Policing and Mental Health: Building Bridges

1. Policing and Mental Health: Building Bridges Mary Lu Spagrud: CMHA Prince George Branch and Northern Health Authority Glen Schmidt: CMHA Prince George Branch and the University of Northern British Columbia

2. Outline CONTEXT: Police, mental illness, public perception, explanations, needs. BACKGROUND OF BC:MHAPP (Building Capacity: Mental Health and Police Project). PRINCE GEORGE: Information on PG, challenges, strategies, process, outcomes of Prince George Police Project. FUTURE DIRECTIONS

3. The Context Canada’s police, especially the RCMP, elicit iconic images that are part of Canada’s heritage and history. However, in recent years the police image has been tarnished for a number of reasons.

4. Issues of Public Concern Mahar Arar and the handling of sensitive information. Air India and the relationship with CSIS. Questions about pension fund management. Release of information with political repercussions. The use of Conducted Energy Devices (Taser). Public accountability. Intervention with people suffering from mental illness.

5. Public Perception On October 14, 2007 Robert Dziekanski died after he was tasered 5 times by the RCMP at Vancouver International Airport. The subsequent Braidwood Inquiry has raised questions about the police action. Questions about police interaction with the mentally ill have been around for many years.

6. Police and Mental Health In October 2000, the Chief Coroner of BC issued a report following an inquest. A man who was distressed and suffering from a mental illness began acting violently in the Emergency department of a BC hospital. The police were called and as a result of their action, the man was shot and killed. The BC Coroner made a number of recommendations to various government ministries. One of the Coroner’s many recommendations was that police be trained in non-confrontational methods of responding to people with a mental illness.

7. First Contact One of the outcomes of the Coroner’s Report was the Study In Blue and Grey, a document produced by CMHA BC Division that explored various aspects of the relationship between police and the mentally ill.

8. Key Findings Over 30% of persons with serious mental illness had an encounter with police while trying to make their first contact with the mental health system. It is estimated that 15% to 40% of the incarcerated population have a mental illness. Dealing with mentally ill people can be difficult and traumatic for police. Police training related to dealing with people having a mental illness generally tends to be very limited. Police encounters with mentally ill people are increasing.

9. Homelessness An increase in the number of homeless people accounts for some of the frequent interaction between police and the mentally ill. In BC the number of homeless people doubled between 2002 and 2005 and increased by 19% between 2005 and 2008. In Toronto 66% of homeless people were found to have a mental illness.

10. Drug Use and Mental Illness Concurrent Disorders (dual disorders, dual diagnosis, co-morbidity, co-occurring substance abuse disorders and mental health disorders) may complicate the interaction. Concurrent Disorders are very common among the population of homeless people.

11. “Suicide by Cop” While it isn’t common, there are examples of mentally ill people who may act on a suicidal impulse by engaging or threatening police in a manner that is likely to produce a lethal response.

12. Coordination and Integration Problems PGRH The Study in Blue and Grey also noted that there may be poor coordination and access to resources such as hospital emergency departments, crisis intervention services, and mental health workers.

13. Deinstitutionalization and Inadequate Resources In CMHA we are strong supporters of deinstitutionalization. However, we all know that the move to community did not come with adequate resources. This leads to frustration, lack of support, and anger among people with mental illness. Many live in poverty on the margins of society.

14. Police Training Training for Police Forces varies. New recruits to the RCMP undergo a 785 hour, 24 week, basic training program that includes: 373 hours of applied police science; 75 hours of police defensive tactics; 45 hours of fitness and lifestyle; 64 hours of firearms training; 65 hours of police driving; 48 hours of drill, deportment, and tactics; and 115 hours for detachment visits and exams. Within this curriculum only 6 hours relate to mental illness and responding to persons with a mental illness .

15. Training Needs Policing is increasingly complex and the amount of information that recruits must learn is immense. Training in the area of mental illness has not been a priority.

16. Outcomes of the Study in Blue and Grey In 2005 CMHA BC Division received funding from B.C. Mental Health and Addiction Services (Provincial Health Services Authority) and the Vancouver Foundation, to work with CMHA branches in six BC communities to identify areas for improvement in the link between police and mental health services and systems. Vancouver, Richmond, Delta, Nanaimo, Williams Lake, and Cranbrook were included in this phase.

17. Prince George Phase The project was called - Building Capacity: Mental Health and Police Project (BC:MHAPP). The second phase of the project included the communities of Prince George, Salmon Arm, and Kelowna. The challenges, the process, the outcomes, and the current status of the Prince George component will be outlined.

18. Prince George Prince George is located in the central interior of British Columbia. It is a regional centre for transportation, government, health care, education, and retail services.

19. Prince George Prince George 1930 A fur trading post was established at the confluence of the Fraser and Nechako Rivers in 1807. This had been a settlement point for First Nations for hundreds of years. In 1903 the Grand Trunk Railway passed through the settlement and this promoted development and agriculture.

20. Prince George The first pulp mill was constructed in 1964 and forestry has been the main industry. In recent years the forest industry has struggled for a variety of reasons: the softwood lumber agreement, the pine beetle epidemic, changes to processing regulations, and the recession. The current population is around 72,000.

21. CMHA Prince George The CMHA Branch in Prince George has about a 1 million dollar annual budget. The branch operates housing, vocational programs, and a clubhouse. It is involved in advocacy and support in a variety of ways such as public education, support of consumer groups, and lobbying government and the Health Authority.

22. Prince George MHAPP A steering committee was established and the project had the following objectives: Completion of a community mapping process of current police practice in mental health crisis situations. Development of a community specific plan of action to improve police responses to people with mental illness in crisis. Strengthening key partnerships to support a more collaborative response to people in mental health crisis.

23. Challenges The Police Project faced a number of challenges in Prince George that included: Meeting coordination and timing to insure maximum participation. Recruitment of key participants. Mitigating suspicion and hostility between and among participants. Avoidance of blaming and attacking police.

24. Meeting Coordination Membership on the steering committee fluctuated but there were 14 regular members all with different schedules and work related demands. Some worked shift work. Maximizing attendance was a challenge.

25. Meeting Coordination The best time to meet in order to maximize participation was from 8:00 AM to 9:00 AM. Meetings were held within one hour so agendas were tight and focused. Attendance ran around 80%. Initially meetings were held every two weeks.

26. Recruitment Recruitment of key people was very important, especially people who could make decisions or who were close to decision makers.

27. Steering Committee Membership • Canadian Mental Health Association Prince George - President • Canadian Mental Health Association Prince George – Executive Director • RCMP - Inspector • RCMP - Constable • BC Ambulance - Superintendant • Métis Association of BC – Program Officer • NHA Mental Health - Supervisor • Crisis Line – Executive Director • Prince George Fire Rescue - Deputy Chief • Mental Health Service Recipient • Central Interior Native Health - Nurse • BC Schizophrenia Society (BCSS) – Program Officer • Northern Health Authority Addictions – Program Officer • Family Member

28. Role of Steering Committee Members • Attend committee meetings. • Share specialized knowledge and information at the table. • Obtain information within their sector which may be of use to the steering committee to achieve its goals. • Respectfully hear and consider the knowledge and experience of others at the table. • Collaborate in achieving the goals of the steering committee in completing the community overview and plan of action. • Develop strong and sustainable partnerships which will continue beyond the term of the project.

29. Recruitment Problems Participation of hospital emergency staff emerged as a problem area. Their participation was limited to non-existent. The Committee and Coordinator worked through other channels of NHA.

30. Project Coordinator The Project Coordinator facilitated the work of the steering committee by providing information and support, organizing, and chairing steering committee meetings, keeping minutes, and ensuring the exchange of information. The Coordinator also promoted the work of the steering committee, dealt with calls from media and other interested parties, and conducted research as necessary. The Coordinator wrote the final report.

31. Mitigating Hostility Some committee members had poor relationships for a variety of reasons. A large challenge was to ensure that past disagreements or disputes did not derail the process.

32. Examples of Suspicion/Hostility The consumer member and family member had difficult experiences with police and it was important to ensure that this did not hamper communication and planning. Blaming and dwelling on past grievances were avoided.

33. Examples of Suspicion/Hostility CMHA, BCSS, and the Health Authority had various conflicts over the years. Some related to competition over resources while other conflicts involved philosophical or ideological disagreement.

34. Avoiding Blame and Attacks on Police The police were the most important group in this project and their support and participation was critical. Blaming or fault finding would only alienate the police and reduce the possibility of meaningful change. It was made clear to all participants that this was not a blaming exercise.

35. Results Community Mapping became one of the initial tasks of the committee. This was a useful exercise for a number of reasons. It provided a graphic example of service provision and service gaps. It allowed steering committee members to clarify and better understand their respective role in a mental health crisis.

36. Focus Groups Potential Focus Groups were planned. The identified groups included consumers, family members, uniformed responders, and non-uniformed responders. Recruitment was a problem and focus groups met with limited success. Three uniformed focus groups were run as well as one consumer focus group.

37. Key Findings and Actions Need for Education. As a result of this broadly identified need, CMHA Prince George, in partnership with other people and organizations launched the Crisis Intervention Training (CIT) Program that was developed in the Lower mainland of BC. CIT is primarily geared toward first responders.

38. Key Findings and Actions • Decision was made to design a one day training session to teach more first responders and then focus on the CIT training for a more specialized team within the community. • To date we have held 14 sessions of this Mental Health Crisis Response Training and trained approximately 130 persons.

39. Mental Health Crisis Response Training • 8 hours. • Brief overview of mental health and addictions, mental health act, signs and symptoms, community agencies, and specific responses in Prince George. • Open to all uniform and non-uniform responders and many social services and community agencies.

40. CIT Training • Critical Incident Team. • Based on the Memphis Model. • Prince George will be the first BC location outside the lower mainland to train in CIT. • 40 Hour – 5 Day training, including role playing and a variety of experts in mental health, law, and communications.

41. Key Findings and Actions Hospital Security staff are poorly trained and lack understanding in the area of mental illness. Meetings and correspondence established communication and discussion of possible solutions.

42. Key Findings and Actions Lack of quick access to resource information. Small information cards were developed for use by first responders such as police and fire.

43. Key Findings and Actions • Suspicion and lack of understanding between service users/consumers and police. • Coffee drop-ins were planned and organized at a local activity centre for mentally ill people and a local mental health clubhouse.

44. Key Findings and Actions • Poor coordination in the ER of the local hospital. • Letters were written and meetings arranged to discuss and identify possible solutions.

45. Current Direction The committee continues to meet once a month. The focus has shifted to training. This has involved presentations from trainers (police and CMHA) from the Lower Mainland as well as sending people from Prince George to attend the training. Local people have been organized to deliver the training.

46. Current Direction The local training has been successful. Participants included police, fire, ambulance, ER staff, local shelter staff, corrections officers, contract nurses, and various non-profit social and health services staff.

47. Current Challenges Funding is a major challenge. CMHA Prince George has provided funding but does not have a budget for the project. Alternative sources of funding are being explored.

48. Current Challenges The project has been able to mitigate the financial problems by securing volunteer trainers and free training space. Funding is being explored through the RCMP, the Health Authority, and a variety of granting agencies.

49. Conclusion With limited resources this project has had a positive impact on mental health services in Prince George. Communication and understanding between organizations have improved; gaps were identified and addressed; training has been developed and delivered. The project is an example of positive advocacy for people with mental illness.