How To De-Escalate A Mental Health Emergency Without Calling The Police
Every time Asante Haughton leaves his home, he sees someone in distress. For the Jamaican-born mental health advocate, encountering a person experiencing homelessness going through a bad mental health episode in public happens often in his Toronto neighbourhood. What’s also common, Haughton said, is seeing them become victims when police get involved.
“People get tackled to the ground, hogtied, choked out and beat up because someone called the police and they escalated the situation,” he told HuffPost Canada. He’s also disappointed with how police have intervened in his own mental health struggles and those of his loved ones. “For me, it never seemed like they were actually helpful.”
Who do you call during a mental health emergency? Dialing 911 seems like the only possible action concerned Canadians can take, but doing so has shown to have fatal consequences for those most marginalized. In the past few months, Canadian police have killed five Black, Indigenous, and people of colour (BIPOC) during wellness checks: D’Andre Campbell, Rodney Levi, Regis Korchinski-Paquet, and Chantel Moore.
Watch: Black Lives Matter Toronto calls for defunding police following death of Korchinski-Paquet and others. Story continues below.
The latest dead is Ejaz Choudry, a Pakistani immigrant killed in his home by police last week. And according to a recent lawsuit filed by B.C. nursing student Mona Wang, having an anxiety attack in January led to injuries caused by an RCMP wellness check.
“Wellness checks” are defined as police responding to concerns that a person is having a mental health emergency. As Global News reports, when police take someone into custody under their provincial mental health act, handcuffs are usually involved.
Mental health response teams do exist, but involve police
Aside from the growing support to defund Canadian police, many are also advocating for non-police alternatives to mental health emergencies, as unarmed professionals wouldn’t have the means to kill without lawful prosecution. Haughton and Rachel Bromberg co-founded Reach Out Response Network, a group that’s lobbying Toronto city officials to divert mental health calls to the 811 healthline; it comes on the heels of another campaign for a federal 911 alternative.
Bromberg, who’s also the Canadian national coordinator for the International Mobile Response Association (IMSA), has researched mobile crisis teams around the world. In Canada, Mobile Crisis Intervention Teams (MCIT) and similar team models deployed by emergency services always mean a police officer will be involved; mental health workers are partnered with cops to answer calls, which doesn’t please critics who want anyone armed out of the equation altogether.
In cities like Toronto, these response teams are never the first on the scene of a 911 call and only available during office hours, which organizations like the Schizophrenia Society of Ontario have long decried.
There are response teams made up of solely mental health experts; mobile interventions by unaccompanied trained professionals are run by non-government organizations, like Toronto’s Gerstein Crisis Centre or Montreal’s Tracom, but they have limited resources and can’t always respond immediately.
While no non-police alternative for mental health emergencies may be immediately available on a national scale, Canadians worried about police violence may want to be aware of what experts do when someone is in crisis and emergency services aren’t the first option or are still on their way.
HuffPost Canada spoke to Canadian mental health workers experienced in de-escalating those in crisis without hurting anyone or being armed. They shared strategies they exhaust before calling 911 as a last resort. Not all tactics may be adaptable and Canadians shouldn’t take on safety risks they’re uncomfortable with:
Unlearn stereotypes about mental health and violence
The widespread belief that people with mental illness are violent is false, Harvard Medical School research finds. In fact, the Canadian Mental Health Association (CMHA) states that they’re more likely to be victims of violence.
Make the person in crisis feel safe with your presence
If someone is in crisis, how are you physically reacting to their emotional state? And what tone of voice are you using?
“Just being physically present is an intervention, don’t take that for granted,” Parker advised. “The message that people in distress actually receive are in our non-verbal communication, not necessarily in what we say.”
There’s no playbook for navigating mental health crises, Parker said, as being emotionally attuned to someone’s needs and having a previous, positive rapport will be a bigger factor in calming someone. In the case of several deaths related to police killings of Canadians, the family members of Choudry and Korchinski-Paquet have criticized officers in the media for refusing loved ones’ entry into homes to help de-escalate.
“We told them, ‘Let the family intervene’ — because that is one of the interventions when someone is schizophrenic,” Choudry’s nephew, Hashim Choudhary, told CBC. “They didn’t let the family intervene … They just pushed them back.”
Mental health experts who are trained like Parker or support peers, such as family members who have assisted de-escalation before, will have more experience gauging the best ways to adapt their presence to the type of distress someone is experiencing.
What can be done by anyone and make a world of difference is body language: Making non-threatening eye contact, unfolding arms, and not raising your voice can keep tensions from getting worse.
Avoid overreacting (or underreacting)
It’s human nature to respond to perceived aggression, such as someone yelling at you for a reaction, with anger. Crisis Prevention Institute (CPI) advises against overreacting or getting into a power struggle because of flaring tempers, as giving in to these emotions and arguing will only escalate bad moods or unstable thinking.
It’s also worth not overreacting to behaviour that may be alarming to you because it seems eccentric, but is harmless. Similarly, immediate danger should be recognized as such.
“When people act weird or lose their minds, it is easy to overreact. It’s also easy to underreact,” states a crisis guide by mental health advocacy group The Fireweed Collective. “If someone is actually seriously attempting suicide or doing something extremely dangerous like lying down on a busy freeway, getting the police involved might save their life. But if someone picks up a knife [to feel safer, but isn’t using it] and is walking around the kitchen talking about UFOs, don’t assume the worst and call the cops.”
If a supporter needs to calm themselves in order to help someone in crisis, it may be helpful to follow CPI’s directives for keeping cool under pressure: Slow and deep breathes can help, as does assessing the situation in terms of what dangers are or are not likely. Sometimes, waiting out a crisis with supervision or allowing the person to express themselves (as long as it doesn’t endanger anyone) may be the safest route for all involved.
Remember that people are people
For some marginalized people it may be reassuring to see someone they have a shared background with. In Fader’s experience running a drug user resource centre, this helped ensure people weren’t dehumanized.
“Say an Indigenous man needed de-escalating, we always made sure somebody Indigenous was a peer or a worker, someone part of the conversation,” she said. “If there was a woman, there would always be a woman on the team. That’s just part of respect. Remembering that people are people works so much of the time.”
Part of that respect can look like taking care of their basic needs. Offering them water, food, or helping them fall asleep might ease them. It can also involve taking care of them once the crisis subsides, as well as keeping tabs on them if external parties get involved.
Respect what they’re going through
Don’t get hung-up on saying the right thing to comfort them, but do make sure you aren’t saying anything invalidating, Haughton said.
“People become agitated because people are not listening to them,” he said. For example, if someone hallucinates, hears voices, or believes delusions, refuting what they experience can escalate the situation. “What works for me and what I’ve been taught is to listen and provide space for the person. What they’re experiencing is very authentic to them at that moment.”
Phrases like “I can’t see them but I know you can,” which the Connecticut Mental Health Center suggests, can be useful, unlike invalidating statements like “That’s not real.”
People with weapons aren’t necessarily going to use them
As unarmed social service workers, Tanya Fader and her colleagues have de-escalated people with weapons hundreds of times. Fader, who is the director of programming at PHS Community Society in Vancouver, says they’re able to do so because of their situational assessment skills.
“Are they having a psychotic break? Are they a danger to themselves and others, or are they just holding it?” she said, as an example. “Are they holding a knife for their own sense of security, to feel safer, or to use it?”
If someone is holding a weapon to feel safer, there are phrases that can promote everyone’s wellbeing, as the Centre for Addiction and Mental Health’s Dr. Brittany Poynter illustrates.
“Instead of saying, ‘No weapons allowed here, give it to us or we’ll call the police,’ I might say: ‘I’m so glad you’re at the hospital. You’re in a safe place now,” Poynter wrote for the Toronto Star. “We’re going to hold on to the knife for you, so that we can all be safe. Let’s sit down and talk.’”
Trauma-informed approaches are necessary
One of the co-founders of PHS Community Society had a famous saying when it came to de-escalation: “Remember, it’s about their pain.”
“People tend to go, ‘Oh, they’re threatening me.’ No, it’s not about you,” Fader explained. “They’re really suffering.”
Are they holding a knife for their own sense of security, to feel safer, or to use it?Tanya Fader
Both Fader and Parker’s organizations operate from trauma-informed frameworks, which takes into account how prior trauma can affect someone and avoids re-traumatizing someone when providing services — an approach not necessarily at the forefront of law enforcement strategies or laypeople’s minds, when crisis can seem scary and uncomfortable from the outside looking in.
For the two of them, addressing the root causes of a mental health crisis involves putting more resources into anti-poverty work and mental health care.
Fader said that addressing trauma often starts in childhood and needs to take culture into account. For Indigenous populations, family removal, abuse, and settler-colonialism can lead to someone adopting survival behaviours that may lead to self-harm later in life, Fader noted.
Understand the lingering effects of trauma
If a Canadian decides to call in another party on a loved one, such as the police, they should consider how their friend or family member may have previously experienced harm during mental health interventions with strangers.
Bromberg has worked in the mental health field for several years. When fielding crisis lines, she often worried about a caller’s safety when dispatching police which crisis line workers are legally obligated to do when someone is in imminent danger, Fader and Bromberg confirm.
“I have heard so many clients tell me about how scary it was when police showed up yelling, tackling and handcuffing them,” she said. “They had nightmares and develop PTSD from that. Every time when they see a police officer walking down the street, they start shaking and crying.”
It’s also worth knowing that even within the psychiatric system, patients can experience harm and abuses of their rights. As the CMHA reports, getting involuntarily institutionalized through the Mental Health Act — also known as “getting formed” — can be a stressful experience for anyone. People on the margins, such as Black men, have historically and continue to report oppressive treatment in in-patient care.
Canadians can get training
There’s no national resource that provides trauma-informed mental health first responder training, but Fader hopes ongoing discussions about mental health lead to it.
Until that happens, Canadians may find it helpful to equip themselves with de-escalation skills through training sessions like NVCI; Parker recommends taking a mental health first aid course and a suicide prevention program similar to Ottawa’s safeTALK.
Many people who have experienced mental health struggles and abuse due to police or institutionalization have found solidarity and support in peer-led groups like the Hearing Voices Cafe and supporting advocacy by the Mad or psychiatric survivor/user/consumer movement.
The Fireweed Collective, formerly known as The Icarus Project, is a long-running peer-led mental health group. In their crisis toolkit, escalation prevention includes encouraging sleep and being realistic about one’s reaction to non-conventional behaviour.
Safety planning is another tool that people who have a history of mental health struggles use to prevent police violence getting enacted on them. In their crisis guide, the U.S. National Alliance on Mental Illness includes a sample crisis plan that the person and their supporters can develop to reduce trauma, which may or may not include alternatives to police involvement.
Open Table Nashville released a trauma-informed guide for protestors de-escalating at events, which include examples of effective questions to ask such as, “If being here is not working out for you, can I help you get somewhere else?” or diverting attention with safe distracting topics.
Want to get involved with advocacy? For the Reach Out Support Network, they’re hoping Canadians contact them if they’re looking to support or learn more about how non-police mental health alternatives can look like.
Are you in a crisis? If you need help, contact Crisis Services Canada at their website or by calling 1-833-456-4566. If you know someone who may be having thoughts of suicide, visit CAMH’s resource to learn how to talk about suicide with the person you’re worried about.
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