Last November, Michael Dawthorne stood in his sock feet in the freezing rain, trying to figure out how to keep his son alive for one more night. Dakota had run from their home in London, Ont., and down the street, waving an air gun his father had tried to confiscate. Mr. Dawthorne chased after him, shoeless, but not before calling the police for help. "If you get a report of someone with a gun on the street,” he told them in a panic, “please don’t shoot him. That’s my kid.”
It was not Mr. Dawthorne’s first call to 911; the police had already been to the house several times in the past six months. Sometimes, Dakota would call them himself, convinced he was being followed or that the neighbour was dealing drugs. Other times, Mr. Dawthorne and his husband, Nathan, would call because they were frantic for Dakota’s safety. Once, they reported him missing after he went out on a bike ride and began sending “goodbye” texts. That time, the police deemed Dakota a risk to himself and sat with him for hours in the hospital emergency department, until he was admitted for six days.
On that night in November, the officer explained the options: Dakota could go home, he could choose to stay somewhere else or, if his father decided to press charges, he could be taken into custody. “But you can’t keep calling us,” an officer told Mr. Dawthorne as he stood there, shivering. “We are not mental-health workers.”
Except police officers in Canada are increasingly fulfilling this very role, as the front-line responders to a steadily rising number of crisis calls made by families, neighbours and even community-health workers who have lost track of their clients. From 2008 to 2018, for example, mental-health-related dispatch calls and suicide attempts reported to the Edmonton police department more than doubled. In Saint John, the number of mental-health-related calls increased by 78 per cent, and the time officers spent on those call increased by 66 per cent.
The larger role police are being forced to play in the mental-health-care system is the inevitable result of a society that has opted to close long-term-care institutions without ensuring there is enough community-based support for patients and the families caring for them, according to mental-health experts. These are the patients most vulnerable when emergency-room wait times are long and communication between different parts of the health-care system is broken. They get lost between the hospital and the community clinic. They end up on the street, counted among the country’s homeless. Or in jail. Or worse.
Dakota’s case is the kind of complicated, chronic situation police are often called to handle. Adopted at the age of 7 after spending his early years in foster care, he was diagnosed with high-functioning autism and a developmental delay. He also has Tourette syndrome and obsessive-compulsive disorder. When he was 10, he tried to hang himself. Drugs haven’t worked, his father says, and one-off consults have gone nowhere. His son has been refused care at one mental-health program after another for being too complex. After he was hospitalized for suicidal behaviour last year, Dakota left with the promise of a psychiatric referral, but the urgent-care clinic never called back. This June, he was still waiting for an appointment with a psychiatrist.
At 20 years old and 240 pounds, Dakota is getting harder for his parents to manage. “We have dealt with outbursts, meltdowns and the house getting trashed,” Mr. Dawthorne says. “When we call the police, it is because, as a family, we can’t handle what is before us.”
But Mr. Dawthorne has good reason to be nervous each time the police get involved. A recent British Columbia coroner’s report analyzed 127 deaths from 2013 to 2017 involving police interactions, including death related to police use of force and suicides that occurred within 24 hours of police contact. It found that more than half of those who died were exhibiting mental-health symptoms at the time, and 69 per cent had a history of mental illness. Some 40 per cent of deaths occurred in rural areas or small communities with fewer mental-health services. In half the cases, the victim was already known to police.
Across the country, the stories are the same, with time spent on mental-health calls and emergency-room escorts swamping smaller police departments. The result: wasted police resources, safety risks for patients and stress for families running out of options. On top of the very real possibility of escalation, there’s also the stigma that comes with being accompanied to the emergency department by police. Are these people patients or criminals?
Through technology and training, police forces are adapting to their new place within the mental-health system. Getting it right won’t only make room in emergency departments and cut down on unnecessary police apprehensions; it will mean better care for the most complex mental-health patients, who live on the fringes until somebody calls 911.
At the police department in New Westminster, B.C., Detective Art Wlodyka is the guy they call for complicated, repeat cases. He has visited apartments to check for surveillance devices hidden in the walls, tested televisions for strange sounds when they weren’t even plugged in and interviewed neighbours to prove they weren’t spies.
“Oftentimes, we get a call, and it is a neighbour worried about someone acting in an odd manner, and there is no crime being committed,” Det. Wlodyka says.
If officers investigating a mental-health call reach out to him from the scene, he can steer them away from apprehending someone unnecessarily; he spends enough time talking to the regulars that he usually knows whether they might act oddly even when taking their medication. One citizen with a mental illness called police 135 times over four years, usually about missing money or because he was worried he was being watched. Two years ago, Det. Wlodyka took over his file and began meeting with the man to develop a relationship. They still chat on the phone for about 20 minutes once a month, but the man has stopped calling 911.
Det. Wlodyka’s position was created in 2013 to manage mental-health calls with a gentler, more efficient touch.
Many police forces have created their own variations of mental-health officers, including mobile units that combine constables with counsellors. One goal is to reduce the amount of time officers spend on calls that don’t require a typical law-enforcement response.
Police officers are required to take people into custody if they have reason to believe they might be a danger to themselves or others, or if they can’t care for themselves. As with Dakota’s experience, a police officer might spend hours in the emergency ward, since they can’t leave anyone they’ve apprehended until they’ve been officially released into hospital care.
In 2018, Edmonton officers waited a total of 2,971 hours in emergency departments, costing the police service between $265,000 and $521,000, depending on whether two officers responded to the call. The police department in Saanich, B.C., estimates its officers waited 773 hours in emergency in 2018 owing to mental-health calls, an average of 95 minutes a stay.
Rural police officers might also have to travel long distances to take patients to hospital in larger cities. Last year, RCMP officers across Manitoba spent 9,518 hours providing mental-health escorts or waiting in hospital, according to RCMP statistics – the equivalent of six full-time officers spending their entire workweeks in the emergency room for a whole year.
In Peterborough, Ont., officers have occasionally been called in on overtime to replace an officer on duty waiting in the local emergency department. In New Westminster, Det. Wlodyka says the force might get up to five calls a day from mental-health agencies asking police to look for appointment no-shows – a hunt that can use up an officer’s entire day.
That’s only if they don’t know where to look, which Det. Wlodyka more often does. He knows the regulars – the small group of mental-health patients who use up a lot of police time – and, when he can’t keep them out of the emergency ward, he has worked to build better communication with hospital staff. A more collaborative approach to mental-health calls, he says, has also helped reduce emergency wait times for his colleagues.
But not every police force can support a mental-health unit, and Det. Wlodyka isn’t always available. Given the volume of calls, regular officers still need real-time support when handling complex calls.
Unsurprisingly, there’s now an app for that.
Let’s say a police officer is called to a person’s home. They’ll probably go inside to check out their living conditions, chat with family or roommates and observe the person on the way to hospital. If they know what to look for, these are details that might be valuable to time-strapped hospital staff. But often, police officers say, they don’t have an easy way to share this information.
One Canadian-made solution being adopted by departments across the country is a mobile program called HealthIM, which gives police a medical checklist to assess a person’s risk level for self-harm, harm to others and an inability to care for themselves. If they decide to take the person to hospital, the information is sent ahead to a waiting triage nurse, so the medical team knows to expect them and can review the police assessment of the patient.
Police can access the program from their cars or via smartphone. The app uses medical language designed to improve communication between police officers and hospital staff, who can sometimes approach apprehended citizens from an adversarial perspective; the gap between suspect and patient can be a wide one. HealthIM is also supposed to shorten the time officers have to spend waiting in emergency: The program reminds hospital staff when police have been there for more than 30 minutes, flashing red when that time stretches past a certain point. When police leave the patient, they sign off on the app. The information can also be securely stored so that officers and medical staff can consult previous reports should the patient turn up again.
The HealthIM system, which was created by an eponymous company in Kitchener, Ont., in 2014, is now being used by 29 municipal police agencies in Ontario, Manitoba, Saskatchewan and British Columbia; another 20 are working to bring it online next year. The RCMP in Manitoba is testing it at its three largest detachments. It costs a mid-sized police force, such as Peterborough, Ont., about $60,000 to implement; York Regional Police, which has more than 1,600 uniformed officers, spent roughly $150,000 to make the program part of standard operations for mental-health calls.
Since HealthIM collects a treasure trove of data, agencies can see whether the program is working, the kinds of patients police are apprehending and the decisions officers are making when responding to calls, says the company’s director of operations, Brendan Sheehan. According to HealthIM data, in the first 12 months after launching the program, police departments see an average drop of 46 per cent in the number of people apprehended after a police call, along with a 39-per-cent decrease in emergency wait times and a 37-per-cent increase in admission rates – suggesting police are making more medically accurate decisions about who to bring to hospital. Police in Brantford, Ont., in particular, have seen a significant change: Since the force started using HealthIM in 2016, wait times have fallen by more than half, to 115 minutes, a benefit to both officers and the people they bring in. HeathIM also says Brantford police took roughly one-quarter of people into custody, compared with 90 per cent before the program was introduced.
In Manitoba, all three RCMP detachments using HealthIM saw involuntary apprehensions fall by two-thirds. Average wait times in emergency also fell. Between February and April, 2019, the Steinbach detachment – the location with the longest waits, by far, for mental-health-related incidents – saw the time officers spent in hospitals drop from an average of 7.5 hours to one hour and 49 minutes.
In Kawartha Lakes, Ont., where the force also uses HealthIM, a dedicated officer makes home visits to patients along with a mental-health nurse. The town’s police chief, Mark Mitchell, suggests partnerships between the medical community and police are an important early intervention for some of the most severely ill people, the ones who might be intimidating to community health professionals. “A lot of these people become isolated from family support, and they become more difficult to access," Chief Mitchell says. "And there may be safety concerns about sending a counsellor out to somebody’s house alone.” A police officer can help ease safety concerns, while ensuring the person still gets seen by a mental-health professional.
York Regional Police Constable Chris Chezzie, who uses HealthIM on patrol, says the program helps to quickly access information that can make a call both calmer for the person in crisis and safer for everyone involved. In one case, while responding to a person struggling with an addiction and contemplating suicide, the program alerted him to an officer’s caution from a previous call – that the individual had hidden a knife in their pants. In another instance, the program advised him that a group-home resident might be triggered by mention of his father, a topic Constable Chezzie then knew to avoid. The program has also improved communication with hospitals: Constable Chezzie was once greeted in the emergency department by a medical team with security guards. It turned out the person he’d apprehended had a history of assaulting nurses, and when the HealthIM system sent his name in advance, hospital staff could prepare to prevent another altercation.
In cases in which a person falls below the threshold to be taken to hospital but still requires care, HealthIM also has the capability to refer them to community services. Setting up this function has been challenging, however, Mr. Sheehan admits. For that side of the app to work well, the services actually have to exist.
This is a problem Dakota’s situation reveals in heartbreaking fashion. Long before his parents placed their first call to police, they had taken him repeatedly to the emergency department. In one instance, they were turned away without even being registered – his condition wasn’t serious enough, they were told. Mr. Dawthorne says his son simply doesn’t fit into the box of treatment options available in the community. “When literally the last place you hoped would help you says no, it is not a refusal. It is a death sentence," he says. "You basically have been told, ‘Your kid is not worth my work.’”
Last month, Mr. Dawthorne – who manages a non-profit and is also chair of the Ontario advocacy group Parents for Children’s Mental Health – finally used a personal connection to secure an appointment with a Toronto psychiatrist. The doctor studied Dakota’s lengthy file and made several new medication recommendations. It was a hopeful sign after a hard summer, Mr. Dawthorne says. In late September, after Dakota was reported missing, he was interviewed by police and released; Mr. Dawthorne later found him in the woods with superficial cuts to his wrists. The family has officially requested an independent review of the incident.
“We have had many good and understanding officers,” Mr. Dawthorne says. He knows they’re in a difficult position and that Dakota’s case is complex. But parents shouldn’t have to press charges to get medical help for their children, he says – a step Dakota’s fathers have refused to take for fear of losing their son’s trust. Still, Mr. Hawthorne worries Dakota will wear down the police, until they don’t take a call seriously on the day he needs them most.
Thinking back to that difficult night last November, “I called the only people I could,” Mr. Dawthorne says. “People who know how bad his illness is. People who have had to physically take him into custody and take away his rights into order to get him help. And they look at me, a parent, freezing cold, in sock feet, and basically tell me, ‘Stop being an inconvenience.’”
That willingness to be an inconvenience is what keeps Dakota alive. “These aren’t cracks in the system,” Mr. Dawthorne says. "This is a grand canyon.” Trapped in the chasm, he will reluctantly dial 911 every time his son needs saving, until they find another way out.
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