Who should respond to Hamilton’s mental health crises, and how?

The man is laying face down on the ground, writhing around, fighting against four police officers on top of him.

Why are you doing this?" he pleads. Ouch."

One of the four male officers struggling to handcuff him says: We're trying to help you."

A few moments later: You're going to hospital ... if the doctor says you're OK you can leave."

This is part of an incident that happened March 13 on a downtown street, in which a man was apprehended under the Mental Health Act (MHA) and driven to hospital in the back of a police cruiser. A video of the event, captured by concerned witnesses and viewed by The Spectator, is upsetting.

It also speaks to Ontario's complicated, imperfect system for responding to people with mental health crises - a problem that is only growing, particularly this past year amid the COVID-19 pandemic.

For police, responding to crisis calls and detaining people under the MHA is a common part of the job.

For observers, including those who advocate to defund the police, this type of incident only raises further questions about what role - if any - police should play in mental health response. Indeed, it is because of concerns around police conduct that the witnesses said they stopped to watch what happened that day.

Hamilton police report the number of calls for a person in crisis - which includes calls related to mental health - jumped 14.5 per cent in Hamilton in 2020 over 2019. Meanwhile, mental health calls made up 7.7 per cent, or roughly 6,700, of the 86,867 calls for service in Hamilton last year, but police say the true number is higher because calls are often initially reported as a something else.

At one point last Thursday, March 18, for instance, police had 14 cruisers at St. Joseph's Hospital for people in crisis. This included half of the 18 vehicles on the road for the Mountain division.

There have been similar spikes in demand for mental health services across the country.

We would rather not be the first responders in these situations," said Hamilton police Supt. Treena MacSween, but it is a fact that right now it is part of police work to respond to these calls.

Many, but not all, are resolved peacefully, police said.

Under Section 17 of Ontario's Mental Health Act only police officers can apprehend someone who appears to be a danger to themselves or others and bring them to hospital.

If police don't respond quickly to a person in crisis, the fear is the situation could get worse, MacSween said.

I understand the public's concern with regards to cuffing someone who is obviously having a mental health episode, but the quicker we're able to do that, after trying to de-escalate, and get that person to hospital, the quicker they're going to get that assistance they need," she said.

When an image from the video surfaced on Twitter, MacSween said police reviewed the incident and found it was handled well by the officers based on the circumstances." There was never a formal complaint.

Two witnesses who spoke with The Spectator said they didn't want to post the video online because they do not have the consent of the man. Both spoke on the condition of anonymity, over fear of reprisal from police or their work.

The man and woman were driving downtown when they saw a man on Hunter Street West, between MacNab and James streets around 5:30 p.m. March 13. He was standing on the sidewalk, with four police officers around him and a lane of traffic blocked. He looked distressed; they rolled down the window and the man in the car asked if he was OK.

No," he said.

So they circled the block, parked and walked down. She stood back and recorded, while the man got a little closer to observe. She spoke with a woman, who appeared to be a family member, who said the man was mentally ill.

They watched as a police offered him a cigarette, but wouldn't let him walk away to smoke it. He wasn't shouting or threatening, but was clearly upset and didn't want police near him. The officers closed in slowly, then quickly grounded him. They handcuffed him, and after a couple minutes they brought him to a police cruiser where he fought being put in the back seat.

In the video, an officer can be heard yelling for him to stop kicking. Then there is movement both witnesses said included an officer punching the man twice in the face. It is these punches of an already handcuffed man that the man who witnessed the arrest said he found the most concerning.

MacSween said the officer's notes reference empty hand techniques" - which include punches - to gain control. Punches are part of use of force training, where officers are trained to use the minimal force necessary."

Neither witness saw what led up to the encounter, but both were upset by what they saw.

They (the police) saw someone who they thought needed help and their version of help is pushing someone to the ground," the woman said.

She believed the police behaviour escalated the situation. Why was he handcuffed and forced into the back of a cruiser?

However, police say it is necessary to protect a person in crisis from hurting themselves or others. All people detained are handcuffed, but police may remove the cuffs in hospital if the person is calm.

In this case police received a 911 call about an unwanted guest near the YMCA, said MacSween. Family provided police with information that the man was mentally ill. When the officers arrived on scene the man immediately fled into traffic.

Police said the officers had to jump out of their vehicles to stop him from endangering himself or others.

Officers spent nearly half an hour trying to de-escalate" the situation by talking to the man. He was combative" with officers and paranoid, MacSween said.

They apprehended the man only once it was clear de-escalation wasn't working, she said. He was taken to hospital and not charged criminally.

One of the four officers who responded has gone through crisis intervention training. Nearly half of Hamilton officers - 440 - have gone through this training with the goal to have all front-line officers trained.

It's not clear why the mobile crisis rapid response unit (MCRRT) didn't respond. The partnership between police and St. Joseph's Healthcare Hamilton pairs a specially trained officer with a mental health worker to respond to crisis calls. There are three teams that work around the clock. However, with high demand the unit isn't available to respond to every call.

For non-emergency calls there is COAST, which also includes a police officer. COAST also runs a 24-7 crisis line.

Could this call have ended differently had MCRRT been available? Possibly.

Historically about 75 per cent of calls for a person in crisis lead to a person being apprehended by police under the MHA. But the five-year average of MCRRT shows just 17.2 per cent of people in crisis ended up apprehended.

In part, that's because the mental health care worker on scene can assess a person and perhaps direct them to another - non-emergency - health-care service, MacSween said.

However, even with MCRRT, patients who are detained are handcuffed and brought to hospital in a police vehicle.

Flaws in the system

It's not a perfect system," said Holly Raymond, clinical director of general psychiatry and addiction service at St. Joe's, adding that she too feels upset to see someone in crisis detained. Her work includes overseeing the mental health workers in MCRRT, COAST and the psychiatric emergency department.

Mental health experts know that it can be traumatizing for patients, particularly those who may already have had bad experiences with policing, she said. Being in a hospital can also be traumatizing. However, it comes down to safety for the person in crisis, people in the community, police and health-care workers.

That is a large part of the reason why we don't just send two mental health workers," she said, adding that you never really know what the situation will be.

Once in hospital, police and, if it's MCRRT, a mental health worker stays with the person until they are seen.

All patients get a psychiatric assessment, sometimes medication can be started right away or they might see a social worker too. Between 30 and 40 per cent of patients are admitted to hospital; the rest are released usually with plans to access outpatient services. Every patient has a suicide risk assessment and a safety plan for going home.

Early in the pandemic there was a drop in patients accessing services. Now demand has spiked.

More troubling is that because many people delayed getting help, the patients coming now tend to be sicker, Raymond said. And many have other health-care needs, including an alarming rise in opioid addiction and overdoses.

There is a significant push in the community to try to shift more focus and funding away from police, to place more emphasis on prevention and social development.

Hamilton police say they want to be at the table and collaborate on programs like MCRRT. Deputy Chief Frank Bergen said they're looking at how to resource those community responses that may keep people out of hospital.

Multiagency collaboration, we believe that's the only way we can deal with homelessness, harm reduction, poverty and mental illness," he said.

Nicole O'Reilly is a Hamilton-based reporter covering crime and justice for The Spectator. Reach her via email: noreilly@thespec.com