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Crisis Lines as the 911 Mental Health Option: Issues Brief

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Background: Special Committee on Reforming the Police Act

  • On April 30, 2022 the Special Parliamentary Committee on Reforming the Police Act released Transforming Policing and Community Safety in British Columbia, the culmination of two years of multi-partisan inquiry into police governance, police involvement in complex social issues, including mental health and addictions, systemic racism in police agencies, and measures needed to ensure a Police Act consistent with the United Nations Declaration on the Rights of Indigenous Peoples.
  • The Committee unanimously recommended the creation of an appropriately funded full crisis response system: a continuum of response to mental health, addictions and other complex social issues with a focus on prevention and community-led responses. The report calls for better coordination between police, health, mental health and social services and integrating Mental Health as a fourth 911 call option.

Crisis Centre of BC

  • The Crisis Intervention and Suicide Prevention Centre of BC (Crisis Centre of BC) provides immediate access to barrier-free, non-judgemental, confidential support and follow-up through 24/7 phone lines and online services
  • We answer 1-800-SUICIDE, 310-6789 (BC-wide mental health line), and regional distress lines in the Vancouver Coastal Health region (Vancouver, Burnaby, Richmond, the Sunshine Coast, and the Sea-to-Sky corridor). 
  • We are part of the BC Crisis Line Network, ten Crisis Centres that collectively respond to British Columbians in crisis, and are in the process of transitioning to the governance of the Provincial Health Services Authority. Crisis centres provided 2.5 million minutes of life-saving and life-changing support to British Columbians when they needed it the most.
  • Crisis Centres onboard 450 new crisis service responders per year, many of whom go on to become doctors, teachers, social workers, police, and other emergency and mental health professionals.

What is a crisis?

A crisis occurs when the level of pain and distress a person is experiencing outweighs the effectiveness of their resources and coping strategies. Anyone can go into crisis, anywhere, anytime. Crisis cannot be planned or scheduled. Crisis can be experienced by people who have psychiatric illnesses, people with mental health issues, and people who are generally healthy. The vast majority of crisis events do not require a police response.

What are crisis lines?

Crisis lines provide 24/7, no-barrier, immediate phone and chat-based support for individuals experiencing situational crisis, struggling with mental health challenges, in the midst of a psychiatric episode, or experiencing suicidal thoughts or behaviour. Services are delivered by highly-trained volunteers supervised by clinical staff.

Crisis Care Continuum

A crisis care continuum is a robust crisis response system designed to handle mental health, addictions and other complex social issues with a focus on prevention and community-led responses. Crisis care continuums include police where there is a specific safety or criminal concern, but do not depend on police to provide emergency care for people in crisis.

Crisis care continuums follow least restrictive, least cost principles, preserving high-cost police and hospital resources while reducing unnecessary trauma experienced by those in crisis. In a 2021 Crisis Centre survey, 58% of respondents reported having a negative police experience during a mental health crisis.

Phone and chat crisis intervention

Currently, BC crisis lines answer calls from the community.  In a crisis care continuum, crisis lines also take mental health calls routed from 911. Crisis lines specialize in trauma-informed crisis de-escalation, suicide risk assessment, and safety planning that engage the caller’s existing supports..

  • In 98% of cases, BC’s crisis service responders safely de-escalate crisis calls, diverting callers from 911 and saving $47.9 million in police attendance at mental health calls.
  • At $26.69 per call, Crisis Centres are the least costly response to crisis; a Vancouver police mental health response costs $465, according to VPD reports.
  • Where crisis care continuums have been established, crisis lines de-escalate 80% of combined 911 mental health and community-based crisis calls
Integrated mobile crisis response teams

When a crisis cannot be resolved by phone or chat, crisis lines need alternative options to 911 and police response. In a crisis care continuum, crisis lines dispatch mobile response teams that may include peers with lived experience of mental illness, mental health clinicians, social workers, or  police.

  • Crisis centres on Vancouver Island and the Interior currently provide intake for mobile crisis response teams made up of clinicians, social workers, and police.
  • Crisis centres serve on the advisory panel of Peer-Assisted Crisis Teams (PACTs) being piloted in North Vancouver, New Westminster and Victoria by the Canadian Mental Health Association. PACTs partner people with lived experience of mental illness with clinicians. 
  • Where crisis care continuums have been established, mobile crisis response teams resolve 71% of their call-outs in the field.
Community-based crisis stabilization

Short term crisis stabilization care provides the function of giving a person in crisis a safe place to sleep, re-organize their lives, and connect with community-based resources. 

  • Currently in BC, police are only authorized to transport people in a mental health crisis to hospital. Police are required to stay with the individual in crisis until they can be assessed for admission. In the majority of cases, individuals brought to hospital by police do not meet the criteria for hospital admission. 
  • Community-based crisis stabilization beds or facilities provide appropriate options for police on calls that turn out to have a mental health or crisis component, preventing the “revolving door” of individuals in crisis coming to hospital for assessment only to be turned away with no resolution to their crisis.
  • Where crisis care continuums have  been established, 68% of people discharged from crisis stabilization facilities are discharged to community, and 85% remain stable in community-based care

Figure 1: Outcomes of a high-functioning crisis services continuum, with data drawn from the Arizona Complete Health service area.

Wraparound crisis follow-up and care

Crisis lines ensure no one is alone in a crisis, no matter where they are in the crisis care continuum. We offer:

  • Outreach calls for people concerned about the health and safety of a loved one or neighbour.
  • Follow-up calls to callers to ensure referrals go smoothly and the crisis is resolved.
  • Crisis management for chronic, acute mental health clients when mental health teams are unavailable.
  • Response to callers using bridge phones intended to prevent suicide deaths from jumping.
  • Response to callers in climate-based emergencies (wildfires, floods, heat domes)
  • On-demand suicide risk assessment and safety planning for friends, teachers, parents, doctors or service providers when someone discloses suicidal ideation or behaviour.
  • Crisis lines the best choice for hospital emergency or psychiatric ward post-discharge follow-up of after a suicide attempt or other mental health concern.
  • Crisis lines support medically stable, isolated callers waiting for BC Ambulance, freeing up 911 and ambulance dispatch to answer their next call.

Crisis Lines as the 911 Mental Health Option

Crisis lines are an unacknowledged but key service in emergency response systems, which means we are not engaged strategically to minimize the financial and human costs of unnecessary intervention. The

recommendations laid out in Transforming Policing and Community Safety in British Columbia are an opportunity for municipalities and the Province to ensure high-costs resources like policing, ambulance, and hospitals are preserved for where they are needed, bu unlocking the potential of crisis lines to de-escalate and manage crisis in community. 

 

For more information, contact:

Stacy Ashton, Executive Director
Crisis Centre BC
sashton@crisiscentre.bc.ca

This brief was prepared on May 2, 2022.