Re-funding the police? No plan for Vancouver to hire 100 mental health nurses to pair with cops

A Vancouver Police Department patch is seen on an officer's uniform. THE CANADIAN PRESS/Darryl Dyck

As Vancouver is set to expand a program that pairs officers with psychiatric nurses, critics remain concerned by the continued reliance on police to respond to mental health calls and the city's decision to prioritize increasing police funding.

Mayor Ken Sim's ABC party campaigned on a promise to hire 100 nurses and 100 cops to expand the Car 87/88 program, which pairs a plainclothes police officer with a psychiatric nurse to respond to non-emergency mental health calls. It was a major plank in his platform, billed as an investment that would improve overall public safety. He pledged to "requisition" the hiring on day one.

Three months after his election, which saw his party sweep to a majority on city council, the hiring of police officers is underway. The Vancouver Police Department's proposed budget, presented to the board last November, earmarks $15.7 million to fulfill Sim's promise.

"The money is going out the door and the money is going out the door to police first,"observes Stacy Ashton, the executive director of the BC Crisis Centre.

A proposal to grant Vancouver Coastal Health $2.8 million to hire health-care staff "to enhance urgent mental health services" is coming to council next week. 

Hiring to expand the Car 87/88 program is included, but only 10 full-time positions are being added. An additional four positions will also be created to support police-based teams.

And while the city is poised to hire 100 new police officers by the end of this year – a goal both Sim and the department have said is achievable – the proposal coming to council makes it clear that 86 of those officers will not be paired with psychiatric nurses or teamed up with other mental health workers.

Asked about plans for how these officers will be used, and where they will be deployed, a spokesperson for Sim deferred to the VPD.

"Mayor Sim has consistently indicated that council would not be prescriptive about operational decisions related to hiring and that specifics related to the allocation of resources were best left in the hands of subject matter experts," an emailed statement said.

Vancouver Mayor Ken Sim, left, and Vancouver Police Chief Adam Palmer arrive to attend an announcement by B.C. Premier David Eby about a new public safety plan, in Vancouver, on Sunday, November 20, 2022. THE CANADIAN PRESS/Darryl Dyck

CRITICISM FROM CRISIS CENTRE 

While a recent press conference saw the city's plan endorsed by provincial and municipal officials, including the premier, the health minister, the police chief and the head of the health authority, others are advocating for a different approach – questioning the infusion of funding to the VPD and the city's foray into hiring health-care workers at the expense of investing in a police-free alternative for people in crisis.

Ashton, whose organization operates several 24/7 phone lines for people in distress or who are experiencing a mental health crisis, including 1-800-SUICIDE, said one of her primary objections to the plan is that it is not what people who are in crisis want or need.

"They are investing in police first. And that's not what we're hearing folks with mental illness are wanting and not what we're hearing is wanted by folks who are vulnerable," she says.

"How we want to approach mental health in the community is really without making the assumption that this person is dangerous from the get-go. It is the police's job to deal with actual danger. The number of incidents of actual danger among folks who are in a mental health crisis is very, very small."

THE LIMITATIONS OF CAR 87/88

The Vancouver Police Department, in an email, told CTV News that Car 87/88 attended 2,482 calls in 2022. In 140 cases a person was apprehended under section 28 the Mental Health Act, which allows police to take someone into custody if they are "acting in a manner likely to endanger that person's own safety or the safety of others."

The fact that this was the outcome in under six per cent of cases prompts professor Emily Jenkins, who teaches in UBC's school of nursing and researches approaches to mental health and substance use, to question the need for officers to be deployed in the vast majority of cases.

"That would indicate that there's a lot of room in there for crisis response that does not involve a police presence," she says.

Vancouver Coastal Health describes the Car 87/88 teams as a "health response rather than a criminal justice response" but Downtown Eastside outreach social worker Tyson Singh Kelsall says this characterization is misleading at best.

"I would be very hard pressed to call anything with police involvement health care," he says.

"It is not a police alternative. It is the police coming."

Even if the overall rate of apprehension under the Mental Health Act is low, he says both the fact that it happens and the threat of it happening when Car 87/88 is called makes community-based service providers extremely reluctant to use it.

"It is an expansion of involuntary care, an expansion of access points to involuntary care at a time when voluntary care services have extremely tight eligibility criteria and are almost impossible to access."

Both Jenkins and Singh Kelsall said the need for alternatives to police is urgent, citing cases in B.C. and beyond where people in crisis have been seriously harmed or killed by police during wellness checks or while experiencing a crisis.

Ashton says expanding the Car 87/88 service will only serve to further entrench police involvement in mental health crises.

"Once they are in place, they'll get used for more and more cases where it's more and more clear that police weren't necessary. Once they're there, you start using them. And the thing is, that every time you send police you have another person who has been involved with police," she says.

"It will make it appear as thought more and more people with mental illness are police-involved when they're only police-involved because there wasn't a non-police alternative."

LACK OF EVIDENCE

Speaking to media on the weekend, Sim said the police-nurse teams have been successful since they first hit the streets in 1978. Currently, there are two of these teams but only one operates in the city at a time. The hours are from 7:30 a.m. to 11 p.m.

Service providers have reported that the waits for a team to attend are long. Sometimes it takes days for them to arrive, sometimes they never show up at all.

While the long wait times might show an unmet demand for the service, they are one of the factors that make it difficult to measure whether the teams' interventions are actually helpful if and when they do arrive.

Jenkins and Singh Kelsall both point out that a thorough evaluation of the program and its effectiveness is not available.

"We really lack good, strong evidence base on the outcomes of such initiatives," Jenkins says. "We don't have a robust evidence base."

Last year the teams were dispatched to an average of seven calls for service each day. However, Singh Kelsall says showing that the teams are being called upon with relative or increased frequency is not the same as showing that they have been effective.

"The number of calls is a neutral stat -- it doesn't mean that something is good or bad, it just means it's being utilized.

"Car 87 and Car 88 actually have no public-facing evaluations. We don't know if the outcomes are good or not."

Ashton says the research she is aware of shows that these teams are most effective at getting people to take medication. The teams will often visit people they have identified as potentially violent if they are, for example, in the grips of psychosis.

"Compliance with medication is not the same as mental health treatment."

AN ALTERNATIVE MODEL

None of the people CTV News interviewed suggested that the municipal government has no role to play in making sure people in crisis are safe and supported, or that they don’t act out in ways that harm others.

But they maintain there are better ways.

The City of Toronto, for example, is using municipal dollars to try a different approach – and it's the model that Ashton advocates for in Vancouver.

The Toronto Community Crisis Service responds to mental health calls and requests for wellness checks. The teams do not include police officers and can be accessed several ways, including by calling 911. According to a third-party evaluation of the first six months of the program, 78 per cent of calls to 911 were "successfully diverted" with no police involvement required or requested. 

In the cases where mobile teams were dispatched, police assistance was only requested in 2.5 per cent of cases. An ambulance was requested in 1.7 per cent of cases and a visit to a hospital emergency department was recorded in eight per cent of cases.

Between March and Sept of 2022, the team responded to 2,489 calls and were dispatched 2.092 times.

The 2022 annual operating budget was $10,982,571 which is roughly half of what Sim said it would cost each year to make good on the promise to employ an additional 100 police officers and 100 nurses.

BETTER WAYS TO IMPROVE HEALTH, SAFETY

Another criticism of funneling money into policing and the Car 87/88 service is that it perpetuates an approach to mental health that is fundamentally reactive.

"We're relying on people getting to the point of crisis in order to access care. And that's, I'd say, the number one issue here," Jenkins says.

"I think often (calls to the service) are initiated out of an abundance of caution and a lack of anywhere else to really turn because we have mental health support systems in the community that are largely inadequate and underfunded."

Ashton describes the current system, including the Car 87/88 teams, as a revolving door where people receive emergency services without ever being connected to longer-term supports.

Singh Kelsall agrees that there is a fundamental lack of resources for people who want or need mental health intervention in crisis situations but also in order to prevent a crisis in the first place. In addition, he says that involving the police in crisis calls discourages people from accessing what little is available.

"When people are coerced into care, or when people have police involved in their 'health care,' they're less way less likely to actually voluntarily seek health care in general, both mental and physical," he says.

The city's decision to spend money on hiring health-care workers to be paired with police is also troubling for those interviewed, given that health-care spending is the province's jurisdiction.

"I think that's basically putting municipal money down the drain in a city that could really use important municipal community services and infrastructure," Singh Kelsall said.

"I think there's many ways that a municipal government could provide services that would protect and promote people's mental health that have nothing to do with health care," Jenkins agreed.

Ashton said her organization, for example, gets a municipal grant from the City of Vancouver each year that is worth about $40,000. While every dollar counts, she says the crisis centre is currently only able to respond to 50 or 60 per cent of calls that come in.

"Seeing an infusion of funding similar to what we're seeing go into psychiatric and police funding would make a huge difference for us in being able to divert folks from unnecessary police and unnecessary psychiatric intervention," she says, noting the annual operating budget of the crisis centre is $2.3 million.

VCH PROPOSES NON-POLICE RESPONSE

The proposal coming to city council on Feb. 14 includes the creation of a new, non-police service "for individuals who are not in high levels of crisis and in need of Car 87/88 supports." It is not clear how people would access this service or how it would be determined that it is an appropriate alternative to a police-based team. While hiring for Car 87/88 is projected to start in March, this new team is not expected to launch until September.

The proposal estimates that this team would have an average of 12 "interactions" with people per day. The estimate for police-based teams is 37.

In total, the proposal would see the City of Vancouver funding 58 new positions with the health authority. The recommendation is to hire 32 staff for this new initiative and another 12 to bolster existing programs and responses for Indigenous people.