From ... in Psychology — Dec 2, 2021

Canada Program Leads the Way in Addressing Mental Health Crises

Instead of receiving community-based services for their mental health needs, many people in Canada face law enforcement and other approaches that are not always suitable, like “wellness checks” by the police. According to data issued by the Royal Canadian Mounted Police, the police respond to 2.8 million mental health-related calls on average each year. Fortunately, Baird sought immediate mental health support and received warm, empathic, and respectful intervention services that did not involve the police. She was able to continue her work in Toronto as a fitness instructor and yoga coach who supports others through their path in mental health recovery. “These feelings of sadness had become chronic and one day a family doctor recommended me reaching out to the Gerstein Crisis Centre,” she told Human Rights Watch. “The Gerstein provided a safe space to just let go.

The immediate crisis didn’t go away from one day to another but being there provided me with space to start seeing things more clearly, enabling me to make better decisions, which was an important step.” The Gerstein Crisis Centre has been providing Toronto communities with safe, humane, equity-based crisis services for more than 30 years. Back in the 1980s, Toronto was deinstitutionalizing mental health services. However, there were not many community-based services available for people and the only response to mental health crises and related support was to take people to hospitals.

The Centre’s founders wanted to create an approach to mental health crisis that also responded to the societal problems that lay beneath these issues to offer an alternative, accessible, and humanistic approach that people could turn to when in crisis. “We can refer people to medical and other services, but what we do is to provide immediate support and relief,” said Elaine Amsterdam, Gerstein Crisis Centre’s crisis services director.

The Common Response People with mental health conditions (or psychosocial disabilities) around the world face stigma, prejudice, and attitudinal barriers. A major barrier is the belief that they are incapable of deciding what’s best for them in a given situation and that it is dangerous for them to do so. But as with any other person, people with mental health conditions can find themselves in a crisis. And when they do, they need to have a response consistent with their rights that recognizes their agency and dignity and allows them to direct how their crisis needs should be handled. Sending the police as first responders for mental health crises could be problematic in various ways.

There have been many instances in which people have been seriously injured or even killed because of a police “wellness check” gone wrong. Between April and June 2020, six people with mental health conditions were killed in Canada when police responded to a mental health crisis.

These incidents often happen when a concerned person calls 911 seeking help for someone experiencing a mental health crisis. Experts at the Gerstein Crisis Center noted that calling the police should not be a starting point for mental health service. “Mental health care is probably the only health service you access by calling the police,” Amsterdam told us. “Getting the police to the scene can be reassuring for some, but for most people it is frightening and negatively impacts how safe they feel. When people have a physical health emergency, their first stop for fulfilling their needs is through a healthcare provider, not the police.

The same should be the case with mental health.” When someone is experiencing emotional distress, disorientation, or other forms of a mental health crisis, their emotional state can deteriorate when confronted by police. That’s especially the case if police give orders they might not be able to understand and follow. “If you’ve been marginalized, if you come from racialized communities, chances are, you’ve been overrepresented in the criminal justice system and so police can take a situation and escalate it without intention sometimes,” Amsterdam said. A Better Approach The right response to a call for help by a person with a mental health condition is to show a non-judgmental attitude, to provide people in distress with a place to stay, giving them the opportunity to have a shower and to get a good meal, creating conditions that enable a person to start the process of recovery, Amsterdam said. “We need to flip our system as it exists right now from a sort of default position where police are responding to mental health crisis and actually purpose-build a system that allows people to access mental health support when and where they need it,” said Susan Davis, Gerstein executive director. Government officials, civil society organizations, and community groups are becoming increasingly aware of the need for alternative emergency response strategies for people in acute emotional distress and mental health crises.

The city of Toronto, for example, is starting a pilot program to replace the use of wellness checks by police and develop new responses.

The program is set to start in January in Toronto’s Northeast and Northwest with the goal of expanding it by mid-2022.

The program’s goal is to organize teams of mental health staff, harm reduction workers, people trained in de-escalation, and peers with lived experience who will respond to mental health crisis calls instead of the police. “Responding humanely, effectively, and without risking further trauma entails maintaining an awareness of what could trigger an escalation path that needs to be avoided, while taking the time to listen to people and understand their immediate and basic needs that may not have been met,” said Darna Savariau-Daley, a Gerstein Crisis Centre intervention worker. Police are authority figures, but what people need when they are feeling vulnerable or under stress is the opportunity to be heard and empowered, Savariau-Daley added. “The first step toward mental health recovery should be having control over your own coping mechanisms without forcing anything. At the Gerstein, we do a lot of listening. Because even though people are having a crisis, they know best about what their situation is.” The starting point for any human-rights-respecting response to a mental health crisis, as outlined in the United Nations Convention on the Rights of Persons with Disabilities, is to consider the will and preferences of the person concerned. Most mental health crises don’t involve a violent event or a public security danger. Respect and Autonomy The overall approach of the Gerstein Crisis Centre is to give people an opportunity to use their own strengths and resources, as well as connect them to resources needed to assist in their recovery. “People should have a chance to define their crisis and to be in control of their own stories,” Davis said. “Our role is to provide support for them to do that. Our philosophy includes letting people be at the helm of their health care. We’ve only asked for the intervention of police services in exceptional cases to ensure people are not left in unsafe situations.” New guidelines from the World Health Organization (WHO) as part of their Quality Rights Initiative, say that recovery is not about removing symptoms or “curing” a person’s condition. It is rather a personal journey to well-being that does not necessarily entail removing symptoms or pain, but rather the opportunity to re-shape one’s own story. Forcing people to do things they don’t want to do might result in further trauma. From the start, the Gerstein Crisis Centre sought to involve people with lived experience of mental health on their staff at all levels, including at least 30 percent of current board members,” Davis said. “So often for people who have experienced mental health crisis the first thing they want to do is to offer you medication instead of looking at recovery as more holistic,” said Michael Creek, a former Board Member of the Gerstein Crisis Centre who experienced homelessness himself. “I think that’s where the Gerstein accomplishes not just the holistic approach to mental health but the holistic approach of humanizing what people are actually going through.” A Working System The Gerstein Crisis Centre provides 24-hour crisis lines, mobile crisis teams, crisis follow-up and short-term crisis beds. In 2020, the Gerstein Centre handled over 42,000 phone calls and, Davis said, they could have handled twice that number with more resources.

The crisis teams include skilled and experienced professionals from a variety of backgrounds who meet with callers seeking help in an informal setting. To reduce stigma and minimize power imbalances that create fear, Gerstein staff do not wear uniforms and drive an unmarked private vehicle. As the Gerstein Crisis Centre sees it, aggressive policing in some communities has eroded trust and does not help the person in crisis regain control for themselves and begin to see choices and opportunities for a more positive perspective. “We won’t engage if the person doesn’t want to,” Savariau-Daley said. “Everything is done on a voluntary basis. First, we contact the person on the phone, and then, if needed, we can deploy in person mobile teams dressed in informal clothes, without uniforms, and civil vehicles, no ambulances or patrol cars. From the outside, no one would be able to tell it is a mental health crisis team. “This work involves active listening, taking the time to really hear the person and what the problems they are facing at that specific moment. We take our time on the crisis line. Follow-up or a crisis bed may also be offered, and they can periodically reach out to us or not if they need help again. It’s up to them.” Although Gerstein is primarily a mental health crisis response service, its staff have also been building networks of support that provide other community services to people. One mental health recovery program, FRESH (Finding Recovery Through Exercise Skills and Hope), uses a peer-led model to help people become active, strengthen their community and social connections, develop new skills and knowledge, and have fun. Another is called WRAP (Wellness Recovery Action Plan). Benefiting from people’s past experience with mental health crises and evidence-based programming, the staff have put together an eight-week wellness group targeted at finding strategies to help people stay well. Speaking from Lived Experience As Baird described: “Sometimes when you go through a crisis, you lose a sense of who you are because everything becomes about this thing that’s happening. I was lucky enough, when I was at my lowest point, to have a place to reach out to get help and the support I needed. “At the Gerstein you still have your independence and your sense of privacy, but there’s a warmth and a trust and a normalization of what you’re going through. That enables you to make better decisions. So you don't feel like a client or a number or that you’re being processed,” Baird said. “I think there's a lot to be said for not wanting to be seen as your crisis, because there's still, there's still a person underneath.”.

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Canada Program Leads the Way in Addressing Mental Health Crises

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