The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.
In the wake of several high-profile cases involving deaths in police custody of persons with mental illness (PMIs), there has been significant public interest in police reform in this area. Much of this interest, and the resulting demands for change, is couched in the language of public health. Mental illness is seen as a health condition in which social determinants—those economic, cultural, environmental, institutional, and other factors that can influence health outcomes—can function as supports or barriers to well-being. In this language, the metaphor of a stream or river is invoked to visualize where appropriate responses to mental health conditions should lie. “Upstream” solutions are those programs, practices, policies, or other innovations that address factors which are limiting or preventing individual and community access to health care treatment. An example of an upstream initiative might be a community-based outreach program aimed at moving mentally ill, homeless citizens into secure housing and treatment. Such approaches are contrasted with “downstream” initiatives, which often entail programs or practices to respond to individuals who, lacking health care access and (or) other necessary supports, are now in immediate crisis. As decades of research has shown, one of the single biggest examples of downstream responses to individuals dealing with significant mental health issues is the use of public policing (Bittner 1967, 1990; Teplin 1984; Patch and Arrigo 1999; Lamb et al. 2002; Wells and Schafer 2006; Schulenberg 2016). To a dizzying extent, policing has in many instances become the de facto response to mental health issues (see also Wood et al. 2017).
The origins of this report, and of the Royal Society of Canada’s Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to PMIs.
In response to our charge, the Mental Health and Policing Working Group set out to assess the myriad ways in which police work results in encounters involving PMIs. The result was a working paper that documented the complex nature of these interactions (Huey et al. 2021). In this second paper, we move away from the dynamics leading to police encounters towards an exploration of some of the existing suite of downstream policing programs and initiatives in use in Canada. In the pages that follow, we present an assessment of the current evidence base for each selected, with a particular focus on reviewing experimental, evaluative, and other research conducted in Canada. Our intention is to provide policymakers and practitioners with a better-informed understanding of the strengths and limitations of the current evidence base for programs that have already been widely adopted. In this paper, we explore the knowledge base in the following areas: mental health screening tools, situation tables/hub models, nonescalation and de-escalation training, and crisis intervention and co-response models. In each section, we provide a brief overview of the intervention, program, and (or) tool. Then we move on to reviewing the evidence base for each, including presenting a discussion of what the relevant literature reveals in terms of the relative strengths and weaknesses of a given response model or tool. From there, we provide a succinct snapshot of what is both known about a model, as well as areas in which future research is critically needed. Finally, based on an analysis of the data and research gathered, we present a series of recommendations for policymakers and practitioners.
Mental health screening tools
In the rush to improve police effectiveness and efficiency in responding to calls for service involving PMIs, as well as case and clinical outcomes for those with mental illness who come into contact with police, an increasing number of Canadian police services are adopting mental health screening tools. Ostensibly, the purpose of employing such tools is to better identify individuals with mental health issues to provide appropriate responses, whether that be reframing de-escalation procedures, taking necessary suicide precautions on-scene or in police custody or, where appropriate, diversion to mental health facilities. In our review of the relevant literature, we identified two primary types of mental health tools in use by police services. These are:
- screening tools used by frontline officers to assist in decision-making, and
- screening tools for assessing depression, suicidality, and (or) other health and mental health related concerns among individuals held in police custody.
Unfortunately, despite a handful of United Kingdom based studies (Baksheev et al. 2012; Dorn et al. 2013), we could locate no Canadian evaluations or other research of in-custody screening tools. Nor did keyword searches using online search engines1 turn up references to such tools in the Canadian grey literature2, media or other sources.