07/25/2014 01:06 EDT | Updated 09/24/2014 05:59 EDT

How a Report on Toronto's Police Became Look at Mental Health

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The media reports on former Supreme Court of Canada Justice Frank Iacobucci's 413 page comprehensive report on how Toronto police deal with people in crisis have missed what I consider to be the key. There is so much in the report that it is not surprising but it isn't until page 91 that he states that "the issue of police interactions with people in crisis is not merely one of policing. Its root causes cannot be addressed without tackling the need for more comprehensive care for people with mental illness."

Two pages later, he states that "the high volume of police interactions with people in crisis is in large part a function of the failure of the mental health system to provide adequate community-based treatment for mental illness." Chapter four is devoted to exploring this problem and the Ontario Government and the Ministry of Health and Long Term Care (MOHLTC) come in for considerable criticism.

He points out that Ontario does not have a mental health system as there is no coordinated, comprehensive approach to treating mental health. Rather, there is a patchwork collection of hospitals community treatment organizations and practitioners with often inadequate funding. Toronto (and the Province) he says would benefit from a well coordinated system.

And while he says that the mental health system is not the subject of his review, he adds that it is impossible to address the topic of policing people in a crisis without referring to it. Because of the weakly organized mental health system and the lack of adequate resources coupled with the high volume of police interactions with mentally ill people, the police service is now part of the mental healthcare system.

Many witnesses reported that the health system is based on crisis management rather than being proactive or having an emphasis on prevention. Police often find themselves dealing with disturbed individuals days and even hours after they have been discharged from hospital. On other occasions, they take troubled individuals to the emergency only to have the hospitals find that they cannot admit the individual.

None of this is surprising to those of us who have experience with the system and Iacobucci does cite the deinstitutionalization movement going back to the 1950s and 1960s as a cause. In those two decades, he says, almost 80 per cent of beds in Ontario psychiatric hospitals were closed while the necessary community services were not fully implemented. "Society has still not risen to meet the challenge of providing adequate community mental health supports."

The report states:

One of the most common themes emanating from the submissions of a wide variety of stakeholders from all communities consulted, including those at the highest levels of the healthcare system, was that resources devoted to mental health treatment and community supports, housing supports, outpatient teams, social work, peer support and other resources are inadequate. Several stakeholders directly linked these inadequate supports to the high volume of crisis calls and apprehensions under the Mental Health Act.

One of the themes in my blogs here is that Ontario has had numerous reports on how to improve the system but that they have done very little if anything to reform the system. Some of those reforms as I stated in my advice to the new Minister of Health would cost very little. The Canadian Mental Health Association has put together a chronology of reports, recommendations and plans completed by the government from 1983 to 2011 to improve mental health care. There have been 16 in total and yet Justice Iacobucci finds, in 2014, that Ontario still does not have comprehensive properly funded services.

There is no justification for continued government inaction.


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