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Jamie Livingston: Mental health crisis responses without police

KJIPUKTUK (Halifax) – Jamie Livingston, PhD, is an Associate Professor at the Department of Criminology, Saint Mary’s University, in Halifax, Nova Scotia. Yesterday afternoon Dr. Livingston presented to the members of the Subcommittee to Define Defunding the Police, the working group, chaired by El Jones, is tasked with proposing a police defunding strategy to the Board of Police Commissioners. Many others made high quality presentations yesterday, and we hope to publish several more over the next few days.

Good afternoon. 

Thank you for allowing me time to speak today and I thank the esteemed committee for its admirable work. I listened to this morning’s presentations, and I am grateful to others who took the time to share their expertise and insights.

My name is Dr. Jamie Livingston, and I am an associate professor of criminology at Saint Mary’s University. I have been teaching about and studying issues at the intersection of the mental health, substance use, and criminal justice systems for over 20 years, including leading the first study in Canada to examine the experiences of people with mental illnesses in relation to their interactions with the police. I also do various work around the city with people who have lived experiences of mental health issues and criminal justice involvement.

I view the application of criminal justice processes and resources to address mental health and substance use needs as a form of structural stigma that produces, reproduces, and exacerbates injustice and inequity.

I’d like to spend the time that I have talking about a serious problem facing people in mental health crisis in Halifax, and that pertains to the absence of a mobile crisis response option that does not involve the police.

When someone living in Halifax experiences a mental health crisis, or their loved one, calls for help either through 9-1-1 or the mental health crisis line, and that person requires that someone come to them to offer help and support, the Mental Health Mobile Crisis Team is dispatched. 

The Mental Health Mobile Crisis Team uses a co-response model in which a police officer is paired with a mental health practitioner to respond to crisis situations in the Halifax area. It has existed in our city for over a decade, meaning that police officers in our city have for a long time been a central component of our mental health crisis-response system. 

It does not have to be this way.

Having police involved in all mental health mobile crisis calls, and not offering non-police-involved options to people experiencing mental distress in our community carries many significant issues. 

I’ll highlight a few:

The first issue is that such a model is outdated and no-longer aligned with best practices. It is now recommended that mental health crisis response systems only involve police when a level of danger or criminal activity warrants their involvement. Contemporary mental health crisis response systems should be actively working towards minimizing interactions between people with mental health issues and the police. Our current model in Halifax facilitates such interactions without knowing whether it works for people with mental health needs. Co-response is better than police-only response for achieving a narrow range of outcomes, but there is reason to believe that non-police-involved response models are better suited for achieving a broader range of objectives for over-policed and underserved communities.

The second issue is that police-involved crisis response models do not work for people who have had previous negative interactions with the police or belong to communities that have had long histories of mistreatment by, and fatal interactions with, the police – and we know that this disproportionately involves people who are Black, Indigenous, or belong to other racialized groups. It also includes people living in poverty or on the streets, immigrants, people who use drugs or involved in sex work, and those with active or previous criminal justice involvement. Such people may be fearful or mistrusting of the police and less likely to call for help if the police are involved and, if they do call for help, are more likely to have adverse encounters.

The third issue is that our leaders and decision-makers have been tolerating systemic deficiencies and ignoring effective options that exist without police involvement. These options are more trauma-informed, more culturally-appropriate, more supportive and therapeutic, more safe, less likely to escalate into violence, less coercive, less criminalizing, and less stigmatizing. Non-police involved models respond to a mental health crisis as a health problem, not a policing problem. They depend on trained peer support workers and mental health practitioners, not police officers. Some have existed for decades, like CAHOOTs in Eugene Oregon or crisis resolution teams in England; others have been around for a few months or years, like the civilian-led crisis response models being implemented in Toronto and New York City. They are led by, and grounded in, the community, which contributes towards achieving broader social goals, like reducing systemic racism, colonial violence, and the stigma associated with mental health issues.

Given these, and many others, issues, I believe that the majority of crisis calls in Halifax can and should be diverted to non-police-involved teams, ideally led by trained peer support workers since health professionals possess coercive powers that may replicate police-like approaches. The police-involved Mental Health Mobile Crisis team should be reserved for use in very rare situations consistent with the recommendations for effective mental health crisis response systems. The CAHOOTs program in Eugene Oregon has been doing this for over 30 years and has had tens of thousands of calls diverted to them; over 99% of diverted calls were handled without any police involvement and none resulted in harm or injury. 

I’ve spent my time talking about mental health crises, but I’d also recommend developing non-police-involved response options for wellness checks, overdose calls, and other types of emergency assistance calls with a social or health needs component. We know from research that a substantial proportion of people are reluctant to call 9-1-1 to seek emergency medical assistance due to their worry about the police responding. Our current system exacerbates treatment delays and health inequities for such people. Making non-police-involved emergency response options available to people experiencing or witnessing a drug overdose is especially urgent in the context of the increasingly toxic illicit drug supply and the growing number of people dying from illicit drug poisonings.

Both the Halifax Regional Council and the Halifax Board of Police Commissioners have roles to play in establishing mental health crisis response options that are accessible to everyone who lives in Halifax when they are at their most vulnerable and regardless of their views towards, or experiences with, the police. Earlier this year, Toronto’s City Council voted to establish four mobile crisis teams that will respond to mental health calls in Toronto without involving the police. A conservative estimate is that, if sufficiently resourced, two-thirds of Toronto’s mental health crisis calls can be diverted away from the police and handled by such teams that have appropriate skills, training, and connections to offer effective help and support.

Healthcare systems and governments at every level, including at the municipal level, must actively address the deficits that have created our current reality in which the police have become a default response to people seeking help for acute and chronic mental health, substance use, and social needs. 

I have focused my comments on mobile crisis response but effective mental health crisis response systems work to prevent crises by effectively building upstream capacity to attend to the social determinants of health, including housing, income security, education and employment opportunities, and high-quality community mental health and substance use services, which also happen to be the social determinants of crime. As well, effective crisis response systems must ensure that people’s needs are properly supported in the community after a crisis has occurred to prevent those people from experiencing subsequent crises.

Thank you again for giving me an opportunity to speak to these issues. I’ll submit my prepared remarks to be part of the record.

See also: Jamie Livingston: Freedom on hold: COVID-19 shines a light on ongoing institutional injustices

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One Comment

  1. I thought of the many points Jamie Livingstone argued coercive actions of current community service along with health and welfare services may resemble police response therefore in adressing the issue of defunding and diverting funding allocated to law enforcerment that rigorous consideration be given (through a non partisan cross sectional committee) as to what a non-police crisis mobile unit would look like and the specialize training/certification required.

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