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Policeman in uniform


Psychiatrists in blue

Improving police responses to people with mental illness

Police interactions with people with mental health problems have garnered a lot of attention over the last decade, thanks in large part to the work of psychologist Dr. Dorothy Cotton and retired Moose Jaw, Sask.–police chief Terry Coleman. Cotton and Coleman spearheaded the Police Project of the Mental Health Commission of Canada, which will develop guidelines for police training across Canada with the aim of improving interactions between police and individuals with mental health problems. CrossCurrents asked Cotton and Coleman about progress in this area.

Why are police interacting more with people with mental health problems?
Cotton spent 25 years working at a provincial psychiatric hospital, starting in the mid-1970’s. Towards the end of her tenure, she noticed how much time police were spending with patients. “A lot of people had been released into the community and didn’t have much in the way of supports,” she says. Cotton sees another reason besides de-institutionalization for increased police involvement: “We’ve seen a shift in social focus towards the right; we’re more of a law-and-order society. Society in some ways has become less tolerant. When people don’t know what to do, they phone the police.”

When do police interact with people with mental health issues?
Media usually focus on police apprehensions under mental health acts, but the far more common interactions involve police serving in more nuanced roles, says Coleman. The shortage of community mental health services means that police often intervene in non-criminal situations to provide assistance and social support.

“Police get called when someone is acting strangely, not necessarily violently,” says Coleman. “Some people are uncomfortable when they see someone dressed strangely, talking to themselves or sounding irrational, even if they’re not threatening anybody.”

Cotton points to the “huge range of functions” assumed by police, from apprehensions—“probably less than 10 per cent of interactions with people who are mentally ill”—to responding to calls from families, co-workers, friends and neighbours. “One role that is overlooked is that of providing informal social supports to people with mental illness. Often it is police who check up on them, give them a buck for a coffee and help them to find a place where they might get food,” says Cotton.

How do mental health consumers perceive police?
In the general population, attitudes toward police are often fear driven. “None of us like to have the police appear on our doorstep,” says Cotton. “It’s frightening for any person, particularly if you are acutely ill, feeling uneasy, maybe paranoid. It’s also very stigmatizing.”

As part of the MHCC’s Police Project, Cotton and Coleman were involved in a newly released study of consumer experiences with and attitudes towards police in British Columbia. “Consumer attitudes are generally positive, although somewhat less positive than those of society as a whole,” says Coleman. He adds that most people feel that police were helpful, that they had an overall beneficial effect on their lives, and that the police treated them fairly and with respect. “I don’t want to paint an unduly rosy picture, because there were also those who think interactions could have been better,” says Coleman. “But particularly for more seriously mentally ill people, the police are the best friends they have. You can’t just phone a mental health worker and get them to come out and see you. They don’t wander by you on the street to check and see if you’re okay. Police do.”

Do traditional models of policing meet the needs of people with mental illness?
“Traditional policing was incident-driven,” says Cotton. “An incredible amount of time spent at hospitals, usually in emergency wards, looking after the person they’d transported, waiting for various people in the health system to attend and take over. I think that was a very practical impetus for police to look for a better way.”

Coleman started in policing in Calgary in 1969, during the traditional era of policing. “I can’t remember any training that prepared me to deal with people with mental illness, never mind someone in crisis,” he says. Coleman frequently encountered individuals with mental illness, many of them homeless and with addiction. “Back then, we had to ‘wing it’; some of us got it right, some didn’t. But when a new chief came along in the early ‘70s, there was an attempt to make referrals to mental health and addiction services.” Coleman says that today, law enforcement is just one tool the police use. “The rest is the social services aspect of the work.”

Are police training and education making a difference?
As part of the Police Project, Coleman and Cotton researched how police basic-training programs across Canada prepare future police officers to respond to people with mental health problems and found quite a range of approaches. “One of the best programs we found was the Royal Newfoundland Constabulary in association with Memorial University in St. John’s,” says Coleman. “At 30-odd hours, it’s a good program. Other police academies and colleges might only dedicate half a day.”

Cotton and Coleman’s work with the Police Project includes a proposed training model called TEMPO (Training and Education about Mental Illness for Police Officers). “TEMPO addresses all levels of training, not just officers on the street, but people working the front desk, the call takers, the dispatchers, anybody interacting with the public,” says Cotton. “Training won’t fix everything, but it is a necessary prerequisite. And because it’s included in basic training, it sends a clear message to police that this is important work.”

Coleman says education must tackle stigma: “Police are better educated, but the public and many police officers still equate mental illness with violence. We’ve discussed stigma with the MHCC to determine how we can introduce this into a program for police personnel.” The TEMPO model is a start.

What are the key components of a police approach to people with mental illness?
Officers must use their own judgment, which is why training and education are so important, says Coleman. “Police by nature are action-oriented; they like to get the job done and move on to the next call. But in some circumstances, a conversation could resolve a situation. Education and training can impress upon police officers that this is an alternative, so they can understand what they’re witnessing and hearing.” Coleman adds that police must be prepared to take their time, and verbal and de-escalation skills are critical.

What barriers do police face in working with the mental health system?
“The biggest problem police have is the biggest problem the rest of us have—lack of access,” says Cotton. “Police may see someone in need of immediate care and treatment, but they don’t have magic ways of accessing help any more than the rest of us do. The only option open to police, aside from informal encouragement, is to determine whether the person meets criteria of the Mental Health Act, and if they think they do, take them to an emergency room, where they might spend hours.”

This is where joint-response teams can be extremely helpful because they facilitate, as much as possible, gaining access to the system,” says Cotton. As an example, Cotton points to joint-response programs like COAST (Crisis Outreach and Support Team) in Hamilton, Ont., which consists of child and youth crisis workers, mental health workers, nurses and plain-clothes police officers. “The officer is there in case there is a risk of danger or harm to anyone,” says Cotton. “Very often these models result in less involvement of the criminal justice system and a quicker way to access services and supports.”

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Related links

Canadian Police/Mental Health Liaison website

Crisis Call documentary

Human Services and Justice Coordinating Committee (Ontario)

Not just another call … Police response to people with mental illnesses (Ontario Police College)

Police and mental health: A critical review of joint police and mental health collaborations in Ontario

Police Project (Mental Health Commission of Canada)

Police and mental illness

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