We’ve seen increased coverage of police-related deaths among individuals experiencing a mental health crisis in the community. In my opinion, chalking up police brutality to lack of training fails to recognize a much more complex and systemic problem. While it has become evident that police officers are poorly equipped to attend mental health crises, the root of the issue stems from the design of our mental health system.
One of the reasons we continue to see undue escalation and violence is the resistance of many police forces to let community services, family, or others who may engage in a more positive manner with the person in distress participate during a crisis. As mental health workers, our goal is to de-escalate the situation and help the person receive the help they need. It is what we do all day, every day. Our specialized training and experience affect the quality of the interaction. Too often, people do not understand that managing mental health crises is a real skill. It takes a long time, hard work, and practice to learn to do it with kindness and compassion, and more to the point, effectively. It also requires knowledge of the community you are serving and very often a relationship with the client in distress.
When a person is feeling vulnerable, they will not respond, let alone trust, a stranger wearing a gun that approaches them with a “you better behave” attitude. That is what happened in the case of Ejaz Choudry, the elderly man who died at his own home this past June after police officers refused the help of his family members. I have heard countless horror stories from my clients about their experiences with the police. For many, these experiences have been more about enforcing authority than providing support.
Attending to a mental health crisis is very time-consuming and runs counter to many other established systems. Too often, police officers are expected to “keep the peace” as fast as they can so they can attend to other calls, rather than being encouraged to resolve issues for all involved. In this way, the police will want the person “contained” as soon as possible so they can pass them on to the next cog – the emergency room (ER) – as fast as they can. When someone suffering severe distress does not cooperate with this agenda, things can get ugly and people can end up hurt.
Unfortunately, our health system is also often ill equipped to deal with these crises. Many staff in ER departments lack mental health crisis management training. Often, the response to a severe crisis in the ER will be the use of mechanical and/or chemical restrains. Then the patient will get passed to the next cog – the psychiatric unit – and the cycle will continue until the person is eventually sent back to the community.
By the time the person is back at the starting point of this cycle, they may not have gained anything from the whole process. On the contrary, the process itself can be traumatic for many mental health patients. Worst still, there are not enough psychiatric nurses, social workers, or specialists in the community to meet these needs, and recruitment remains a challenge due to lower than average salaries. Funding for adequate programs is insufficient as are community resources.
Many patients who have been through the “revolving doors” of the mental health system know exactly how to answer a health care professional’s questions to avoid admission. Too often, staff in the ER do not review the collateral information provided by community services and do not engage them in the care plan before considering discharge.
It is not that they don’t care, it’s that the system they are working under is pushing them to move the patient along as fast as possible and assume that the next cog in the system will take care of the issue. This leaves most patients who are resistant to accept help without support returning to the community untreated and potentially at risk of causing harm to themselves or others. If a person has gone through this process several times and continues getting discharged without receiving proper help, they will eventually become disruptive and possibly dangerous. Police officers are then called to contain these situations and the vicious cycle starts again, each time more volatile, and requiring more extreme measures.
The great majority of severely ill mental health patients endure enormous social inequalities. Most live in shelters or on the streets. In the best of cases, they live in very precarious housing. Many suffer from concurrent disorders and even present untreated dual diagnoses. It is even more common for them to have been born and lived all their lives in generational poverty and suffered severe emotional and/or physical trauma. The great majority belong to an ethnic minority or marginalized group, have passed through the foster care system, and/or are in some kind of legal trouble. It should be revealing to learn that the average life expectancy of a person living on the streets is 56 years when the national average is 81.
Unfortunately, most police officers do not get trained on these subjects, and many do not engage with the communities they serve in meaningful ways that would allow them to see these disparities. Some are also affected by their personal biases and do not receive anti-oppression and anti-discrimination mandatory training on a regular basis as most other community organizations do. If you don’t know the factors that contributed to a person’s crisis and have not been trained to understand why they are behaving the way they are, it is so much easier to use extreme force.
So much needs to change to improve the lives of people with mental health illnesses. Right now, we are still refusing to see them, to really understand them, and to design a system that truly serves them. Until profound reforms come to place, we will continue seeing people die and suffer under the current system. I hope that the winds of change coming our way are strong enough to make a difference.
About Anisa
Anisa graduated with Honours as an RPN from Humber College in 2011. After graduation, she worked at the Inpatient Psychiatric Unit at the Michael Garron Hospital, and at the same time as a Community Mental Health Nurse for Good Shepherd Non-Profit Homes. She is currently working as a Nurse Case Manager at the New Dimensions ACT Team for the Canadian Mental Health Association. She is passionate about advocating for equality in health care and the improvement of mental health services.
