More than defunding police needed to fix ‘broken’ mental health system: experts

Before moving to Toronto, Dr. Kwame McKenzie ran a mental health service in north London, U.K.

When someone with psychosis or another serious form of mental illness was in crisis, it was his team of medical professionals that showed up first. Not the police.

If, after arriving at the scene, it was decided the police were necessary, they could be called in, which almost never happened, Mckenzie said. This was possible because the U.K. funds mental health care in ways Canada does not.

“Even if you ignore the police killings, do not underestimate the trauma of having the police called on you,” said Mckenzie, a psychiatry professor at the University of Toronto and director of health equity at the Centre of Addiction and Mental Health.

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Since the death of George Floyd on May 25 while in Minneapolis police custody, there have been protests around the world calling for changes to how police use force, especially deadly force, against Black and racialized communities.

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In Canada, a number of police-involved shooting deaths, including the recent death of 62-year-old Ejaz Choudry, have also contributed to calls for change and for politicians to “defund the police.”

In Toronto, Mayor John Tory put forward a motion to city council last week calling for the creation of “alternative models of community safety,” including developing a non-police response to calls that don’t involve violence or weapons, such as when a person is experiencing a mental health crises.

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Two city councillors have also proposed cutting Toronto’s police budget by 10 per cent, or about $120 million a year, and reallocating this money toward improving community supports, such as skills training, childcare, affordable housing and alternatives to policing.

Dr. Kwame McKenzie, psychiatry professor at University of Toronto and director of health equity at the Centre of Addiction and Mental Health. YouTube

McKenzie said he understands why groups such as Black Lives Matter are calling for cuts to police funding — adding that it makes no sense for police to respond to mental health incidents when they lack training and expertise. He also said proposed cuts to police budgets will only free up a fraction of what’s needed to resolve chronic underfunding of Canada’s mental health care system.

“(If) you end up in prison for a broken leg, everybody would say this is stupid,” McKenzie said.

“But somehow you can end up in prison for a broken heart. You can end up in prison for a psychiatric breakdown.”

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If the long-term goal is improving outcomes for Black and racialized people, Canada must also address the underlying causes of mental illness, he said. This includes poverty, access to justice, education, housing and employment opportunities, plus systemic racism, both in policing and health-care delivery.

“After we’ve decided what we want, we may then have a conversation about how to fund it,” he said.

Police vs. mental health spending

How much money does Canada spend on policing and mental health each year?

According to a 2018 report from Statistics Canada, nationwide police funding reached $15.1 billion in annual operating expenses in the 2017-18 fiscal year.

More than three-quarters of this, or roughly $12.8 billion, was spent on wages and benefits, data showed.

The highest average police officer salary was reported by the Ontario Provincial Police, at nearly $103,000 a year, while Quebec provincial police had the lowest average salary, at about $87,000 a year. Both of these amounts were roughly double provincial averages for workers’ salaries.

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Over the past three decades, per capita spending on policing in Canada also rose, from $222 a year in 1988 to $318 a year in 2018, an increase of roughly 43 per cent after accounting for inflation.

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However, despite this increase, the relative strength of Canadian police forces has declined during the past decade, going from 203 officers for every 100,000 people to 185 officers.

Meanwhile, the amount of money Canada spends on mental health care also increased in recent years, reaching $15.8 billion in public-private spending in 2015, according to a report from the Mental Health Commission of Canada (MHCC).

In terms of government spending, a report from the Canadian Institute for Health Information (CIHI) says the provinces and territories spent about $4.4 billion on mental health and addiction care during the 2017-18 fiscal year, an increase of roughly 38 per cent compared to a decade earlier.

Still, these amounts fall short of what Canada should be spending on mental health and addiction, McKenzie said.

According to MHCC, which helped design the federal government’s long-term mental health strategy, at least nine per cent of every health care dollar in Canada should be spent treating mental illness and addiction. Yet recent data shows just seven per cent of total health care spending goes toward these issues, a shortfall of about $4 billion a year at current spending levels.

Canada also spends significantly less than other developed countries on treating mental illness, with annual expenditures in France and the U.K. roughly double what they are in Canada relative to total health care spending.

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How Canada spends this money is also important, McKenzie said.

At present, many mental health care programs, such as those based on cognitive behavioural therapy, work well for “mainstream” populations, he said, but are not suited for treating Black and other racialized communities.

This, McKenzie said, is because most therapeutic techniques are based on “Euro-centric” models for mental health care that do not consider the challenges marginalized communities face, including systemic anti-Black racism.

And while there are community-based programs that provide services tailored specifically to Black and immigrant experiences, these programs are significantly underfunded compared to other services, such as acute or emergency mental health care provided by psychiatric hospitals, he said.

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“Everybody talks (about) mental health, everybody says it’s important, but when it comes down to it, we don’t pay for it. And you get what you pay for,” McKenzie said.

Police should be a ‘last resort’

Sandy Hudson, a founder of Black Lives Matter Toronto and UCLA law student, has been one of the most active proponents of defunding police.

She said continued police violence and killings of Black people in North America have sparked resistance movements “from Whitehorse to Miami.”

“If we truly want to effect change that could stop police killings of Black people, we must have a conversation about defunding the police,” she wrote in a recent HuffPost Canada op-ed.

Hudson also said defunding the police is a matter of public safety for Black communities, which interact with police regularly because they live in neighbourhoods that “police target.”

“We are experts in the ways that police can brutalize and inflict violence upon us,” she wrote.

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She also said up to 80 per cent of policing in Canada has nothing to do with crime, citing the same 2018 Statistics Canada report that looked at police spending.

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According to the report, police responded to 12.8 million “calls for service” during the 2017-18 fiscal year. This includes calls related to alarms, traffic accidents, sick or injured people, overdoses and mental health-related incidents.

Hudson said examples of Black community members experiencing mental health crises who then die after interacting with police are reasons why police should not be responding to these types of calls.

“Policing is ill-equipped to suit these needs,” she wrote.

And Hudson isn’t alone in this way of thinking.

Tom Stamatakis, president of the Canadian Police Association, which represents about 60,000 police officers across Canada, said police are relied upon for responding to “wellness checks” and other mental health-related incidents not because they’re experts, but because there’s no one else to do it.

“We’ve become the agency of first resort instead of the agency of last resort,” he said. “That needs to change for sure.”

Stamatakis also said police associations have long advocated for improvements to basic mental health care services, with little to no action from governments in terms of providing necessary funding.

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And in terms of defunding the police, Stamatakis said politicians must choose what services the police will no longer provide and then sufficiently fund any alternatives before making decisions about police budgets.

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Once the need for police to respond to these types of crises is lessened, he would support reallocating portions of police funding to improve access to mental health care.

“If we don’t start to have those conversations, and all we do is focus on the end result, we’re never gonna get ahead of this,” he said.

“Things are never gonna change. We’re still going to have these tragedies because we get called when things spiral.”

Mental health and criminal justice

Black Canadians are far more likely to die following an interaction with police than white Canadians.

A 2018 report from the Ontario Human Rights Commission found Black residents of Toronto were 20 times more likely to die than white residents following situations involving police.

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The same report found that while Black residents make up just 8.8 per cent of Toronto’s population, they account for 61 per cent of incidents involving police use of force that result in death and 70 per cent of police shootings that result in death.

Members of the Black community are also more likely to experience mental illness due to precarious housing, social exclusion and racism, the Public Health Agency of Canada said. While low-income earners, which include a disproportionate percentage of Black people, are three to four times more likely than high-income earners to experience poor mental health.

All of this has caused advocates to call on governments to recognize anti-Black racism as a public health emergency.

“As Black health leaders, we put out a statement saying this is a public health crisis,” said Liben Gebremikael, executive director of TAIBU, a community health centre in Scarborough, Ont., that provides health care to Toronto’s Black population.

“This is not just a Black problem, or our problem that we need to solve. It’s everybody’s problem,” he said.

Liben Gebremikael, executive director of TAIBU Community Health Centre in Scarborough, Ont. TAIBU/Facebook

Gebremikael also said there are fewer health-care facilities and medical professionals — especially mental health care providers — working in predominantly Black neighbourhoods. This has created a “huge gap” between the services available and the current need for mental health care.

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“The system was not designed to support racialized and marginalized communities,” he said.

Another problem, Gebremikael said, is that when Black people do receive treatment for mental illness, it often happens within the context of the criminal justice system, meaning it’s offered only after a person has been arrested, charged, or as part of sentencing. All traumatizing and stigmatizing events, he said.

“We need to look at that and say something is not right,” he said.

“Once you are accessing mental health services through the criminal justice system, you are going to be in this revolving door.

“Mental health institutions on one side, and criminal justice on the other.”

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