The role of police in a crisis intervention
Reprinted from the "Families and Crisis" issue of Visions Journal, 2017, 12 (4), p. 36
With the shift from institutional care to community-based mental health care, more people with mental illness are living in the community. By default, police officers are becoming the first point of access to mental health services for persons with mental illness. Given that 20-30% of police contacts involve persons with mental illness,1,2 many communities are looking at different models of care. People with mental health issues or addictions are not criminals; they are ill.
When an individual is in crisis, family members may not know how to help their loved one. Often their first instinct is to call 911.
“Police officers play a small role on the path to care for those suffering from mental illness, but it is an important one,” says Corporal Ian Hastie of the Salt Spring Island Detachment. “We are often the first professionals to meet and identify people requiring help.”
The first role of the police, is to assess the situation, reduce any threats, and ensure the safety of all involved. When police attend the scene, they will make the initial assessment to identify what is needed to establish safety. They also will need to determine if the situation is a criminal investigation or a medical emergency. If necessary, they can use authorities granted under the provincial Mental Health Act to keep individuals and the public safe from harm. Under the Act, a police officer can apprehend* a person and take them to a doctor for immediate examination, when they are observed to have a mental disorder, or they are acting in a way which endangers themselves or others. If police take the individual to the hospital, they must wait with them in the emergency room until the doctor examines them. This can take a great amount of time and can be a huge drain on police resources.
This is why it is critical that families provide as much information as possible when they call 911. It may seem invasive but police need to know all the facts before attending. Police need to know what the family is experiencing. Are they afraid? Is the person threatening them or others? Is the person threatening or causing themselves personal harm? What medications has the individual been prescribed? Have they taken the prescribed medications or any other substances? Does the person react to specific stimulus such as loud noises, fast movement, or the presence of more than one person at a time? How are they behaving—angry, paranoid, or agitated? Is the person hearing voices?
“We need the family to be honest with us,” says Staff Sergeant James McLaren, Detachment Commander for Kitimat. “Don’t minimize or downplay the situation. If we show up not prepared—without critical information—we react appropriately to the situation according to the information we have, but it may not be what the person in distress needs.”
Families should tell police what they are expecting. Do they want police to calm the situation down? Do they want the police to assist them in taking the individual to receive medical care? Do they want the police to apprehend the individual and take him or her to the hospital? “Families know what works and what doesn’t work,” says S/Sgt. McLaren. “If the person feels ambushed if they see a lot of people at once, we’ll send one officer in and the other one remains out of sight but available if needed.”
Police recognize the value of taking the time to talk with the person in distress, to ask the right questions, and to listen.
“Officers must approach these situations with a high degree of patience, care and compassion,” says Cpl. Hastie. “We work towards building trust with the person to gain their cooperation.”
Police officers are often asked to respond to multiple calls about the same person in distress. It becomes a revolving door. Often a person in distress will call 911, and police will attend as first responders to assess the safety of the situation. The person may receive emergency services or extended hospital care, then be discharged only to repeat the process the next day, week or month. It becomes a “cycle of crisis.”
Surrey RCMP Detachment has had great success with the Car 67 Program, which is a partnership with Fraser Health Authority and the Surrey RCMP. Once police officers who initially arrived on scene responding to the 911 call have assessed that the individual may need additional emotional or psychological support, they can request that Car 67 attend.
Then, a specially trained uniform RCMP officer and a clinical psychiatric nurse—arriving in an unmarked police car—work together and respond to calls received involving emotional and mental health issues. Car 67 provides on-site mental health assessment, crisis intervention and referrals to appropriate services. In a single decade, Car 67 handled 12,000 files. Unfortunately, some of these calls were for the same individual.
While officers can bring at-risk patients to the hospital for immediate treatment following an intervention, it is ultimately up to the patient and their health professionals to set a long-term strategy.
However, if the person has been assessed numerous times, or has been apprehended repeatedly, or is the subject of multiple 911 calls, there needs to be another level of crisis intervention that is long lasting. Corporal Taylor Quee took a lead role in standardizing a coordinated, multi-disciplinary team approach. In 2011, she created a new position, the Police Mental Health Liaison Officer (PMHL), whose role is to focus on the long-term case management of clients who have persistent or high-risk contact with police.
“I used to work in Whalley and I would see the same people in crisis over and over,” says Cpl. Quee. “Their risk behaviour would start to escalate, perhaps involving a weapon the next time.” She wondered, “Why couldn’t we resolve it at the first incidence of interaction and not wait until it escalated to criminal behaviour?”
Surrey’s approach to mental health clients involves a three-tiered approach. The first level of support for mentally ill individuals is the general duty officers responding to crisis situations as identified from 911 calls. The second level is the Car 67 program, which responds to mental health calls at the request of general duty officers. The third level is the Police Mental Health Officer who focuses on the long-term case management of clients who have persistent or high-risk contact with police.
Now manager of Surrey’s new Police Mental Health Intervention Unit, Cpl. Quee has five PMHL officers on the team. These officers are trained to liaise with hospitals, psychiatric professionals, and care workers who together will determine how best to approach each individual situation.
“The PMHL officer will explore interventions that would be beneficial to the individual in breaking the cycle of negative behaviour and manage the client before the risk behaviours escalate,” says Cpl. Quee.
The Car 67 team will bring a person to the attention of the PMHL who is high risk or has had multiple police contacts. The PMHL officer will work with the mental health care team to develop a collaborative strategy for support before the client’s behaviour deteriorates. If the client does not have a mental health care team, the PMHL officer will advocate for one and connect the client to the necessary services offered by the mental health system.
The mental health care team may include a psychiatrist, case manager, social worker, probation officer, family caregiver, and emergency room professionals who together will develop a response plan tailored specifically for each client. Typically, this team will meet monthly with the hospital and the client to problem-solve. This could include helping to find the person a home or a job.
Since these clients have been treated for their mental health disorders and have the appropriate care, there is no longer any need to dispatch police. Police can be back on the streets to respond to emergencies.
Recognizing the success of this model, other municipalities across BC have implemented a similar program with a mobile crisis intervention team.
“My role is to reach out, connect, obtain trust, and link those in need with the resources that will help them get better,” says Cpl. Quee.
Cpl. Quee is the former chair of the BC PMHL committee and there are now 25 officers around the province with designated police and mental health positions. She indicates that police in communities of any size can partner with the health care professionals and case workers to develop a plan for their shared client.
This model of collaborative problem solving for complex cases has many benefits, including reducing emergency room congestion, freeing up police resources, saving money, and potentially decreasing homelessness. It is also better for the quality of life of the client who is supported for several months after the initial intervention; and it’s better for the families. It’s better for everyone.
Visions recommends—related resource
Tips for Communicating with Police in a Mental Health Crisis. From the US, but relevant for any family member. See http://bit.ly/communication-with-police
*apprehend is not the same as arrest and will not generate a criminal record or appear on a police record check
About the author
Deborah Skaey is a Senior Communications Strategist for the RCMP and has managed multiple projects throughout BC RCMP. She also teaches media relations to future RCMP spokespeople and teaches the Internal Communications Workshop to senior leaders. Before working for the BC RCMP she ran her own communications consultancy and taught public relations at universities in Metro Vancouver
Vancouver Police Department. (2013). Vancouver's mental health crisis: An update report. http://vancouver.ca/police/assets/pdf/reports-policies/mental-health-crisis.pdf
Boyce, J., Rotenberg, C., & Karam, M. (2015). Mental health and contact with police in Canada, 2012. Juristat, 35(1). Statistics Canada. http://www.statcan.gc.ca/pub/85-002-x/2015001/article/14176-eng.pd