We get the details about the pilot project in partnership with the Canadian Mental Health Association coming to the city of Victoria. We also speak to a consultant from a similar program that has spanned decades in Eugene, Oregon.
We get the details about the pilot project in partnership with the Canadian Mental Health Association coming to the city of Victoria. We also speak to a consultant from a similar program that has spanned decades in Eugene, Oregon.
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Disclaimer: These interviews have been edited for clarity and length.
Jackie: Hi, my name is Jackie Lamport. Today is Wednesday, August 18. Welcome to the Capital Daily Podcast. Today on the show, Victoria is introducing a new pilot project that would send a crisis response team to certain situations in place of police, not unlike a similar project that Eugene, Oregon, implemented over 30 years ago. Today, we learn about both projects, and what it means for the city's future.
On July 4, 1989, the city of Eugene, Oregon, changed how they respond to people in crisis. Instead of police, they began sending a team of a medical worker and a crisis worker to calls where police would traditionally be dispatched. Their teams are sent to calls such as conflict resolution, welfare checks, substance abuse and suicide threats. They are trained in de-escalation techniques and provide immediate mental health care. The program is called CAHOOTS or Crisis Assistance Helping Out On The Streets. In 2017, the CAHOOTS teams answered 17% of the Eugene police department's overall call volume, and the de-escalation seems to work on their nearly 24,000 calls; police backup was only requested 150 times. In the wake of recent events in America and Canada. Many cities have begun creating programs such as this one, Eugene has acted as a case study, and they've inspired many cities to create their programs. This includes Toronto, which is currently in a planning phase, Edmonton, which is currently operating, and now Victoria.
On August 12, the province announced that Victoria would receive more than $4.7 million through the strengthening community services program. Mayor Helps released a statement that same day listing some of the projects that would be funded with that money on that list was a partnership with the Canadian Mental Health Association to pilot a peer-assisted crisis team. According to the Canadian Mental Health Association (CMHA) BC, one in five interactions with police involve someone with a mental health or substance abuse order. They're excited to change the way that we approach those situations. Today, we'll learn about what the project will look like right here in Victoria with a conversation with the CEO of (CMHA). We'll also learn about the success of Eugene's CAHOOTS program with a conversation with the Director of Consulting at White Bird Clinic, which runs the program.
First, our local focus, we welcome back Jonny Morris, the CEO of CMHA BC. Jonny, welcome back to the podcast.
Jonny: Thanks so much, Jackie, for having me back on your podcast.
Jackie: Can you first explain to me what exactly the peer-assisted crisis team is?
Jonny: Well, it's a concept that's very much in development here in the city of Victoria. It's a concept that's got some legs and maturity in its development as a concept and other jurisdictions like Toronto and Edmonton and Eugene. The idea is to expand the mental health response and to reduce reliance upon police and look at the option of civilians only. So our peer-assisted crisis team typically is composed of team members that include those with lived and living experience of mental health and substance use problems, who are trained to respond as well as to respond effectively and safely and carefully in a crisis paired up with professionals that could also include a social worker, a clinical counsellor, a nurse, or another practitioner like that, to help people in the space of distress. So that's the team composition.
There's often a linkage into the emergency response systems that there need to be tight connections in there, good connections there, because there's an elaborate dispatch framework that's often in place. That's the model, at least, that we've seen implemented in cities like the City of Toronto recently.
Jackie: This may seem like an obvious question to some people, but what gap is it filling exactly?
Jonny: So we currently have a mental health and substance use care system. At least in the context here of this province, now known as British Columbia anyways, where if people are in crisis, a mental health crisis, or space of distress, often there's two real poles of response. The emergency department and even I've talked a little bit about that before the emergency department is the place you attend, or you are brought to, or there's the police response. Of course, there are crisis lines, other resources available along our crisis care continuum, and Island health here has developed a range of pieces in that continuum that are important to talk about today or some other time.
Often in communities, police are known to respond to the crisis in question. So what we're trying to do is expand the resource continuum and strengthen the opportunity for health responders to be responding to a health crisis. Often crises come from what we understand is about housing security, employment security, fleeing discrimination, violence, trauma, all of those pieces, plus mental health components. We're trying to create a response that can respond to that need in expanded ways that are designed to augment emergency departments and things like that.
Jackie: What is the Canadian Mental Health Association of BC's role in this project?
Jonny: So here in the city of Victoria, we are playing a convening role. So we are in this region. We don't have a significant footprint in direct service delivery. We hope to play here with partners like Island Health, the police, and significant community agencies, of which there is a number who have a stake in this issue, and support a process where the community designs this response. This is such an opportunity in the province to discuss how we strengthen and improve crisis care, build upon what's been done with our partners like Island health, and find a way forward. So in many ways, what were the roles we're playing, and we're doing this in a couple of other jurisdictions in the province, is helping lead the community design process—engaging with the community, including people with lived experience, to think through. For example, if we were to add to the continuum of crisis care, what would be the best way to do that? In this first phase, we're really leading what we're calling the community design phase, and we'll get underway with that very soon. Then, we hoped to develop a series of recommendations and next actions for key decision-makers like the city, the Health Authority, etc., to identify an agency and an entity that would carry this work forward in a community in partnership with others. We are kind of the ignition or the starting point for the process to get going here.
Jackie: It's super important to figure out exactly what each individual community needs because they're all going to be different. You listed Toronto, Edmonton; they're different places than here. There is a similar program from Eugene, Oregon, that has a lot of attention from America and Canada called CAHOOTS. Does this take inspiration from that program?
Jonny: Yeah, we were resting on the shoulders and the leadership of other initiatives. So in our work, CMHA, we've cared for the issues related to the interface between police and people living with mental illness for over two decades. So we've been at this for some time and thinking through what we could do differently. And in short, yes, we took significant inspiration from CAHOOTS being one of several models, including the Edmonton reach program and the recently founded city of Toronto program, all in service I think of in reducing reliance upon police responses enhancing the health response.
We also recognize Eugene is a very, very different community. You just said Jackie, a very different community to Victoria. The element of having a team that's well primed to support people in crisis, navigate care. We have other ideas about how to develop further crisis care and community, which I can talk to you about. It's a very inspirational model. And I think that the city, the city here, and there are huge kudos to leadership at the city level, the city that it would be, it's really important for me to name that at the city council level. Folks like Councillor Potts and Councillor Aalto, Mayor Helps, and others who have had the vision to have been inspired by CAHOOTS municipally.
Jackie: While we're on the topic of acronyms. Is this going to go by PACT?
Jonny: I think we rely upon the community to help name it. I mean, we've been using PACT as a bit of shorthand because it kind of describes that key ingredient of peer and lived experience, support. But it's a good idea to go by PACT. CAHOOTS is quite compelling too, as an acronym. I think the community will have a lot of great ideas. I know GVAT, which is another acronym, Greater Victoria Acting Together, who have lots to say about this might also be very influential. They're around how we name this additional response in the community. Jackie, I'm sure you and your colleagues might have great ideas, too.
Jackie: Oh, well, we'll send you an email. It's interesting, though, because you said that the community was going to be involved, and they're going to be involved in everything right down to the branding.
Jonny: Yeah, it's one of the principles that we hold daily at the Canadian Mental Health Association. It starts within the context of community and, and that's so important, I think, for building a system with people who live the system. Rather than something getting cooked up in a removed way, sending alongside people who can tell us where the doors are locked, where they can't go through, where there are dead ends, where there are cliffs, where there are problems, where there are challenges. And we're seeing this with great success because we were sitting alongside communities that serve racialized populations, immigrant refugee newcomer populations, different cultural groupings, faith communities, all of who have a sense and a say of how crisis care could be improved.
We want the community to be a significant driver of this process and also recognize the municipality. So city leadership at the manor staff level and the elected level, the province, police, emergency responders, paramedics by the Health Authority, Crisis Line Care, that's the array of crisis care right now. We have to find ways to ensure whatever we design with the community and partners doesn't leave anyone behind.
Jackie: How closely will Vic PD be involved?
Jonny: I would say we hold the position, whilst we want to reduce, which I think we've heard Chief Manak and others say reduces reliance upon the police. In so many ways, police and paramedics and fire are firmly ensconced within the crisis care system. I think many would say the pendulum has swung so far where we are collectively overly reliant upon the police to be the de facto responder to a mental health crisis and think a coroner's report a number of years ago framed the police as the de facto response. This leaves the question of what we want to rely upon, is that the role of police? So I think there's a sense of support, and I've talked with a number of Chiefs of Police recently who've said let's expand the continuum. We can get behind this. I think we have to recognize and understand that having the police be part of a process where they're so deeply intertwined is critical for the success of this going forward.
Even the question of dispatch and the response is determined, you need to have an awareness of police response, because there are absolutely going to be occasions when police response is required. So to have the police involved to make sure that they are part of thinking this all through is so critical for the project success because otherwise, it's the same thing as leaving out the health authority or leaving out other key players. We end up with another island that's detached from the system, which ultimately doesn't serve people very well. So yeah, we anticipate working closely with police in thinking all of this through.
Jackie: What scenarios would a peer-assisted crisis team be sent out over police?
I think some of that is going to be clarified. I mean, the big chunk of the work, and I would say the important expectation from the health authority is first to get really sharp and clear together around these definitions of crisis and and and crisis's overlapping, complex, nuanced, gray, ambiguous, and sometimes very sharp and clear. I think one of the clear things is establishing that if there's an absence of, of a threat of violence, an absence of a weapon, or an absence of something very, very dangerous happening with us, no determined risk of life. That's arguably where, with all of the safety protocols and background in places, but arguably where we would not see police deployed.
We can imagine situations where someone is in crisis because they're experiencing profound panic. They're experiencing a profoundly distressing episode, where they're in need of some care and support that arguably would be a good peer response opportunity. Crises involving housing security, and displacement and those pieces where mental health crisis is ensuing, we could imagine that that might meet some of the criteria where a PACT team could go out and start to get that person connected to the right care at the right time, at the emergency time doesn't seem like the best response for that kind of situation, nor does police. So as those pieces have kind of fallen into a space where I'm here, we have a great team called the integrated mobile response crisis team to insert, or I got the acronym a bit wrong there. It's the spaces that fall outside of where those services currently apply.
Jackie: Okay, if I assume that this is something that will, has yet to be ironed out, but if there was a situation where the team would or has become in danger, what steps would be taken?
Jonny: I think that's partly linked to balance in a very important way to link to that earlier question you raised around the kind of the interconnectedness with existing systems so that there's always. I've heard the Chief without wanting to put words in his mouth, I've heard him talk of the need to have for each of those emergency systems to be aware of what's happening with a team because there was a dynamic and rapidly changing circumstances and safety for the person in distress safety for responders is always a paramount concern. So I think that's going to boil down to really good dispatching and having really good information available in dispatching decisions. We've seen that kind of done exceedingly well in the crisis line world like those are some of the best-trained folks who think that through and kind of very active and dynamic communication and this does have to be worked out. That's what would be the vision to be making the most data-driven decisions. T
he flip side right now, as we send police to situations where there's like a 17-year-old who's experiencing profound panic, they're in a mental health crisis, police attend, for whatever reason, and I think many would agree that that's an inappropriate response. We've got lots of examples of young people in distress who ended up finding themselves in the back of a police car being conveyed to the hospital, which has its own profound impact upon your mental health and well-being. So that's the flip side of how do we mobilize a system in a much more discerning way in the midst of a crisis?
Jackie: What kind of results are you hoping for? What would you measure as a success?
Jonny: I think of the podcast we did with the important narratives of the two young people who were experiencing care within the emergency psychiatric system. Their stories are very influential to me in thinking this work through as a leader in the mental health space. I think some of the results we'd hoped for would be a diversion. So if someone's in crisis, connecting, transporting and liaising them to the right care at the right time might avoid the need to take them to the emergency department or the need for police to attend. So I think one key outcome is the right care, the right response, and the right time for someone in crisis. I think the other key outcome would likely be getting people attached to care in a much more thoughtful way. I think of a young person in crisis, a crisis team responds, and they're bridged into a foundry, for example, and here in Victoria, that would be a good outcome in some ways.
The other outcomes, I think of the work that's being done in the United Kingdom and Australia right now, which are really looking at third spaces for crisis care. So we rely on the emergency department in England. They really tried to drive a reduction in the use of police, jail cells, and emergency departments in some context around crisis care. They've created what are called recovery hubs, which are third spaces where someone who's in crisis can go to. There are peer peers, there are trained mental health professionals, they might need a cup of tea and a supportive conversation, they might need something more intensive, but it's another space where people, particularly folks who are grappling with thoughts of suicide, etc., who don't have weapons or means of harming people need a place to go. There's some really promising evidence that these third spaces in Australia and the UK are my hope because, of course, you've got a PACT team if you've only still got two places to take them. We need to map the places where we can take people in a supportive and caring way, and my hope is, as there's a bit of a transformation there in the places that people can experience care when they're in crisis going forward.
Jackie: I recently did an episode where we talked about the police and how they are struggling to meet all of their requirements regarding finishing cases and whatnot. And it feels like this is not only an answer to help people, but also to help police to be able to focus on the things that they're better suited for. Like it feels like this is a win-win all over.
Jonny: I think Jackie and I appreciate the spirit of your question. I think this could be fully realized and resourced well. We're so appreciative of the support of the city, the province, and the ministries involved in this pilot. I think it could be a game-changer. We've seen evidence of a game-changing in jurisdictions like Eugene, where they've seen a plummeting level of police deployment in the UK, with some of that work plummeting the use of jail cells because we've expanded options. So, you're right. A big part of the role is back to your question, what CMHC is doing here? We're convening and getting it going. We'll also be tackling the evaluation. The evidence and evaluation side is absolutely we're looking for that return on investment. And it does reduce the need for police to attend incidents where they're not the most appropriate response, freeing them up to tackle some of the things that are core to their mandate going forward. That would be a win-win in so many ways.
Jackie: Lastly, would you be so kind as to give us a timeline for when this could become a reality?
Yeah, so we have a pretty engaged co-design process, and so those things are things that we are talking about. I was talking with a police official recently, and we are talking about a massive paradigm shift like this is a big shift. This isn't just a little tinker; this is quite a significant chunk of work. So the community process, I think in the other communities, we're trying this out anywhere, kind of from three to six months to land. The design of this, there's likely going to be a process after that around processing recommendations, working closely with Island health, the city police, community agencies to make sure the framework is safe and secure for trying out. There's a recruitment process and all of those pieces. The other day, I said on the news that I hope we've got some very meaningful traction under our belts within the 12-month mark. That might be something you revisit with me 12 months from now and say, "How are you doing, Jonny?" That's our goal. We want to be nimble here because really, that's the moral imperative. We can't wait around on this stuff, and it's nicely indexed with the work that we're seeing Island Health do and The Ministry of Mental Health and lining up with the Minister of Mental Health mandate letter commitments.
Sometimes it takes a long time to align all key ingredients for changing political will, money, and people. Given last week's announcement, they have so many of those key ingredients and real leadership at political levels, and I can't say that enough about the city of Victoria, Victoria Council and other key decision-makers. So that all helps with delivering on time. So yeah, I'm very optimistic. I hope you follow and kind of check in with us, Jackie, regularly, and we can give you a sense of how things are going over the next little while.
Jackie: Awesome, for sure, Jonny. Thank you so much.
Jonny: Thank you so much, Jackie, and excellent questions, and I look forward to keeping in touch with you.
Jackie: And now we learn more about the program that serves as a vital inspiration for programs like this all over the continent. We welcome Tim Black, the Director of Consulting at White Bird Clinic, to the show.
Tim: Thanks for having me; it's good to be here.
Jackie: Can you first give an overview of what exactly CAHOOTS is?
Tim: CAHOOTS is an acronym, and it stands for Crisis Assistance Helping Out on the Streets. We're a mobile crisis program dispatched by the public safety system here in Eugene Springfield in Oregon. But we're operated by the wiper clinic, which is a nonprofit Health Center. We take over 20,000 calls for service annually and serve as behavioural health first responders, really dealing with situations involving mental health, addiction, homelessness, poverty and everything else that's not a medical emergency and isn't a crime that's going on in the community.
Jackie: It's, surprisingly, a decently old program. It was developed 31 years ago. What prompted that?
Tim: We got started in the summer of 1989. When that happened, it was made possible through some community policing grant funding that Eugene had accessed. It really seems like a lot of their decision to come and approach White Bird Clinic about that response was based on the fact that for 20 years prior, White Bird Clinic had been serving the community and demonstrating that there was a role for a health clinic to play in diverting folks from the hospital, or from jail. The initial funding for what became the CAHOOTS program recognized the power that community organizations had to play in public safety in our community.
Jackie: Once the idea was formed, how long did it take before the program was actually realized?
Tim: We had been doing community-based outreach and response for years. We kind of knew what we wanted to do; those were all volunteers granted. It was really a matter of taking about a year to iron out what the contract looked like, what hours of the day, what days of the week our teams were going to be out there. We kind of knew already what we wanted to do, how we wanted to serve our community. That was based on the work we'd already been doing. The input that we were getting from those we served was really a matter of trying to figure out how to translate that into a kind of public safety sphere.
Jackie: When did results start to come in?
Tim: The results started right away on the 4th of July 1989, which was the first huge shift and the fact that you had somebody other than a sworn police officer being dispatched on that system to go and respond to a call that even literally hours before would have gone to an officer. That's a success right out of the gate. Over the 30 plus years that we've been doing this, we see similar successes and measure our efficacy in the community around how we're being utilized and how the community is receiving us.
Jackie: Clearly, the program has been a success, given that it's spanned over three decades. Now, when did the city realize that it was working?
Tim: I think that the city really recognized it was working right away. Immediately, you saw officers responding to fewer calls for service that were ultimately socio-economic. There was an immediate effect on the availability of officers and what they were responding to when they were on duty. And so that led to a pretty immediate change, both for the experience of an officer, going through their job, their career with the Asian police department, but also for our community there was an immediate shift and who would be available and what options were at the disposal of dispatchers when it came terms to what resources were available to dispatch when it came time actually to send that resource out to somebody in need.
Jackie: In light of recent events, there's been this large shift from cities around the world and how they approach policing and responding to crises, such as the ones that CAHOOTS responds to. Have a lot of cities reached out to you for a consultation?
Tim: Whether it's a more direct request for consulting on a project they're putting together or trying to learn more. I think we've been contacted by over 1000 different communities in North America in the last year and a half. There are new requests for information rolling in on it on a daily basis. It hasn't slowed down as we've gotten further and further from what happened to George Floyd.
Jackie: Is there anything you think could have been done differently earlier in your program that you would urge other cities to consider?
Tim: Absolutely. The biggest thing for us was that we didn't directly involve our community and those who were receiving services in the planning and implementation in the early years. I think that a lot of this has to do with larger systemic issues in community services. It seems like when our program first got started, our providers assumed that because our services were being utilized by other White Bird Clinic services that were being utilized by the community, we had our finger on the pulse and that that was good enough. By doing so, we allowed ourselves to build a system that was completely reliant on calling the non-emergency police number if you are in crisis, and wanted CAHOOTS, we built a system that requires you in the cities of Eugene or Springfield, Oregon, to have enough privilege to feel safe, and confident that you'll be okay. If you call a number connected to the police department to get the CAHOOTS response. If we had really centred our work more directly on lived experience when we were first starting our program, you would have seen a greater degree of separation in our point of access. As communities now, we're considering the CAHOOTS model.
One of the things that we talk about a lot with them is recognizing that one, if we don't centre this work in those most impacted populations, then we're never going to accomplish the kind of outcomes that we hope for that we allude to in public forums and town halls. The other thing is to recognize that there are very likely already folks in every community who are doing much of what we would describe as this work. There are mutual aid networks, right there violence interrupters, there's the person at your church that everybody goes to when they're having a hard time. When we're building these programs, we're going to be completely ignoring either successful systems or folks who, if given the resources to really develop that system, would create something even more powerful and impactful than anything that we might be working on at the present moment.
Jackie: It's interesting that you say that because I was speaking to one of the organizers or the partners of the Victoria program, and their whole thing is spending the year developing this program based on consultation with community organizations. So that does seem like a good thing for us then.
Tim: A really good example of how that that could be done poorly is a couple of years ago, obviously, before the pandemic, myself and a colleague from my clinic, we went down to Oakland to the Bay Area to meet with the mayor to meet with public safety command staff and talk about this program and what it would mean for the community of Oakland to bring a mobile crisis in. While we were having those conversations with largely white elected officials. Mental Health First, in Sacramento and in Oakland were doing community-based crisis response, they're not getting the recognition and they're not getting a seat at the table, or the financial support that so many other community groups are. So the city of Oakland provides a really good example of how this shouldn't be done, in that they completely disregarded a community-based organization that was making big changes and accomplishing the outcomes that the city wasn't recognizing, and saying that they hope they could get to eventually. To hear that in Victoria, there's a group taking a year to learn from the community. That gives me a lot of hope. Personally, that reason for optimism is when we take the time to slow down and listen to those we want to serve with these resources.
Jackie: What are some of the differences that Eugene, as a city, experiences from cities that don't have a similar program?
Tim: I think we need to recognize that Eugene city, Springfield, our metro area, is a white liberal town on a major highway corridor that connects us to other predominantly white, mostly liberal communities. There's not a lot of gun violence in the Eugene Springfield area relative to other communities. We have one of the highest rates of homelessness per capita, and in the US here, in Oregon, here in Eugene. So I guess there are many differences between the makeup of our community, but also where we're seeing the most socio-economic need. So other communities, again, need to consider the needs of those who are being over-policed and centre this work on the experience and the perspectives of those impacted populations. That's something again, where if we had done better outreach, for instance, to communities for whom English is a learned language in our area, I think that you would see a lot of different approaches and how CAHOOTS respond to language needs in our community and what we have is really kind of built on a lack of community input. As other communities are really looking at this, accessibility is a huge part, and language will be one of those biggest barriers that we have to overcome because you have to be able to connect with somebody if you're going to have an effective intervention.
Jackie: Aside from the positive social implications of this program, it also saves the city money. How does that work?
Tim: We estimate that in our diversions from the ER and from reduced ambulance rides, the CAHOOTS program saves our community $14 million a year. We have struggled to get verified information from the police departments with which we work about cost savings there. I think that's something that is kind of a universal issue. New police departments are really protective of their budgets and are cautious to point to anything that says that they should get less money in the future.
We see that the Eugene Police Department estimates that in labour alone, we're saving their response that we're saving the city $2.2 million a year, which is nearly twice what the Eugene Police Department oversees and expenses related to service delivery for CAHOOTS. So from the police department standpoint, we're saving them $2 for every dollar they spend on us. When we blow that out, we start to look at the entire community. We include that cost savings buy fewer trips to the hospital. That's coming out to 15 or $16 million a year there that are being saved by a program that costs a little over $2 million to run as it's currently funded. So for every dollar being spent on your mobile prices response, based on our experiences here in Eugene and Springfield, it's reasonable to say that 6,7 or 8 dollars will be going back into the community.
Jackie: Wow, that's incredible. Tim, thank you so much for this. This has been really interesting.
Tim: Oh, it's been a pleasure to talk with you.
Jackie: You can also read about this story at capitaldaily.ca. If you want to help support Capital Daily's local journalism and connect your business with our engaged and curious Greater Victoria audience of over 50,000, email our partnerships team at advertising@capitaldaily.ca.
Thanks so much for spending some time with us. Again, if you enjoyed the show, please leave a rating and a review, and also subscribe so that you don't miss any episodes going forward. We post new shows every Monday to Friday. My name is Jackie Lamport. This is the Capital Daily Podcast. We'll talk to you tomorrow.