We hear about horrific situations in Canada when interactions between mentally unstable people and law enforcement lead to tragic outcomes.
Less well known are the longtime efforts of the Vancouver Police Department (VPD) to meet the needs of the 30% of their calls that deal with mental illness. A summary of their most recent and ongoing efforts was released this summer in their policy statement "Vancouver Police Mental Health Strategy." This document offers a template for what an enlightened broadly-based approach to mental illness looks like.
One of the very successful VPD programs described in the policy statement is Car 87, a service that began in 1978. Car 87 involves sending a police officer along with either a registered or psychiatric nurse to assess and respond to an emergency situation.
Often people who become very psychotic have a brain-based lack of awareness of being ill, also called anosognosia, and so do not see a reason to seek or agree to medically-based help. Families often struggle to get an ill person to an ER, only to find out that they will have to wait hours before they can see someone. When families call Car 87, the police officer and clinician assume responsibility for getting a very ill person to the help they need.
I often describe the valuable services provided by Car 87 when I do public speaking about the perspectives of family caregivers. Often families in the audience come up to ask more about this service. If these caregivers were allowed to play a more active role in suggesting services for their communities, a role recommended by the Mental Health Commission of Canada, these kinds of sensible services would grow.
The VPD and the Vancouver Coastal Health Authority have expanded their level of cooperation in better meeting the needs of people with severe mental illnesses. Besides cooperating in Car 87, police are involved in both Assisted Community Treatment teams and in Assertive Outpatient Treatment programs; both of these programs focus on providing help to the most high needs populations by taking services directly to them.
Of special interest to families is the clear support for cooperating with families. The policy encourages:
"engaging the assistance of a family member or caregiver of the affected individual, who can often provide insight and perspective on the behaviour, and may be able to serve as an advocate...."
Earlier in our daughter's illness, we had to twice contact the VPD. In both cases the officers who responded surprised us with how much they knew about mental illness and how skillful and compassionate they were in the important help they offered.
Families supporting people with severe mental illnesses were very encouraged at the most recent annual Family Conference in Vancouver which included a presentation by Constable Heidi Schoenberger.
Her description of the VPD's approach to dealing with mental illness not only demonstrated the extent of their training about mental illnesses and in crisis intervention and de-escalation techniques; it also confirmed their interest in working cooperatively with families. You can hear her at this link at 20:23.
Law enforcement approaches in B.C. for dealing with mental illnesses are being seen as a model for other jurisdictions. However, interactions with a volatile population still can go wrong. When law enforcement reports, as they do in Vancouver, that almost 30% of their calls involve mental illness, we need to better examine the various social forces that contribute to these problems. Here are just two of the factors:
- Because we lack appropriate mental illness literacy campaigns, the public doesn't develop adequate knowledge about severe mental illnesses and how best to respond. Our current national mental illness awareness campaign doesn't even offer basic information about schizophrenia or bipolar on its website. And although Dalhousie psychiatrist Dr. Stan Kutcher has developed an excellent school based mental health/mental illness program, too few schools have incorporated it. The program has been shown to increase knowledge and help seeking behavior while also reducing stigma.
- Even though B.C. has a very good mental health act, it's not adequately understood and implemented. People who are too ill to realize that they need help are eligible for involuntary treatment. And service providers are allowed to communicate with family caregivers in order to provide continuity of care. Too often this treatment and this communication doesn't happen.
Trends to de-medicalize severe mental illnesses contribute to these problems. Psychiatric survivors are often seen as the legitimate voice for people who have mental illnesses. They and their allies, who often argue that mental illnesses don't actually exist, lobby against any involuntary treatment and against the mental health acts that allow it. Also, in the name of privacy, they seek to bar communication with families. Meanwhile, the perspectives of family caregivers are generally ignored.
The under-treatment of people with severe mental illnesses has led to members of this population becoming homeless and, increasingly, incarcerated. The problem is even bigger in the U.S., which has been more severely impacted by the lack of appropriate treatment. We have a lot to learn from California where disability activists have created the biggest barriers to treatment.
Police there are more powerless to get help for profoundly psychotic people. One Los Angeles police officer, Deon Joseph, has been creating video blogs documenting the problem. In this video, he describes his unsuccessful efforts at helping a profoundly psychotic, homeless woman, covered in her own urine and feces, get the involuntary treatment she is too ill to know she needs.
Canada is asking police forces to deal with a population they were not designed to focus on. While applauding the efforts of police to adapt, shouldn't we also be looking more closely at policies that are creating the chaos of so much untreated mental illness?
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