Andrew Loku inquest calls for 24-hour crisis intervention teams, but how do they work?

The inquest into the police shooting death of Andrew Loku explored the issue of race but it also re-ignited the conversation over how the police respond to calls involving people with mental illnesses.

Loku, who had post traumatic stress disorder, was holding a hammer when he was shot and killed by police on July 5, 2015.

On Friday, the jury tasked with trying to prevent similar deaths made recommendations to expand the hours of the Mobile Crisis Intervention Teams (MCITs) and upgrade the unit to first responders. 

• Andrew Loku inquest verdict 

• SIU: no charges in the death of Andrew Loku​

The MCIT, a joint effort between the Toronto Police Service and mental health nurses from six area hospitals, responds to calls involving emotionally disturbed people.

A month before the inquest got underway, CBC video producer Craig Chivers got a closer look at the MCIT.

Police, nurses team up

It's May 1 and Const. Rob Koops and registered nurse Shelagh Scanga are working together as partners. 

"We primarily respond to calls for people in crisis, a mental health crisis or threatening suicide," Koops says.

"My role is to work with the officers in terms of de-escalating people who are in crisis and facilitate the process of them getting support," Scanga says.

CBC Toronto is there when a call comes in for a person with a history of mental health issues, believed to have taken crystal meth. 

"The behaviour was too erratic and too threatening and very intimidating," said Scanga.

Frontline officers, a sergeant and paramedics are already at the scene, when the MCIT is asked to attend. 

"This person has a history of requiring many officers to apprehend," Scanga says.

But on this day, the woman invites the officers into her apartment. She's very vocal, her thoughts are disorganized and hard to follow. CBC Toronto has agreed to protect her identity.

"I see you guys wearing police uniforms," she tells the team. 

That's the opening that Scanga needs. "Well, actually, I'm a nurse," she replies. 

Scanga later explains: "When someone hears ... there's a nurse involved, it can help with decreasing their anxiety and fears."

Over the next 20 minutes the team learns that she has schizophrenia and she receives medication by injection once a month.

It's almost time for her next shot.

"I'm totally sane. I'm totally fine," the woman says, trying to convince them that she doesn't need to go to the hospital. 

"We might have to take you against your will but we'd appreciate it if you would cooperate," Koops tells her.

This time, she does.

First responders? 

On average, the Toronto Police Service responds to more than 23,000 mental health related calls a year.

More than 8,000 end with an apprehension under the Mental Health Act, meaning the person who is the subject of the call is taken to hospital.  

According to Supt. Scott Gilbert, the project lead for MCIT, the teams were involved in almost 30 per cent of those calls last year. 

Currently, front-line officers are sent first to a call involving a mental health crisis. MCITs are called in only after those officers have assessed the situation.

One of the recommendations coming out of the Loku inquest is for the province and police to look into whether the MCIT could be called in first to deal with crisis situations, including when weapons are involved.

During an interview with CBC Toronto's Dwight Drummond, before the recommendations were released, Toronto Police Deputy Chief Federico explained why the teams are secondary responders. 

"If we sent the crisis team first, it would be a single police officer dealing with a uncertain situation at the time and a nurse who is not either authorized or trained to deal with a public safety issue."

He said Toronto Police Service's MCIT is "very comparable to the other jurisdictions." 

Toronto should learn from other services, says Terry Coleman, former Moose Jaw police chief and co-author of the TEMPO Police Interactions report for the Mental Health Commission of Canada. 

"I would probably take the model that's working well in Hamilton," Coleman told CBC Toronto. 

Hamilton's Mobile Crisis Rapid Response Team also pairs up a police officer with a mental health professional and "they have teams who are actually designated as first responders," said Coleman.

They "obviously are not going to go charging in, if a situation is unsafe. So there's a process to make the situation safe, but they've been very effective as first responders," Coleman said. 

On its website, the service last reported in September that far fewer people have ended up in hospital since the team was launched in 2013 and many more are getting the mental health care they need. Over that period, the apprehension rate dropped from 66 per cent to 25 per cent.

Around the clock 

The jury also recommended making the MCIT available 24 hours a day, calling on the province to provide additional funding for the nurses to make that happen. 

Currently, MCIT does not operate between 11 p.m. and 11 a.m. 

Federico says both police and hospitals recognize "more teams and the teams being available more hours and across a greater span of the city would be desirable but it is limited by resources." 

Supt. Scott Gilbert said on most days there are 10 teams that cover all the divisions.

Friday through Sunday that number drops to seven because the hospitals can't provide as many nurses.

"The hospitals have to, of course, balance their commitment to the police mobile crisis teams with the other demands their mandates have placed upon the hospital," Federico said.  

The Local Health Integration Network (LHIN) for Toronto Central provides the funding for the MCIT.

In an email sent before the recommendations were released, spokesperson Megan Primeau wrote the operating hours "are based on the times where the police receive the highest number of calls related to people experiencing a mental health or emotional crisis."