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..
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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
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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
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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
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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
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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
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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
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works well in rural or underserved areas

police have 24/7 telephone access to
hospital staff for advice and guidance
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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,
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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?
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[email protected]
 www.pmhl.ca
 www.pmhlsolutions.com
 www.mentalhealthcommission.ca
