Canada from the outside.
FATAL POLICE SHOOTINGS
Obviously, one of the most obvious differences with the UK is that our colleagues in Canada are all routinely armed. Controversy therefore arises from fatal shootings in a way we don’t see in the UK. As the (UK) Independent Police Complaints Commission was busy reporting in 2013 that the UK did not fire a single bullet in the preceding twelve months, intense debate was being sparked in Toronto and beyond about the shooting of Sammy YATIM.
(The UK shouldn’t be complacent or superior about this, we see greater numbers of restraint-related deaths in contact / custody.)
TRIGGER WARNING! >> I will shortly make mention of incidents and provide video links to them. They relate to two men being shot and killed.
Please carefully consider the impact of watching them — they are posted not for gratuitousness, but to show the tactics used by the police which prompt the debates.
To be clear from the start: there is no evidence that Sammy YATIM was mentally ill, although he was emotionally disturbed and it may well have been reasonable to wonder. However, in the case of Paul BOYD in Vancouver in 2007, it he suffered bipolar disorder and the video of the shooting only emerged last year and has prompted a re-investigation.
There have been other fatal shootings involving vulnerable people. The YouTube videos of these incidents are well circulated and in Sammy YATIM’s case involve him being shot whilst alone in Toronto street-car, brandishing a knife and in a distressed state. I’m not going to say too much at this stage about the incident, because the officer who shot him has been charged with murder and will yet stand trial. Suffice to say that when watching the video, I was stunned to see how the incident was handled.
In Montreal in 2011 Mario HAMEL was shot, alongside an uninvolved commuter after a police response to knife related attack and in 2010 in the Alberta town of Okotoks, south of Calgary, Corey LEWIS was shot in an apparent “suicide by cop” incident. These events and recent developments have led to calls that the police need to learn to de-escalate.
It is worthy of note, that since the shooting of Sammy YATIM just one month ago, the government of Ontario has already announced the expanded roll-out of Tasers to operational officers. The timing of the announcement, not long after the police officer concerned was charged with murder, has all the potential to be labelled a “knee-jerk” but in fairness, Ontario is reported to be behind other areas of Canada in providing this tactical option, which is now widely used around the world as a less-lethal option where force is required.
The overwhelming impression I have from following Canadian issues from the UK with my parallel interest, is that the police there having been very directly facing the issues presented by mental illness in a way that we only recently have in the United Kingdom. Despite the notoriety that inevitably attends the police use of lethal force, I have a feeling that there is very much that the we could learn from their experiences over the last ten or fifteen years. I also suspect, they could take something from UK policing, not least in terms of unarmed resolution to crisis events.
More Links -
- Study in Blue and Grey
- Canadian Mental Health Association
- Mental Health Commission of Canada
- Canadian Broadcast Corporation
The Mental Health Cop blog won
- the Mind 2012 Digital Media Award, in memory and in honour of Mark Hanson.
The Awards celebrate the “best portrayals of and reporting on mental health in the media.”
- a World of Mentalists 2012 #TWIMAward for the best in mental health blogs.
It was described as “a unique mix of professional resource, help for people using services and polemic.”