Inside the uphill battle to innovate mental health response in Vancouver

When Vancouver city council got an update from Vancouver Coastal Health about a program embedding mental health nurses upstream in the Vancouver Police Department's response plan, the health authority was appreciative of local government support for their de-escalation initiatives. 

But CTV News has learned that the health authority “dusted off” the idea and re-advocated for the concept after past attempts failed, implementing the strategy in June of last year after lengthy discussions with police, local government and the provincial government.

“They came to the table and listened to our thoughts and ideas,” said Bonnie Wilson, the executive director of community services for VCH. “I'd say it's an entire team who has really pushed forward and come up with very creative ideas.”

One of the ideas public health officials championed is paying off, even with part-time implementation: For 10 hours each day, a specialist health nurse sits in the Vancouver police operation command centre and triages 911 calls where mental health is identified as a major issue.

If safety concerns are high for the subject or those around them, uniformed officers will still be dispatched. But in half of all calls assessed by the call-taking nurses, they were able to de-escalate the situation on the phone or assign a “moderate de-escalation team,” which is typically a nurse and social worker, instead of a uniformed officer. More than 700 police interactions have already been avoided this way.

“The philosophy stems from the real desire to intervene as early as possible and really, we want the most appropriate service responding, and whenever we can, providing a health response to a health call,” Wilson explained.

At the presentation to council on Monday, Dr. Saad Ahmed, the medical director of homelessness for VCH, emphasized that those teams also have their own medical backup.

“There is a physician who is on call for the moderate de-escalation team” and able to advise on medication or other options to address the subject’s issues, Ahmed said.

Vancouver police didn’t have anyone available to discuss the program, but the chief has often expressed support for a more robust medical response to medical issues, rather than a police-only reaction. And while Mayor Ken Sim had campaigned on hiring 100 mental health nurses and 100 new police officers, that’s proven difficult to deliver on due to a shortage of health-care workers and the challenges of the job. 

One of the key architects of the upstream nurse strategy believes de-criminalizing mental illness and crises in public is already showing evidence of longer-term benefits as well.

“It gives us that chance to connect on a human level with a kind, compassionate, health approach and either re-engage in the health system or engage for the first time,” said Wilson.