Recently I did a post expressing my concern about learning that a local police force routinely handcuffs people that they are taking to hospital under a Mental Health Act apprehension. That got me thinking about what it shoulds look like to help people in mental health crisis.
The police force in the city where I live (different from the one referred to in my previous post) has a partnership with the local health authority to operate what’s referred to as car 87/88. This involves an unmarked police car, a plainclothes police officer, and a mental health nurse. They attend mental health emergency situations, and track down people who have been certified under the Mental Health Act in the community but left before they could be taken to hospital. If they’re attending a call and someone needs to be taken to hospital involuntarily, either the police officer will do a Mental Health Act apprehension or the on-call psychiatrist will be called to assess the person and do a Mental Health Act medical certificate if appropriate. An ambulance is then called, and the person is transported to hospital in the ambulance, with the car 87/88 police officer accompanying as needed and the nurse following behind in the police car.
I really like this system, and the biggest problem I see is that there is only one car for afternoon shift and one for night shift in a large urban centre. It seems much more civilized to have a more subtle police presence (unmarked car, no uniform), a highly experienced mental health nurse, and transportation in an ambulance (what with mental illness being a medical issue). I understand why police need to be involved sometimes if someone is being taken to hospital on an involuntary basis, but I don’t think that’s any excuse to take the health out of health care. Mental illness crisis is an emergency medical issue, and I strongly police should be involved in a primarily supportive role unless there is an imminent safety risk.
Speaking of which, I think it’s crucial that police attending situations where a mentally ill person poses an imminent threat be well trained in the use of less lethal force options, such as weapons that fire rubber bullets or bean bags. A number of years ago at a mental health clinic where I worked, a client had come in who was highly suicidal and wished to commit “suicide by cop” (i.e. goad police into shooting and killing him). The team of police officers that attended handled the situation extremely well trained and were able to utilize these less lethal options to make sure that nobody got hurt, including the client.
Because mental illness is unpredictable, mental illness crisis situations are equally unpredictable. However, I think having a well-designed crisis response system can go a long in in both promoting safety and preserving dignity of the mentally ill person in crisis. A system that further traumatizes mentally ill individuals does no one any favours, and we need to do better than that.