A 28-year-old Toronto woman went to the doctor to get help. She ended up in the back of a police car, being driven to a psychiatric facility against her will.
It was June 2014 and the woman had gone to her family health team because she had an adverse reaction to her antipsychotic medication and was feeling anxious. When she revealed she was having thoughts about hurting herself, someone at the health team called the police.
The woman had a history of mental health issues. Two years earlier, officers in another GTA city had handcuffed her to a hospital bed after she took an overdose of pills during a suicide attempt. Afraid of going through a similar ordeal, this time when the police showed up, she went into shock.
“I was so seriously … psychologically and emotionally disregulated that I couldn’t fully take in what was happening to me,” recalled the woman, who the Star has agreed not to name because of the stigma experienced by people with mental illness.
The first hospital the police took her to was full, so they drove her to a different facility she had been to before, and where she believed she had been mistreated. She told the officers she didn’t want to go there, but they told her she had no choice.
“I was incredibly distraught,” she said.
According to new statistics released by the police, the number of people apprehended by police under Ontario’s Mental Health Act in Toronto has increased dramatically in recent years, which experts and advocates say is a troubling sign the mental health system is failing badly to meet demand.
They argue that supports for people facing mental health challenges have become so inaccessible that potentially treatable conditions are going unaddressed until they become full-blown crises, and somebody calls the cops.
“At some level it shows a failure of the system,” said David Gratzer, a psychiatrist and co-chief of the general adult psychiatry and health systems division at the Centre for Addiction and Mental Health. He said the mental health system has historically been underfunded, and has only become more stretched during COVID-19.
“People are becoming very ill in the community, when they could have been helped before they ended up being picked up by the police,” he said.
Under Ontario’s Mental Health Act, police are empowered to apprehend anyone they believe is suffering from a mental disorder and who poses a danger to themselves or others, and take them for an evaluation.
But both police and mental health experts agree that so-called “apprehensions” aren’t an ideal way to respond to people in crisis. They can be traumatic and even dangerous for the vulnerable person involved. They also eat up police resources, and the Toronto Police Service (TPS) acknowledges trained crisis workers are better equipped than their officers to ensure those in distress get proper support.
In the 28-year-old woman’s case, she says she initially stabilized after police took her to the hospital.
But the woman, who is transgender, said she was misdiagnosed and misgendered by staff, and after about two days in the hospital she became agitated. She barricaded herself in her room and tried to cut her wrists, first with plastic cutlery, then with a screw that had come loose from a piece of furniture. Staff had to break open the door.
She was discharged, but in the months that followed her mental health deteriorated. She was using drugs and alcohol heavily, and estimates she tried to kill herself 10 times before she got effective treatment.
“In an ideal world I would have sought out mental health supports (sooner) but I didn’t, out of fear of being apprehended again,” she said.
She’s now doing better. She says she got sober in 2015 and had done a lot of work in therapy. She has a prominent job and owns a home. But she still has scars from that day eight years ago.
“I’m just very lucky that I’m still alive, quite frankly,” she said.
According to the TPS statistics, the force conducted more than 13,300 apprehensions in 2021. That was about 81 per cent more than in 2014, when there were about 7,400. The increase was particularly pronounced in 2021, the second year of the pandemic, when apprehensions shot up by almost 14 per cent year-over-year. The numbers only include apprehensions of adults, and would be higher if subjects under 18 years old were included.
In a statement, TPS Staff Supt. Randy Carter said the rise in apprehensions is “reflective of increased demand.” According to TPS, mental health calls to police rose by 59 per cent between 2014 and 2021, to more than 35,300 last year.
Carter asserted that an apprehension “is only used as a last resort,” and the force only conducts one “when it is necessary to protect the safety of the individual or the public.” He added that all officers receive trauma-informed mental health training, and are taught how to de-escalate interactions with people in crisis.
TPS says it has been working with the city and other partners to develop alternative responses to mental health calls. This month the service announced it was extending the 911 diversion pilot project it launched last year, under which police operators transfer some low-risk mental health calls to the Gerstein Crisis Centre. The force says in its first year the program successfully diverted 610 calls.
Since 2000, TPS has operated Mobile Crisis Intervention Teams, which pair a mental-health professional with a specially trained police officer to respond to people in mental distress. And earlier this year the force cooperated in the city’s introduction of a pilot of Community Crisis Support Service teams, a pioneering service that dispatches nurses and mental health support workers, instead of officers, to some 911 calls.
However, police officers remain the primary response for any calls deemed to have the potential to turn violent. Carter said the new initiatives will have to be assessed to determine whether they decrease apprehensions.
Last month it was police, rather than crisis workers, who were dispatched to the 16th-floor apartment on Finch Avenue where Taresh Bobby Ramroop’s family lived, after TPS said it received calls of someone throwing objects from the building. Ramroop, whose family says was severely depressed, fell to his death. The province’s police watchdog is investigating.
Butterfly Gopaul, a resident member of Jane Finch Action Against Poverty, said incidents like Ramroop’s death are proof “police shouldn’t be responding to folks that are in mental health crisis at any point.”
“The police have a history of causing harm to community members,” particularly in Black and racialized neighbourhoods, she said, and their very presence can heighten tensions with someone in mental crisis.
“They’ve never been able to de-escalate situations, nor are they remotely trained (to be able to do so),” she said.
TPS said it could not immediately provide figures about how many people are injured during attempted apprehensions. But even when subjects aren’t physically hurt, there’s evidence apprehensions can do long-term harm.
A recent study published in the Canadian Journal of Psychiatry about the rise in involuntary psychiatric hospitalizations in British Columbia reported that apprehensions are “often traumatic experiences that generate distrust” in police and the mental health system, and people who endure them may be discouraged from seeking out care in the future. That makes it more likely they’ll go untreated.
“We see that outcomes are better when people voluntarily access services,” said William Small, assistant professor in faculty of health sciences at Simon Fraser University and one of the study’s authors.
In some cases, what constitutes voluntary and involuntary health care may not be as clear as the general public assumes. While popular debates contrast police use of force to supposedly softer approaches like interventions from crisis workers, Jennifer Chambers, executive director of the Empowerment Council, a Toronto non-profit, said it’s important to remember “the mental health system also uses force.”
Involuntary seclusion as well as physical and chemical restraints are common features of the mental system regardless of police involvement, she said, and the application of those measures are affected by the same racial and other biases that influence policing.
Like Small, Chambers argued “the remedy is to have decent funding for consent-based” treatment that people can access before their conditions escalate, and they’re forced into involuntary treatment.
According to the Ontario chapter of the Canadian Mental Health Association, only about three per cent of the province’s $355-billion health spending since 2016 has gone toward community mental health and addiction programs. That’s despite the fact that mental health and addiction accounts for between 11 and 15 per cent of Ontario’s disease burden, according to the Centre for Addictions and Mental Health. Meanwhile, at $1.3 billion, the TPS is the largest single line item in the city of Toronto’s budget.
At current funding levels it can take months for people living in Toronto just to see a therapist, while those with more complex mental health needs have to wait between five to seven years for permanent supportive housing, according to the Access Point referral service.
Chambers said the shortage of services like supportive housing means people with mental health challenges have to stay in hospitals longer because there’s no safe place for them to be discharged. That forces hospitals to turn away others seeking treatment.
“The whole system is constantly dealing with all these bottlenecks that result in more and more crises,” she said.
With files from Alyshah Hasham, Jennifer Pagliaro, and Nadine Yousif.
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