It's Not a Policing Matter: Decriminalizing Mental Health Crises

All right, I think uh we should get started. Uh we don't want to miss a minute with our speaker today. It's wonderful to see so many people out on a rainy Friday uh for the first in this year's edition of the Health Justice Institute speaker series. I'm Sheila Wildman. Sounds a little like there's a Is there a little sound like a rain? >> Yeah. >> I'm just saying that. I don't know. I'm not good at solving that. But >> can you Okay, I'll keep talking and maybe the rain will go late. But uh so I'm director of Delhausy's Health Justice Institute, which is an interdisciplinary collaboration of Dallas faculties of law, health, medicine, and dentistry. And we're dedicated now. Can you still hear me? Pretty good. Okay. dedicated to uh promoting health justice in research, teaching, and public policy and other community engagements. So, I'm delighted to see um a few of our core members here in the room today. And uh I'm particularly delighted to single out where are you, Matthew? There. um the Health Justice Institute's longtime director and now associate director, Professor Matthew Herder, uh who along with the Health Justice Institute's administrator, Ashley Johnson, who's in the back and responsible not just for cookies and all those wonderful things, but so much. Both of them have done the lion share of putting together the speaker series this year. So, if you just join me for a second and thanking THEM [applause] CONVENE uh today in the unseated territories of the Mikua M sorry Mikmma Holistic Way and Besi peoples sovereign nations holding inherent rights as the original peoples of these lands. We each carry collective obligations under the peace and friendship treaties and under section 35 of the constitution act 1982 which recognizes and affirms Aboriginal and treaty rights in Canada. We further recognize African Nova Scotians as a distinct people whose histories, legacies and contributions have enriched that part of known as Nova Scotia for over 400 years. We're always learning on these lands and we at the Health Justice Institute commit to continued reflection on the role of universities in a white supremacist and colonialist power structure and to the work of repair uh of helping to build respectful relations and knowledge creation situated in the wisdom and justice struggles of African Nova Scotian and Migma communities. So, it's in that spirit that I'm delighted to welcome our first speaker of the year, Dr. Jamie Livingston. Dr. Livingston is an associate professor of criminology at St. Mary's University. For over a decade, he studied police responses to people experiencing mental health issues and the criminalization of mental illness and substance use. His research critically examines coercive incarcereral interventions and explores more humane responses uh sorry more humane approaches to crisis response. So, of the many things that I appreciate about Jamie Livingston, uh, which include a kind of unshakably ride, I would call it mischievous outlook on the world world that I find hard to put into words, um, and find really admirable maintaining it across so many hard things that you see and do. Um, beyond that, I particularly appreciate Dr. Livingston's community engagement. So he's lending his scholarly rigor and expertise generously to local, national, and international health justice struggles. So just one example that stands out uh to me, Jamie did not hesitate in joining with me uh Dr. El Jones and others at East Coast Prison Justice Society a year ago for public education and media immediately following two successive tasering deaths in Halifax within one week during police wellness checks. Dr. Livingston's depth of knowledge, both [snorts] local and comparative, made it possible to think through causes and solutions uh of those uh horrific violent events. Uh at a time when many including family and loved ones of the two men killed who were in touch with East Coast prison justice and path legal at the time, uh many were struggling to simply absorb the violence that had occurred. Jaime's engaged scholarship takes many forms, including a current multi-year evaluation of a crisis intervention and outreach program run by peer support services and outreach or posy in West Hance. And a couple years back, a community-based evaluation of the North End's mobile outreach street health justice project. And last, I know I have to stop, but I wanted to mention Dr. Livingston's a couple things. is his co-authored chapter with Jennifer Chambers, lawyer on civilian mobile crisis services and that's in Getty and all's 2024 anthology on mental health and law and also his contribution to a co-authored 2023 article in the Canadian Journal of Public Health which exposes bias in an Alberta government commission report used to justify attacks on supervised consumption sites. So these uh examples reflect the dual commitment to rigor and to justice in all of Jamie's major accomplishments. So that's my cue to stop and let Dr. Livingston take the stage. [applause] >> Thank you so much Sheila. Those are wonderful words. Hi everyone. Thanks for coming today. It's a real privilege to be with you and to be able to speak to this topic. Um my work on this topic really began like almost 15 years ago when the questions were quite different around this topic. Uh I was working with a team that was trusted with um actually and um trusted by a committee that Archie Kaiser was part of with the mental health commission of Canada and we were given the opportunity to ask a question for the first time in Canada of how people with mental health issues experience their interactions with the police. This at the time was in Vancouver at the on the heels of some some tragic events and um so our questions were like how do we better prepare police for interacting with people who are in mental health crisis or experience mental health issues. The questions have changed considerably um today and those are the types of changes that I'll explore with you um in in this presentation. So I'm going to be talking about the criminalization and decriminalization of mental health crisis and the general criminalization of mental health and people who live with mental health issues uh broadly. Uh I'll focus on how police have become such a central component of our mental health crisis systems. We'll explore kind of the history and factors related to that. I'll be drawing on research um with people who live with mental health and substance use issues as well as broad scholarly work related to policing crisis response stigma as well as mental health reform. My argument today is straightforward. Mental health crises are often treated as public safety events when they should be more accurately understood as and responded to as health and social issues. As a result, police have become deeply embedded in crisis response systems, often with harmful consequences. I'll begin by grounding our discussion in the local case that Sheila alluded to um in her introductory remarks that illustrates these issues and then use that case to explore how police be have become the central component of crisis response. Why this model is being criticized and what alternative approaches look like. The case occurred in Halifax in February 2025 and involved a family trying to get help for a man whom I'll call John experiencing acute mental health crisis. Over the course of several days, multiple systems became involved including emergency services, police, paramedics, mental health services, and hospital-based care. Ultimately, the situation ended very tragically. The events were investigated by Nova Scotia's serious response team or CERT serious incident response team or C the independent agency responsible for investigating cases involving death, serious injury or significant incidents connected to police actions. As we work through this case, I'd encourage you to pay attention not just to what individuals did, but also the systems and structures um that shaped the options that were available. One of the questions we'll return to throughout the presentation is why police became such central actors in a situation that began as a mental health crisis uh rather than a criminal matter. The first call for help occurred on February 20th. John's mother, whom I'll call Jill, contacted 911 because her son was experiencing psychosis and appeared disconnected from reality. She reported that he he believed he was trying to someone was trying to kill him and she was concerned for his well-being. Importantly, she repeatedly emphasized that Jon was not violent. Around the same time, another resident in the building where this was occurring called 911 after an unusual interaction with John. By that point, Jon had already left the scene, but a police officer responded and was able to determine that Jon was traveling to be with family members. And once Jill was satisfied that Jon was safe, police involvement ended and no further action was taken. At this stage, the situation was not violent and was not criminal. It was fundamentally a mental health crisis. But notice that the first point of contact was already the police. The following evening, Jill called 911 again. She was increasingly concerned about Jon's mental state. She reported that he had been isolating himself, hearing voices, expressing suicidal thoughts. Once again, she emphasized that he was not violent towards others. Two police officers attended the residence and spoke with John. They concluded that there was no legal legal grounds to apprehend him under the involuntary psychiatric treatment act. and they provided him with contact information for the mental health mobile crisis team. This is a team that's existed in Halifax for over a decade. Co-response team, social worker or nurse co-responds with a police officer to mental health crisis. They also have a telephone line. At the same time, Jill had been trying to access support for John from this mobile health mental health mobile crisis team, but she was told that this the service was short staffed and an in-person response would not be likely for several days. Jill was told that if the situation be became urgent, she should call the police. This part of the case is important because it illustrates a recurring theme in crisis systems. Even when mental health services exist, they may not be available when people need them the most. As a result, families and people in crisis often find themselves redirected to emergency services and ultimately the police. The situation escalated the following morning. Jill contacted 911 again and reported that Jon was experiencing what she described as a mental break. She rem remained concerned about his safety, particularly when he had been talking about harming himself. And as in previous calls, she emphasized that John was not violent towards others. Police attended and arranged for emergency health services to transport John to hospital, and John agreed to go voluntarily. Once he was at hospital, he waited for 10 hours for a psychiatric assessment that never happened. By that time, a nurse came to the hallway to bring him in and he had already left. I imagine most of us would already leave after 10 hours. The these details matter because they illustrate another common reality of crisis systems. Getting someone to hospital does not mean they'll receive the help that they need. Families and people in crisis are often confronted by one barrier after another. And by that evening, John was back home increasingly distressed and agitated, and the crisis had reached its most critical stage. Later that same evening, Jill called 911 once again. This time, the situation was more serious. Jon had returned home from hospital in an increasingly distressed and agitated state. Jill reported that his condition condition was deteriorating and that she was now concerned about the safety of others in the residence. Jill reported um rather two officers were dispatched and while on route they requested that emergency health services attend as well. EHS agreed to stage nearby um to wait until the police determined the scene was safe. However, the cert investigation revealed that this didn't happen and no ambulance was assigned to the call. When the officers entered the residence, John appeared to be experiencing acute psychosis. He spoke about a deug a device or a bug being inside his body and was desperately trying to remove it. The cert report indicates that officers report attempting to communicate with Jon and attempted to deescalate the situation. However, things escalated. John became increasingly agitated and began throwing objects. At that point, the officers decided to take him to into custody so that he could be transported to hospital. A physical struggle followed. Officers restrained Jon and used a conducted energy weapon and applied handcuffs and leg restraints. While being restrained, Jon experienced medical distress, lost consciousness, and stopped breathing. Despite the despite the officer's resuscitation efforts, he died. For me, one of the most important things about the case is that the fatal outcome occurred at the intersection of multiple systems. This was a mental health crisis, but it invol also involved 911, hospital services, mental health services, crisis response, and the police. By the time events reached this po point, rather, numerous opportunities to appropriately support Jon's mental health needs had already passed. An autopsy concluded that John's death resulted from quote complications followed by following an physical altercation during an acute acute psych psychotic episode. The manner of death was classified as homicide. Following its investigation, sir concluded that the police officer's use of force was legally justified under the circumstances and there were no reasonable grounds for to lay criminal charges. The certain investigation assesses the facts and the law to determine um to make a very narrow determination about whether criminal charges are warranted against police officers. And the autopsy gives us approximate cause of death. So complications of a physical altercation during an acute psychosis. But there are larger questions that should be asked and investigated, including what put Jon in a physical altercation with police in the first place. We know the contributing factors included three days of escalating contacts, a 10-hour wait in the hospital emergency department with no psychiatric follow-through, a co-response crisis team that couldn't respond in time, and a crisis response system that centers police and involuntary transports. There's an underlying cause of death that the autopsy and the cert investigation were never designed to capture, which points to the criminalization of mental health crisis. Others have reached similar conclusions that raise questions and issues that deserve investigation, scrutiny, and accountability. The director of CERT himself along with the East Coast Prison Justice Society, Sheila, myself, and others have called for a public fatality inquiry into John's death. one that would look like at not just the actions of the officers or the approximate cause of death, but at policies, institutions, and systemic factors that shape the response to John's crisis and Jill's call for help. Displayed on the screen is the headline that ran the day after John's death. It reads, "2-year-old man dead after being tasered and taken into hospital, taken into Halifax police custody, rather." The article article goes on to highlight how police stated that the man became aggressive with police prior to being tasered. What this report misses is how far things escalated from where this started three days earlier. A mother calling 911 because her son needed help. And I want to pause here and reflect on the trajectory of the case because of course it's not about one interaction, one decision, one point in time. It's a sequence of responses across different systems, each operating within its own limitation. Notice too how the ple how often the police were the agency that showed up at several critical moments. they were the primary responders even though the underlying issue was mental health and not criminal behavior. That raises questions worth interrogating. Why were police repeatedly the default response? What alternatives existed but weren't available at the time? And what alternatives didn't exist but may have prevented John's death? These questions shift our attention to the broader ways uh that we organize crisis service systems. Which brings me to the next qu next question at the center of the talk. How did police become such a central part of mental health crisis over the over um several decades since I guess since the 1960s. Police have assumed an increasingly dominant role in responding to situations that are not primarily criminal in nature, including mental health crisis, substance use issues, homelessness, and other social problems. Today, if somebody was experiencing a mental health crisis, either they and either they or their family member called emergency services, a police response is often considered routine. In many communities uh including in Nova Scotia, police involvement has become a normalized feature of a crisis response system. And it's important to recognize that this wasn't inevitable and there's nothing normal about this. We don't do this for physical health emergencies. rather reflects a series of historic political and institutional developments that shape how we understand crisis and how we organize our responses to it. In other words, the question isn't simply why the police responded to John. The bigger question is why our systems are designed in such a way that make a police response likely in the first place. And to answer that questions, I'll focus on a broad set of factors and forces that have helped place police at the center of contemporary crisis response systems. Now, the police didn't become centered to crisis response because they're uniquely qualified for the task. rather their role emerged through interactions with several broad several broader influences. So for simplicity I've grouped these uh and displayed them on the screen. First there's been important changes to policing itself including the expanded scope of police work alongside a steady growth of police budgets. Second, there are factors within our own health care and social welfare systems, including the chronic and persistent underinvestment in community- based mental health services and social programs. Third, there are broader social beliefs about people experiencing mental health crisis, including equating crisis with dangerousness. And taking together these systemic and structural forces have helped make police default responders. Let me elaborate on each of these. The first factor concerns policing itself. Over the past several decades, police have been increasingly expected to respond not only to crime but also a wide range of social issues. As I mentioned earlier, the shift was partly influenced by the community policing model. This model encourages police services to take a more proactive role in our communities to actively address what are perceived as community problems and to promote public safety and well-being on their own accord. One consequence is that the boundaries of police work have expanded considerably. Issues that were once seem seen as primarily health or social concerns increasingly became part of the police mandate. Over time, police involvement in mental health crisis became normalized and increasingly expected and communities demand that the police respond to these problems. We see this in John's case. The officer who responded to the very first call wasn't there because a crime occurred. He was there because policing has become the default response to distress of almost any kind. So one reason the police are now central to crisis response is that policing itself it itself expanded beyond traditional law enforcement into governance of social problems and that are rooted in social inequity. [snorts] One way we can see this is the expan uh see the expansion of policing is through patterns of public spending. A 2023 study in published in the Canadian polic public policy looking at 20 of Canada's largest municipalities found police spending increased in the vast majority of them even when there was no apparent relationship to increased funding and crime rates. Even when reform was on the table after the 2020 Black Lives Matter protest, cities that promised to cut and reallocate budgets largely reversed course and a separate study found no evidence that the protest activity led to lasting defunding anywhere. This isn't a really a story about whether defunding succeeded or failed as a movement. It's a story about where resources go by default and where they don't go. poling keeps getting funding regardless of what the evidence says about its effectiveness in terms of crime control and crime rates. And as we'll see in a moment, the mental health and social services that could absorb this work more effectively have not been funded nearly as reliably. The result is that police remain one one of the most available and visible institutions to respond to mental health crisis. Again, not because they're the best suited for the job, but because they're the most resourced. A second set of factors relates to what has been happening within our health and social welfare systems. People often point to deinstitutionalization of mental health hospitals as the reason police became more involved in mental health crisis. But the issue isn't simply that psychiatric hospitals closed. The bigger issue is that governments failed to make investments in social and community uh programs needed to support people outside of institutions. Over several decades, political and policy decisions have contributed to chronic underinvestment in mental health and substance use services, affordable housing, income supports, and other social programs that help people remain well. All of us help us remain well and stay connected to our communities. >> [snorts] >> The result is not only that people have fewer opportunities to access support before situations escalate, but also because they be they become increasingly vulnerable to crisis, surveillance, coercive interventions, and contact uh with the criminal legal system. And we can see this dynamic in John's case. His family repeatedly sought help, but community services were unavailable. There were lengthy delays in hospital care, and police became the most accessible response option. At the same time, police have become increasingly integrated in mental health systems through activities like doing wellness checks, involuntary apprehensions under mental health legislation, and also participating in specialized forensic types of of teams. So, this is not simply a story of police stepping in to help. It's also a story about ho how policy decisions have allocated resources and responsibilities in ways that leave many people with few options other than systems that rely heavily on coercion and control to explore these issues. A couple years ago, along with help with folks in the community, I conducted a survey with people who live with mental health and substance use issues in Nova Scotia. Participants in part of the survey were asked to rate 20 potential barriers to seeking help during a crisis. These were folks who live with mental health and substance use issues and more than half of them had experienced a crisis within the last year. So they rated 20 potential barriers to seeking help during a crisis. And this figure uh shows 10 barriers that were rated as either moderate or extreme barriers to seeking help during a crisis. The most commonly reported barriers relate to access including 91% of the sample said that long wait times in emergency rooms were a significant barrier for them reaching out during crisis. We also see concerns about the availability and quality of services in their local communities. We see concerns here about being treated poorly by health care providers and by police. And about twothirds of participant identified fear of police involvement or fear fear of being criminalized as a significant barrier to seeking help. What these findings suggest is that people's perceptions and experiences with health care and crisis response systems can influence significantly whether or not they'll seek help. Negative experiences, long wait times, concerns about police involvement may deter people from reaching out out for help until they have no other option. And that's because we've chosen to organize crisis services in a way that rely on police and increase vulnerability to crisis. This means that people also have increased exposure to harm as a result. In other words, crisis response systems don't simply respond to crisis, they alter. They also shape people's pathways into crisis and exposure to criminalizing processes, coercive interventions, and lifealtering events. Another influence involves how we understand people experiencing mental health crisis and the situations they find themselves in. As I mentioned earlier, mental health crises are often framed not primarily as health events, but as public safety events. When that happens, police involvement can come to seem natural, necessary, or even unavoidable. And this framing is reinforced by longstanding stereotypes that portray people with mental health issues as dangerous. Also as unpredictable, prone to violence despite evidence that most mental health crisis don't involve any threat to to others or any violence at all. Once a crisis is understood as a public safety problem, the question becomes who is best to manage that risk. And in our society, the answer is often assumed to be the police. John's case shows us this. Since throughout the case, Jill repeatedly said her son was not violent and for most of those three days, he wasn't. Yet, every single call brought the police as a response by default. These dynamics can be particularly harmful for racialized and indigenous communities. Anti-lack and anti- indigenous racism and other forms of systemic discrimination can shape perceptions of danger and threat, increasing the likelihood of coercive and violent interventions and harmful outcomes during crisis response for racialized and indigenous people. As I mentioned before, we don't do this for other types of emergencies. For health emergencies, for example, nobody dispatches the police for a heart attack or for a diabetes crisis, even those those situations can involve confusion, agitation, unpredictable behavior. The fact that mental health crisis roots the police first before any risk has been established tells us the dangerousness belief is doing its work even before anyone arrives on scene. The key point is that police involvement is not driven only by institutional arrangements or resource allocations. It's also shaped by powerful social beliefs about who is dangerous, what constitutes a crisis, and how so society should respond in turn. One way to understand these dynamics is through a a concept that I've been working with for several years called structural stigma. As I discussed in this old report and several subsequent reports, structural stigma occurs when stigmatizing beliefs about people become embedded in policies, practices, and institutions, and they shape everyday life, contributing to discrimination, structural violence, diminished opportunities, and its harmful outcomes. In the context of mental health crisis, it helps explain how perceptions of people in crisis as being dangerous, risky, or in need of control become reflected in the design of our crisis systems. This perspective um emphasizes that police involvement in crisis response, as I mentioned before, is the product of broader social beliefs that have become institutionalized and embedded within our policies, our laws, and our social institutions over time. John's case illustrates some of the severe risks associated with relying on police to respond to mental health crisis. More broadly, a growing body of research has raised concerns about police centered approaches to crisis response. And these concerns generally fall into four areas. First, police involvement can be experienced as stigmatizing and traumatic. Routine practices such as handcuffing, restraint, transportation, and police vehicles, involuntary interventions can leave people feeling criminalized for experiencing a health crisis rather than being supported through one. Second, police centered approaches exacerbate in inequities. This includes the racialized harms that I described earlier and it shows up consistently in police centered crisis response specifically. Third, despite investments investment rather in policebased crisis programs, including these co-response programs that embed police in response, the evidence supporting police involvement remains rather mixed. Simply put, the evidence doesn't show that a policebased model outperforms non-please-based models of crisis response. Fourth, and perhaps most importantly, police involvement often does not align with what people in crisis actually want. Crisis response systems have historically been shaped more by institutional priorities such as risk management, liability concerns, public safety, rather than the express preferences of people who actually use these services. So rather than assuming what type of response communities need, perhaps we should ask people directly about what kinds of crisis services they would find helpful, what kinds of services they would reach out to when they're at their most vulnerable. So that's what I did in the 2024 survey I mentioned earlier. Part of the survey, we asked people with lived experience, if you were to experience a mental health or crisis, a substance use crisis tomorrow, what types of crisis response team would you prefer to have sent to you? We didn't show pictures, but we had we had descriptions of three available models, not not available in Nova Scotia. This model is available in every community. This model's available in Halifax. At the time of the survey, this model was not available. [clears throat] So they were asked to choose between three models. Police officers who were specifically trained in crisis response, the model called CIT or crisis intervention team, co-res response team that I described earlier, um or sending mental health providers, could be clinicians, peer support workers, community crisis workers, etc. unarmed, not with the police. Before I show you what I found, let's see what you have to what your preferences are. So, let's start. How many people if you were in crisis with a show of hands would prefer to see this option, a civilian option without police? >> Right. Crisis generic term. >> We'll get there. >> Okay. >> We'll get there. >> But it's interesting your mind goes there. But yes. We'll get there. But yes, show of hands. I see almost like lots of people. Yeah. Yeah. So, so lots of people for yourself or your loved one would prefer to see people who aren't armed attending to your crisis. So, in our sample, no one chose the police option despite this being available in every community. 12% chose the um the co-response to your question and I asked asked them about different types of situations and it points to so people had different responses when risk was involved. So absolutely but generally 88% wanted a civilian crisis response team. Not that much of a surprise, but very few people have asked this question and certainly our services aren't aren't designed around these answers. >> So there's a two important takes takeaways from this finding. First, it suggests that opposition to routine police involvement is not confined to a small group of academics or activists. Among people with lived experience, there's strong and consistent preference for responses that don't involve the police. Second, it raises important questions about the alignment between crisis services we provide and the crisis services people actually want. So if this slide represents an overwhelming preference uh of people who use crisis services, why do the police remain the default response in so many communities? Of course, asking people which team they prefer is part of the story. We also ask people about their level of support, their level of comfort involving different types of support during a crisis. Here [snorts] I display the top five and bottom five support options that people rated as comfortable or uncomfortable during a crisis. And the pattern is quite clear. Participants rated reported the highest level of comfort with community and health-based supports including mental health professionals, peer support providers, or trusted family or friends. In contrast, they've rated the lowest levels of comfort with police, policebased crisis teams, emergency departments, and 911 services. What's particularly striking is that many of these supports um people are least comfortable with [clears throat] are the supports that currently sit at the center of Nova Scotia's crisis response system. So this indicates a severe disconnect between how crisis services are organized and the kinds of supports people feel most comfortable receiving. It also signals an urgent need to rethink how people in crisis are being supported in our communities. One response to the concerns I've been discussing has been the development of civilian centric mobile crisis programs. So these programs are based on a fairly simple idea that mental health crisis should be responded to primarily by health and community based workers rather than the police. And while interest in these programs has grown rapidly in recent years, the idea itself is not new. It's been around for like 30 years. Some programs have existed in in uh select communities for 20 to 30 years. But the Black Lives Matter movement brought this alive. What distinguishes civilian crisis models is not that the police are uh never involved. Rather, calls are screened using a risk assessment process, not unlike the process used for paramedics. Civilian teams respond to most situations that uh don't involve a risk and that that can be safely managed without the police. While police involvement is reserved for situations involving serious and imminent safety concerns, this represents an important shift of how crisis is understood. Instead of treating police as the default response, police now become a specialized response only used when the level of risk justifies their involvement. This is decriminalization in practice. redesigning pathways and structures to reduce the risk of exposure to criminal legal processes and interventions. And at the core, these programs attempt to realign services with principles of care, support, consent, all while reducing unnecessary exposure to coercive and carceral interventions. In recent years, civilian mobile crisis programs have expanded rapidly across nor North America. This map that I put together shows where these crisis programs are and the different colors are the different types of crisis crisis programs, whether they dispatch clinicians, whether they dispatch peer support workers, etc. So um and what's striking is that most of these programs have only been implemented within the last five years. This map would look radically different be before 2020. Canadian communities have begun developing piloting their own versions including the care program care program in HRM and the posi child program that Sheila mentioned in Windsor, Nova Scotia. The Posi Child program sends community crisis responders with various levels of qualifications and backgrounds and lived experience and is one of the only ruralbased programs that I know about in North America or the world. Toronto has positioned their civilian crisis response service which was first launched in 2022 as their fourth branch of emergency response. So along with fire, police and paramedics, they have a fourth branch of community response. Research and evaluations on these programs are slow to come, but they're encouraging. It's showing that even without the police, people can safely go to these events and rarely do the police are the police required to be called to intervene. So many in these teams are capable of managing safely managing and responding to many crisis situations that would otherwise have a police response all while reducing people's exposure to criminalization and coercion. And the benefits aren't just limited to the people in crisis. They extend to the broader community including reduced strain on the criminal legal system and on emergency services. uh study in Denver, Colorado has demonstrated a decrease in lower level crimes when you mobilize these teams and intervene early. So we have community level um uh positive outcomes that can be accomplished through these programs. That's the case for civilian crisis response. But I wanted to add co caution before I close. So I'm a strong advocate for these programs. I've been advocating for at least six years um for these programs to be implemented locally. And fortunately we're seeing some traction. They're important. They're lifesaving. They and importantly they align with what people want in their own lives and they offer a real alternative to police center responses. But on their own, they're a reform, not a structural transformation. So many of the crises that these civilian teams are responding to are rooted in housing insecurity, poverty, trauma, unmet needs, conditions that aren't resolved by changing who shows up when a crisis occurs. Decriminalization in its fullest sense isn't isn't only about changing who responds to a crisis. It's about addressing the conditions that root people towards crisis and criminalization in the first place. So while these though these programs um represent a a an important and necessary change and progress, they're only part of a solution. The work to decriminalize mental health crisis continues well after crisis response civilian crisis response programs are implemented in our communities. It continue it it continues as we take on the hard work of addressing the material and social conditions that keep people trapped in desperation and in crisis. So, I'd like to end where I began with John's story. Over three days, his family repeatedly sought help from the very systems meant to respond to a crisis. Despite that, the crisis escalated and ended in tragedy. I don't think John's case can simply be understood as individual failures. As I made the case for, this reflects policy choices, institutional arrangements, and social beliefs that shape a response to folks who are experiencing distress in their own lives. So, two questions run through this talk. How should we respond when someone is in crisis? And why are so many people reaching the point of crisis in the first place? The first question is about decriminalizing who responds. And the second question is about decriminalizing the conditions that produce crisis at all. And John's story is really about both. Thanks for your time and attention and uh I look forward to your questions. [applause] >> How can the person who's observing it who's not trained? It's a rare event for most people. How can they decide whether they want the police to respond or a mental health person? And I agree with you. There's a serious problem that we often put people in jail for non-events that they wouldn't put a criminal in jail for. But it still remains how how do people decide which service to call? >> Yep. So, first of all, most people aren't calling the police. They're calling 911. And 911 is then tasked with deciding who goes. So, most people in the community aren't deciding whether or not they call the police or or sort of other services. It's usually a central either 211. In some communities, like in Toronto, 211 is used instead of 911 or or 911. And it's about similar to how paramedics are dispatched based after a a risk assessment. The same process is used for folks who are in a mental health emergency. And then and then so these uh some of these programs as as I mentioned have existed for decades and have been doing this work for a long time and there have been no fatalities. Um because of course we want to people who are responding to these situations to be safe. But the research shows that there's um there's um an overestimation about uh how much uh we're jeopardizing the safety of folks who are responding to crisis when you have a wholesome ability to assess that prior to someone responding. Right? So that's how I've answered that question. It's an imperfect science. I know I work in forensic mental health and things like that risk assessment >> and it implies that doctors are able to deescalate or clinicians if somebody shows up believes they the non that that lay people sense legal lay people are able to but Archie has a question >> I'll just before I get to Archie but but so a couple of things So the the question is, are police better equipped to deescalate somebody who may be paranoid, fearful of the police, in a heightened state of agitation? Um, or is somebody who's unarmed and not uniformed, has tons of experience doing this in the community? >> So, so it's it's about not police or nothing. It's about police and something better. Right. >> Okay. I've been involved one way or the other professionally or academically at least involved public homicides particularly for a very long time. Um and in my classes more recently I've been talking about without ulogizing it the UK response which is known as the right care right person uh response uh which means by no means is the police response preferable. But the interesting point that I think is worthy of consideration today is that this is only about three or four years old in the UK that it's become a federalized response. But it was really the London Metropolitan Police by their resistance, you know, to be uh called out for essentially mental health concerns that the paradigm was flipped on a national basis. They just said I think they gave about 60 to 90 days as of the end of the summer. I think it's 2023 approximately. We're just not responding to mental health calls unless there is, you know, a legitimate goodfaith non-stigmatized assessment of a public safety criminal justice response. I I'm surprised actually that there isn't greater police advocacy for just saying we're done here. The UK police said we're not the best people. It's that simple. We're not the right people for most of these crises. But I I don't know why our police services have let themselves be co-opted into the joint response model when they really should be saying crime of face you were divesting from. >> Yeah, I mean it's certainly, you know, um the UK's approach to just stop responding raises questions about folks who are in distress and, you know, and whether or not they're receiving um response that they need. But you're right, the the police in Canada have been complaining about responding to mental health crisis for at least a decade. I attended a conference a decade ago and we were talking about the same stuff and police said, "We're not equipped for this job." Um, but yet they're still going and they're still asking for more money to respond to these calls. They're still asking for increased budgets to wait with people in emergency rooms. So there's um a a um a fiscal benefit for policing in terms of budgets to continue to be involved in these cases instead of saying here's a portion of our budget to give to someone else that's more equipped to handle these calls. Um that would that might be one one possibility but interesting. Yeah, that's that's an interesting uh way of taking leadership of on the issue and something that we haven't seen in Canada, the national leadership on on the issue. In the United States, um the reason that you see so many blips on the map, so many programs developing in the United States is because there was actually federal funding made available to transform crisis response systems in the United States. And many of these programs were a direct product of federal funding coming to communities to create um civilian crisis response programs. Pretty pretty amazing actually. >> Yeah. Over here grant in the United States through JJ they restrict the movement to fully suffer. So even if it's a not a co-responder model, you can't put forward community response without mandated. We're still routing it through. So most of those programs have also been part of noncaral crisis response in Oregon, New York, Massachusetts, and so forth. I'm curious. So the I see this as connected to the movement of transformative justice, which is like much longer. And I think while it's true that Black Lives Matter became public in 2020, that existed obviously for decades ago in 2020. Um so I'm curious right I hear the the concept of social factors but without actually looking at a critique of the state and this settler colonial mindset how do you see this being successful because police are enforcing the interest of the government which is colonizing state creating a mindset of a settler society. So how do you see that actually successfully it's it's doing what it's intended is my point and so >> while we have civilian response teams I hear you naming the social factors that are present without adequately addressing it will still not necessarily like those >> the statistics you have did you aggregate it based on race identity, ethnicity, gender identity, immigration status, disability because those factors obviously as you know change but why not speak to that throughout the entire talk because while it's true for anyone, you mentioned it once throughout the hour talk, it's fundamentally different for black, indigenous, racialized, disabled, immigrants, and also being part of the BC's uh court news death review panel. 95% of the deaths that we reviewed recently, all of the intimate partner homicides, police have touched on every single one of those cases. Not one of the police interactions prevented the intimate partner homicide. And again, disproportionately indigenous women, black women, trans women were murdered by their partners. So when we see these, it's like I don't hear necessarily a war on drugs, the creation of the criminalization of intimate partner violence without actual adequate structures to support it. We're kind of I see in some ways talking around the root issues of the heart of this. Yeah. No, I would agree with you. I have a 14week course that talks about what you're just talking about. So, some of these nuances um are really important um and uh were kind of glanced over in in the the larger kind of arc of the pres presentation. I'd most definitely agree, including some of the nuances about um how community is involved in the development of these these these services themselves and making choices about um things around consent, things about representation, things about, you know, all of that sort of thing. Um so the so I I would agree with you. I don't think I have much much to add to what you said, but those are all important um considerations. The last slide that I showed, I have an I have an entire presentation spent talking about some of the things that you mentioned. And in terms of the survey data, yes, we asked those types of questions around around identity characteristics and looked at how that how that shifts how people responded, which is very important. So all the things you mentioned is uh is critical and important. Um but I don't think I have much more to comment beyond beyond that. Thanks. >> Yeah. >> Um I was wondering on the slide where you had your figure about um groups that people might want to reach out the top five. Um the fifth one for people groups that people were more likely to reach out to were friends and family and only 16% of people said they would reach out to friends and family. Do you know why that figure was so low when you look into it? Is it like stigma access to friends and family or your respondents? >> So no I did not so there was no kind of follow-up qualitative dimension to ask probing wise. So some of those important questions um but but it would likely involve all of those things. So not having supportive family available, not feeling comfortable with family um being involved in in a crisis, being more comfortable with somebody somebody else being involved in a crisis. So unfortunately with this survey, it was quantitative data only and we weren't able to get at well well why which which are important follow-up questions. Yeah. Thanks. Yeah, >> just curious. You were talking about the um the John incident and the search um kind of how they um investigated it um being the homicide, but there were no charges kind of to be faced in that sense um because it was a reasonable level of force in the incident. Knowing the vulnerability of people dealing with mental health crisis, is there any talks, discussion, education for police forces or any level of that to kind of highlight that inherent vulnerability and how I don't know if that's a discussion, but in my logical mind it says, well, maybe it's not reasonable use of force if there's a vulnerability present. Additionally, just curious about that. Yeah, I mean there's been decades of corners and quests, recommendations, pointing to some of the things that you mentioned, training that's developed from those recommendations that attend to some of those things. And then there's legal questions about what you mentioned that have been the center of several several of these cases. So yeah, I think that's been kind of considered and contemplated and and um folks that I knew that know that do training of police certainly consider that kind of question with them. Um we I've come to the kind of conclusion in my own work that we've been trying to train the police for so long. It's important and people need to be doing the work so that police are showing up and um responding appropriately. Um, however, they've got we need to move on [laughter] >> to something different and rather than continuing to sport the status quo, >> reworking things to give people better options other than the police. But yeah, great question. >> Thanks. >> Oh, curious to know with the call for a fatality to just fall into it go anywhere. It sort of seems to be that we need like this is such a heartbreaking example. There were so many instances where it could have not ended this way. Uh that an inquiry of that nature would help to shine an official light on the gaps that exist and hopefully get some of the government on these things. But did the Department of Justice do anything with the the call? >> As far as I know, no. >> Yeah. >> Um uh so I sent a an email, you know. Um uh and I received a lovely reply [laughter] um but as far as you know actually um mo moving forward on it as far as I know it's gone nowhere. >> Yeah. Unfort unfortunately >> what I assume is I Googled it quickly just to see that >> yeah thanks the heartbreaking. >> Absolutely. Yeah. It deserves to be asked. Those questions deserve to be asked and investigated. Um, and it seems so it seems to make so much sense that things have fallen apart and it's likely that it's going to happen again. >> Um, so why not we why don't we take a look at the system and make some recommendations of improving it. >> Thanks. There was a question over here. Well, I think following in that analysis of what Taylor said about like the way ah this is also embedded in um systemic structures and I guess I'm just wondering the map you showed and I don't know what the legend exactly with the different colors meant like I think there was a lot of a lot more orange and red in the US and more yellow and purple I think in Canada. I don't know what those um what they represent but I guess I'm just feeling like a lot of the examples given of these more sort of atomized community-led um initiatives it sounds like which is kind of lovely in a certain way but how like I'm curious about particularly I guess the regional context the efforts to reach that level of systemic change where you know police budgets are being redistributed or at the government level top down changes to who you call and what happens when you do like what's what activities happen. >> Yeah. I mean, a lot of these don't happen without a huge amount of community effort and um that has been um ongoing for numerous numerous years to make those kind of changes, structural changes that you you mentioned. And in many of these communities, there's a window of opportunity where they can do something something new. and whether or not the the um kind of hopes and dreams of the community get embedded within these services is a is another question. So sometimes the community mobilization produces the opportunity that's then used by the state and they construct things in ways that the community ultimately didn't want. um that kind of replicate replicate coercion um but just people wearing different uniforms and don't really speak to kind of like involving folks with lived experience in the table um including diverse voices and how you build these things. Um so there are certainly some examples but a lot of people are expressed concern about the um the uh institutionalization of civilian crisis response and how that kind of takes away from the uh the the grassroots um inertia and and values that ultimately was uh important for for this movement. Yeah. Hope that kind of touches on your >> Yeah. I guess I can absolutely see that as being like critical to um guiding how yeah as authentically it's responding to the local community and who's there. I guess partly just on the resource level of you know because what's really noticeable is partly who shows up for John was a result of who wasn't there to see the hospital who wasn't there to come from the mobile crisis center. And so just having the budget to have as many people available in those capacities as a police system. >> I can tell you in terms of funding, so Halifax is piloting a civilian crisis response program. I can tell you that a lot of the discussions around this program were about the municipality saying that we don't have the money for this and then folks saying, "Well, you're already paying for it through the police. [laughter] You're playing the police to respond to these things." And there hasn't been that next step. Well, if we're we're if these teams are responding to 3 to 5% of police calls, then maybe 3 to 5% of the budget should come come over, you know. Um so there hasn't been that next step. Um it's uh the resources have been a major barrier for for these. Yet at the same time, police budgets are increasing. Yeah. >> You have time for more questions or >> we've got time for maybe a couple more quick questions. Okay. Thank you very much, Dr. Really enjoyed your presentation. You did a great job. Um, something just came to mind for me, and I'm sure this has been logged in, too. Is there a difficulty with the proportion of police available? Like how many more police in a general sense are available versus a trained healthcare worker? When we have psychiatric nurses, social workers, physicians that are able to go out in the community at 3 in the morning. Is that part of the problem that there are more police officers available? >> Um, I think part of it is true. So that the police are the most available, most resourced >> agency that can do this 247. Um the next part in terms of comparisons about the availability of mental health services and supports um is is not something that I'm aware of but I think the the the next step to the question is why is our health care system continuing to maintain this institutional arrangement where they're sitting in hospitals and offices and police are responding to people in the community. So there seems to be um a neglect of our health care system to take care of people's needs when in ways that they they should be. Um and it's not just like psychologists, nurses, social workers that can respond. There's folks doing this work in our nonprofits and our community agencies on a on a daily basis, right? They're working with um uh victims of domestic violence. They're working with folks in shelters. They're working with folks in food banks and and they're deescalating all the time. and and support supporting people. So there's a colossal um sort of resource to draw from beyond the health care system of people that are already doing this work in our community. They just often don't give um get they don't get credit for for for crisis response, right? >> Yeah. >> Thank you. >> Yeah. Thanks. Uh >> just like on the topic we're speaking to >> um at what point do we declare it a public health and it's actually public health's budget not so much the acute care budget of the people in the institution. >> Yeah that's an interesting idea. However, uh you know, the drug poisoning crisis was declared a public health emergency in British Columbia a decade ago and uh look what's kind of come come of that. Not a whole lot of action. Um a lot of people dying and a lot of people turning their backs, you know, um on folks who are really vulnerable to uh the contaminated drug supply. 23 people die a day in Canada then and yet this has kind of been framed as a public health emergency with really few little action and few few resources. So that may be one way of going it but going about it but we have some examples where that hasn't really turned out too too well >> stand up here room monitor but I noticed you had a question go ahead >> hi thanks so much for for your talk it was great to hear you um thinking about the like co-response models that involve healthcare workers specifically I think one of the concerns that like comes to my mind is um like if there are cases where police have you know gained access to health information or like health records um or if there are typically like safeguards in place for those. I know that might be kind of a niche question but I'm just curious if you have heard anything about that. >> No, it's a I don't think it's niche at all. like privacy concerns are huge in this police responding and I receive letters from folks who had their who were had police responding to they were suicidal or they were um in crisis and police responds responds and all of a sudden their information gets somewhere else where it shouldn't be. Their health information gets to um you know border security when they're trying to cross cross a border. Um, so there's huge privacy concerns that I didn't touch on. Um, that's part of the harms of involving um, the police in in health related events. I think you touch on an important point. Yeah. Thanks. >> I'm going to just say last. Yeah. Well, hold your applause. [laughter] Last thing. Uh, that's usually how it's go, but okay. Uh, I do want to thank Professor Livingston, but I also I just want to thank all of you. And I know some people have had to go as, you know, time is ticking on, but I just really appreciate the spirit in the room and the the leaning of the questions, you know, beyond that that slide. You know, I'm fine with all the burning around this very evocative slide. And I just really welcome the um the ways that people are questioning like the sources of those flames around the the edges of the picture there. And so going back to, you know, the the linkages that that Jamie and others in this room do both in academic work and then grassroots work uh to make those links between ableist, you know, structures and police responses and the rest uh to colonialist as well as racist structures. They're working together and of course we're not going to unpick them all in this room like right now, but but bringing those to the surface is part of the the mandate of the Health Justice Institute in these in these community gatherings that we have. And I I just want to Yeah. So Sonia um uh Klein is here who's the uh East Coast prison justice community lead uh advocate responsible for the volunts. And I know there are many others here who I don't know um but are doing all kinds of work sometimes in fairly isolated ways. But I love the the idea that we can get together and and try and share uh you know on a based on the kind of setting of the table that uh Jamie and others do with their academic work. we can share um ideas and and strategies. I want to say one last thing before I close up uh with the thank you because I was brought to mind of of this again around uh you know local investment and divestment and lack of investment. But um so Harry Critley, a wonderful uh former law student here, legal aid lawyer and former co-chair of East Coast Prison Justice, made a made a pitch a few years ago with Dr. Lee again. she's well-known uh substance use medicines doctor uh for a sobering center locally and the municipality did a big study of it and then they finally voted and they agreed to open a sobering center and so that's an alternative for people who are in crisis related to alcohol use an alternative to the drunk tank and so everyone was on board John Howard got the contract um they looked around and you know what what happened to that contract people know what happened to the sobering center idea that everyone yeah it's tanked It's been called off. Why? Because John Howard couldn't get a site for it. There was just no place that they could find for the Sobering Center. What does that mean? There was no place they could find. There was sort of rumors of nimism in the background to that. What does it mean? They didn't have the funds to find a place in a market where right the costs have gone up. They didn't have the funds. And what did they even have as funding to operationalize that program? As I understand it, there wasn't even a health worker that was budgeted on site. It was going to be someone like you see in the shelters, right? Where so I can't, you know, I can't stop this without this particular because I seem to have the power to stop this conversation. I'm not doing it without reminding myself [laughter] of Harry's and others dogged advocacy. These are the right Leah Genge who had worked in a sobering center in Alberta. They brought it all, set the table and and it's petered out in this way that even we like I have to say even we with East Coast we haven't managed to kind of get it together and go absolutely not like absolutely not. Let's do it. Okay. So with that uh and lament for the future, thank you so much Jamie for coming and opening our series this year. [applause] Coming up, it's October 16th, art and abortion utopias. You're going to love this with Emma Campbell from Olter University and Alliance for Choice. And actually the next day here at the law school, October 17th is a dayong conference that Wellness Within is doing and they're going to do what like Zen making and all these kinds of like grassroot activities around this idea of abortion utopia which somehow connects also with resisting solitary confinement. So it'll be great. October.