Health PEI has disregarded the recommendation of a steering committee by moving forward with mobile mental health units that include plainclothes, armed police officers in every mobile response.
Opponents of this model say it criminalizes mental health issues.
“In my opinion there are better models proposed but not chosen,” Dr Scott Cameron, PEI’s Medical Director of Emergency Health Services, said.
The crisis teams are intended to provide earlier and more appropriate care to those experiencing a mental health crisis: the right care at the right time and in the right place for the patient.
Rapid, mobile mental health care has shown potential to reduce higher than necessary emergency department and police responses, both of which have been identified as problems in PEI. This type of intervention can also reduce psychiatric hospital admissions.
A variety of models have been discussed on PEI and across the country.
The model chosen for PEI – pairing police with mental health clinicians, is similar, with some variation, to models implemented in Toronto, New Brunswick, and Newfoundland.
A proposed model
Tasked by Health PEI, over the course of 2018 and 2019, Dr Cameron worked with representatives from police, the Department of Justice, Victim Services, EMS and emergency departments to develop a model recommendation.
The model recommended by the group would have seen allied mental health professionals such as registered nurses or social workers leading crisis responses with support from paramedics as principal responders, according to Dr Cameron. Police would be available to assist when needed.
Health PEI has instead chosen a model that dispatches plainclothes, armed police officers teamed with mental health clinicians such as social workers or registered nurses to all mobile responses. The officers will have a minimum of 40 hours mental health training.
A total of three teams, one per county, will be available to respond to mental health crises in unmarked vehicles, noon to midnight. The mobile units will be complemented by a mental health phone service, able to provide over the phone care 24/7.
The program will be led by psychologist, Jonathan Dudeck. Some virtual psychiatric care will be available through the mobile units.
Continuum of care needed
The CAMH (Centre for Addiction and Mental Health), Canada’s largest psychiatric teaching hospital stated this year, “Police should not be the first responders when people are in crisis in the community,” and “transformative change is needed to support a new way forward.”
Dr Vicky Stergiopoulos is the hospital’s physician-in-chief.
She is also part of a group reviewing mental health crisis teams internationally to provide a recommendation for the Mental Health Commission of Canada.
Dr Stergiopoulos said it’s important to look at crisis response along a continuum and offer a variety of service options to achieve the appropriate responses.
“There is not a miracle service that can do it all,” Dr Stergiopoulos said.
Police may fit into a continuum of care but “as a first response this is something we should be moving away from.”
Moving away from police as first responders
“It is absolutely time we go beyond interventions where police are involved at all,” she said.
After some experience with a co-response model, which pairs police and mental health workers together, “Toronto is changing the model and actually funding a new model where police are not involved,” Dr Stergiopoulos said.
In jurisdictions with co-response teams pairing police and mental health care workers as first responders, said Dr Stergiopoulos, “we still see people in a mental health crisis being shot by police.”
This year, Chantel Moore, a 26-year-old Indigenous woman was fatally shot during a wellness check by police in New Brunswick.
Eight days later, Rodney Levi, 48, was fatally shot by the RCMP in the same province. It was later reported by the chief of Mr Levi’s First Nation in a Canadian Press Article that Mr Levi was not violent and had tried to get a mental health assessment at a hospital shortly before the incident, but was refused.
Dr Stergiopoulos said availability is generally one flaw with existing mobile mental health crisis response teams in Canada. When the teams aren’t available, in some cases, police end up answering mental health crisis calls as the sole, primary responder.
Room for improvement
“I think we can do better,” Dr Cameron said.
“I think that (sending police to mental health crises by default) sends a rather negative message to the public about what we as a system institutionally think of mental health.”
He said messaging may not be intentional but members of the public could perceive that mental health is being equated with criminality, potential criminality or violence.
Having police respond in the same vehicle as a mental health clinician to all mental health crises also brings up concerns surrounding public perception of how privacy and confidentiality between patients and mental healthcare providers might be maintained.
“When we are trying to de-stigmatize mental health and encourage people to reach out, I think embedding law enforcement in the circle of care is concerning,” Dr Cameron said.
“If you were starting from scratch in 2020, I would question, would you really want to build a model that embeds police in the health care team?”
Verna Ryan the chief administrative officer of Mental Health and addictions said a number of models were considered.
“The majority of models that provided evidence to us were mental health and addictions led with police. Sometimes there was a police lead with mental health and addiction as a secondary,” she said.
“I don’t think PEI should necessarily look at what’s on the ground now,” Dr Stergiopoulos said.
“Nobody within Canada or very few jurisdictions in Canada have a model that seems to work.”
She said variations in implementation in PEI’s model compared to others could affect outcomes for the better so could other local factors.
She added “the models that are looked at internationally are for police to not be the first responders but to have mental health exclusive teams with perhaps some back-up when police is needed.”
A step forward
Despite this, Dr Stergiopoulos sees PEI to be advancing.
“I think it is definitely a step forward and the intentions are good, the intentions are to improve the experience of people with mental illness and problems and to just evaluate.”
Dr Heather Keizer, Health PEI’s Chief of Mental Health and Addictions Services also sees the planned model as an improvement and an enhancement of services already available.
“The motivation not to criminalize mental health and addictions is really part of the reason for this,” she said.
Responses addressed by mental health care workers rather than police on their own will be helpful, she said.
In PEI, police respond to about 2,000 calls annually, according to Ms Ryan and EMS responds to about 1,200. She said cases where both police and EMS are needed on scene cause some overlap in the numbers.
Dr Keizer said the minimum of 40 hours of mental health training affiliated police officers will undergo should be beneficial.
The unmarked vehicles and plainclothes of police officers were also chosen in part to mitigate stigma.
She said policing on PEI is somewhat unique because of the Island’s small and closely connected population.
“A lot of what might be perceived as risk is really mitigated here because our police are very well connected and actually well received within our communities.”
Conversations about the program and implementation are ongoing between Health PEI and all Island police authorities: RCMP, Charlottetown Police, Summerside Police and Kensington Police.
So far agreements and logistics such as staffing considerations have not been finalized, Ms Ryan said.
Summerside Police Sergeant Jason Blacquiere said, “We certainly welcome the creation of the new mental health units and feel they will be an invaluable resource to us and the community.”
“The police are not trained mental health professionals, although we do try to do our best to service clients in crisis, we are certainly not the best first option when dealing with these types of calls.”
Sherry MacDougall, senior communications officer for RCMP Island-wide said, until there are more comprehensive conversations about the program and something has been decided amongst everybody, it’s not fair for RCMP to comment on how it would affect their organization.
She said comments about the program at this time would be putting the cart before the horse.
Addressing confidentiality concerns, Ms Ryan said the mobile response vehicles will be equipped with two separate database systems, (an integrated health system and a police system). But information on each system will only be accessible by the appropriate staff.
As for patient confidentiality concerning the mental health crisis in consideration, Ms Ryan said police and mental health clinicians will be working and communicating as a team.
Ms Ryan advised to keep in mind, right now police regularly respond to and communicate with those experiencing mental health crises.
Performance and monitoring metrics are expected to develop and measure the ongoing impact of the program, according to the federal-provincial funding agreement which outlines the project.
Both individual outcomes for referred clients, and the program’s overall impact on pressure points and service use within the broader mental health and addictions system are expected.
Ms Ryan said the program will be up for evaluation and adjustments if needed. She wouldn’t provide a timeline as to when the program would be up and running.