Approach mental health crises with care, not policing: crisis worker

What if a response to a mental health crisis, or a person sleeping in a parkade, was a couple of people in plain clothes asking, "How can we support you?"

Ebony Morgan is a crisis intervention worker with Crisis Assistance Helping Out on the Streets, or CAHOOTS, in Eugene, Ore., which has served its community since 1989.

Through CAHOOTS, medical professional and crisis worker teams provide first aid in case of urgent medical need or psychological crisis. They assess, provide information, referrals, advocate for people and even bring them to another non-profit where they can get additional support.

"We have the trust of our community so when we arrive, we lead with, 'How can we support you? What's going on? What do you need right now,'" Morgan said.

CAHOOTS provides one model of working with — but also independently of — police.

Calls for defunding

The concept of reallocating money from the police has gathered increasing steam in the wake of the protests sparked by the deaths of George Floyd and Breonna Taylor by police in the U.S.

In Canada, the role of police in the deaths of Black and Indigenous people who suffered from mental health problems — including Chantel Moore, Regis Korchinski-Paquet, D'Andre Campbell and Machuar Madut — is also coming under increased scrutiny.

Many people have called for defunding the police, in whole or in part, in order to reallocate that money to social service organizations that are better equipped with dealing with the root causes of crime, including poverty, unstable housing, mental health problems and addictions.

Across Canada, city councilors and even Winnipeg's police chief have signalled a willingness for change.

Social agencies have had funding cut back "pretty dramatically" over the last decade by various levels of government, which forces a lot of the work to front-line workers like paramedics and police, Chief Danny Smyth said earlier this week.

He says he'd like to see social services receiving an increase in funding to a sustainable level, then the police service could look at lessening their roles and work instead as supports to those agencies.

CAHOOTS can handle 99.4 per cent of calls

In Oregon, CAHOOTS teams are dispatched by the local police department's non-emergency line and are sometimes sent out with law enforcement. Last year, they were called to deal with crises about 24,000 times and only needed to call 911 for help 150 times.

"That works out to 0.6 per cent. So 99.4 per cent of the time we can handle what we encounter without a police officer," Morgan said.

"The times that we do have to call them in, we're very clear with our clients that that's what the outcome is about to be and the reasoning for it."

The free service in Eugene and neighbouring Springfield has a yearly budget of $1 million, compared to the the local police's budget of $60 million, Morgan says, but it does about 20 per cent of the work. 

Staff at CAHOOTS travel across the country teaching people the CAHOOTS model, and so far it's been picked up in Oakland, Cali.; New York City and Denver, Colo.

So far there's been no uptake in Canada, but Morgan thinks that should change.

"I truly believe we should be in every city," she said.

"I think it helps gets rid of some of that stigma around needing help when it's just a couple of people that are walking up to you in their hoodies and jeans, saying 'how are you doing? Can we offer you anything?'"

Mental health ambulance

Meanwhile, in Stockholm, a mental health ambulance has been lauded by advocates and patients for elevating the status of mental health care.

The program, which started in 2015 as a two-year pilot project, became a permanent fixture in the county's emergency medicine response, according to Andreas Carlborg, the managing director of Northern Stockholm Psychiatry at Stockholm Health Care Services.

"If you had a stroke or a heart attack you'd be treated by nurses in an ambulance ... but if you would have an emergency mental health issue you would probably be dealt with by the police. Now, you would be taken care of by trained nurses in the same way as you would have if you would have a somatic problem," he said

Carlborg says police who aren't trained to deal with these issues can focus on other things, and from a medical perspective, patients get a thorough pre-hospital screening to determine whether they need further care.

Although the program is working well, Carlborg says there's room for improvement. The mental health ambulance is called 15-20 times a day, but with just one vehicle, it isn't possible to see all those patients in a timely manner, so the staff attend to the most serious patients — normally five a day.

"I think there's a general need to increase funding for mental health services in society and definitely in Stockholm, Sweden, as well," he said. 

There's keen interest in other jurisdictions, including the U.K. and New Zealand. He says there's a similar program in the Netherlands and Norway as well.

'Great need out there' for specialized workers

Police in Winnipeg say they're working to ensure officers have a better understanding of mental health when responding to calls, but it would be ideal to have more highly-trained mental health and social workers in the field.

"Yeah, specialized people in the field, I'm in support of that all the way. There's great need out there and the more people who are out there the better," said Deputy Chief Gord Perrier.

He told CBC News the police receive mental health training and use tools to assess people's history with police to learn how to approach a particular situation.

Currently there's a program that ensure paramedics are sent to certain 911 calls when they're better suited to the situation, and the Vulnerable Persons Unit pairs a social worker with a police officer when responding to some mental health or addictions calls. 

Perrier hopes that unit will expand and that more social service agencies will be open 24 hours for people in crisis.

"People can't control their crisis to be between 8 a.m. and 4 p.m.," he said.

Morgan worries that people only know to call police in an emergency, when that's not always the right choice.

"The cops don't always have to come, but it's the default to call them, and I think that's where even they get frustrated."

If you're experiencing suicidal thoughts or having a mental health crisis, there is help out there. Contact the Manitoba Suicide Prevention and Support Line toll-free at 1-877-435-7170 (1-877-HELP170) or the Kids Help Phone at 1-800-668-6868. You can also text CONNECT to 686868 and get immediate support from a crisis responder through the Crisis Text Line, powered by Kids Help Phone.