This article by Akwatu Khenti is part of our series, “Advancing justice,” which explores the relationship between human rights, poverty, racism, and the criminal justice system.

Resounding calls for reform in policing have prompted urgent consideration of alternative law enforcement models. Centring social justice as a key component in the effective delivery of public safety has long required a reimagining of modern policing. Such reimagining is now driven by a sense of urgency. Widespread, problematic trends such as disproportionate violence by police in their interactions with racialized citizens, particularly those from Indigenous and Black communities, are policy priorities in municipalities across the country. The intersections of race with homelessness and with mental health and substance abuse challenges are widely perceived as symptomatic of entrenched, systemic bias within Canadian policing.

Though police reform has long been deemed necessary to address inherent structural issues, police forces and governments have largely circumvented any meaningful accountability to bring about the required changes. Indeed, police budgets have been impervious to change efforts despite decades long decline in crime. The growing consensus is that substantive solutions will entail looking beyond the police.

Community-led health and safety initiatives, rooted in principles of public health, have been increasingly acknowledged as innovative strategies that can optimize public safety. Such approaches aim to shift resources from traditional stakeholders for criminal justice (e.g., law enforcement and corrections) to community partners who can identify local public safety priorities and offer critical services in these areas of need. These approaches effectively reject narrow conceptualizations of public safety defined largely by crime rates and, instead, look to a broader set of indicators of social policy issues that increase risk factors such as secondary school graduation rates, employment rates, and health statistics.

Mobile, community-based crisis programs are one strategy to reduce violent outcomes seen in policing. These programs are staffed by non-police first responders who can attend to non-violent crises in the community where they use their de-escalation training to provide immediate stabilization. In mid-2021 the City of Toronto approved non-crisis response teams for non-emergency, non-violent mental health calls. These teams, scheduled for piloting in 2022, will include crisis workers with training in mental health and de-escalation, who will respond to such calls instead of police. A Toronto model may well emerge from the collaborative process of development and implementation currently taking place.

An exemplary model of community-based public safety strategy that should inform all contemporary efforts is CAHOOTS (Crisis Assistance Helping Out on the Streets). This 24-hour mobile crisis service offers a non-police alternative within the emergency responses systems of Eugene and Springfield, Oregon. Although the service runs parallel to the police service and is dispatched by 911 operators, the staff are not trained by law enforcement, do not possess any legal authority, do not carry weapons, or share a database with the police service. Rather, CAHOOTS staff employ interventions guided by trauma-informed crisis management and harm reduction approaches to address homelessness and addictions and mental health crises, in addition to non-emergency medical issues.

CAHOOTS typically responds to calls to manage conflicts, conduct wellness checks, provide transportation, offer public assistance, mitigate suicidality, and address intoxication and other substance abuse related issues. In 2019, approximately 20 per cent of 911 calls were dispatched to CAHOOTS, and police support was requested for less than 1 per cent of those calls.

Canadian cities looking for a way to restore confidence in public safety and emergency response approaches have taken a keen interest in the Oregon model. While some cities have already implemented mobile mental health programs, limitations in the delivery of those services have created access barriers and resource challenges that have limited the effectiveness of these programs.

A close examination of the Oregon model highlights key features that have optimized the alignment of non-police and police resources. Taken together, the following considerations outline a template for the successful dissemination and implementation of similar services:

1. Conduct an environmental scan that can guide program planning and decision-making.

Every community will be different. The precise replication of the CAHOOTS program in another community does not guarantee success. Communities considering their own alternative model will need to evaluate local population demographics, social outcomes indicators, health data, and the distribution of emergency response service demands to tailor the program to local needs.

2. Ensure civilian management of the mobile response program.

The mobile crisis intervention program should not be run by law enforcement nor associated with the legal authority of police. The program should represent an alternative to police action at policy, administrative, and operational levels. This approach will support efforts to gain the confidence of marginalized populations who are at increased risk for negative outcomes in response to standard policing policies, particular members of communities who are disproportionately affected by police violence (e.g., Indigenous and Black communities), as well as individuals experiencing mental health and addictions crises, and the unsheltered.

3. Dedicated funding and capacity building is needed.

Mobile crisis teams are a cost-effective delivery strategy that reduces costs to psychiatric emergency services and the criminal justice system. From a customer service perspective, these services are responsive to humanitarian concerns of the public and a welcome diversion tool for first responders and are therefore well-received. Reallocation of funds from stable police budgets to mobile crisis teams and associated community, mental health, and social services (e.g., shelters and mental health providers) could sustain a reliable alternative to police interventions. A long-term commitment will promote systemic change informed by longitudinal analysis of evidence-based outcomes based on a comprehensive set of indicators. The capacity of communities to sustain a non-police response will also need ongoing attention and support. Key relationships with the community and a sense of reliability of this alternate method of intervention will have to be nurtured and sustained.

4. A working relationship with the police service is essential.

Regardless of the positioning of the mobile crisis team in relation to the emergency services infrastructure, a strategy for real-time collaboration on the frontlines is crucial (e.g., ensuring continuity of care at points of transfer). Situations may involve threats of imminent harm to oneself or others, and police may be called upon to stabilize the environment. Similarly, police may request assistance for circumstances that are best addressed by someone who can adeptly navigate community services. All responders must grow to trust their partners. Including detractors in program planning is crucial to crafting sustainable partnerships.

5. Mobile response staff need to be dispatched from central emergency response call centre by staff trained to identify non-violent situations.

Calls that do not involve a crime are triaged to the mobile crisis intervention team. Appropriate calls typically cover the following crises:

• individuals who are intoxicated or under the influence of a controlled substance;
• individuals who need immediate care or treatment of mental illness;
• individuals who require shelter; and
• individuals who require non-urgent medical attention including prescription refills.

Urgent calls are prioritized for dispatch. For example, a person actively threatening suicide would be tended to before a person who needs transport to a shelter.

6. Prioritize independent dispatch of mobile crisis intervention teams.

While many cities have mobile crisis units that co-respond with police officers or can be called upon by police officers, few are self-sufficient. The independent dispatch of alternative first responders minimizes inefficiencies that stem from models that dispatch police officers to all crisis intervention calls. Default responding by police is problematic in that the mere arrival of police on the scene can escalate someone in crisis, reducing the chance that the care they require will be received, and increases the likelihood they will be subject to punitive (i.e., arrest and custody) or restrictive measures (e.g., inpatient hospitalization).

7. Commit to in-house training in crisis management and de-escalation.

Though mobile crisis team staff typically possess health care certifications upon recruitment (e.g., nursing, social work, and paramedic), they are also required to complete intensive field training before they can operate autonomously with the model of a two-person team that is typically staffed by a medic and behavioural specialist. Post-training, they are also expected to participate in a mentorship process during their course of their tenure with the team, which focuses on promoting self-care and minimizing burnout.

8. Availability of services needs to be uninterrupted.

Ideally, mobile crisis intervention teams should be operational 24 hours per day, 7 days per week. The greater the level of availability, the sooner the program will become an established point of access for the services offered via the mobile crisis intervention team.

9. Scale up the number of mobile teams to service the population.

Communities have become over reliant on police to respond to social issues. Strengthening the responsivity of social services may assist in circumventing tragic and preventable outcomes. Scaling up the number of teams to the right size for the population will help to ensure that people in crisis are being seen by the right people at the time they need assistance.

10. Collaborate with a wide variety of partners to meet local needs.

Mobile crisis intervention programs would be further bolstered by a network of services that suit the needs of their clientele. This will likely require partnerships with organizations that can offer a network of services ranging from case management to addictions treatment to short-term, inpatient psychiatric stays. All will have to be provided in spaces that are both culturally and racially safe.

Conclusion

Among Indigenous and Black communities in Canada, there is a crisis of faith in public institutions. Belief in the social contract is collapsing, exposing a racial reality that is difficult to deny – unequal power relations that are embedded in historic racialization of social order. Mistrust of the medical system and COVID-19 vaccines are a contemporary expression of racialized histories and experiences. This is particularly true of the relationship between the police and Indigenous and Black communities in Canada.

Public silence about intractable racial disparities is no longer a neutral position. Opening access to potential avenues for change is a contemporary necessity. One potential avenue for change is the adoption of alternatives such as the CAHOOTS model. Toronto’s pilot initiative is a potent beacon of hope in this regard and should serve to guide provincial and municipal efforts to reconstruct public policy to address social and economic rights through an anti-racist lens, while at the same time promoting public safety. Fingers crossed!

References

• Global News: Mental health emergency response service based on noted Oregon model could come to Toronto
• White Bird Clinic: What is CAHOOTS?
• CNN: This town of 170,000 replaced some cops with medics and mental health workers. It’s worked for over 30 years
• The San Diego Union-Tribune: Defunding police to build stronger social services in communities
• Toronto Star: Toronto approved non-police crisis response teams. This woman is trying to build them
• City of Toronto: City Council consideration on February 2, 2021 – Community Crisis Support Service Pilot

Advancing justice podcast: Interview with Akwatu Khenti

For the transcript of the conversation, visit the podcast page.