Dorothy Cotton, Ph.D., C. Psych. PMHL Solutions [email protected]
Transcription
Dorothy Cotton, Ph.D., C. Psych. PMHL Solutions [email protected]
Dorothy Cotton, Ph.D., C. Psych. PMHL Solutions [email protected] IACP October, 2011 …in Canada, as in many western countries, interactions between people with mental illnesses and the criminal justice system are increasing at a dramatic rate …the police are the starting point of these interactions apprehensions under the MHA suicide attempts accused who are mentally ill disturbances/unusual behavior in which a person appears to be mentally ill victims who are mentally ill Social support/”wellness” checks More likely to be arrested More likely to be detained Likely to have first encounter with MH system through police (in other words….yes) 4 While VERY rough estimates indicate 3 million+ interactions between police and PMI per year, Maybe one fatality per year (11 in the 10 year period 1992-2002) Setting the Canadian context Historical and developmental factors The current state of affairs Special roles of Psychologists Canada….. …not the 51st state…… The Canadian is the one with health care and no gun Stuff we don’t have in Canada.. Death penalty Jury selection Diminished responsibility Elected judges Prohibition on hiring people with axis 1 disorders as police officers Tarasoff Daubert Lay offs of police officers Mandatory CE hours for psychologists Higher rate of suicide among police officers It is very big It is very empty It is cold a lot of the time Favourite pastimes include hockey, drinking Tim Horton’s coffee, sticking random ―u’s‖ in words and feeling superior to Americans (the latter primarily as a reflection of generally feeling inferior to Americans) Average minimum daily temperature in January… Vienna -2.0 Oslo -6.8 Moscow -12.8 Paris 2.5 London 2.4 Washington DC -2.9 Ottawa -15.3 Toronto -7.3 Calgary -15.1 Population: about 34 million Density: Population per km2 Netherlands UK PR China France Ireland USA Canada 395 243 136 110 57 30 3!! Population just over 10% of the US (34 million vs 312 million) Much lower violent crime rate Much lower rate of imprisonment Much lower officer fatality rate Fewer police officers per population U.S. has much higher rates of violent crime, while Canada generally has higher rates of property crime. In Canada, there were 542 homicides in 2000 resulting in a national rate of 1.8 homicides per 100,000 population. By comparison, there were 15,517 homicides in the U.S., resulting in a rate (5.5) three times higher than Canada’s. Despite differences in rates, trends in crime between the two countries have been quite similar over the past twenty years About 220 police services—1 to 15,000 members Policing at municipal, provincial and national levels Administered provincially….yet Criminal Code is federal Canada: 189/100,000 USA: 231/100,000 UK: 241/100,000 Germany: 289/100,000 France: 381/100,000 Deaths of members of the public in encounters with the police…. US: Canada: roughly 300 a year roughly 10 a year › Prorated, the Canadian rate is 1/3 the US rate w/o a court order, police in all jurisdictions may apprehend a person who meets certain criteria—takes him to a physician (de facto a hospital ER) Family or other may go to a judge/ justice and get an order which they take to police to carry out Physician may issue a certificate that police have to act upon Police also apprehend involuntary patients who are AWOL from psychiatric facilities In two provinces, police may apprehend PMI who violate community treatment orders No other police powers specific to mental illness Government operated—provincially Canada Health Act—excludes mental health care No national agenda or strategy for mental health (coming soon…) Little duplication of services in a region No competition really but Interagency rivalries and politics are alive and well Improved treatment for psychiatric disorders Deinstitutionalization Increased emphasis on individual rights and freedoms (Charter of Rights and Freedoms, 1982) Changes in mental health laws Increased concern with ―law and order‖ Definite need for liaison activities Huge variability in demographics Remote locations problematic Fatalities not the only driving factor Conflicting social mores Conflicting federal versus provincial laws 1st Canadian formal joint response initiative—Vancouver, 1967ish arose in the context of a justice reform movement whose aim was ―to explore new avenues to solve old problems‖ to explore ways to use police and community resources to develop diversionary and preventative programs including methods of informal dispute resolution. the impetus did NOT arise from a violent incident, a shooting or other death a conscious focus on delivering quality and valued customer/client service; consultation and collaboration internally and with the community; procedural justice; ethical conduct; decentralization of authority and decision making; increased communication by actively sharing information internally and externally with the community; and an outcome focus. a focus on a pre-emptive operation where vulnerable PMI are identified and provided with instrumental assistance and interventions to avert more serious problems such as arrest, involuntary hospitalization or even serious physical harm to the PMI (or to police). such assistance and intervention is achieved through communication, co-operation and collaboration with other agencies such as mental health care providers the establishment of guidelines for police services about how to develop relationships with the mental health system; specialized education and training for police personnel about mental health, mental illness, and mental health resources; (the TEMPO model) a variety of formal joint response initiatives between police services and mental health agencies. CACP Contemporary Policing Guidelines for Working with the Mental Health System Prepared by the Police/Mental Health Subcommittee of the Canadian Association of Chiefs of Police (CACP) Human Resources Committee CACP Guidelines Development of recommendations for key components of police-based programs and services for working with the mental health system and people with mental illnesses Flexible enough to accommodate a wide variety of jurisdictions See www.PMHL.ca for completed ―Contemporary Policing Guidelines for Working with the Mental Health Systems‖ Leadership Interagency cooperation Communication channels Resources Education Each police organization should foster a culture in which mental illness is viewed as a medical disability not a moral failure, and in which PMI are treated with the same degree of respect as other members of society TEMPO Training and Education about Mental Illness for Police Organizations http://www.mentalhealthcommission.ca/E nglish/Pages/ThePoliceProject.aspx For all police personnel—not just officers Reflects Canadian context Delivered by local experts Addresses crisis and non-crisis interactions Consumer involvement Not ―one size fits all model‖ Adaptable to local needs Over-riding themes.. a focus on anti-stigma education to challenge the attitudinal barriers that lead to discriminatory action by police; and ethical decision-making, human rights protection and social responsibility. Local MH expertise—to increase interagency cooperation The importance of consumers, consumers groups, families The importance of operational credibility in policing Specific Content 1. Roles and Systems 2. Knowledge about mental illness 3. Legal and organizational issues 4. Communications strategies 5. Risk assessment 6. Problem-solving to ensure that police first responders have sufficient knowledge and skills to be able to manage the types of encounters that police personnel have on a regular basis Includes: new and lateral transfer officers dispatch, call takers, support staff Offender Transport/ Prisoner Care Personnel Presumes completion of/knowledge of 100 level information TEMPO 201: Continuing Education (In-Service Training) for Police First Responders—at least one day per 3 years TEMPO 202: Field Training Officers (FTO)/Officer Coaches & newly promoted Supervisors for police personnel in specialized assignments TEMPO 301:police crisis negotiators, incident commanders, firearms/use-of-force instructors, ERT/SWAT commanders and search and rescue managers. full week of specialized training for specialist officers who will be providing expert or consultative services with regard to Police/PMI contact TEMPO 401 : full week with a focus on joint response Learning Module to be integrated into Useof-Force training A comprehensive educational model Research and practice-informed More than just skills training An aide in integration of community and police-based services Provided within the framework of the CACP Guidelines Focus on anti-stigma and human rights •Mechanism for facilitating involvement of both police and MH workers as needed •Greater collaboration •More access to health care services •Specialized training for police •Addresses both safety and health needs police and MH staff work out of same location (can be either) and co-respond together, same vehicle dedicated police officers assigned very effective – but relies on sufficient critical mass Arguably, the Predominant Model in Canada More multi-faceted than crisis response Smaller number of MH agencies Common funding sources Less concern with safety of responding personnel Consistent with community policing orientation (e.g. system approach) Shift responsibility back to the MH system originated over concern about police shooting and safety of officers and PMI select subgroup of officers receive extensive mental health training and act as consultant/resource to other front line police officers first response remains exclusively with police ―everyone is an expert‖ MH training is part of advanced patrol/in-service training for all officers expensive! works in larger urban areas with good working relationships with mental health services MH staff arrive at incident separately but nearly simultaneously with police ―hand off‖ to MH occurs as soon as safety is assured police respond alone—some upfront training needed for all police once safety is assured, there is an agreed upon ―hand off‖ agency or clinic where police are ―guaranteed‖ that the PMI will be taken in MH system assumes responsibility for all but immediate safety expensive for MH system works well in rural or underserved areas police have 24/7 telephone access to hospital staff for advice and guidance Precipitating factors pre-existing police/MH systems relationships Geography Demographics including cultural considerations Available resources Extent of recruit level training re Mental Illness Privacy issues I’ve got some really negative ones [experiences with the police], and I’ve got some quite positive ones, so, you, know, averaging out, it’s right in the middle...Because I’ve met a lot of good police people, who have been kind and knowledgeable, and they really helped me when I was really low or high as the case may be. And there are some good ones out there. And I think they really want to do a good job, and sometimes they want to do a good job and they just don’t know how. They’re just good people, with not the right skills...and sometimes they’re jerks (Brink, J., Livingston, J. D. Desmarais, S., Greaves, C., Maxwell, V., Michalak, E., et al., 2011, p. 69). while PMI are somewhat less positive about police than is the general public, they are nevertheless more positive than negative expressed concerns about police use-offorce, about the relative insensitivity of some police officers Many described their interactions with police personnel as positive and were appreciative of the assistance that police had provided, particularly in times of crisis some felt they had been treated disrespectfully and with more force than necessary general interest by participants in establishing not only closer working relationships between police and the mental health community, but also for increased civilian oversight of police in this area Less likely to be first responders May be managers..but in addition I/O stuff on both sides Curriculum development Knowledge brokers—re mental illness, systems theory, conditions for behaviour change, The practical questions…. What really works—and what does not Outcomes? (what exactly is a good outcome??) Selection: what POs make good MH officers? What are the effective ingredients in training and education? Problem solving around ―special‖ populations What SHOULD be the role of police? Are MH law provisions appropriate? What are the practical effects of differing MHA provisions—e.g. how do differences in MH law play out in real life? Does improving police response actually increase criminalization and stigma? What is the role of the PMI? [email protected] www.pmhl.ca www.pmhlsolutions.com www.mentalhealthcommission.ca