‘Support better care’: Advocates argue need for mental health emergency service

Khalil Dorival knows what it’s like to feel lonely.

The Toronto-based mental health advocate has struggled with social anxiety, depression and suicidal thoughts.

“I really suffered in silence, and I used many ways to cope in unhealthy and toxic ways,” he says, adding he turned his life around and uses his story to try to help others.

Dorival is a crisis worker with Toronto Community Crisis Service, a project launched in 2022 that responds to mental health crisis calls and wellness checks.

The service has been dubbed the city’s fourth emergency response service — after police, paramedics and fire services.

Other major cities are examining the benefits of an alternative model as they investigate police wellness checks that have led to fatalities.

Winnipeg Mayor Scott Gillingham has asked for the creation of an emergency service dedicated to mental health calls.

“There is an understanding across our nation and within Winnipeg that addictions are on the rise, mental health crises are on the rise, homelessness is on the rise,” he said in an interview. “We’re in a time right now when the need, it seems, has never been greater.”

Winnipeg police data from 2023 shows there were more than 21,000 calls for well-being checks, making it the top request for service for the fourth year in a row.

“When someone calls 911, we need to make sure we’re sending them the right agency to respond to their need,” said Gillingham.

Requests for a new way to handle mental health calls in the city were renewed last year after deaths while in police custody.

In January, a man died after police used force to subdue and arrest him. The man was reported to have been acting erratically. He became unresponsive during the interaction and was later taken to hospital, where he died.

In February, officers fatally shot a man while carrying out an order under the provincial Mental Health Act.

Those two cases are being investigated by Manitoba’s police watchdog.

Indigenous and other racialized communities have long asked for options for crisis care that divert police response.

Toronto city council was prompted to approve its community crisis service after the 2020 racial justice movement stemming from the deaths of George Floyd in the United States and Regis Korchinski-Paquet in Toronto. The Afro-Indigenous woman fell from an apartment balcony.

The crisis service sees two mental health clinicians respond to well-being checks without police. Calls are received through 211 or 911, and workers are dispatched if there aren’t immediate public safety or medical concerns.

The teams are employed and managed by four community partners.

“Right off the hop, the teams work to try and understand the individual,” said Mohamed Shuriye, the city’s director of community safety and well-being. “Sometimes the presence of a uniformed officer, paramedic or firefighter can sometimes escalate people.”

Data from its first year shows the service took 6,827 calls, with less than two per cent requiring additional assistance from police, said Shuriye.

Toronto Mayor Olivia Chow has said the service saves lives. City council made the pilot project permanent and expanded the service across the city.

A similar model is offered in parts of B.C.

The program uses teams of two workers to respond to mental health crisis calls in North Vancouver, Victoria, New Westminster, Prince George and Comox Valley.

They are trained in de-escalation strategies, scene safety and situational awareness.

The program receives much of its funding from the provincial government.

“It’s ingrained that people in crisis need a police response,” said Jonny Morris of the B.C. division of the Canadian Mental Health Association, which oversees the program. “But jurisdictions, I think, are waking up to approaches that destigmatize and actually support better care.”

Since it started, the program has taken thousands of calls, with police involved in about one per cent, said Morris.

It has a 48-hour followup requirement with clients, something also implemented in Toronto, to ensure individuals are provided with the correct resources and supports.

Morris said more than 70 per cent of people in the provincial justice system have a mental illness or substance use disorder.

“It’s arguably an incredibly vulnerable experience to be in crisis,” said Morris.

“The more that we can do for people to have crisis care experiences that don’t retraumatize them, don’t cause them to never want to go near the system, means that we’ll hopefully see reduced crises in the future.”

While these initiatives are fairly new in Canada, a city in the United States has had one for decades.

Mental health workers in Eugene, Oregon, saw the need to help the police department with social service calls. In 1989, Crisis Assistance Helping Out On The Streets, or CAHOOTS, was born.

Staff with the mobile crisis intervention program respond to a range of calls relating to welfare checks, public intoxication, ride requests and environmental concerns, such as drug paraphernalia.

The program operates 24 hours a day in Eugene and its sister city, Springfield. A mental health worker and a medical professional respond to the calls.

“There are situations where our training is just so different, and the way we think about these scenarios are so different,” said program coordinator Justin Madeira. “So, our interactions are just innately different.”

Advocates say the biggest challenges these services face aren’t safety but precarious funding, a small pool of mental health workers to choose from and a lack of upstream support.

“There’s just not enough crisis beds and shelter beds,” said Shuriye.

Back in Winnipeg, Gillingham said provincial government support is needed to get a fourth emergency service in the city. It would require changes to the Mental Health Act, which is currently being reviewed by the government.

Manitoba Premier Wab Kinew said there are government initiatives to bolster mental health supports, including a partnership with a downtown Winnipeg foot patrol and funding for 25 mental health staff to work with police.

Kinew said he expects more positions will be added in this year’s budget, but he stopped short of committing to funding a fourth emergency service.

“There is a readiness there, but the how to me is a big question.”

This report by The Canadian Press was first published Jan. 4, 2025.

Brittany Hobson, The Canadian Press