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It has taken months to accomplish, but Theresa Pratt has learned to appreciate visits to her home from social worker Brendan Munden, a member of the Assertive Community Treatment team. ‘They do their job well and they’re a likeable bunch,’ she says.John Lehmann/The Globe and Mail

Theresa Pratt sits at her dining table and lights a cigarette, the flicker of the flame briefly illuminating her otherwise dim apartment. Placing the lighter on the table – among the clutter of coffee mugs, utensils and papers – she turns her attention to a visitor, a former adversary turned friendly acquaintance.

These days, Brendan Munden's weekly visits are made up of casual chats about the past seven days.

But they weren't always so pleasant. A couple of years earlier, Mr. Munden and his colleagues in Vancouver's Assertive Community Treatment (ACT) teams had to track down a reluctant Ms. Pratt several times a week to make sure she was taking the anti-psychotic medication prescribed for her bipolar disorder. The 57-year-old was born at Riverview, a century-old mental health institution, to a mother with schizoaffective disorder. She says she first connected with the teams after a hospital stay during a dark period in her life.

"At first, I didn't know what to think of [their visits] but, over time, I liked it," Ms. Pratt said. "They're a very good team. They do their job well and they're a likeable bunch."

The expansion of these teams was one of a handful of urgent requests Vancouver's mayor and police chief made to senior levels of government one year ago in declaring a mental-health crisis in the city.

With hundreds of people with severe and untreated mental illness posing a high risk to both themselves and others, Mayor Gregor Robertson and Police Chief Jim Chu made five recommendations they said would have an immediate impact on affected populations.

But 13 months later, there are no meaningful signs of improvement: Some recommendations – such as growing the ACT teams – were implemented, while others were dismissed entirely. Meanwhile, the numbers of psychiatric emergency visits and police apprehensions of people with mental illness continue to climb year over year.

A month away from the municipal elections, mental health has also become a campaign issue, inextricably tied to Mr. Robertson's ambitious goal to end street homelessness by 2015. Kirk LaPointe, the mayoral candidate for the Non-Partisan Association, has accused the mayor of being disingenuous to the public by setting an unrealistic target.

In an interview with The Globe and Mail this week, Mr. Robertson said he was pleased that last year's call for action sparked some response from the province, such as the ACT teams. However, he said more needs to be done, and soon.

"A big gap remains with the lack of long-term care beds," Mr. Robertson said. "That's got to be addressed urgently, as we see, in the crisis with homelessness, mental health and addictions are a big factor. There's no treatment available for many of these people who are desperately in need." The mayor has called for 300 long-term mental health beds.

Under Section 28 of B.C.'s Mental Health Act, a police officer can immediately take a person to a physician if the officer believes that person has a mental illness and could be a safety risk to that person or others. In Vancouver, these apprehensions have grown year after year to 2,872 in 2013 and police expect this year's total to top 3,000. As of this week, there have been more than 2,400 Section 28 apprehensions in Vancouver this year.

Constable Brian Montague, a spokesman for the Vancouver police department, emphasized that these figures account only for Section 28 apprehensions – the most serious of such calls.

"This doesn't include all the calls that our officers go to every day involving individuals with mental health issues or concerns," he said.

Of all reported incidents that police respond to, 21 per cent involve a person with mental illness – and the department feels the true figure is probably closer to 30 per cent, Constable Montague said.

"But even at 21 per cent, you're looking at tens of thousands of calls a year – like 30,000 calls a year, 75 calls a day, every day," he said. "It's a huge issue, there's no doubt about it."

Acting Inspector Howard Tran, who is in charge of the VPD's mental health portfolio, attributes Vancouver's situation largely to the "gravitational pull of the Downtown Eastside," where lax attitudes and low-barrier services can draw vulnerable populations from across the region. An increase in crystal methamphetamine use, which is linked to psychosis, and a reduction in stigma surrounding mental health may also be reasons mental-health cases are becoming more visible, he said.

The Vancouver Police Department created its mental-health unit in November, 2012, and it now comprises about a dozen officers dedicated to mental-health initiatives. This includes working with health authorities, serving on the mayor's task force on mental health and being embedded with the ACT teams. Vancouver's ACT teams started in 2012; two new teams added this spring bring the total to five.

The outreach teams – which comprise nurses, social workers, police officers, psychiatrists and other mental-health professionals – target some of the city's most difficult to treat by taking their services out into the community and following up with clients indefinitely.

George Scotton, manager of the Vancouver ACT teams, describes it as turning the conventional doctor-patient model on its head.

"The office space model works great for guys who can keep their appointments, know what day it is, what time it is, that sort of thing," he said. "Where it tends not to work really well is for guys at the far end of the continuum. They're quite addicted, [with] challenging psychiatric illness, in and out of the hospital, police contact, that sort of stuff. That's our specialty; that's our bread and butter. And that's where we're most effective."

In the program's first year of operation, ACT clients had a 70-per-cent reduction in emergency department visits, a 61-per-cent reduction in criminal justice involvement and a 23-per-cent reduction in incidents of victimization, according to the Ministry of Health. The five teams, which each cost about $1.6-million annually, can take on a total caseload of 420 people.

"These are expensive programs and [the Ministry of Health] wouldn't be investing in this if they didn't think there were some gains," Insp. Tran said. "But I don't want to make it seem like ACT is the panacea; there should be many levels of services. Not everyone is appropriate for ACT, and ACT is not going to work for everybody."

The new teams were part of an action plan by the province released in response to Vancouver's concerns. That plan also included the development of a nine-bed behavioural stabilization unit at St. Paul's and a new intensive case management team for youth. However, the mayor's call for 300 long-term mental health beds remains unmet.

Asked about the request, B.C. Health Minister Terry Lake said the province is not confident that 300 long-term beds are urgently needed. The priority, Mr. Lake said, is to move away from the Riverview model of institutionalization and toward community-based supports. "We have to somehow move off this idea that we need to put people behind walls," he said. "We we want to provide supports in the community to the greatest extent possible, and then go from there."

In September, 2013, Mayor Gregor Robertson and Vancouver Police Chief Jim Chu declared a mental-health crisis in the city and made five urgent recommendations to senior levels of government.

Recommendations met:

More significant support through Assertive Community Treatment (ACT) teams for psychiatric patients living in the community. Two new ACT teams were created in May.

An enhanced form of urgent care (crisis centre) at a Vancouver hospital. A nine-bed acute behavioural stabilization unit opened at St. Paul's Hospital in March.

The creation of a joint Vancouver Police-Vancouver Coastal Health Assertive Outreach Team (AOT) for people who do not qualify for ACT teams. The AOT team – which includes a nurse, social worker, psychiatrist, physician and VPD staff – came online in March and helps transition people with mental illness from local emergency departments to community services.

Still outstanding:

Add 300 long-term mental-health treatment beds. There remains a gap of 250 secure mental-health treatment beds. A 14-bed secure mental-health facility is pending.

More staffing at BC Housing sites to support tenants with psychiatric issues. More training capacity to support mental health and addictions staff is pending.

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