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NO MAGIC RECIPES


September 10, 2012
By Dorothy Cotton

Generally, when you hear the phrase “Tis the season” it means Christmas is coming. However, Christmas isn’t the only activity that appears to create a seasonal flurry of activity.

In my own little area of practice, I notice that every now and then I get a flurry of requests and questions about how to create some kind of organized police response to people with mental illnesses. I note that these requests often come on the heels of some high profile and generally negative event where something bad happens to a person with a mental illness in an interaction with police. Recently, this area seems to have hit the press a lot – again – and so I am getting calls (and happy to get them, I will add).

Life would be easier if there were some definitive one-size-fits-all, tried and true model guaranteed to suit all need, but like everything else in policing, one size does not generally fit all. I just came back from a visit to Cape Breton and I gotta tell you, I would be very surprised if the models they use in downtown Toronto would work very well there.

Kelowna is not Trois Rivieres. There are differences in geography, population and population density, available resources – of both the policing and the mental health variety. Community relations, cultures and community expectations are different… pretty much everything is different.

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I suspect you knew this already.

So if you are one of the many police services developing, thinking about developing, thinking about revising or revisiting, or even thinking about thinking about an organized response to situations involving people with mental illnesses, here’s my two cents worth about where to start:

  1. Check out the website www.pmhl.ca . Sponsored by the CACP, it has a ton of info about police/mental health activities. It will give you an idea about what’s out there and where to start.

  2. Also check out the Contemporary Policing Guidelines for Working with the Mental Health System–available at http://pmhl.ca/webpages/Tips.html

  3. Based on #2, start thinking about your own local needs, what drives the need for a service in your area and your relationship with the local mental health agencies. The most important consideration in developing a program is to make sure it fits your jurisdictional needs. As noted, a model that works in one area may not be the best for another area.

  4. Before you even start developing a program, get data. How many calls do your officers handle? What types are they and how do they play out? If the problem is one of frequent brief encounters with homeless people with mental illnesses, that is a whole different problem that dealing with frequent crisis situations. Is the issue that your officers spend too much time cooling their heels in the ER? Maybe you have generally bad relations with the mental health system and they give you grief about everything? Maybe the mental health people are a five hour drive (or flight) away? What is the biggest pressing need?

  5. What is your goal? You will never know if you have reached it if you don’t know what it is to start with. Many programs developed in the US aim to decrease the number of injuries and deaths in interactions with people with mental illnesses. If you community hasn’t had any injuries of deaths, this might not be the best model for you. Why solve a problem you did not have to start with?

  6. If you have gotten as far as sorting out data and goals, then you can start planning. First, who are your community partners in this? Obviously, you need to include the mental health people but which other agencies? How about paramedics? ER? People with the lived experience of mental illness need to be included. There may be other local agencies that should be part of the effort. At least one jurisdiction I know of has included the parks and rec people because that’s where a lot of the calls originate. How about subsidized housing people?

  7. Then there is the whole issue of choosing a model. Unfortunately, for many police organizations, this seems to consist of “Let’s develop a CIT team” (aka “the Memphis Model”). Don’t get me wrong – I am a big fan of the CIT model but I also like the mobile crisis response model, the sequential response model, the co-response model, the advanced patrol training model, the “let’s-not-have-a-formal-model-but-just-work-better-with-our-community-partners model…” There’s even the “we have unique considerations here and will develop our own model” model. The important thing is to really think about your local needs, explore the existing models and choose wisely. (You can find brief descriptions of these models at http://www.pmhl.ca/webpages/Workingtogether.html). There is no doubt the CIT type approach is the best developed and mostly widely researched – and it might be just the thing for you – or it might not be.

  8. Training is key – but it is not everything. If you read a lot of inquest and fatality reports, you’ll get the impression that training cures all ills. Hah. Training is good and essential – but it is not the be-all and end-all. Training applies not only to police but to your mental health partners. Most do not have a clue what goes on in policing. You need to educate them, just as they need to educate you. However, training is not going to be done in an hour – or even a week. There are lots of good training resources out there; you need not reinvent the wheel. I suggest you check out the document which is available at http://www.mentalhealthcommission.ca/English/Pages/ThePoliceProject.aspx . It is a couple of years old now but it will give you an idea of what some of your colleagues are up to – and most importantly, it provides a prototype for what the ideal education and training look like. It will give you someplace to aim.

  9. Choose a strong leadership team – both in your agency and local community. In policing, being assigned to the mental health team does not have the cache of ERT or major crimes. However, that does not mean it should be the place you send your problem officers. If you play your cards right, people will be fighting for a place on this team – ask some of the jurisdictions with well established teams.

  10. Once you get started, monitor, measure, count… is it working? What are the effects? How is the community reacting? I refer you back to item #2 – setting goals. Were you able to achieve them – or are you even heading in the right direction? Were there unexpected effects of the program, good or bad?

  11. Finally, talk to your colleagues across the country. On the aforementioned pmhl.ca website you will see info on how to join a listserv/electronic mailing list which will provide you with ready access to police officers and mental health folks from Toronto to Nunavut, Sydney to Victoria, some who have have been doing this work for decades. They are your resources – use them!

Darn. I was hoping I could make this a Top 10 list but there appear to be 11 items. Oh well.

Personally, I think the biggest challenge in this whole process is figuring out what your local goals are. I was recently approached by an extremely small and remote area where there had been a death some years ago. Their goal was to prevent another death. This sounds good – but given that there had only been one death in the area’s history, you can bet that even if they don’t do anything, the likelihood of another death is virtually zero. This does not mean you should ignore the problem; it means you need to be very clear about why you are doing whatever you plan to do and what effect you want it to have.

Not as easy or obvious as it sounds!