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Summary
When people in Toronto most commonly subjected to police use of force in crisis situations took to the streets, they marked a turning point. People with lived experience (in dealing with mental health issues), Black, and Indigenous peoples demanded and with sustained effort, obtained a halt to conventional policing. Alongside the City of Toronto, these communities developed the Toronto Community Crisis Service, a programme inclusive and reflective of the population it serves. This crisis service –now permanent after a successful pilot stage– set itself apart from traditional mental health approaches in that it is consent-based, non-coercive and rights-respecting. Seen as a huge success, it has since been expanded and can afford important advice on building a crisis service that doesn’t further victimize and stigmatize people with lived experience (PWLE). Rather it gives them tools to survive and thrive.
Taking traditional policing out of mental health care
Across most of Canada, social services have failed to keep pace with a growing population and its needs. There is an inadequate supply of affordable housing, of disability and other income supports, and of community services and mental health services that people want to use. But police budgets have grown. As a result, when a person is in crisis, 1A note about terminology. The term “person in crisis” is broadly used in Canada, and has been defined as follows: a member of the public whose behaviour brings them into contact with police either because of an apparent need for urgent care within the mental health system or because they are otherwise experiencing a mental or emotional crisis involving behaviour that is sufficiently erratic, threatening or dangerous that the police are called in order to protect the person or those around them. The term “person in crisis” includes those who are mentally ill and people who would be described by police as “emotionally disturbed”. (https://www.ciddd.ca/documents/phasetwo/police_encounters_with_people_in_crisis.pdf) there is often one service with the resources to respond rapidly all day, every day – the police.
The result is a significant over-policing of this community. Many of these calls are resolved peacefully, with no apprehension. But if an interaction escalates, police can use force, including lethal force. The statistics on police use of force in Toronto clearly demonstrate these trends. In 2022 the Toronto Police Service (TPS) attended over 33,000 mental health calls for service – an increase of nearly 50% since 2014.2https://data.torontopolice.on.ca/pages/persons-in-crisis. Although these calls relate to 3.5% of the TPS’s annual calls for service, use of force is much more common in these calls: more than one in ten incidents of police use of force involve a person in crisis.3https://torontops.maps.arcgis.com/home/item.html?id=2f2ca5f1780b48b182293157f04eb64e Police use of force is even more likely if the person experiencing the crisis is Black or Indigenous.4https://www.scribd.com/document/578462243/Toronto-police-report-on-systemic-racism-in-officer-use-of-force-and-strip-searches
More than one in ten incidents of police use of force involve a person in crisis. Police use of force is even more likely if the person experiencing the crisis is Black or Indigenous.
History of police reform in Toronto
Communities – in particular racialized communities and people who have had personal experience of crisis, often referred to as people with lived experience (PWLE)5More broadly, people labelled with mental health issues at some point might identify as psychiatric survivors, service users, Mad, mentally ill, experts in experience, people with lived experience (PWLE) and so on. In this article we primarily adopt the term “persons with lived experience” or “PWLE”, which is used most in Canada at this point. However, when describing a particular event when people have self-identified with another term, we adopt that self-identifier. – have been calling attention to disproportionate policing and police killings for decades.
In Ontario, many of these early efforts resulted in various types of police reform. Community protests and grass-roots advocacy regarding police killings in the 1960s, 70s and 80s, for example, eventually led to the development of province-wide quasi-independent and independent police oversight regimes.6 https://www.siu.on.ca/pdfs/report_of_the_independent_police_oversight_review.pdf
In the 1990s the Queen Street Patients Council, a peer advocacy organization for PWLE, began requesting standing inquests into police-involved deaths. For many years, inquests’ recommendations had focused on using different types of force on PWLE – whether in or outside the mental health system or through a focus on “less lethal” police use of force. With greater input from PWLE, inquest recommendations expanded to include urging the adoption of a non-medical, consensual and community-based crisis service in Toronto.
The TPS were somewhat responsive to these inquest recommendations, although the changes they adopted often diverged significantly from what the PWLE community had intended.
In 2000, for example, the TPS and some Toronto-based hospitals partnered to create Mobile Crisis Intervention Teams (MCITs). Each MCIT brings together a front-line police officer and a mental health nurse, who act as “secondary responders” to calls for service involving mental health issues.7For a fuller review of the history of reform initiatives in this area please see https://www.ciddd.ca/documents/phasetwo/police_encounters_with_people_in_crisis.pdf. As secondary responders, the teams were only dispatched once police officers had arrived and evaluated the situation.
Before hospital-based MCITs were launched in Toronto, the Queen Street Patients Council organized a focus group to discuss what sort of help people wanted when in crisis. A peer consultant was hired to survey people about their needs when or if crises happened. The consensus among PWLE was that they wanted and needed a community-based, non-medical, non-coercive crisis service. The MCIT met none of those criteria. Despite this fact, the police and hospital nurse co-response model has continued to expand. This expansion was often supported by well-meaning community members who were not PWLE, drowning out the voices of people directly affected by the nature of the crisis response that was on offer.
Over the past two decades, the TPS have also increased the level of training they provide in de-escalating crises, although the degree of community involvement and community confidence in the programme has varied over time.
Governance transparency and accountability has also been on the agenda. In 2009 the Toronto Police Services Board (TPSB), the body that provides policy oversight and general civilian governance for the TPS, established a Mental Health Sub-Committee8This was established as a result of an inquest recommendation by the Empowerment Council, of which the QSPC was a forerunner. to increase dialogue with PWLE and broader mental health stakeholders and the police.9This enduring structure to address police treatment of people in crisis was formed as a result of an inquest recommendation made by the Empowerment Council, descendant of the Queen Street Patients Council. It was co-chaired by the Chair of the TPSB and a mental health peer advocate, and its membership included representatives from mental health organizations, organizations of people with lived experience, and TPS representatives.
Development and implementation of Toronto’s Community Crisis Support Service
The focus on increased training and partnerships between police and the healthcare system remained relatively entrenched until the summer of 2020 when thousands of people took to Toronto’s streets to protest anti-Black racism in policing and demand drastic cuts to the police budget.
The protests prompted responses at all levels of government, including within the TPS, at the TPSB and at Toronto City Council. Toronto’s mayor put forward a report proposing, among other things, the development of alternative service-delivery models for community safety response.10https://www.toronto.ca/legdocs/mmis/2020/cc/bgrd/backgroundfile-148277.pdf. At this time the peer advocate Chair of Mental Health and Addictions Advisory Panel (MHAAP) was able to prevent the TPSB from requesting more money from the city to expand MCIT in favour of more resources being available to support the development of a community-based model.
City staff began work to develop an alternative, non-police-led community safety response for calls involving individuals in crisis. Extensive community consultations were held. In January 2021, the resulting report recommended that Toronto undertake a pilot project establishing a community-based team of crisis workers to respond to “non-emergency calls involving persons in crisis, wellness checks and other calls to be determined”.11https://www.toronto.ca/legdocs/mmis/2021/ex/bgrd/backgroundfile-160016.pdf The report anticipated that the pilot would operate in four regions of the city and that one of the initiatives would be Indigenous-led and focus on Indigenous callers. Services were also to involve the Black community. All services would be made available through a non-police line that individuals could phone, as well as calls being diverted from the police and emergency services call centre. Finally, staff proposed that community organizations be given new funding to expand crisis-prevention and post-crisis-intervention support and activities. The report proposed that existing community health service organizations would act as the “anchor partners” leading the delivery of the crisis response service.
Community reaction to the staff report was mixed.
The Empowerment Council (EC) pointed out that while the report rightfully focused on Indigenous and Black communities, other groups were simply referenced as other “equity-deserving communities”. The effective erasure of the community of PWLE and the peer organizations representing this community was identified as a discriminatory act. It was argued that all considerations of crisis options needed to involve PWLE who would be 100% of its recipients and to operate according to the principles of empowerment, respect for human rights, trauma-informed care and harm reduction. What was needed were community-based, non-coercive services, accountable to and inclusive of the people they existed to serve. It was emphasized that providing mental health services unaccountable to the people they served would simply recreate the existing system, that not only used force extensively, but also used it with a racial bias.
What was needed were community-based, non-coercive services, accountable to and inclusive of the people they existed to serve.
More broadly, while there was strong civil society support for the expansion of non-police crisis response focused on mental health, there was concern about the limited geographic scope of the programme and its ability to displace police activity: 911 response and dispatch remained in police control, and it was unclear which calls would be diverted from the police to the civilian crisis response. It was also not the substantial diversion of funds from the police budget that community advocates had hoped for. The total amount of money dedicated to the pilot project – which was projected to be CAD 7.9 million in 2022 – was not funded by diverting money from the police and represented just a fraction of Toronto’s annual policing budget, which is over CAD 1 billion per year.
Community Crisis Support Service pilots
City Council approved the pilot project in February 2021,12http://app.toronto.ca/tmmis/viewAgendaItemHistory.do?item=2021.EX20.1 and Toronto’s Community Crisis Support Service (Later branded Toronto Community Crisis Service or TCCS) Pilots were launched in 2022.13https://www.toronto.ca/legdocs/mmis/2022/ex/bgrd/backgroundfile-175060.pdf
The pilots ran in four distinct areas of the city with a different community partner providing services in each region. Despite the diversity of service-delivery organizations, the four pilots shared a number of core features. Each pilot had a mobile, multidisciplinary team of crisis support specialists who are available to respond to calls within their catchment area twenty-four hours a day, seven days a week. Teams consist of non-police community crisis workers who bring various types of training, work and lived expertise to the services. Peer workers were integrated and paid equally within the teams.14This is a positive step as it is quite common in traditional mental health services in Canada for peer workers to be in a job category that is paid less, and they have less say in outcomes than other workers on a team. Workers also reflect the communities most impacted by policing – such as Black, Indigenous 2SLGBTQ+,152SLGBTQ+ is an acronym that stands for two-spirit, lesbian, gay, bisexual, transgender, queer or questioning and additional sexual orientations and gender identities. Two-spirit is a term used within some Indigenous cultures and for some Indigenous people, meaning a person with both a feminine and a masculine spirit living in the same body. This is often used to describe sexual orientation, gender identity or spiritual identity, either in combination or on their own. and PWLE. All are trained in areas such as crisis management, de-escalation, advanced first aid and overdose response. All the pilots also have follow-up support that was offered (when desired)e within two days of the initial contact.
TCCS teams could be reached by calling either the traditional emergency number – 911 – or 211, which is a pre-existing phone line that is intended to help people find local community and social services. If a call came in through 911 the dispatcher made the initial decision about whether to offer the TCCS to the caller. 911 calls had met the following criteria before they were transferred by police to 211:
- The call was a non-emergency and presented no public safety concerns;
- The call was within the prescribed pilot area;
- The call fell within the prescribed call types eligible for a TCCS response (threatened suicide, person in crisis, wellbeing check, disorderly behaviour, disputes);
- There was a behavioural or mental health element to the call that would benefit from a TCCS response; and
- The caller consented to a mobile crisis team being dispatched.
In its pilot launch of Toronto Community Crisis Services, TCCS received 6,827 calls for service, with 2.2% resulting in a request for police attendance, and 8% leading to a visit to a hospital Emergency Department. Post-crisis follow up interactions took place for 2, 936 people. An Indigenous specific crisis response line was initiated that received 459 calls in the first year. Frontline officers requested the Toronto Community Crisis Service attendance at 406 events.
While the majority of calls diverted from the general emergency number were in the first year, the numbers were shifting toward more direct contact to the services as time went on. Calls to 911 about mental health crises had previously been initiated primarily by people other than the person in crisis, but TCCS callers were typically the person who wanted the support themselves. After the first year, Toronto City Council voted to deliver the service city wide by the end of 2024, with a fully staffed and developed Fourth Emergency Service in 2026. Integration efforts have been progressing with Police, Fire, and Ambulance services.
Preliminary reflections
The TCCS programme is one of a growing number of civilian-only mobile crisis response programmes that exist around the world that have been developed or expanded as alternatives to police response. It is too soon to determine whether Toronto’s programme will be successful in achieving its stated objectives of saving lives and diverting crisis calls from a police-led response to one centred on choice, empowerment and wellness. The reflections offered below focus on the process in Toronto to date and some of the key policy choices that were made in the development of Toronto’s programme.
The importance of process: community direction, consultation and engagement
Not all of the recommendations from communities have been incorporated into the pilot projects. Nevertheless, it would not be possible to have a successful, accessible, accountable service without meaningful, early and ongoing community engagement – and in particular the intentional inclusion of PWLE throughout the process.
From the outset, Toronto community groups and residents have been highly engaged in the elaboration of the pilot project. The initial impetus for TCCS came from the advocacy groundwork of PWLE and most emphatically the hundreds of thousands of people who marched in the streets and wrote to their elected representatives demanding concrete alternatives to policing. Community organizations and local leaders, in particular, communities of Black, Indigenous and PWLE that face disproportionate police use of force, were vocal about the need to be involved, from the ground up, in any and all proposed solutions.
In Toronto, city officials prioritized outreach and engagement throughout the policy-development and pilot project deployment phases, with a particular focus on engaging with PWLE who use substances, those experiencing homelessness, and Indigenous, Black, racialized and 2SLGBTQ+ communities 16For a summary of community engagement see https://www.toronto.ca/legdocs/mmis/2021/ex/bgrd/backgroundfile-160016.pdf.
To ensure the ongoing flow of community feedback each pilot site has its own Community Advisory Table composed of PWLE, family members, caregivers and support networks. Representatives from each local table sit on the overarching City-Wide Pilot Community Advisory Table. This Table also includes senior leadership from the City of Toronto, the TPS and the community partners who are providing the crisis response services.
Degree of peer support and involvement
One of the primary recommendations from peer and other community-based organizations was the need to have a peer-centred crisis response model. A peer-only model was not recommended initially in consideration of the need for capacity to be thoughtfully developed to be successful, but the values supported by PWLE of empowerment, self-determination and respect for rights are integral to the projects, as is equitable peer inclusion throughout the crisis services’ staff and governance. A goal with considerable support from PWLE is for the city to expand and develop entirely peer-run support options – such as peer respite centres – as an integral part of the crisis response in Toronto. Ontario was once a world leader in its support for extensive peer-led organizations, but support diminished as governments changed, and many were subsumed into traditional mental health services.
Internationally there are few examples of entirely peer-run crisis response options. People USA is a peer-run mental health organization based in New York.17 https://people-usa.org/about/ It creates, provides and promotes its own crisis response and wellness services, all of which are developed and operated by people who have personally overcome mental health issues, addiction or trauma. People USA offers a mobile crisis team available by phone 24/7, which can also be requested directly by the police or courts, with a response team composed only of civilians with lived experience.18https://people-usa.org/mobile-crisis-response-team/ It also provides peer-run respite centres, crisis stabilization centres, and jail diversion teams. None of the community service-delivery partners selected in Toronto are entirely peer-run. All the partner organizations, however, have recognized the key role that peer workers must play in supporting individuals in crisis.
Interface with the police
The immediate impetus for Toronto’s pilot project was widespread community outrage at deaths and serious injuries during police interactions with Black and Indigenous communities. The extent to which the TCCS will prevent serious injuries and deaths, however, is dependent on its ability to intervene before a serious safety crisis and therefore prevent the need for police involvement, or more directly respond to and successfully manage crisis calls that police would have otherwise attended.
In Toronto, 911 calls are received and triaged within the police service. For the pilot project to achieve its goals, therefore, it is essential that as many 911 calls as possible are diverted from police to the 211 system, which can dispatch the civilian crisis teams. The ability of people to avoid contact with police services altogether and call services directly will be enhanced when the project expands and is therefore able to be publicised city-wide.
There are reasons to question the extent to which Toronto’s civilian response service will displace police use of force. Toronto’s criteria for transferring a call from 911 are relatively restrictive, and include requirements that it be a “non-emergency” with “no public safety concerns”. Many of the people in crisis who have died during police encounters, however, would not have satisfied these criteria. Often, when 911 is called by a family member or bystander, the person is perceived by others as threatening or a potential assailant. These are the very situations in which de-escalation is most required. If the TCCS teams are restricted to only the lowest-risk situations, they may be unable to displace police in situations where force, including deadly force, is most likely to be used.
The fact that police have played an increasing role in responding to individuals in crisis speaks to a broader issue – perceiving societal crises of homelessness and poverty, racism and other traumas as safety concerns that could require the use of force.
Providing support beyond crisis response
The fact that police have played an increasing role in responding to individuals in crisis speaks to a broader issue – perceiving societal crises of homelessness and poverty, racism and other traumas as safety concerns that could require the use of force. These unaddressed needs are often at the root of what is characterised as mental health problems more generally. Crisis services will have little lasting impact if there are no adequate means of support for people to survive and thrive. Toronto’s pilot programme has recognized the importance of follow-up care, and some money has been allocated to enable community organizations to expand crisis-prevention and post-crisis-intervention support and activities. Ultimately, however, addressing the broader issues driving crises is a responsibility that is shared between multiple levels of government and requires substantial resource investment. Crisis teams enabling people to live another day can at best create an opportunity for a better life, they cannot provide it alone.
Endnotes
Contributors
Jennifer Chambers is the founder and Executive Director of the Empowerment Council, Systemic Advocates in Additions and Mental Health, a peer advocacy organization in Toronto, Canada. She is a member of the Mental Health and Addictions Advisory Panel and Anti Racism Advisory Panel to the Toronto Police Services Board. She has been a witness at inquests, tribunals and other proceedings addressing police-related deaths of people in crisis. She is on the City Wide Advisory for the Toronto Community Crisis Services.
Abby Deshman is a lawyer at St. Lawrence Barristers PC. Abby maintains a broad civil litigation practice and has particular expertise in public and constitutional law, media and defamation, privacy and online harassment, and systemic legal challenges involving policing, prisons and the criminal legal system. Before that, she was the Criminal Justice Program Director for the Canadian Civil Liberties Association (CCLA), overseeing the organization’s litigation and systemic advocacy in relation to policing, the criminal legal system, prisons and community supervision.
Illustrations by Kathryn Boyd via femiñetas
Kathryn is a Toronto, Canada-based multimedia artist, mindful art facilitator, avid reader and wellness enthusiast, as well as an outspoken queer activist. As an artist, her mission is to create meaningful, impactful art that finds its way to the right individuals, offering lightness, understanding, love and courage to those who need it.
As a yoga and meditation teacher, Kathryn fuses breathwork and intuition into both artistic practice and her workshops. She firmly believes that art has a powerful ability to heal and connect us with our true selves.
At the tender age of nine, Kathryn’s life was forever altered by the heartbreaking loss of her mother to cancer. As a child, she struggled to cope with the enormity of this loss, lacking the necessary tools to navigate such profound grief. Amid this tumultuous period, she discovered solace in art. Over time, she has come to recognize art as a profound tool for self-reflection and introspection, providing her with a means to explore innermost thoughts and emotions, and ultimately fostering a deeper understanding of oneself.
femiñetas: feminism in vignettes. Femiñetas is an illustrated and transoceanic collective and media. It comprises some 300 illustrators and writers from different parts of the world who form a story-telling community in the language of comics.
Flor Coll is the coordinator and founder of @feminetas. She is a journalist and Social Communication graduate from Universidad Nacional de Rosario (Argentina) and holds a Master’s in Gender and Communication from the Autonomous University of Barcelona (Spain). After working for more than 15 years as a journalist in Argentinian radio, TV and print media, she currently carries out gender and sexuality campaigns for the NGO Sexus and teaches at the Master’s in Communication and Gender at the Barcelona Open University in Spain (UAB). She co-created Chamana Comunicación, a consultancy firm based in Barcelona where she is the director of communication and capacity building.
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