Demystifying the Justice and Mental Health System 2008.05.03

1. Demystifying the Justice and Mental Health System2008.05.03 PC Patricia Fleischmann Vulnerable Persons Issues (416) 808-7040 patricia.fleischmann@torontopolice.on.ca www.torontopolice.on.ca TPS Community Mobilization Unit

2. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS - 2007 EDP Calls for Service • 10,460 calls received/cleared as EDP • Total time: 38,182.4 hrs with average 2.8 officers/call TPS Community Mobilization Unit

3. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS: Emotionally Disturbed Persons Procedure • “The Mental Health Act (MHA) provides for the control, apprehension, detention and treatment of emotionally disturbed persons. This Procedure addresses situations where officers observe verbal cues, behavioural cues or other behaviours that provide them with reasonable cause to believe a person is apparently suffering a mental disorder. The following process governs police interaction with and apprehension of emotionally disturbed persons and their subsequent admission to psychiatric facilities.” TPS Community Mobilization Unit

4. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS: Emotionally Disturbed Persons Procedure • Governing authorities & forms • Definitions • MHA apprehension, responsibilities of frontline police officer, OIC, Divisional Mental Health Liaison Officer & CMU - Vulnerable Persons • Access Line, quick reference guide & designated psychiatric facilities TPS Community Mobilization Unit

5. “I've Called the Police... Now What? A Journey Through Crisis Response" Abnormal Behaviour • Unusual • Socially unacceptable or violates social norms • Perception/interpretation of reality is faulty • Person in significant mental distress • Maladaptive or self-defeating • Dangerous TPS Community Mobilization Unit

6. “I've Called the Police... Now What? A Journey Through Crisis Response" Why is it important to educate the public on use of force/crisis resolution training? • Misunderstanding of our role & responsibilities • Crisis vs. mental illness • Consideration of worst case scenarios TPS Community Mobilization Unit

7. “I've Called the Police... Now What? A Journey Through Crisis Response" Why Crisis Resolution Training on “Emotionally Disturbed Persons?” • Coroner’s Inquest recommendations • Officer safety initiatives • Use of Force Review Committee • Police Services Act Reg. 926 • Adequacy & Effectiveness Standards Regulations (Ont. Reg. 3/99) TPS Community Mobilization Unit

8. “I've Called the Police... Now What? A Journey Through Crisis Response" Behaviour motivations • Officers are required to deal with subjects in crisis, subjects who suffer from a mental disorder or, subjects who suffer from both • However, what induced the crisis, or what type of mental disorder can be difficult for officers to determine TPS Community Mobilization Unit

9. “I've Called the Police... Now What? A Journey Through Crisis Response" Important lessons • Not all people in crisis are mentally ill • Not all people who commit suicide are mentally ill • Communication is key to assisting emotionally disturbed person • Main goal to assisting EDP’s is officer & public safety TPS Community Mobilization Unit

10. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS:Emotionally Disturbed Person • Any person who appears to be in a state of crisis or any person who is mentally disordered • 2 categories: • A person in crisis • A person who is mentally disordered TPS Community Mobilization Unit

11. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS: Crisis • A circumstance, or set of circumstances, perceived or real, internal or external that causes the individual to change TPS Community Mobilization Unit

12. “I've Called the Police... Now What? A Journey Through Crisis Response" Person in Crisis • A person who suffers from a temporary breakdown of coping skills, but often reaches out for help demonstrating that they are in touch w reality • Once the person receives the needed help, there is often a rapid return to normalcy TPS Community Mobilization Unit

13. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS:Mental Disorder • Any disease or disability of the mind • A person suffering from a mental disorder may have to live w a long-term break-down of coping skills including perception, decision-making & problem-solving abilities TPS Community Mobilization Unit

14. “I've Called the Police... Now What? A Journey Through Crisis Response" What Happens? Radio room: • 911 call – EMS, police investigation/report • Non-emergency call – investigation/report or provide information/referral TPS Community Mobilization Unit

15. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Calls for Service • Exact location & address history • Caller identity & status • Nature of incident • Need for EMS (ambulance) • Suspect information • Weapons • Children present • Court orders TPS Community Mobilization Unit

16. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Calls for Service • Q.: Criminal or civil matter? • Criminal investigation: arrest/charge or, no charges laid • Who is suspect/abuser? Special consideration? • Provincial statute • Civil matter: advise & refer • In all cases: referral to other agencies or additional resources • TPS procedures – CCC arrest or MHA apprehension, referral/follow-up TPS Community Mobilization Unit

17. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS EDP options: • Arrest (CCC) • Apprehension (Mental Health Act) • Mobile Crisis Intervention Team (MCIT) • Police-only Access Line • Advise Form 1 (M.D.) or Form 2 (J. of P.) (MHA) TPS Community Mobilization Unit

18. “I've Called the Police... Now What? A Journey Through Crisis Response" MHA s 17 Action by police officer - Where a police officer has reasonable & probable grounds to believe that a person is acting or has acted in a disorderly manner & has reasonable cause to believe that the person • has threatened or attempted to cause bodily harm to himself or herself or • is threatening or attempting to cause bodily harm to himself or herself; • has behaved or is behaving violently towards another person or • has caused or is causing another person to fear bodily harm from him or her; or • has shown or is showing a lack of competence to care for himself or herself, TPS Community Mobilization Unit

19. “I've Called the Police... Now What? A Journey Through Crisis Response" And in addition, the police officer is of the opinion that the person is apparently suffering from a mental disorder of a nature or quality that likely will result in, (d) serious bodily harm to the person; (e) serious bodily harm to another person; or (f) Serious physical impairment of the person, And that it would be dangerous to proceed under section 16 (Form 2 Application to a J.P.), the police officer may take the person in custody to an appropriate place for examination by a physician TPS Community Mobilization Unit

20. “I've Called the Police... Now What? A Journey Through Crisis Response" What Happens Next? • CIB: CCC investigative follow-up • Bail hearing/court appearance (mental health issues - 102 Court?) • CRO or CPO visit/follow-up/meeting • CMU: resource/referral, staff presentation, committee, initiative or meeting TPS Community Mobilization Unit

21. “I've Called the Police... Now What? A Journey Through Crisis Response" Who, when, why & how to call? • Who: Radio room, specialized unit, local division or individual officer • When: Need to report (suspected) criminal matter or suspicious/unusual occurrence, or need answer to question or discuss concern or other pressing issue • Why: To advise, for information or for clarification • How: 911, non-emergency # (416) 808-2222 or direct # TPS Community Mobilization Unit

22. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Police Resources • CMU – DV Co-ordinator (416) 808-7041 • CMU – Crime Prevention (416) 808-7044 www.torontopolice.on.ca/crimeprevention/ • Divisional Community Relations Officers (CRO’s) & Crime Prevention Officers (CPO’s) (17 divisions) • CMU - Vulnerable Persons Issues (416) 808-7040 www.torontopolice.on.ca TPS Community Mobilization Unit

23. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Role • Investigation/enforcement • Education/empowerment • Provide access to network of social services & community agencies • Increase awareness of resources • *Response: criminal or civil TPS Community Mobilization Unit

24. “I've Called the Police... Now What? A Journey Through Crisis Response" Final Thought “Police officers are concerned with immediate crisis response whereas the mental health system is slow, cumbersome and looks for longer term solutions. Whereas the motto of the medical profession might be “Above all, do no harm,” the public expectation of the police is more likely “Above all, do something!” (Dr. Dorothy Cotton, Feb 2005) TPS Community Mobilization Unit

25. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Police Resources • Mobile Crisis Intervention Teams (St. Michael’s, St. Joseph’s & all Scarborough Hospitals) • TPS Community-Based Mental Health Services “police-only” Access Line TPS Community Mobilization Unit

26. “I've Called the Police... Now What? A Journey Through Crisis Response" Mobile Crisis Intervention Team • MCIT program (June 2000) initiated in direct response to concerns raised regarding police response to calls involving mentally ill individuals TPS Community Mobilization Unit

27. “I've Called the Police... Now What? A Journey Through Crisis Response" MCIT Mission Statement • MCIT is dedicated to the dignified treatment of EDP’s in crisis • By partnering law enforcement & the medical profession, this unit strives to assist individuals before they enter a crisis, while enhancing support to frontline officers TPS Community Mobilization Unit

28. “I've Called the Police... Now What? A Journey Through Crisis Response" MCIT Vision • Goal is to invest/partner an officer & a psychiatric nurse into the management of the EDP calls • Program strives to decrease unnecessary use of hospital emergency rooms & divert EDP’s from the CJS when appropriate TPS Community Mobilization Unit

29. “I've Called the Police... Now What? A Journey Through Crisis Response" • MCIT provides a skilled & compassionate response to mental health emergencies in the community • Team works alongside local community mental programs, public safety organizations, hospitals & other community support groups to promptly de-escalate crises & avoid unnecessary arrests & emergency room visits by providing appropriate referrals, services & resources within a patient’s own community TPS Community Mobilization Unit

30. “I've Called the Police... Now What? A Journey Through Crisis Response" MCIT Services Upon arrival at a crisis scene: • Assess the situation • Attempt to stabilize & defuse the crisis • Provide supportive counselling as needed • Provide information & referrals, linkages with appropriate community services & supports for ongoing treatment & follow-up • Transport to hospital emergency if further psychiatric &/or medical assessment is required TPS Community Mobilization Unit

31. “I've Called the Police... Now What? A Journey Through Crisis Response" Criteria: • TPS: 1st class PC • Voluntary application • Interview by both Service & hospital • Training in medical issues (substance abuse & psychiatric illness) • Training in police duties & responsibilities • RN agrees to follow police direction in emergent situations TPS Community Mobilization Unit

32. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Access Line • 16+ years of age • Have a mental illness &/or are emotionally disturbed • In the presence of a police officer • At significant risk of imminent or re-involvement with the criminal justice system • In need of support, but do not require apprehension under the (Ont.) Mental Health Act • Can be safely supported in the community • Willing to access the services TPS Community Mobilization Unit

33. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Access Line Safely supported • those who, with the support of mental health & justice services, do not pose a threat to themselves or others Willing to access the services • voluntary participation, person agrees to referral TPS Community Mobilization Unit

34. “I've Called the Police... Now What? A Journey Through Crisis Response" TPS Access Line If criteria met, individual has access to the following services: • Short-term residential beds • Mental health & justice prevention program • Information & referral to other community mental health services TPS Community Mobilization Unit

35. “I've Called the Police... Now What? A Journey Through Crisis Response" Police-only ‘Access Line’ (24/7): • Confirmation that person understands that ‘Access Line’ services offered are voluntary • Contact info: officer & individual • Discussion to best determine specific needs of individual • Discussion on how to connect person w ‘Access Line’ services TPS Community Mobilization Unit

36. “I've Called the Police... Now What? A Journey Through Crisis Response" Additional Resources • Victim Services Program (416) 808-7066 www.victimservicestoronto.com/ • SSO Justice & Mental Health Program - JAMH TPS Community Mobilization Unit

37. Demystifying the Justice and Mental Health System2008.05.03 PC Patricia Fleischmann Vulnerable Persons Issues (416) 808-7040 patricia.fleischmann@torontopolice.on.ca www.torontopolice.on.ca TPS Community Mobilization Unit