Toronto is getting a fourth emergency service. That’s vital for helping people in crisis

Posted on November 29, 2023 in Inclusion Delivery System

Source: — Authors: – Opinion/Editorials
November 25, 2023.   By Star Editorial Board

While psychiatric crises affect people of all socioeconomic classes, the crisis teams are serving those whose needs go far beyond mental health care.

By voting to expand Toronto’s Community Crisis Support Service, city council has taken an important step toward improving mental health services. But that step must be followed by many more, and all levels of government must participate.

The service, which offers a non-police, community-based response to people experiencing mental health crises, has been operating in 16 wards since early 2022. Now, thanks to council’s recent unanimous vote, it will soon cover the entire city.

It will become Toronto’s fourth emergency service — joining police, fire and paramedics — and according to an evaluation of the program’s first year, it’s a welcome addition.

The evaluation, which was conducted by the Centre for Addiction and Mental Health, found the service responded to nearly 7,000 calls during its first 13 months, and 78 per cent of calls transferred from 911 were resolved without police contact.

This is an encouraging finding, since avoiding police contact in mental health calls is one of the primary purposes of the service. Police are, after all, not trained mental health professionals, and police involvement has all too often ended in tragedy.

In contrast, 93 per cent of the crisis calls were successfully completed, and 95 per cent of people served by crisis teams said they were either satisfied or very satisfied with the service.

And the teams didn’t stop working when the crises ended. Teams made nearly 3,000 attempts to offer post-crisis support, and more than 60 per cent of service users agreed to accept help.

The program has therefore proven to be a resounding success, and city council deserves credit for its commitment to the service. However, for that success to continue, council must ensure funds are available for the citywide expansion.

The evaluation report noted concerns about the service’s current resources and capacity, and those concerns are likely to intensify as the service expands. While the city budgeted just shy of $14 million for the service in 2023, a staff report estimated that costs for the expansion will increase to more than $26 million in 2024 and $34 million in 2026.

But this isn’t merely the city’s responsibility, as service users’ demographic characteristics demonstrate. Fully 85 per cent of service users said they had challenges meeting basic needs within the past month, and 81 per cent were receiving social assistance.

Just 59 per cent said they were stably housed, and another 59 per cent reported living with a disability, with 63 per cent of those reporting a mental health disability.

Hence while psychiatric crises affect people of all socioeconomic classes, the crisis teams are overwhelmingly serving those whose needs go far beyond mental health care.

And yet, far too often those needs continue to go unfulfilled. Housing and crisis beds accounted for more than half of all on-scene crisis team referrals, yet housing was the most difficult follow-up support to access, followed by primary care, psychiatry and addiction services.

In effect, then, the very factors that frequently precipitate a crisis – housing insecurity, lack of basic income and inadequate access to health care – are the ones that remain unaddressed. And until those underlying factors are confronted, we can expect to see an ever increasing spiral of crises, and the need for ever more crisis teams.

The city is, fortunately, acutely aware of this, and on Monday it released Our Health, Our City, a comprehensive strategy to tackle mental health and substance use challenges. But the city can’t do this alone. As the strategy notes, investments “from all orders of government . . . are essential to creating a liveable city for everyone.”

The crisis service represents an important step in achieving that goal, and it is doing its part. But it is only a part, only a first step. Now is the time for the provincial and federal governments to step up and do their part.

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