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 BCMHAPP (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

• Canadas police, especially the RCMP, elicit
  iconic images that are part of Canadas 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 Coroners 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 Coroners 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 isnt 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 (BCMHAPP).
• 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 800 AM to 900 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.