Creating a space for safety and support

September 3, 2023
Toronto Community Crisis Service (TCCS), launched in mid-July 2022, is a pilot program that is creating space and safety between the police response to those in mental health crisis and the often-retraumatizing hospitalization or incarceration.
Archana L., manager, and Matthew C., clinical lead, of Toronto Community Crisis Service (TCCS) – Northwest spoke with us about the program on the anniversary of its first year of operation. This conversation has been edited for length and clarity.

Tell us about the Toronto Community Crisis Service – how did it start?

Archana (AL):  The Toronto Community Crisis Service was created from City of Toronto's police reform initiative and is intentional about reducing the harm, especially for people of colour, Indigenous people, people from the queer community, and other marginalized people.

A lot of the work we do is around system change and allowing all Torontonians to feel safe.

People experiencing a mental health or addiction issue are not criminals and it shouldn't be a police matter.

CMHA Toronto is working with community partners to pilot this approach in four areas of the city where there are higher call volumes for crisis calls to police, or areas that are considered a ‘desert’ with fewer mental health and addiction supports.

The TCCS pilot program operates in four areas of the City of Toronto, delivered by CMHA Toronto and community partners.

How would you describe the program’s approach?

AL: The program is trauma-informed, consent- and harm reduction-based, and fully transparent.

We encounter a lot of people that have trauma from the system, from colonization, from the oppressions that exist in our society. There's a lot of mistrust. Our program works to build relationships and trust with the community.

How do you engage people and begin that process of trust-building?

AL: We're always transparent about who we are: we say upfront we're not the police, we're mental health workers. We wear identifying clothing that says we're from Toronto Community Crisis Service. Our clothing is green, our vehicles have our logo on it.

We take a friendly approach. We don’t ask ‘what's your diagnosis’ or ‘are you're experiencing delusions right now’? We're trauma-informed and we use the language that people are using with us. We’re mindful of how people identify.

TCCS is clearly differentiated from police or other emergency services.

MC: We're not taking an authoritative approach. Police officers may be hovering over you while you're sitting on a sidewalk in an emotional state, whereas our team is sitting down on the sidewalk with you and having a conversation. We try to humanize and normalize that experience of crisis.
We recognize that [the person in crisis] is human and that this is a really natural human response to crisis. This is a normal response when things have gone awry.

How is your approach different from the police or paramedic response?

AL: We recognize that people are in crisis for many different reasons. When we think about poverty, or people who are homeless, people facing various barriers and oppressions, they're often in crisis because of their life circumstances. Without targeted support to address the root causes, they're going to be stuck in a revolving door of crisis.
We're trying to put a foot in that revolving door of crisis, and help people get to the root of the issue.

A unique aspect of this program is that we connect people to short-term case management once they’ve met with our crisis team, connecting them to the resources and supports they need so that there can be improvements for them, and so that things can get better.

It is consent-based so some people say ‘no, I'm not interested’, even though we might feel that they could really benefit. We respect their autonomy.

We carry engagement tools with us. So, if someone is homeless, we might give them a tent. If someone is living out in the cold or the heat on a hot day, we’ll give them food or water. Sometimes our support is just that, saying, ‘hey, it looks like you might need this.’

People might refuse crisis support but they're willing to take those sorts of things from us.

We also check in on people. For example, if someone refused our service but they're open to a check-in by the team, we might visit them every day and provide supplies to them. We build relationships that way.

For example, we had a client who was living in a park, refusing our services. We visited them about 19 times; it took us almost a month to build that relationship until they were finally willing to work with our team, agree to case management and to getting the support that they needed.

How is the team configured and how does it reflect the communities you serve?

AL: We’ve hired people who are representative of the community, they look like the community. We have a multidisciplinary team with many peer workers and people with lived experience. They self-identify that way when they arrive on scene. Team members are able to say ‘I've been here, it might not be the same situation you've been in but I can share my story and what's worked for me’, and this fosters hope and resiliency with people.

MC: For me, I’ve had mental health issues in my life and I also identify as queer. I notice when I'm on calls, especially with queer people, I'm able to connect to them so much quicker. I can understand the language they're using and what they're saying. I’m more sensitive to their life experience.

How do you train crisis workers to be sensitive to the nuances of different client identities?

AL: We’ve set ourselves up so that our Indigenous crisis worker supports the team with an Indigenous perspective. He's been doing a lot of teachings and cultural activities with the staff so that they get that perspective. Addiction workers are doing a lot of addiction training with staff and mental health workers are focusing on mental health aspects, and so on.

The team works within that multidisciplinary environment and can rely on each other. If our Indigenous worker is not available to be sent on the call, the crisis worker can call him and get that perspective. Or, there could be a learning opportunity once that call is over to talk as a team and learn from that call and from each other's perspectives.

We've fostered a culture at TCCS that we're all here to learn and this learning is ongoing.

TCCS operates independently of police, but it still needs to collaborate with them. Tell us about how the collaboration with police works.

MC: Even though we're trying to make system change, we're working within a system. So there are times that we respond to calls and we have police there.

We don't want people with mental health issues or those in crisis to be stereotyped or labeled as violent because we know that the vast majority of the time that's not the case.

But the person might be really unwell and their safety is in question, so there are going to be times where we have to collaborate with the police.

A goal for us, in the long vision of the program, is to remove police completely from the equation.

Over the last year it's been kind of an experiment where we've been learning how to work with police as best as possible, even though we may not necessarily want to be on calls with them just due to the nature of the service and its goals.

The good thing is that, even when police are there, we're able to have eyes on what's happening and advocate for the client to reduce that harm when police are present. We're able to hopefully divert the situation away from hospital or an apprehension or an arrest. These are the things that we're trying to avoid when we're providing care.

What kind of education or training have you done with Toronto Police Services?

MC: We've done a lot of work to help them identify mental health or addiction-related calls and to build that trust with them so they can call us and know we will handle it.
Our system never really had a non-police option to mental health crises and police became the de facto response. But they were just simply not the right response.

The City of Toronto has been very intentional saying we're kind of building the fourth emergency service (the other three being police, fire, and paramedics). They’re saying that this is the future and asking themselves why police were even there in the first place.

We're part of that journey right now, trying to figure out what it should look like and thinking longer-term, how to expand city-wide.

AL: We get calls directly from police where they recognize this is actually a mental health call, and it's more appropriate for TCCS.

The reality is there are going to be times where police are on the call, and we don't want to get polarized with them. We want to do what's best for the client in front of us. And to be able to support the client in the best possible way, all parties need to be on board. 

In many ways it’s no fault of their own; they have limited resources, they're not mental health workers, they’re police officers – that’s the training they have received. We're freeing up so much time for them. This allows them to do the work that they were meant to do. In any given year Toronto Police Services receives about 33,000 mental health calls. If we can take even some of those calls away from them, it frees up a lot of time.

Can you give us a sense of the case numbers and the time involved?

MC: System-wide we’re getting close to having done about 9,000 calls – and we're not across all of Toronto yet. One thing to recognize about those calls is how much time they take. Our longest call was probably a whole shift, 12 hours. If you look at the staff hours dedicated to the work that we're doing, we’re looking at thousands upon thousands of hours.

This is extremely beneficial to police. What typically happens with these calls is that police are not equipped to deal with the situation and so their automatic response is to apprehend the person and bring them to hospital. Now, they’re in hospital for six, seven hours, not able to respond to other critical situations happening in the community.

A lot of our education has been to underline that the hospital is not always the best solution; in fact, it's actually the last resort.
One very telling statistic, published by the City of Toronto at the six-month mark of the pilot, shows that TCCS is presenting to hospital approximately eight percent of the time compared to police taking people to hospital between 60 and 70 percent of the time.

So it's not just the police resources that you're freeing up, it's also the hospital resources, not to mention that it's probably a better solution for the client.

AL: Yes, exactly. Many people who die from suicide have visited a hospital in the last month. Often hospitals are so under-resourced themselves that they're just putting people back into the community without any support.

Our service does not leave these people unsupported. We're able to keep them safe, and then connect them with the supports that they need to move in a different direction.

What are some of the other challenges you are facing?

MC: Homelessness is a big issue. We don't have housing. There are so many situations we encounter where we feel like we don't have the resources to best support the person because the situation demands so much more than what we can do.

But sometimes, it's just the simple things. Clients will say, ‘even though you weren't able to get me into a shelter today, thanks for coming, I appreciate you being here versus the police’.

That is an important impact: the client didn't have to interact with police and risk a potential and unnecessary escalation. Just by us being there, that risk is reduced.

What are your proudest accomplishments, having done this work for a year?

MC: In a year, we've accomplished so much more than just the crisis response. We’ve trained and prepared the team to do something that's really unprecedented. There's really not another model that exists like this – there are models of crisis teams where they respond with police, but in this model we are a separate entity. So creating what we've done in the last year from scratch in this unprecedented territory has been huge.

Also, the amount of engagement has been huge: going to police stations, going to the paramedic stations, going to malls, going to community organizations. Getting the word out while building a service that hasn't existed before.

AL: We have such a strong leadership team. As Matthew said, rolling out this program in a year is a big accomplishment. We've worked long hours, lost hair – I've gotten grey hair! – but it’s so meaningful; we’re both so passionate about this project. I'm proud of where we're at and how much our crisis workers have grown in the last year, personally and professionally.

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