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Mental health emergency response service based on noted Oregon model could come to Toronto

Ongoing protests spark debate over police defunding
WATCH (June 29, 2020): The calls to defund or dismantle police departments are growing louder in some cities, including Toronto. But what would that look like?

A program based on a noted emergency mental health response service in Oregon could be coming to the streets of Toronto if advocates and city councillors have their way.

The program is part of Toronto city council’s approval of a suite of initiatives aimed at reforming the Toronto Police Service and changing local policing. A proposal by Coun. Mike Colle for a report back on creating a mobile crisis assistance intervention service similar to the CAHOOTS program by the White Bird Clinic in Eugene, Ore., passed 23 to one on Monday.

“We are demanding everything of the police,” he said on Monday in reference to mental health-related calls across Toronto, citing examples in his ward where officers were called to an apartment building and a group home collectively, without incident, hundreds of times in a year.

Read more: Toronto council votes against defunding police budget, approves various reforms

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“Somehow, we’ve got to take those responsibilities that can be done by unarmed, medically trained crisis intervention professionals — assign them those duties.”

Part of the proposed report on creating such a service called for the new service to respond to a “range of community challenges,” including among those experiencing homelessness, intoxication, substance abuse, mental health-related issues and those in need of dispute resolution and basic medical emergency care services.

City council approved deducting the total cost of the program’s operations from the Toronto Police Service’s budget after the service is created. Colle said that since the initiative would reduce the number of calls to police, it could potentially reduce the number of officers needed.

“It’s going to save lives and save a lot of agony in this city,” Colle said.

Despite formal calls to defund the Toronto police by community advocates and several councillors, council overall voted against cutting the service’s budget and opted to approve a number of reform measures.

Mayor John Tory put forward a motion proposing a suite of changes to policing that also included anti-racism measures and the implementation of body-worn cameras. The motion passed along with many amendments.

The calls also come about a month after the death of 29-year-old Regis Korchinski-Paquet, a Black woman who fell from her balcony while police were in her home during a mental health-related call.

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Thousands of protesters have taken to Toronto’s streets over the last month demanding change to policing in the city.

What is the CAHOOTS program, and how did it change emergency response?

Described as a community-based public safety system, CAHOOTS (Crisis Assistance Helping out on the Streets) was launched in 1989 by the White Bird Clinic in Eugene, Ore., which had a 2019 population of more than 172,000 people. The 24-hour service has since been adopted by Springfield, Ore., which had a 2019 population of more than 63,000 people.

A medical professional — such as a nurse or a paramedic — and a well-trained mental health crisis worker employed as part of the CAHOOTS program are paired up and dispatched through the region’s 911 and non-emergency response systems.

“Dispatchers are trained to recognize non-violent situations with a behavioural health component and route those calls to CAHOOTS,” a program information guide put out by the White Bird Clinic noted.

Read more: Regis Korchinski-Paquet’s death reinforces need for major mental health and policing reforms, advocates say

“A team will respond, assess the situation and provide immediate stabilization in case of urgent medical need or psychological crisis, assessment, information, referral, advocacy and, when warranted, transportation to the next step in treatment.”

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Despite being dispatched through 911, it is an independent emergency service funded by municipal governments and donors. It is not staffed or trained by law enforcement. CAHOOTS workers can be dispatched on their own or as a co-response with police, firefighters and/or paramedics.

The clinic said workers are unarmed and do not have police powers, calling their training and experience the workers’ “tools.” They are required to complete 500 hours of de-escalation and crisis training.

Read more: Community needs better system to respond to those in crisis, Toronto police board member says

“CAHOOTS was not designed to replace policing … CAHOOTS offers a service that responds to non-violent crises so police don’t have to,” the clinic said.

“CAHOOTS’ efforts focus on a set of problem areas that otherwise would take up a lot of police time and attention. Police training also doesn’t provide adequate preparation for dealing with mental health, homelessness and other front-line social interventions.”

According to White Bird Clinic documents, there were approximately 24,000 calls — accounting for around 20 per cent of all 911 calls — referred to the CAHOOTS program in 2019. Of those calls, the clinic said police backup was only requested approximately 150 times.

Read more: Canada’s policing failures show systemic need for better mental health crisis response

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When it comes to the most common call referrals from police, the clinic said welfare checks, public assistance and transportation to services were the top call types. CAHOOTS sometimes also provides death notifications. A portion of those calls can involve more than one type of call.

The clinic said the CAHOOTS program’s annual budget is currently US$2.1 million, noting the total budget for the Eugene and Springfield police departments is around $90 million. In 2017, the clinic estimated the Eugene Police Department saved approximately $8.5 million by utilizing the CAHOOTS program.

Officials also estimated $14 million was saved in 2019 in paramedic and emergency room costs, noting staff have provided assistance with self-harm calls, risk assessments, basic medical care like wound cleaning and infection prevention, medication management, help with substance abuse, lift assists and isolation.

‘The time to act is now’

As protests related to anti-Black racism and the Black Lives Matter movement have grown in recent weeks, along with more instances of individuals in mental health crisis dying after interactions with police, calls by advocates for an emergency mental health response service have grown louder.

Rachel Bromberg, Canadian national co-ordinator of the International Mobile Services Network, and Asante Haughton, a Toronto-based mental health advocate, joined together with others to formally push for a civilian mobile crisis program to be adopted in the city.

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“There needs to be a shift in the way that we respond to mental health crises in this city … the time to act is now,” Bromberg told Global News before Monday’s council meeting while referencing the concept of dedicated mental health response teams.

“They save money, they reduce stigma around mental health challenges, they free up police resources to actually do policing tasks, they provide really good support to people in crisis, they connect (residents) to resources, they promote their dignity and autonomy.

Read more: Toronto’s CAMH says police should not be 1st responders to mental health calls

“When someone is in crisis, what they really need (is) to have that power and control given back to them and for someone to empower them.”

Bromberg said she has been doing research on the concept of mental health emergency response and cited the work by the CAHOOTS program. She also said the city of Stockholm has a mental health ambulance service and the city of Denver has a model similar to CAHOOTS. In the Bay area of California, she referenced a youth crisis response service that was established. In North Yorkshire, England, Bromberg said mental health nurses are staffed in the dispatch centre.

The Centre for Addiction and Mental Health recently issued a statement saying police officers shouldn’t be the primary first responders for mental health calls.

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“Mental health is health. This means that people experiencing a mental health crisis need health care,” read a statement issued by the hospital on June 23, adding police should not be expected to lead crisis care.

Read more: ‘Defunding’ police and funding mental health resources will save lives, experts say

“Recent events have exposed the tragic outcomes that can occur when people with mental illness experience a crisis in the community and are not able to get the care that they need. Racism and anti-Black racism compound these crisis interactions.”

Currently, Toronto police Chief Mark Saunders said officers respond to more than 30,000 mental health calls per year, or about 82 calls per day.

Saunders said during Monday’s council meeting that there are also eight mobile crisis intervention teams that involve a police officer and nurse trained in dealing with those in the throes of a mental health crisis, but the teams do not operate 24 hours per day and are unstaffed overnight. He said mental health calls are complex.

“We’re talking about calls where machetes are involved, axes are involved, and whenever we do have these calls, it’s mandatory two officers respond,” he said.

Read more: Advocates call for community led mental health crisis intervention, not police

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“I’d rather have the sit-down and all educate ourselves a little more on what we do and what the public wants done.”

Saunders said after Korchinski-Paquet’s death that the mobile crisis intervention teams don’t go to Priority 1 calls — such as how the call was dispatched to Korchinski-Paquet’s home — in “real time,” citing a “high probability of violence.” He said police need to “restore calm, investigate and then proceed in accordance to law with what they need to do.”

“There is no way that I would put a nurse in the middle of a knife fight, and that is something that is not in any processes that I am aware of nor supportive of at this particular point in time,” Saunders said, adding that police need to consider the information given and the safety of all.

Under a CAHOOTS-type of program model, Bromberg said if workers responded to a situation that was criminal in nature, they would likely call for police assistance but not leave the scene just in case.

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She said the current Toronto police mobile crisis intervention team model is not efficient because of the number of officers deployed to support the teams.

“It’s matching the resources to the needs of individuals in crisis more efficiently and more effectively than what we have right now,” Bromberg said.

She said current training and policies do not properly support those in distress.

“When tragedies happen, it’s often because police were doing exactly what they were supposed to do — like the policies that are set up are the policies (that) often traumatize people in mental health crisis,” Bromberg said.

Haughton echoed the comments, adding that the consequences for racialized residents are less severe if unarmed workers can respond to mental health crisis calls.

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“In training officers to do better in these situations rather than having personnel whose job is to specifically respond to these situations, those officers become disempowered, and we’re just not putting them in a situation where they aren’t the best folks to be there,” he said.

“When you have officers who show up with weapons and instruments of force, it allows racism to be weaponized and amplified in such a way where people can become seriously injured or die. It’s not to say that racism wouldn’t exist in the service we’re imagining, but the consequences would definitely be less dire in terms of loss of life.”

Haughton said education about an emergency mental health response is going to be important going forward, such as health-related impacts and financial savings.

READ MORE: Why are police wellness checks ending violently and what experts say needs to change

“What we’re not really thinking about sometimes is all the people who aren’t calling 911 and all the people who aren’t doing well and all the people who are in crisis and would like to call someone and would like to get help, but they don’t want to trust police,” he said, adding more people might experience mental-health trauma related to police interactions compared to those who are seriously injured or die.

“If we give those people an option — and I’m sure there are many of them — it does a great service to our society.”

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As for whatever the service would look like, the pair envision either a separate emergency number — for example, 811 — or having service staff directly attached to 911, depending on consultation and consensus.

Bromberg said a short number would be easier to remember and that there are benefits and drawbacks to both models. While 911 is a well-known concept, she and Haughton said there could be concerns about calling 911 since it is run by Toronto police.

Bromberg added that it is essential the emergency mental health service have response times equal to other first response agencies.

Meanwhile, Haughton said he and Bromberg are trying to build awareness and gather support for implementing a mental health emergency response service — especially one that is culturally appropriate and sensitive to all of Toronto’s communities.

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“I think it’s possible to do this. I think we sometimes look at the work that will be required to make these things happen and we shy away from it,” he said.

“It’s divesting work from other places to invest that labour somewhere else and it’s creating less work when you really zoom out and take a big picture of it.”

— With files from the Canadian Press