Ontario relying on police to deliver what passes for mental-health care in this province

Posted on May 6, 2014 in Health Debates

NationalPost.com – Full Comment
May 5, 2014.   Christie Blatchford

It is indeed splendid news that Toronto has a brand new nurse-and-police-officer crisis intervention team on the job to respond to calls involving mentally ill and emotionally disturbed people.

Toronto Police and its hospital partners formed the first Mobile Crisis Intervention Team (MCIT), as these squads are called, 14 years ago.

There are now six teams, and they cover 14 of the force’s 17 divisions, and by year’s end, with geographic expansion of territory, they will offer coverage of the entire city, if only nominally due to their numbers.

The new team is made up of Lisa Pritchard, who is the mental health nurse, and Constable Rob Dyer, who is the cop. Their base hospital is North York General; they work in North York, the north central part of the city.

Each was called to this work through a desire to help and personal experience in their own families with mental illness — as so many of us have, if we will only acknowledge it.

These people rock.

They are on one of the most difficult front lines there is, the tricky intersection where the mentally sick encounter the law. That they are believers in the need to treat the mentally ill with compassion is right there on their kind faces.

Const. Dyer tried for three years to get the job he now holds; Sharon Lawlor, a psychiatric nurse with 25 years’ experience who works on the St. Joseph’s Health Care team in two other divisions, has made this sort of work her professional life.

The formal announcement of the new team and the geographic expansion of coverage was made at Toronto Police headquarters Monday.

It was a nice moment, and the joint was jammed, mostly with folks who appeared to be from the health care end.

In the public imagination, MCITs are seen as the answer to the increasing number of calls police receive involving those who are mentally ill or emotionally disturbed, and the occasional tragic end — when police use lethal force — to a very few of these encounters. A recent coroner’s inquest, for instance, spent months examining the deaths of three mentally ill Torontonians, all of whom were armed with sharp-edged weapons when they were shot and killed by police bullets.

But lost in the inquest focus — which was exclusively on the police response — and much of the press attention was the fact that all three of these citizens had also been significantly involved with the health-care system and had been seen by psychiatrists or mental-health clinics.

And yet, they remained so ill and so alone — so un-helped, if you like — that they nonetheless ended up in these lethal and tragic encounters with the police.

In fact, at the inquest itself, considerable time was devoted to asking witnesses how things might have turned out differently if only an MCIT team had been called — ignoring the fact that the teams aren’t allowed to act as first responders in cases where people are intoxicated, acting violently, or armed, or that perhaps the crises could have been averted had there been decent help much earlier along the line.

This isn’t, by the way, to say the MCIT teams can or even try to avoid risk; they don’t, and there is danger inherent in dealing with unpredictable people in crisis.

But what they are at best, and what they only ever will be at best, is a small part of the answer.

Of the 20,000 calls the Toronto force receives every year that are related to a mental-health crisis of one sort or another, the MCITs handle about 2,000.

Yet most of the other 18,000 calls are also resolved peacefully, because, as Deputy Chief Mike Federico said Monday, all his officers have some training in how to do this right.

I am in no way knocking the program and certainly not those who work in it, but it is really wearying and irritating how much the larger community has come to rely on police, who are after all at the back end of this equation, to deliver what passes for mental-health care in this province.

There remain few supports for the seriously mentally ill. There are few available beds for the mentally ill who are also homeless; shelters do what they can, and they are a valuable resource, but they can be unpleasant, dangerous places, and some people prefer the streets. There is little choice for beleaguered families who are trying to cope with a member struggling with a major mental illness.

The truth is, when decades ago we closed the big psychiatric hospitals in Canada and “de-institutionalized” the mentally ill in order to allow them to live in the community, precious little in the way of community supports were put in place. There really is no mental-health care system, but rather a hodge-podge of badly funded, under-staffed services where people burn out very quickly.

As Deputy Chief Federico said at one point, “The solution to the mental-health crisis in our community is not another mental health team… You can’t get well if you haven’t an address.”

The mentally ill among us need supportive housing (that means actual housing with nurses and others to make sure they are taking their meds and getting the help they need), jobs, access to good doctors and recognition that they are no more responsible for their illness than the cancer patient is. This sort of stuff doesn’t come cheap, but little that is worthwhile does.

The police can turn themselves inside out — and some, like the Toronto force, have come close to doing that — but without the rest of the pieces in place, they are doomed to whistle in the dark.

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