Calling police when someone is suffering a mental health crisis can have horrific consequences; what is the alternative?

In February 2014, Mohammed Eshaq fell to his death from the 10th-floor balcony of his South End Halifax apartment.

Eshaq lived with schizophrenia, and was an in-patient at the Nova Scotia Hospital’s Simpson Landing at the time. He left on a 15-minute pass and didn’t go back, instead taking transit to his parents’ place. They drove him to his apartment to pick up a few things, and expected he would return to the hospital.

As Judy Haiven wrote in the Nova Scotia Advocate:

[Eshaq] insisted he wanted time to himself in his apartment, and that he would return to the hospital later. The mother and son contacted the hospital to tell them. A hospital nurse phoned the police, and asked them to bring him back.

Up in his apartment, Eshaq barricaded himself inside. He refused police requests to leave and return to the hospital.

With police in his apartment, he fell from the balcony and died.

In June of the same year, the Serious Incident Response Team concluded its investigation into Eshaq’s death and the police’s role in it. The investigation found… wait for it… that there was no criminal wrongdoing on the part of police.

Without a hint of irony, the report, quoted in a CBC story, says:

“Knowing that an involuntary patient is a person who may be a danger to themselves, the police made the decision to enter the apartment to ensure the safety of the man…

“The police have a duty to protect life, and in the circumstances were justified in entering the apartment out of concern for the health and safety of the man.”

Adrienne Power knew Eshaq. Power works for the Schizophrenia Society of Nova Scotia, but spoke to me as an individual, and not as a representative of the society. In an interview last week, she said Eshaq “jumped out the window and died. Police came banging at his door, and he was in distress… When someone’s in a crisis, who knows what people’s experiences are? What state they’re in?” She added, “Also, someone who has a psychotic disorder might have some delusions or paranoia about the police. So the police might just be coming to take you for treatment, but who knows what your fears are around that?”

As you surely know by now, having police respond to people in a mental health crisis can have horrific consequences. Since May, Canadians have been shocked by the death of Regis Korchinski-Parquet, who died in circumstances similar to Eshaq’s, as well as by the killings of Chantel Moore and Ejaz Ahmed Choudry, both of whom were shot by police who had been called by friends or family concerned about their mental health.

Rodney Levi, who was shot and killed by the RCMP in New Brunswick, was also said to struggle with his mental health. Back in April, Peel Regional Police in Brampton shot and killed D’Andre Campbell, after he had called 911 himself seeking help with a mental health crisis. And Kelowna nursing student Mona Wang is suing the RCMP after her boyfriend got worried and called for a wellness check. The officer who responded dragged her down a hallway, stepped on her head, and pulled her up by her hair.

Movements to defund the police frequently point to the mistreatment of people with mental illness, saying surely there must be a better way.

“Given what’s going on right now with people who were receiving wellness checks and have unfortunately died at the hands of police, it’s overdue, it’s [past] time to be thinking that police are not the right people who should be responding,” said a parent and advocate for people with mental illness and their families, who spoke with the Halifax Examiner on condition of anonymity.

“They’re not trained for it, and policing is not health care… If you come at it in the first place with people who have much better skills and experience, you have a better outcome and a less traumatic outcome,” she said. “If they are manhandled, handcuffed, that’s so traumatic, and that trauma gets layered on.”

RCMP commissioner Brenda Lucki, meanwhile, told a House of Commons committee that, “When someone is holding a knife and suffering from a mental health crisis, that is not the time to be bringing in mental health practitioners.”

Considering that 70% of the nearly 500 people killed by Canadian police between 2000 and 2018 had addictions and/or mental health concerns, it’s hard to see how Lucki could be more wrong.

In an interview with CBC, Wang, the nursing student abused during a wellness check,  called for officers to at least be accompanied by health professionals:

“I don’t believe that police officers should go alone to a wellness check,” she said. “[And] I think it’s very important for a mental health nurse or a social worker or any other kind of allied health to accompany police … because they have the skills needed.”

Referring to her own training, Wang says nurses are specifically taught to use de-escalation techniques without resorting to force.

“We have combative and aggressive patients all the time,” she said. “It’s telling them that your feelings are valid and speaking through it.”

Halifax, it turns out, has just the kind of team Wang was talking about. It’s called Mental Health Mobile Crisis. (A fun game to play if you have time to spare is to try and find information on the service on the NSHA’s mental health and addictions website.)

The service offers phone support 24/7 to anyone in the province. It also has teams that will respond to calls within HRM, between 11am and 1am. Those teams consist of a mental health clinician and a plainclothes Halifax Regional Police officer, who arrive at calls in an unmarked vehicle. The program is run in partnership by the NSHA, the IWK, and HRP, and also has service agreements with EHS and 811.

Matt White, who heads mobile crisis, is a social worker by training. He started at the service in 2008 on a casual contract and worked his way up to management. Currently, he is program leader for crisis and acute support, meaning he oversees other services as well as Mobile Crisis.

Given the recent spotlight on police killings of people with mental illness, I asked White if he would consider having mobile crisis not send cops out on calls.

“That wouldn’t be anything that we’ve discussed as a team. You know, we really value our partnership with the regional police,” he said. “For our service, that partnership with the police allows us to to attend higher acuity [ie, greater state of crisis] calls where normal clinical staff wouldn’t attend, and our police partners that you have through the HRP, the four officers who are seconded to our unit… I just can’t speak highly enough of both a) the additional training they have, and b) the mindset and how they want to work with our population. That has really shone through.”

Spend any amount of time speaking to people with experience in the mental health system, and you’ll hear a couple of different reactions to mobile crisis. There are those who have found the service helpful. Then there’s the question of resources and funding — lots of complaints from people who called but found the team was tied up and could not send someone to them. People with lived experience of mental illness may have fears about calling because they don’t want the police to take them to hospital, potentially against their will.

Conversely, some family members are frustrated because they see their loved ones in need of help, but perceive mobile crisis as having its hands tied when it comes to getting them treatment. This is particularly true of people who are suicidal, and may find themselves seen briefly at the ER and then released, the family advocate I spoke to said.

Recently, mobile crisis and similar services in other provinces have been cited as models for an alternative to calling 911 for wellness checks or for people in crisis — not only by activists critical of police, but, in some cases, by police themselves.

In a CBC story, Chief Dave MacNeil of the Truro Police Service said:

“This isn’t the type of work that we sign on to do, and it’s not the type of work that we’re actually trained well to do… We don’t call mental health clinicians to respond to break and enters, but unfortunately the police are kind of the agency of last resort,” he said. “We’re the only 24/7 helping agency in most communities, and people call the police for all kinds of things.”

But that kind of service would require a huge increase in staff and resources. It was only in 2017 that the mobile crisis phone system was upgraded so that callers could be put on hold if there was nobody available to speak to them right away.

White said both the number of calls and number of staff have “increased significantly” over the last few years. Around the same time the phone system was upgraded, the service got two new staff members. The team now includes 12 full-time staff, and four police officers. Most of the time, there is only one mobile team (made up of a clinician and a police officer) available to respond to calls, though there are a couple of hours per day in which the two daily teams’ shifts overlap.

The family advocate said mobile crisis is struggling just to meet current demand. “I think it’s a great concept but it would be better if it were taken more seriously and expanded, because if we had mobile crisis responding to all these mental health crises instead of the police, we would need a much larger team and make the service available more readily,” she said.

“They may answer the phone but not be able to send the crisis team out because they have other calls they are already dealing with — and if they are not able to respond in time, the opportunity may be missed. That’s not the fault of mobile crisis… If the government and the health authority were to take the value of this service more seriously, and funded it, and provided training in an effort to provide an excellent service, a lot of this stuff in the news would not be happening. ”

But is mobile crisis the best model out there? Social worker Andrew Childerhose doesn’t think so.

“I think we need to be cautious any time the police are involve in mental health crises,” he said in an interview. When it comes to “intergenerational trauma, and people who are vulnerable or marginalized, the police are not necessarily a helpful force, and we need to be conscious of what those police officers are bringing into this.”

Childerhose, who did his undergraduate degree in social work at Dal and has an MSW from York, now works in Kitchener-Waterloo for  Specialized Outreach Services (SOS). It’s a non-profit serving people who are homeless or at risk of homelessness and who live with mental health or addictions concerns.

“We have a policing system that’s not unbiased. Across the board, a lot of [marginalized people] don’t feel safe having a police officer respond,” he said. That holds true even if they are in plain clothes and part of a specialized response team. “At the end of the day, there is still somebody deeply intertwined in the criminal justice system and prison-industrial complex… When police respond to something, they are not part of the long-term solution, where a social worker, nurse or peer could be.”

White says all officers working with mobile crisis have taken part in a 40-hour crisis intervention program originating in Memphis, Tennessee. The program describes itself like this:

An innovative police based first responder program that has become nationally known as the “Memphis Model” of pre-arrest jail diversion for those in a mental illness crisis. This program provides law enforcement based crisis intervention training for helping those individuals with mental illness. Involvement in CIT is voluntary and based in the patrol division of the police department. In addition, CIT works in partnership with those in mental health care to provide a system of services that is friendly to the individuals with mental illness, family members, and the police officers.

White said the training is mandatory for officers who want to work with mobile crisis, and that ideally those responding to mental health calls more generally will be drawn from the pool of police who have been through the program.

Halifax Regional Police runs these crisis intervention training programs twice a year, with 20 HRP and four RCMP officers participating each time. The local force has over 500 sworn officers, so less than 10% get training in responding to mental health calls in any given year.

And how effective is the training? A New York Times story last week noted that since the introduction of a program aimed at training NYPD officers in responding to mental health crises, the rate of people with mental illness killed by the police has gone up:

The program has so far given half the officers on the force 40 hours of training in handling encounters with people suffering mental health emergencies.

Since the program was implemented in 2015, 16 people with mental illness have been killed in encounters with New York City police, a higher rate than before the training started, said Carla Rabinowitz from Community Access, an advocacy group that has worked with the Police Department to expand mental health training for officers…“Forty hours of training can’t counter the police mentality; it can’t counter the police values,” Ms. Rabinowitz said. “When someone calls for help, they need help. They don’t need someone with a gun pointed at them.”

All but one of those 16 people with mental illness killed by the police were people of color, Ms. Rabinowitz added.

Closer to home, Sir Wilfrid Laurier criminology professor Jennifer Lavoie said on a recent episode of the CBC’s FrontBurner podcast that there are no national standards for crisis intervention training, and that:

“Most of the training that is being offered, and it’s haphazard at best, has never been tested empirically to show whether or not the kind of training officers are doing actually results in better de-escalation and better responses to people in mental health crisis.”

Asked what he would say to people who hesitate to contact mobile crisis because of concerns about police, White said he would encourage them to call anyway, because a call to mobile crisis doesn’t have to result in a visit from the mobile team, and callers can remain anonymous. “They don’t have to give us their name. We don’t register people.”

He added, “We can provide somebody with a lot of support and begin having those conversations around exploring solutions and options as to how they may get support for themselves or a loved one. So if police are a real barrier to that, we can help support someone get to an emergency department or get connected with our central intake team to get them an appointment. You know, there’s a variety of  different ways we could get creative to help them connect with mental health services.”

The family advocate is hopeful this moment will lead to change — even if that just means more funding for alternative response teams like mobile crisis. She said, “Maybe this current crisis with policing and their handling of mental health crises will bring this to the fore enough that people will say we have to make this service much more robust, recognize its value in the community and see how it can change things in a dramatically positive way.”

For his part, Childerhose thinks we need to go farther, and completely rethink crisis response and wellness checks.

“Many of us are currently asking: ‘how do we create a more just world?’” he said in an email. “We first need to shift wellness checks from criminalizing individuals living with mental health issues to holistic community-led responses. These moments need to be understood as health care issues, but they also need to community-led, and build both capacity in communities’ ability to respond to crisis, and the resources there are to offer. Black people, Indigenous people, disabled people, people that use substances, and queer people need to be the ones leading the responses, and those acting in solidarity must follow their lead… The more we begin to understand the needs of individuals, the more we should be able to expand services.”

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