Policing Mental Health Crisis: Personal and professional perspectives
Centre for Research on Security Practices
INTERVIEWER: Avery Moore Kloss
PARTICIPANT[S]: Jennifer Lavoie, Greg Hodge, Krystle Martin, Paul Wilson
LENGTH OF INTERVIEW: approximately 1:06:06
Greg Hodge 00:04
We need people in these positions that care and that have a drive and a passion to help people. With these people in these positions, that's how we're going to change it.
Avery Moore Kloss 00:20
Welcome to CRSP Talk, the podcast from the Center of Research on Security Practices, also known as CRSP. I'm Avery Moore Kloss. Today on the podcast were diving into the research of one of our esteemed CRSP members, Jennifer Lavoie. Jennifer is an assistant professor crossed appointed to the departments of criminology and psychology at Laurier. And her academic background is primarily based in training as a forensic psychologist. On this episode were going in depth into Jennifer's research on police interactions with people in mental health crisis and we thought there was no better way to tackle this topic than to have Jenn herself be our guide. Hi Jenn.
Jennifer Lavoie 00:59
Hi Avery. I am happy to be here and to have the opportunity to talk about my work in this podcast form.
Avery Moore Kloss 01:04
Well, I'm glad to have you here. Your experience in this area will honestly be super helpful as we navigate through this conversation, and we bring in knowledge from the three guests we interview for this episode. Maybe the best place to start, Jenn, is to get a clear idea about the research you do. Can you give me some background on your research and your area of interest?
Jennifer Lavoie 0:1:26
Sure. I’ve been conducting research in the area of mental illness and criminal justice outcomes since completing my doctoral work at Simon Fraser University in BC and a postdoctoral work at the centre for addiction in mental health here in Toronto. And after starting at Laurier, I became interested in how Police Services respond to people who are living with serious mental illness. As well as family cares who call police for help. In the last few years, I have received national and provincial government funding to conduct research that specifically focuses on how police services intervene in circumstances where a person is experiencing a mental health crisis. I think the real impetus behind this work is around the fact that contact between police officers and people with mental health or substance use problems who are often in crisis has been routine and tends to recurrently involve the same citizens and is on the rise in Canada. While the vast majority of interactions between police and people with mental illness are resolved peacefully, there are trends that require attention. Unfortunately encounters between police officers and people experiencing mental illness or Mental Health crisis are all too often reported to be experienced by citizens as negative, they involve heavier reliance on the use of physical force by police and disproportionately in fatality. For myself, I'm interested in understanding these patterns and making a contribution to improving the quality and safety of interactions between police and people in mental health crisis. I want to do this in a critical way that involves participation of community experts and stakeholders in the co-design and co-production of our research.
Avery Moore Kloss 03:12
Yeah. Thanks for the rundown Jenn. I should say from the beginning that we've mimicked almost the way you perform research in this episode with the guests that you've invited to be part of it. And before we start exploring, I want to ask you why do you think that this topic comes with a lot of controversy?
Jennifer Lavoie 0:3:29
I think there's several misconceptions about this issue in part because there are myths about mental illness. And these troops are sometimes perpetuated by media portrayals of people with mental illnesses being dangerous. We also experienced very selective and overly simplified reporting about police encounters and complicating this is that often people have strong opinions about either mental illness or policing that shapes and sometimes forecloses discussion. The truth is that the issue is complex and it's replete with dualities. Today I hope we recognize the importance of exploring this issue through the lens of multiple stakeholders and experts. Will come to an understanding of the issue through these very few points as it stands today. And I think specifically investigate what's behind police services receiving so many mental health calls. And what is the quality of these interactions? And how can it be improved? How can research help make meaningful change to improve the situation?
Avery Moore Kloss 04:28
Okay. So, just to simplify, we have three questions to answer today to explore through multiple perspectives. What's behind this pattern? What’s happening now? And how can research shape where we go from here?
Jennifer Lavoie 04:41
Exactly. And we are fortunate to have three guests who agreed to help us explore this topic.
Avery Moore Kloss 04:28
Yes, exactly. In this episode you will hear from someone with lived experience, a research scientist from a mental health hospital in Ontario, and a police officer from the training and education division at York Regional Police. So, Jenn I think it's important that in setting up this episode we talk about kind of the scope and volume of calls involving police and people in Mental Health crisis. So, can you give us a rundown of the notable research in this area that might help guide that specific discussion.
Jennifer Lavoie 05:14
For sure. There’s been many studies devoted to understanding the problems of mental health calls for police services. Estimates of mental health calls range markedly from 1%, as high as 30% of police calls for service. But it's somewhat difficult to get a clear-cut answer as to the volume of mental health calls for police service. And the chief reason behind this is the problematic ways that Police Services collect and classify data. There's data quality issues and records management systems and a lack of uniformity on how a mental health call is coded and recorded. People with mental illness and substance use disorder are actually two to three times more likely to be arrested compared to those without a disorder. There are many reasons for police contact among those with mental illness. For example, criminal victimization or asking for assistance. But according to the Standing Committee on Public Safety and National Security published in 2014, most encounters are not in response to the perpetration of crime but instead primarily involve Mental Health crisis circumstances or managing a social disorder. To this point research consistently shows that citizens who are homeless are over-represented in police contact as well.
Avery Moore Kloss 06:29
Yeah. I think it is really important to have those numbers to understand, you know, what we’re here to talk about. And I think a lot of those numbers, I mean to the general public who don't do this work, would also be somewhat surprising just that over-representation. So, set this up for us again, when we talk about police responding to a mental health call, what does it mean? Who is calling? And maybe why are they calling?
Jennifer Lavoie 06:54
To answer that question, I am going to call on Krystle Martin, who we interviewed for this episode. I'll let Krystle introduce herself.
Krystle Martin 07:00
Hi, my name is Krystle Martin, and I am a clinical and forensic psychologist. I work as a research scientist at Ontario Shores Center for mental health sciences. And there I mostly research the intersection between the mental health and the legal system. I also consult with our local police service to help them around some of their issues related to mental health. Both in terms of their staff and their wellness, but also in, how to support the community that they serve.
Avery Moore Kloss 07:35
The nuance between mental illness and Mental Health crisis is often missed. Here is how Krystle illuminates for us what exactly we mean when we say Mental Health crisis.
Krystle Martin 07:45
So essentially a mental health crisis is any situation where you know a person's feelings or actions, or behaviours made leave them to extreme emotion. So, it may be that they feel like hurting themselves or someone else or put them at risk of not being able to take care of themselves or perhaps function in their daily life. You know situations that can lead to those types of crises might be an increase in stress at home, perhaps someone has a conflict with a loved one, they might have experienced their own trauma or violence, it could be stress at school or at work, you know like exam times for students, or perhaps someone has lost their job. So essentially some type of external or environmental stress contributes to this heightened state of psychological distress. These situations usually require or at least a person in the moment really feels like some type of immediate action or intervention is needed. And well we know that individuals who do have a diagnosis of a mental illness perhaps are at greater risk of experiencing some type of crisis. It certainly isn't that all people in crisis have a mental illness. And anyone could experience this external stressor that may lead them to this heightened state of mental distress that could lead to a mental health crisis.
Avery Moore Kloss 09:10
Yeah. I think the distinction that Krystle makes here is really important. Just because someone is in mental health crisis doesn't mean they have a mental illness. Though people with mental illness diagnosis are at greater risk of experiencing crisis. I just wanted to point that out. So, I think my next question here is when we talk about police responding to mental health calls, what does that mean and what are the volume of calls that they are receiving?
Jennifer Lavoie 9:38
Great Question. In Ontario similar to the rest of Canada police officers, are usually the first and sole emergency responder who is dispatched to attend a mental health crisis. Under the provincial mental health act, police are the only individuals who have the authority to make a mental health apprehension. Now this power allows officers to take a person who recently appears to have a mental health problem, who's acting in a disorderly way and appears to be at risk, place them into custody and transport them to a physician for evaluation. According to Laura Huey and her colleagues, fewer than two percent of all police calls for service are mental health act apprehensions. For example, in 2020 the RCMP made about 88500 mental health apprehensions among the almost 3 million total calls for police service.
Avery Moore Kloss 10:32
I think this is where we should introduce Paul Wilson. Paul is a Sergeant with the York Regional Police. He's assigned to the training and education Bureau in the practical skills unit. Here’s Paul telling us more about that role.
Paul Wilson 10:45
I’ve been with the Regional Police for 21 years. I started off as a front-line police officer and spent about 6 years doing that. And I spent six years in our surveillance unit, went back to the road, eventually landed in the training and education Bureau and I've been here seven of the last eight years. My main portfolio is managing our defensive tactics and physical control techniques.
Avery Moore Kloss 11:10
Paul says in 2020 York Regional Police responded to somewhere around 10000 calls that had some kind of mental health aspect to them.
Paul Wilson 11:19
We had 3297 calls that were listed as EDP, emotionally disturbed person, and we had 1345 suicide attempts so right there we have about 5600 calls that are automatically mental health related. That's out of a population of about 1.1 million residents. And in terms of call volume if you take a daily number of calls on average York Region would be dealing with something in the area of 10 to 15 calls a day at minimum that are at face value considered mental health related calls.
Avery Moore Kloss 12:04
Jenn, from Paul's perspective York Region saw what he called a truly small number of calls that required mental health help or assistance. Does that match up numbers outside of York Region and is that in fact a small number on a wider scale?
Jennifer Lavoie 12:20
I think it is a smaller number. During the pandemic we know that mental health calls for police service skyrocketed, and this makes sense. The covid-19 pandemic has had a negative impact on people's mental health. People are dealing with illness, stress isolation, financial strain, elder and childcare demands, and grief. In 2020 stats Can took a cross sectional snapshot of mental health calls through service during the spring months of 2020 which of course was during the pandemic. And reported that mental health apprehension rose about 3%, other mental health calls had increased by 10% and check well being calls increased almost 12%. So, these trends indicate an increase in demand for police services during the pandemic for mental health-related calls
Avery Moore Kloss 13:08
Yeah. I think that’s really good to have those numbers to put them into context that Paul talks about kinda but on that wider scale. I guess my next question here is really just about the actual crisis situation and what do people do when they're in crisis and when they're seeking help?
Jennifer Lavoie 13:27
So, Krystle Martin was able to lay this out for us really clearly. How people end up in crisis situations. Here’s Krystle.
Krystle Martin 13:35
Certainly, we have services that can support someone if they're looking for Psychotherapy or an assessment but in those heightened states of psychological distress, we don't have a great system. Most of the time people are encouraged to access their local hospital in the emergency room. Which we know is not a very welcoming inviting environment. There's a long wait list, you’re around other people who have physical injuries. And typically, the hospital will assess you but unless you are having an imminent or you're at imminent risk of harming yourself or someone else, the likelihood that you're going to be admitted or offered treatment services are quite low. So, people are sent home essentially, with no follow-up care or connection to services. So again, you know for those really difficult mental health crises that people have there aren't good options to accessing support. We do have something called crisis beds in the community and yet they are very difficult to access and there’s not very many of them. They’re usually full and most people don’t even know about them let alone mental health care providers aren’t aware of them. So again, these are beds that are an option for people to use if they are not imminently at risk but again, they’re not a good answer to being able to support folks in a mental health crisis.
Jennifer Lavoie 15:27
Krystle also says a huge portion of services provided to people are private. So, in order to access services from someone like her, a clinical psychologist, it's a private system not covered by OHIP and it’s very expensive.
Avery Moore Kloss 15:41
Which I assume makes it much more complicated for the average person to kind of navigate where to get help or to even be able to afford it.
Jennifer Lavoie 15:48
That’s exactly right.
Avery Moore Kloss 15:50
So, we asked Krystle to give us a sense of the background of how we got to a place where police are the default call and response system during a mental health crisis.
Krystle Martin 16:01
I mean I think that's complicated. I don't think there’s one answer necessarily of how we got there. However, the way that we are funding and resourcing community services is seemingly in my opinion, a bit haphazard. And that there are, you know we have tertiary mental health hospitals like Ontario Shores. And then we have a whole bunch of community resources that aren't necessarily all connected. So, they are each doing their own thing and fabulous things at times, but you know again because there's not this interconnectivity between them, communication is low, or people don't know how to access them. So, I think police get involved with mental health challenges for a few different reasons. One of which, like I said, is that we don't have services that are set up for mental health crises. So that’s other than the hospital. So, people think, you know, they may not understand that you could go to the hospital for some of the challenges they're having but again I think it's not just a perception but the reality. But that's really only for folks who are let’s say actively suicidal. So, if that's not the case, we don't really have the services available to, you know, for someone to walk in and say “hey I'm really struggling and I'm not able to take care of myself. I really need help and I don't know where to go and it's so urgent that I don't feel like I can, you know, keep doing what I'm doing today”. And so, then people feel, I think this urgent need to have support or interventions and they just don't know what to do. And so, I think that adds to this incredible layer of stress and frustration and despair and hopelessness that elevates or escalates their psychological distress. Then police may get involved because I mean police are helpers. They are emergency workers who are there to help us when we don't know what to do. So, I think that people do lean on them in those moments.
Avery Moore Kloss 18:24
One question that occurred to me while I was listening to Krystle, was who is making the call to the police? Is it family members? The person in crisis? Who is it?
Jennifer Lavoie 18:35
That's a great question Avery. I'm sure the research is a bit mixed on this and it's really different across jurisdictions and localities. But many of the calls are initiated by service providers themselves who are looking for assistance from police. So, you can imagine and maybe a person who's in the crisis at the moment and there in an office at a service provider. This can also include service providers like hospitals who were calling about people who have absconded or left secure units. Often it can be family members or friends who are calling a lot of times or caring for people living with mental illness. We should recognize that a lot of care does fall to the family. I recently published an integrative review looking at family carers of people who are living with mental illness. I found that families had problems and proactively accessing services especially when they're noticing a family member is struggling. They talked about having to wait until the situation became an emergency in order to meet the stringent criteria to qualify for services that they needed. So, families will call police services when they become overwhelmed, or they need help. A person in crisis themselves will place calls to police for help as well. And finally, police services also received calls from concerned bystanders who may request police presents as well.
Avery Moore Kloss 20:06
So, when we are talking about what actually happens during a mental health call, I think it's really important that Greg Hodge lead this part of the conversation. Greg was the voice that you heard at the very top of this episode and in our interview, I asked him to introduce himself. So here is that introduction.
Greg Hodge 20:24
Hi, my name is Greg Hodge. I am a person with lived experience. I currently work as a peer support specialist with CMHA. I do have extensive knowledge on mental health signs and symptoms.
Avery Moore Kloss 20:41
In are conversation, Greg really wanted to underscore that no one chooses to become ill. Even though he feels that people with mental illness are often treated like they chose it. Greg shared a little with us about his diagnosis when he was a teenager.
Greg Hodge 20:55
I was 14 when I developed signs and symptoms of it. And at 14 I was diagnosed with manic depression which is now known as bipolar disorder and then it escalated from there. So, at 16 being diagnosed with paranoid schizophrenia so hearing voices and things like this.
Avery Moore Kloss 21:20
We are super grateful to Greg for sharing so openly with us about this. One of the things he did share was his perspective on his very first police interaction.
Greg Hodge 21:30
My personal perspective from dealing with police was never good. So yeah, a big part of it was the language that they would use, and intimidation is a big factor that I remember being put in the officer's vehicle so many times and it was always they were laughing about it and thought it was funny. Just angry, almost annoyed that they had to deal with me, so they were rough. They were never like abusive to me or anything like that, but they are always rough about it. Even when you comply, still rough. But my first experience with the mental health system as a whole as police showed up, arresting me or apprehended put me in handcuffs quite roughly threw me in the back of the car brought me to the hospital through me on a gurney and next thing you know I had a needle in my butt and I was out. And stuck in a hospital. So that was my first experience with policing in regards to mental health and policing is a whole to be honest. There just wasn't any empathy back when I was younger and to be truthful there’s still not a lot of empathy today.
Avery Moore Kloss 22:43
Like I said we're very grateful Greg was willing to share with us here and to kind of layout for us the experiences that he's had with police. So Jenn I think my question to you is, you know, we're talking about empathy and Greg's wish is that there was more empathy in these interaction and so is there any research here that you can think of that's important to kind of lay some groundwork when we're talking about that interaction and how Greg was feeling after his specific interaction that he shared with us.
Jennifer Lavoie 23:13
Absolutely I mean the research coming from people with lived experience of mental illness does talk about it being a very mixed experience. Where some people experience very, very negative interactions with police and talk about excessive force being used. And other's experience positive outcomes and encounters with police as well. Jamie Livingston, a Canadian researcher, found that for one in ten people, their pathway to mental health services was through a police encounter. So, it's really important to emphasize that officers have a key role to play as gatekeepers not just to the criminal justice system and making decisions about arrest but diversion to Canadian mental health services and resources as well. Having empathy or rational compassion for a person in crisis or living with mental illness helps an officer understand the person's needs because they can take their point of view. This in turn helps with collaborative decision-making and building empathy may also reduce stigma or negative attitudes towards people with mental illness.
Avery Moore Kloss 24:23
Yeah. From Greg's perspective he says that more people, especially the police need to have more empathy for people in mental health crisis and that police need to be trained to understand how to change their behaviour to match a diagnosis. For Greg, his diagnosis is schizophrenia, a condition that he says he controls by making sure he's comfortable in his surroundings. That’s how he says he feels the safest.
Greg Hodge 24:47
With me my house is my safe zone, it has always been my safe zone. This is where I know I can come home and not worry about what voices are doing and things like that because I'm in the safety of my own home. And then an officer will break down the door, I'm being a little dramatic with the breaking down, but they have kicked my door open a few times. And then they come in with that force. I know they have weapons so I know they can shoot me if they want to, or they can tease me now or they can spray me or hit me with a baton. I know these things when they come into my home. So, they're in my home, telling me what to do. Now if I already have voices that are telling me what to do, how do you think that's going to go over? It's not going to go over pleasantly in any way shape or form. So just understanding, that alone when you go to a call, it's like what is that going to make you do different?
Jennifer Lavoie 25:40
So, Greg’s perspective here is the cornerstone of an approach that our team developed in consultation with the community stakeholders and experts, and we call relational policing. It's vital that a person in crisis is supported in feeling safe but the arrival of police can be escalating for people especially if they've had a difficult experience with police in the past. Now relational policing approach center on a humanistic approach where officers take their time to focus on communication, validation, empathy and building a report with a person in crisis. Officers here learn to minimize they’re authoritative presence and calming body language and tone of voice. They learn a trauma-informed approach, knowing that mental illness and crisis are often connected to trauma and fear. Officers are trained to use active listening and take a person-centered approach where they give voice to the person in crisis and collaborate with that person towards a resolution where possible.
Avery Moore Kloss 26:36
Yeah, Jenn as you know we are talking about this relational police training. Just one question occurs to me; how do officers react to that training? Or how do they engage with it? And how have they engaged with it so far?
Jennifer Lavoie 26:51
We've been running a long-term study in Southern Ontario looking at the effectiveness of training officers in relational policing and what we found is, after just a few days of training officers show improved de-escalation strategies. They are more confident in the way that they respond to Mental Health crisis simulations, and they have increased empathy towards people who live with mental illness. We've also shown that this kind of training around relational policing decreases stigmatizing attitudes towards people living with mental illness as well. So, we see a lot of attitudinal changes, but we also see behavioural changes among officers who are more likely to take their time to build a report with a person in a simulation. Essentially what we need to do from this point is to understand whether or not relational policing training or these approaches can be seen in police practice in the fields are moving out of these simulations and looking at a context of policing on the streets and in the field.
Avery Moore Kloss 28:05
Jenn when you talk about that stigmatization, I think one really good point Greg focussed on is obviously the stigma around mental health but also how that plays out on a call. And just really the simple things like he takes issue with the term quote mental health call being used from a dispatch point of view. So, I'll let Greg tell you why.
Greg Hodge 28:27
If you're an officer and you go to a call and you hear on the radio or through the computer that it's a mental health-related call where does your mind automatically go? Like where does it automatically go as soon as you hear a mental health call? So that alone is a stigma that's creating bias by putting that call out there that you're going to a mental health-related call so I'm pretty sure that most people when they hear that automatically think the worst of the worst. And all you have to do is look at the media and everything else to realize that someone with a diagnosis of schizophrenia is generally where people usually go when they hear a mental health call. For most people that suffer from schizophrenia specifically it’s seen as a it's a very dangerous mental illness in that it's a violent illness and don't get me wrong there's definitely cases out there that would show that but for the most part people that usually suffer from that are paranoid are usually just trying to protect themselves that's that's a biggest thing is that is that paranoia aspect which is wicked what usually in my opinion creates the reaction. So, people just want to be safe so whether they run where they hide into a corner and then you have to remember if you're an officer if you're a part of that hallucination or that delusion and you show up to these calls you could be making that paranoia that much worse.
Avery Moore Kloss 30:07
Jenn, this is something we spoke to Krystle Martin from Ontario Shore at length about and she says despite leaps our society has made to normalize and accept mental health struggles we still really have a long way to go.
Krystle Martin 30:21
There remains a lot of stigma and negative attitudes held by people and essentially views, you know, mental illness as people who perhaps are weak for not being able to change their mental health status or broken for some reason. There's also a misperception around the relationship between mental health, mental illness and violence, which significantly contribute to the stigma that the general population has towards people with serious mental illness. I mean essentially, overall, studies indicate that people living with mental illness are no more likely to engage in violent behaviour and in fact more likely to be a victim of some type of violent experience or difficult experience. And, you know, when we say the word mental illness, I think it's misleading and suggest that you know, that this is just one mental health condition, but we know that there are many different types of difficulties that fall under this umbrella term of mental illness and have different characteristics or traits that people might experience. So, I think it oversimplifies discussion or this understanding of any possible link between mental illness and violent.
Jennifer Lavoie 31:41
What Krystle is saying here about stigma mistakenly tying violence to mental health conditions is actually another part of the answer to one of your questions from earlier in this episode. Who's calling the police? Here’s Krystle.
Krystle Martine 31:54
Sometimes it could be a community member who sees someone or observes someone and if they believe that they have much at home as they may overestimate the risk to themselves or the likelihood that violence might occur. And so, they may call the police and similarly when police show up on scene, it may be that they're more likely to infer that violence is possible or that the person may not cooperate if they believe that the person, they're engaging with has mental illness. This is where some of that stigma influences, you know, the relationship for that engagement between folks in Mental Health crisis and police.
Avery Moore Kloss 32:32
Jenn Based on what Krystle is saying here what does the research say about that mistaken link
to violence through a mental health diagnosis? Is there a link there?
Jennifer Lavoie 32:44
Well, it’s important for us to acknowledge that police are going to respond to a call based on the information that they're getting from dispatch and what the caller has reported. And often the caller information is shaped by their perceptions of the situation. Perhaps they've observed strange behaviour, something unusual and feel that public safety is being jeopardized. So, it's up to the police when they arrive on scene to verify information from multiple sources and be mindful of their own assumptions. Part of police training that our team developed in partnership with cultural safety experts includes anti-bias training where we deconstruct common stereotypes and address implicit and explicit bias head-on. And we present the science which clearly shows that people with mental illness are not more likely to be violent in fact they're more likely to be victimized by crime and violence. Yes, there are risk factors for violence that are connected to specific psychiatric symptoms such as delusions or a person feels persecuted or threatened or the other personal control is being overridden. Yet the risk factors that increase the odds of violence among people with mental illness are exactly the same as for those without a mental illness. Perpetration of violence is more strongly linked to a substance use.
Avery Moore Kloss 34:08
Krystle mentioned in our interview that they’re efforts in police training to provide information and education to new and current officers about mental illness and the likelihood of violence occurring in the community. Can you give me a sense of the current state of police training around mental health?
Jennifer Lavoie 34:25
Absolutely. It's been consistently reported that police officers receive insufficient training and responding to mental health calls for Police Service. Mental health training is not uniform across the province. It’s really left up to the individual services about what kind of training that they offer here and there is no provincial standard or National Standard for mental health training.
Terry Colbone and Storthy Cottonroad seminal report looking at mental health training that was occurring in police services across the country. And what they found was the training really varied immensely across services and then officers could receive anywhere between 1 hour of training or 40 hours of training and that's just not it's, just not good enough to have such a lack of uniformity that means the quality of service is going to be different depending on where you live in the province or the country. Research has also shown that officers feel fairly uncertain and ill prepared when responding to mental health calls for service. One of the most widely implemented training programs is called Crisis Intervention Team training or CIT training. And this was designed to foster safer encounters between police and those in mental health crisis. And it really emphasizes de-escalation techniques, mental health knowledge and diverting citizens towards Mental Health Services. All in all, mental health training programs delivered to police personnel have increased over the past 20 years. But effective validated frontline police training and de-escalation intervention are clearly still wanting. And we know this because we still have the prevailing negative outcomes for people in Mental Health crisis or in contact with the law. I think police reforms that are specific to specialized frontline officer training programs that are co-designed with committee experts and stakeholders hold a lot of promise.
Avery Moore Kloss 36:22
Yeah. So we heard from Paul Wilson at the top of this episode and to remind you Paul is a sergeant with York Regional Police, he's in training and education and he said at the top that in 2020 York Regional Police responded to 400000 calls for service and 6000 of those calls included a person in crisis that's what he called it a truly low number. He also says that out of those 6000 calls there were about 40 of them that ended with Police use of force.
Jennifer Lavoie 36:54
So, I would say that while the majority of police interactions with the public are resolved without force it's actually around or less than 1% of encounters. The use of forces is far more common among people who are living with mental illness or we're in crisis compared to those who are not. There was a systematic review that was conducted by Tahiri who looked at CW or taser use and they found a taser use is far more common among people who are living with mental illness. If we look at your more serious outcomes, lethal force for example, this is extremely rare, rarely used by police but international policing research literature consistently shows that people with histories of mental health are disproportionately killed in police interactions. I think in cases where force is used, substance intoxication, coupled with aggressive behaviour and weapon possession feature commonly as does a diagnosis of psychosis and schizophrenia and so these are very complex kinds of behaviours that officers have to respond to. In practice responding to a person in crisis can be the most challenging and uncertain of calls that police response in the field and what the literature tells us is that sometimes officers use force to subdue people who are perceived as being aggressive or erratic and the officer does not recognize the person is behaving in this manner due to crisis. Other times officers detect the person is in crisis or has a mental health problem but views that person as being non-compliant and even resistant and so they correspondingly are more likely to use a course of tactics and are forced to gain compliance in situations. And so, officers must be able to recognize cues and symptoms of Crisis, but they also have to accurately assess genuine risk to Public Safety to the person's safety or their safety and respond in ways that are most helpful to the person in crisis.
Avery Moore Kloss 39:08
Yeah. I think it's all really important information, Jenn and I think from Paul's perspective one of the questions we asked him is to lay out what training has been like in the past and how that training for police officers new and veteran officers is changing. So, here's what I had to say about that.
Paul Wilson 39:27
I think that in the past there was such a significant amount of training put on or that was centered around will say equipment, use of equipment, use of tools, and basically how to deal
with, will say, high risk events. In reality they are not as common as people think they are because first of all I would never want to work wherever the people who are on the show 911 work. Because there's absolutely no peace in that world. And that's not are world but there was a lot of focus on that type of training and I think that because of that Law & Order direction that that police have that really became the foundation of policing. And so now we're at a point where we recognize that you know we do need a more cerebral response to most of our circumstances it's just about how do we get officers to maintain some level of Officer safety or a full spectrum of Officer safety but recognize that it doesn't impact their ability to still come to a resolution and most of it is about having officers manage their own circumstances so all the controllables in terms of an officer recognizing their own physiological responses is a factor critical factor in the event will will turn out what the resolution will be.
Avery Moore Kloss 41:05
So there seems to be a couple things that come to play here. I think the first is this kind of media impact on police mentality that Paul talks about and the second is the stigma that we talked about earlier and how the term mental health call can change the trajectory of an interaction. So, we have a clip wind up here from Paul about, you know, that media impact. Can you set that up for us Jenn?
Jennifer Lavoie 41:29
A couple years ago Paul was asked to join the Ontario police college to help develop some curriculum. He's also worked with our research team for a number of years and assisting with the development of our training as well. And he says that's where he really started to understand how much an officer's attitude towards the work, they do is so important.
Paul Wilson 41:58
We talk about the attitude that they bring and if it's somebody that's coming in with a very open mind, if it's somebody who's coming in that is truly looking to be the boy scout and girl scout that they say they all are cause trust me every one of them stand up on their first day and says “I want to help the community” and we go “well that's great, that's great that you want to help the community”. The community does need help, but they need you to truly believe what you say, and you have to want to help people, so attitude is a big one. We can train skill. It’s pretty easy to get people to replicate the hard skills that we need, and I won't go into details. I think everybody knows what I'm referring to but it's the soft skills that are the hardest. Probably because people are still victims of the media and of Hollywood. Hollywood has trained every police officer in Canada a lot longer than I ever will. And that's just the reality. So, we're trying to get people to get away from the machoism and some of the preconceived ideas of policing and in really get them to just understand that it is a game of being there for people
Avery Moore Kloss 43:04
So, the next big topic here brings us right back to stigma and I mean like it or not officers are going to come to their job with a certain level of stigma around mental health and so Jenn I wonder from you, I mean is that something you think you can train out of people?
Jennifer Lavoie 43:22
Well, that is the question of the day isn’t it. I think all committee members, including officers hold implicit biases that are informed by really a lifetime of connections that we make that reify stereotypes and we tend to rely on these biases in ambiguous situations where we need to make quick decisions and if you think of most policing situations, often are situations where you officers they don't have the benefit of knowing the person who is the subject of the call. They don't know this the circumstances that are leading up to the call for the service they don't really even know the risks in the location itself and so they tend to rely on biases stereotypes or connections that they’ve learned over time. I think I've All Humans will hold these biases and they are difficult to to distinguish to your question; can you get rid of of stigma? I think it's difficult to extinguish biases that we have especially when they're related to our safety, but it is possible to disrupt them from becoming action. And the way that you disrupt implicit bias is by that self work that's done in becoming aware of our own biases and you're checking our assumptions and working to build familiarity and positive associations with groups with whom we hold by biases towards. So, when that work is done it should disrupt our thoughts into becoming actions that can be harmful towards people. I think in the end the public expects officers to respond and safe and fair ways to all citizens. The public has really high expectations of officers and they should have very high standards for officers to achieve but we also know that training can either come training scars that that officers have been subjected to military types of training there is there such a focus on use of force training among officers and it is to the detriment of really centralizing the de-escalation kinds of training and why isn't there a provincial standard here so offering officers a chance to practice de-escalation and really nipping in the bud ideas that and resistance around de-escalation as being unsafe is really important that something we encountered earlier on and in our work is that there was a reluctance to to use de-escalation or train on de-escalation because there's this perception that it might place officers at risk. So really exploring you know, why an officer feels this way and officers do encounter trauma themselves in the field and taking the time to explain why time and space and and dignity and validation are calming things and when a person is is calm does that create safety for everyone so those kinds of discussions really break down the barriers but it's a paradigm shift.
Avery Moore Kloss 46:47
So I mean on the training front Paul does say that York regional is working to change their hiring practices because one thing he says is that you can train skill that you can't change you know it's harder to change attitude but I do wonder about that kind of old guard the officers with decades of experience who are trained in a completely different way or honestly even new officers coming in with a bad attitude and despite attempts to change hiring practices
Jennifer Lavoie 47:14
I think hiring is a big part of police reform and what Paul says make sense it's born out in the literature that suggests that it is very difficult to change attitudes of officers who've had a lifetime of training in a particular way often training with at times a hypervigilance towards perceived threats being able to respond immediately to threats so there's this real military ask or warrior like kind of training that many of the old guard have received and it that's really hard to the train out and the end the attitudes that come with that and how officers may perceive the public it can be difficult to train out and so there's a lot of hope around hiring a new generation of officers who have more divers attitude to have come with a mental health awareness already and with an attitude towards guardianship towards the utility of the de-escalation and a different form of policing that highlight relationships between police and the community
Avery Moore Kloss 48:31
So obviously hiring practices, changing hiring practices is one piece of it but what else do you think needs to be done here to to move the needle?
Jennifer Lavoie 48:41
The system should be improved. It needs to change. This is the system we have right now, and right now officers are the ones who are going to be responding to Mental Health crisis calls and so the quality of that call is not just around use of force but what happens in that interaction. Did it feel like a supported and safe interaction? Did the person feel like there was procedural justice? Was their dignity that was offered to that person? Where they listen to? Do they feel like their perspective was listened to? Were they part of the resolution? I think officers are very quick to be like while you're going to the hospital it's really trying to move away from these paternalistic kinds of approaches to the working with a person in in crisis which involves de-escalating the situation, calming the situation to a point where officers can I get an assessment of the needs of that person
Avery Moore Kloss 49:43
Yeah, Jenn to underscore what you are saying here, I want to go back to Greg, who of course has lived experiences of negative responses from police well in Mental Health crisis himself. And we talked a lot with Greg about this idea empathy about having compassion and empathy for someone in crisis and have enough time as an officer to properly handle a situation. Those were two really important pieces for him. It's really an understanding of the situation and that he wants officers to actually care about the person in distress and in a lot of ways those points in his view are hiring issues and so Greg has been a part of some training sessions with police officers and he says this is one of the things he tells them when they ask how they can improve in their response to Mental Health crisis.
Greg Hodge 50:30
Hiring, having multidisciplinary professionals on the hiring panel would be beneficial to someone within human race, someone within social work, someone with peer support. Could be on these things and ask these officers the questions that really should be asked. Officers hiring officers sounds great but what if the officer doing the hiring doesn't care? We don't know what's happening with that. one thing that I usually talk about a lot to officers is if you really want to help someone is learn your local resources because I know when officers from my experience when officers show up to a call they kind deal with it a little bit and then they hand out a community card and with on this card is has resources of local agencies. Which is nice but time and time again I've watched those people they visited throw the cards at the second they leave.
Jennifer Lavoie 51:27
I think Greg point is well-taken you knowing how to leverage local resources is key to keeping people in the community and there's been a lot of initiatives across different police services that have made community resources more accessible to officers so for example you briefing officers on new community resources or having a database that's accessible through the cruiser or through phones to make referrals are a really great initiatives I think what can be problematic is that they're just so many different resources that are that are out there that tend to be silo there they're not well-connected there in fact quite fragmented its funding can be precarious and so there may be a particular community resource that’s available one year but then is gone the next so it really it comes down to you having consistent well-funded community resources for which police can make referrals in the first place.
Avery Moore Kloss 52:40
Yeah. So, Jenn most of what Greg pitched in our interview and in these clips. The previous clips kind of fit into hiring or training. But I guess my question is what about people who say we're spending too much already on training instead of reallocating funds to support mental health services in the community. I just wonder why you know what's your reaction to that school of thought.
Jennifer Lavoie 53:03
I would say why do we have to choose? It’s really a combination of funding both. The mental health system in Canada is desperately underfunded. Having accessible Community Mental Health Services could prevent some crises from happening in the first place, not all of them but many of them. And having adequate Mental Health Medical housing, employment, food security services, are all vital as well. Again, if these Services don't exist First Responders would have fewer options to make referrals for people in crisis. On the other hand, specialized frontline police officer training is in my opinion is it's a necessity because under the constraints of the current system the demand is so high on police services to respond to mental health calls for service mobile crisis teams which are specialized teams. They can only get to a fraction of these calls and so it's a patrol officers who were on the ground you have to be trained really to effectively recognize signs of mental illness or crisis and trained to prioritize de-escalation strategies where it is possible. Be trained to use relational policing techniques that are trauma-informed that are culturally safe that are person-centered will it takes funding to you to put on this kind of training.
Avery Moore Kloss 54:28
Yeah, and to set some context there I really just wanted to bring in Krystle Martin from Ontario Shores. She had this piece of her interview where she really talked about the mental health system and where we were lacking at the moment, so I just wanted you to hear that. So, here’s Krystle.
Krystle Martin 54:43
There really isn’t a good mental health service for someone who's in Mental Health crisis and so what they need is mental health support and not legal involvement. Certainly, the police may be needed to help someone in that sort of imminent moment, but we really don't have good mental health Crisis Support in the community. we know that lots of people need to access emergency Mental Health Services every year and that there really aren't good options and so unfortunately our community is left to lean on police in those moments because that is what we have so that's the first thing that I think is really important to understand that we don't really have other options and so where the police are doing a good job is that they are trying to you know improve training they're trying to create in a large number of services have units that are dedicated specifically to mental health or maybe officers who have received extra training and specialized training and how to support people who are presenting in Mental Health crisis and those Services may actually be one in which they partner with some type of Public Health Service so whether it's at a mental health nurse or social worker Partnerships between police officers and Mental Health expert who then correspond to folks who are presenting again in a mental health crisis.
Avery Moore Kloss 56:23
Jenn, Krystle is hinting at something here that I know, you know a lot about which is the need for partnerships moving forward. Can you give me a sense of the conversation that's being had now around those kinds of partnerships?
Jennifer Lavoie 56:37
Yeah. I think what Krystle is referring to here is called a co-response model and that's also known as a mobile crisis team or mobile crisis rapid response teams and what these are all units that are especially trained police officer with a mental health specialist usually a nurse or a social worker and here mental health worker provides expert knowledge accurate assessments and they facilitate graphic referrals to appropriate services and then the officer is it in the unit to provide safety and stability to the situation and remember they possess the authority to apprehend if that's required. In a study conducted by a lorry a graduate student Crystal Shore in myself we found that less than half of the people the police apprehend were admitted or involuntary hospitalization as research shows that reduce the burden on ER by safely diverting people away from emergency care which can be expensive who can safely stay in the community so what I'm saying is that some people don't need to be apprehended they need support in that moment when these teams do decide to make an apprehension those individuals are much more likely to be admitted to the hospital then police only kinds of responses research also tells us that people in crisis actually have preference to engage with co-response teams compared to police alone responses so these partnerships are making a difference.
Avery Moore Kloss 58:09
yeah, these partnerships Krystle is talking about are at the core of where she thinks the respond and care needs an update. She says it's about connection and collaboration and also the sharing of secondary resources and information.
Krystle Martin 58:24
So when someone is at risk for becoming involved in the law or has repeated contacts with police I think it is tremendously important to bring all the caregivers together and make sure that everyone's on the same page in order to better support that person and perhaps may give police more information so that they can respond more effectively so for example if we could of course with the consent of the other person or their loved ones be able to give police more information about things like coping strategies or their preferred name or their contact information for their case worker who they are currently working with it if something happens in the community where the police need to respond then they have information that is more personalized to that person and have the information of their Community Support so they can pull those folks and and maybe then the police can step away and say okay now you have your community support and you no longer need us right and so I think they're if we could facilitate more connection collaboration and communication between mental health support and police that I have seen this work and it can help again reduce involvement in the legal system and make sure that mental health crisis or mental health events today in the mental health system
Avery Moore Kloss 59:57
Yeah. So what Krystle Is actually saying here reminds me a little bit of something that Greg told us when he was talking about the work he does as a peer support specialist with CMHA so here is Greg just briefly talking about his role there.
Greg Hodge 1:00:12
Currently I am with the EPI, which is the early psychosis intervention team, so a lot of the clients are new to experiencing psychosis so not all these individuals have been diagnosed so they're going through the process of trying to figure that out. But because of my experience living with mental illness and love knowing the signs and symptoms I'm there to support them with any questions they have or with just even being social within the community, so I offered to visual support or group support.
Avery Moore Kloss 1:00:49
So, from Greg point of view way to keep people in Mental Health crisis from entering the system via the crisis response route that we need to be catching diagnosis earlier and understanding what that diagnosis means and this is something he says is helpful for him with his own diagnosis
Greg Hodge 1:01:09
Catching the early diagnosis is so important so that way they're familiar with the mental health system so it's not so damaging or traumatizing to them so they could think of where I am at is it can be a self-referral so if you're not sure what's happening with you then you can be within their program and learn about yourself and if you do have a diagnosis then at least you're prepared for that world as opposed to being a crisis situation where people don't have a choice.
Jennifer Lavoie 1:01:43
Just to echo what Greg is saying here it's critically important that people will live experience of mental illness be empowered to participate in these systems in meaningful ways. Peer supports are going to be a much softer place to land for a person who's new to the mental health care System. Peers are coming from places familiarity understanding and compassion and they're experts that can help guide both staff members and the patient to connect and communicate more effectively. The reality is that the mental health care system is fragmented, it’s very difficult to navigate and not only do peer support workers help guide people through but they also serve as role models for what recovery and wellness can look like. let's hear from Greg about his perspective about why peer support inclusion is so important.
Greg Hodge 1:02:31
I don't come from the clinical side so therefore I'm not there to give them therapy I'm not there to prescribe the medication for make sure there's heading taking there medication so being peer support is that lived experience perspectives so I've been through the system I've been on medications I've been hospitalized I've been treated poorly by many aspects of the mental health system so because I have that understanding if they do have questions or support that's non-judgemental and that's where our role is peer support is useful because there is no Stigma attached to us it's just strictly we want to support them we know what it feels like to have been there and for us set of recovered we know that it is definitely possible and we want to help him get there and it's a genuine thing. Although peer support can be paid in that position into that role, money has no bearing on me, as far as how much passion I have for seeing someone get better.
Avery Moore Kloss 1:03:41
That's a really powerful point Greg makes there about the inclusion of people with lived experience in the response to Mental Health crisis and and I think it's a perfect note to end on and then we talked a lot and this episode about research that's been done in this area or is in progress but from you I want to know like what do we still need to know what's what's on your research must have list
Jennifer Lavoie 1:04:04
I mean we need to continue research to determine what elements of specialized police training are effective in making actual difference in police practice in the field and that's in terms of reducing the incidence of use of force and certainly reducing fatalities but you know also looking at the the ratio of apprehensions that result in care when that's required, better referral to the community. I think most importantly a renewed relationship with the Mental Health Community where trust and respect is established in both directions.
Avery Moore Kloss 1:04:36
Yeah. Jenn Thank you so much for Lending us your expertise and your research for this episode. I so appreciate all the help you've provided to me especially along the way and understanding the work that you do
Jennifer Lavoie 1:04:48
Thank you so much for the opportunity to create this podcast episode Avery.
Avery Moore Kloss 1:04:51
Yeah. We would like to thank our three guests today for their time and their own expertise. Greg Hodges is a peer support specialist with the Canadian Mental Health Association. A big thank you to Greg for sharing his experiences and his extensive knowledge of mental health signs and symptoms with us.
Jennifer Lavoie 1:05:08
Krystle Martin is a clinical and forensic psychologist she works as a research scientist at Ontario Shores Center for Mental Health Sciences
Avery Moore Kloss 1:05:15
Paul Wilson is a sergeant with the York Regional Police, and he is currently assigned to the training and education Bureau in the practical skills unit.
Jennifer Lavoie 1:05:24
Thank you to Carrie Sanders and Samantha Henderson from CRSP for their help with this episode.
Avery Moore Kloss 1:05:32
You can find links to any of the research Jenn mentioned in this episode in the show notes. CRSP talk is a production from the center for research on security practices at Wilfrid Laurier University. For more research stories listen to past episodes of this podcast and for more information about the work that we do at the center for research on security practices please visit are website at CRSP.online. Thank you for listening to CRSP talk. We will be back again soon for more research to uncover. I’m Avery Moore Kloss and I’m Jen Lavoie.