Mental health is ‘real police work’
By Dorothy Cotton
By Dorothy Cotton
1093 words – MR
Mental health is ‘real police work’
A psychology student asked me recently how I became involved in police psychology since it’s not acknowledged, let alone taught, in psychology school. I gave her an abridged version, leaving out all the parts about my bad judgment, butting in where I shouldn’t have and being too stubborn to go away when it was apparent that I should have.
It did get me thinking about my pet area of police psychology, which has to do with interactions with people with mental illnesses. It’s been about 15 or so years now since I first darkened the doorstep of the police world, and I got to thinking about how far we have come since I accidentally wandered into this area.
Back in the ’90’s, there was still some degree of debate about whether police even had a role to play in regard to people with mental illnesses. Ontario’s Chief Coroner commented that “the police are the front line extension of a mental system,” and an Ontario police chief picketed a mental health conference with a sign stating “we are not mental health workers.”
Even in some of my early research in the area I still found a significant number of police officers who didn’t feel that this kind of thing was “real” police work. I like to think that sentiment has subsided. One might argue about whether it OUGHT to be police work, but it’s tough to dispute the reality. Statistics Canada suggests that there are upwards of a million such interactions every year. That sounds real to me!
The real question has always been what to do about it. Initially, the remedy seemed pretty straightforward. Clearly, police did not know or understand much about mental illness – so they needed training. There seemed to be a bit of wishful thinking going on here but the belief seemed to be that if we just taught everyone the signs and symptoms of schizophrenia, they could recognize a hallucination and all would be well.
Don’t get me wrong – education is essential and I have spent more than my fair share number of hours trying to figure out how to make it as effective as possible (see http://goo.gl/CrWxY8 for conclusions in that regard). The fact is, though, education alone won’t do it.
Most police services also figured that out. Enter the second generation of solutions. Along came the specialized programs and staff assignments to address the problem. Whether it was CIT-type training, joint response models, a designated mental health officer or MOUs with local agencies, police services tended to develop some targeted and specialized responses for situations involving people with mental illnesses.
There is no doubt these kinds of approaches have been effective in many ways. Mental health agencies and police now work together more effectively and more referrals are made. Fewer people are arrested or taken to the hospital emergency room. The community seems to like and appreciate these programs. As far as they go, they are very successful – but like all individual programs, they have their limits. There are too many variables and different kinds of interactions with people with mental illnesses – and too many kinds of problems – to be easily addressed by a single add-on program.
In the last couple of years, we seem to have moved on a third generation of approaches – the strategic approach. Many police services have “strategies” in place for things like youth, domestic violence, gangs or organized crime, but the notion of taking a strategic approach to interactions with people with mental illnesses is more recent.
At the time I am writing this, the OPP is the only Canadian police organization I know of that has such a strategy, actually done and in writing. You can read it at http://goo.gl/40ZIzt . Last I heard Vancouver was on the verge – and its multifaceted approach to the problem certainly reflect the principles of such a strategy. The Vancouver Police Department’s initiatives in this area include:
• a mental health unit led by a sergeant who coordinates all activities related to P/MHP;
• police inclusion in mental health care teams, which provide for exchange of information between the medical system and the police when appropriate;
• the Car 87 program (co-response program);
• Downtown Community Court;
• an Assertive Community Treatment (ACT) team, which includes a police officer;
• a homeless outreach coordinator – a position that also provides a focus on the role of mental health problems in homelessness;
• a sex trade liaison officer – again, providing recognition of the role of mental health problems and substance use in this population; and
• Project Link: a joint activity of the police and Vancouver Coastal Health Board, whose goals include both improved outcomes for clients and improved and more efficient use of both police and mental health resources.
Hamilton has been a leader in this area for many decades. While probably best known for its co-response team COAST, it now also has several different co-response teams; a mobile response that does not include police, and a rapid-response team for crisis situations which require immediate response and greater overall police involvement – all for improving outcomes for people with mental illnesses. Specific initiatives include:
• a high visibility foot/bike patrol team in the downtown core where about 80 per cent of mental health encounters occur. This team is supported by a social navigator who proactively helps to prevent crises by linking individuals to services and supporting community partners;
• several co-response teams with a mental health worker and police officer; these include teams focused on providing services to adults, children and family and seniors;
• the COAST program, which also operates a suicide prevention help line;
• almost half of frontline police officers have completed the 40 hour crisis intervention team training and currently the Hamilton Police Service is training all personnel with a program specific to suicide presentation;
• a Mobile Crisis Rapid Response Team (MCRRT) in which a mental health worker and police officer in the same police vehicle provide a first response to situations involving P/MHP; and
• the development and utilization of the patient transfer document (MOU), developed in partnership with St. Joseph’s Hospital, which has succeeded in reducing wait times in the emergency room from an average of 2.5 hours to 70 minutes in general and to under an hour for the MCRRT.
What all of these approaches really speak to is the need for an integrated and comprehensive approach rather than a single add-on program. Wondering where to start? The Mental Health Commission recently released an updated version of the Contemporary Policing Guidelines for Working with the Mental Health System – http://goo.gl/ZoBk4a .
Have a look.