CMHA Toronto’s pilot program, Toronto Community Crisis Service (TCCS), is working in four areas of Toronto to address mental health crises among vulnerable populations where a police response is inappropriate and sometimes dangerous for the person in crisis.
The diverse and representative TCCS team offers in-the-moment support for immediate crises and, even more importantly, a comprehensive client-centred approach that focuses on the social determinants of health and harm reduction. Archana Lingendran, Manager – TCCS Northwest, explains that TCCS tries to “put a foot in that revolving door of crisis, and help people get to the root of the issue” for those who are often in crisis because of their life circumstances. This typically means extending case management services and other supports.
The goals and benefits of this approach to responding to mental health crises are many, as these case examples show.
1. A co-ordinated, client-centred response can help prevent future crisis and retraumatization
Situation: An individual struggling with multiple mental health problems, who had supports in place but then lost them, presented with acute and persistent suicidal ideations which involved Toronto Police Services (TPS) multiple times over the prior six months.
Response: TCCS responded with empathy, appreciating the client’s cultural identity and religious beliefs. The team validated the client’s frustrations, provided emotional support and psycho-social education on coping strategies, and worked with the client to develop a safety plan. Rapid access to case management diverted the need for hospitalization.
The client mentioned that, after many calls with police and the City of Toronto’s mobile crisis intervention team (MCIT), this was the first time someone listened to her and was able to provide tangible support, and that she had “hope for tomorrow.”
Reflection: Police officers mentioned how grateful they were that TCCS was able to connect the client so quickly with case management resources as they had previously only been able to make “soft referrals.” TCCS reported that “it became abundantly clear that our work, although at times band-aids and gauze, can throw its foot in the revolving door to prevent cyclical oppression. The team was able to focus on the client and their unique needs and collaboratively plan and instill hope for a future where recovery is possible.”
2. Inclusion and belonging – social determinants of health – are facilitated by connecting clients with community social supports
Situation: A mother called about her 28-year-old child believed to be under the influence of alcohol. She was concerned about their safety due to previous behaviours and interactions with police.
Response: TCCS de-escalated the dispute and learned, when speaking with the client, about their struggle with addiction and feelings of guilt because of their dependence on their family’s support. The client shared that they would like to speak to a priest so TCCS took the client to church where members of the church community arranged for a priest to be available. The client’s church community provided validation, crisis support, and spiritual support.
Reflection: Providing a safe, non-judgemental space for the client and their spiritual community gave the client comfort and prompted positive action. This led the client to share their desire attend church more often and potentially attend an Alcoholic Anonymous meeting. The client also learned that they could call TCCS themselves.
3. Trauma-informed crisis workers with common culture and lived experiences can recognize and respond to the unique needs and circumstances of Indigenous clients
Situation (1): Shelter workers called TCCS for help with a resident who was seen singing, dancing, and crying on the roof of the shelter. Afterwards, the client locked herself in her room and did not want to communicate with shelter staff.
Response: The TCCS team visited the client and the Indigenous specialist on the call recognized that the client was speaking Oji-Cree. Speaking with her in her native language, the client shared with the TCCS Indigenous specialist her grief about the death of one of her children and the loss of another who was placed in care by children’s services. She also revealed a history of domestic violence. The client said she had no thoughts of suicide but wanted to express her pain and loneliness in her own language and give her pain to the Creator. She said that she felt closer and more connected to the Creator by being on the roof.
The TCCS crisis worker shared lived experiences, recognizing the intergenerational trauma that the client had suffered, and offering culturally appropriate, compassionate validation and care.
Reflection: Shelter staff thought the client was showing suicidal ideation by being on the roof. The Indigenous crisis worker was able to share with shelter staff a broader understanding of the client’s behaviours while also working with the client to gain her agreement not to break shelter policies by going on the roof. TCCS was able to refer the client to case management and help her find Indigenous services within the community.
Situation (2): A client, who self-identified as a member of the Mohawk Nation, was distressed and upset, having suicidal thoughts, and running through the halls of the LOFT community building where they lived. Police, Toronto Housing Special Constables, and LOFT staff were already on scene with the client.
Response: TCCS connected with the client, who was in significant distress and feeling ashamed about crying. TCCS’s Indigenous worker provided crisis support and validation incorporating the Seven Grandfather teachings and the Medicine Wheel and helped to diffuse the client’s suicidal ideations. The TCCS Indigenous worker reassured the client that they were safe, and that it was okay to show tears. They shared that crying is not a form of weakness but should be seen as bravery, strength and resiliency, and that – because water is life – tears are prayers to the Creator. Tears are also a way to release stress and reduce cortisol levels, which is healthy.
TCCS connected the client with case management for employment supports. The client wanted to know more about their Indigenous ancestry, to see an Elder, and to take part in a men’s healing circle regularly, all of which the TCCS Indigenous worker was able to act as a liaison to support.
Reflection: The Indigenous specialist’s shared culture and lived experiences facilitated a deeper connection with the client and made a broader range of supports available. TCCS is also able to work collaboratively with LOFT community housing workers to make these resources available to this client and others.
4. By working collaboratively with police and other emergency services, TCCS can reduce the potential of apprehension, incarceration, and routing to hospital emergency departments – a safer, more effective option for clients
Situation: Officers on scene of a woman who was suicidal called for a TCCS team response because they realized the client needed more support than they could provide.
Response: TCCS identified that the client’s current living situation with her extended family was worsening her emotional state. They helped secure a temporary safe bed that night for her.
Reflection: This call was a great example of collaboration between TPS and TCCS. TPS understood how vulnerable this client was, and how a hospital response was not beneficial in the longer term because of the stress the client was in due to her current living situation. TPS stayed for the TCCS assessment not at the urging of the team but rather to support TCCS as the team completed the intervention. The TCCS team was very appreciative of this support as they were able to safely assess without interruption from extended family.
Situation (2): A client had been hospitalized for mental health issues and, upon his release, had returned to his mother’s home which was a breach of his probation (the client had committed a prior offense against his mother). The client’s probation officer called 911 because the mother and her son were in their office; the son in crisis having just learned that he could not live with his mother.
Response: When TCCS arrived, they found the client outside of the probation office, experiencing some psychotic symptoms and smoking cannabis. TCCS contacted the probation officer for background information and offered the client some water and food. TCCS educated the client about the breach to his probation and offered some alternatives for living arrangements. The client agreed to go to Covenant House, with which he was familiar, and TCCS accompanied him there. TCCS also offered the option of shelter at Safe Bed.
MCIT and TPS completed their own assessment, finding that the TCCS plan was sound, and the client agreed to move to Safe Bed. Police transported the client to Safe Bed and TCCS crisis workers contacted the client’s mother to explain the service. They retrieved the client’s belongings and medication and took them to Safe Bed. The client requested his ID so that he could pursue employment and was connected with a case manager for follow up.
Reflection: TCCS was able to gain the co-operation of the police, the probation officer, and the client’s family member to organize alternate living arrangements for the client and provide follow-up services to set him on a more constructive path, avoiding the much more likely outcome of re-incarceration.
5. When hospital support is needed, TCCS can advocate for and provide a client-centred, holistic level of care for clients and their loved ones
Situation: A caller requested support for her mother, who was experiencing auditory and visual hallucinations, was not eating, and tried to run away. When the TCCS team arrived on scene, TPS, MCIT, and paramedics (EMS) were standing around the client outside the home.
Response: The TCCS team assessed the situation and provided crisis support. The client’s daughter explained that her mother had previously experienced similar episodes and been hospitalized. The TCCS team, gaining agreement from TPS, MCIT and EMS and with the client’s consent, provided safe transportation to the hospital’s emergency department, advocating for the client from triage to admission. The TCCS team also provided support and case management services to the client’s daughter, who appreciated the validation from TCCS about the toll these situations can take on the family.
Reflection: TCCS was able to assess the situation and come up with a safety plan that allowed police, MCIT, and paramedics to be freed up from time-consuming attendance at the emergency department. The TCCS team’s ability to advocate for the client in the emergency department, remain with her throughout the intake process, and provide ongoing and additional case management for the client and their family is a distinguishing aspect of the service.
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