Jack Knox: How teams, with police on board, wrestle with crises on Victoria streets

Slice of reality: Psychiatrists, social workers, addiction-recovery workers, registered nurses and others work to help the vulnerable and the volatile

Jack Knox mugshot genericHere, while the spotlight shines on the way police deal with mental illness on the streets, is a slice of the existing reality.

Seven people are huddled around a table, poring over a list of almost 80 names.

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The names belong to people whose severe mental illness is often compounded by substance use.

The seven belong to one of Victoria’s ACT teams, the people — psychiatrists, psychiatric nurses, social workers, nurse practitioners, police, registered nurses, addiction-recovery workers, mental-health workers, probation officers — tasked with keeping those vulnerable, sometimes volatile, clients on the rails.

They have begun this Monday morning by gathering to talk about how each of the clients is doing, and what kind of help they’ll need — everything from medication delivery to transportation to appointments, to solutions to incipient crises. As the team works through the list, it’s evident that they know their clients well and genuinely care about them. Reports of individual progress earn quiet cheers. Shoulders slump at news of setbacks.

Among those reporting in is Sue Hamilton, one of three VicPD officers assigned to the city’s four ACT — that’s Assertive Community Treatment — teams and their 340 clients. The three are copied on all police reports involving those clients. On a typical weekend, that might mean 15 to 20 reports.

Among last weekend’s files:

• A homeless man was reported to have passed out drunk in the parking lot of a residential building, but in fact had simply fallen asleep there after several days of drug use.

• A man who suffered a brain injury has punched a convenience-store worker in the face after being caught stealing chocolate bars. After Hamilton gives a heads up to Crown counsel, the man will likely be diverted to integrated court, where there’s more of a focus on applying supportive, individually tailored conditions than there is on punishment.

• Another guy came onto police radar twice, the first time after an elderly woman in a car was heard crying for help as a man walked away. It turns out she was his grandmother, who both feared for him and said she was sick of him taking advantage of her. Police were called again the next night when the man trashed her apartment, where he had been living. He ended up in the 900-block of Pandora, which drew grimaces around the ACT table, though one team member suggested that no longer being welcome in his grandmother’s apartment might make him more willing to move into supportive housing.

Some critics really don’t like including cops on the ACT teams, which are part of Island Health. A pair of UVic studies found that while, on balance, police presence is beneficial, detractors fear it stigmatizes mental illness, unfairly linking it with criminality.

It’s true that the officers aren’t needed for most interactions with clients, many of whom distrust the police. Still, removing the officers would backfire, says one of the team’s most-experienced members. “It’s frighteningly naïve for the general public to think that it’s appropriate to defund and remove police from a team such as ours,” she says. “There’s no understanding of the kind of support they give us in terms of being able to do our jobs properly.”

Without the safety net provided by the ACT officers, there are certain clients, those with a higher propensity for violence and criminality, that the team simply couldn’t take on, she says. The presence of Hamilton and the others allows ACT to cast a wider net in offering supports such as access to housing, psychiatric help, help managing medication or money, and medical care.

As if to emphasize the point, one of the team members at the morning meeting mentioned that she had seen a client carrying a knife, but she didn’t feel comfortable trying to get him to surrender it when she was alone. Could Hamilton go with her?

Yes, she could, though when Hamilton did so, it wasn’t as a badge-flashing, intimidating presence. She never wears a uniform. Getting physical with clients is extremely rare.

Instead, interactions with the potential for violence tend to be what Hamilton describes as a dance whose movements come from knowing people as individuals, knowing what sets them off, what makes them more secure, when to back off, when to press a little. Building trust and developing one-one-relationships is key. (On two different occasions recently, clients came to her after being sexually assaulted while substance-impaired.)

Hamilton’s day consists of a series of stops, most of them downtown, that often involve heading off trouble before it begins. There’s a man whose meth use exacerbates his psychosis, and another who has gotten into a squabble with a fellow tenant at a supportive-housing building on Johnson Street.

The next call was to watch a man swallow his medication. When he doesn’t do so, his mental stability deteriorates and, historically, he can become violent. He has been cheating recently, and Hamilton and ACT staff were needed to ensure he complies.

It’s when people go off their meds that they are most at risk of being brought back to hospital under the Mental Health Act, a frightening prospect for people who, already in a bad state, might lash out. There’s less chance of that happening if the cop apprehending them — only police have the legal authority to do so — is familiar.

“It’s all about relationships,” says Holly Craig. As the ACT teams’ outreach probation officer — the one who monitors clients to ensure they’re adhering to court orders — she is often accompanied by Hamilton. Occasionally that’s for safety, but more often it’s about opening doors that might otherwise remain closed. “Clients don’t see Sue as the ACT cop, they see her as Sue.”

They also have a different relationship with Craig than they would with regular probation officers. It’s why she likes to meet them in their homes, where they’re more at ease. “You just really get a good sense of their mental health when they trust you.”

ACT clients are among Victoria’s most vulnerable residents. “Our clients are not always the offenders. They’re often the victims.” It’s all part of being in a therapeutic alliance where the focus is on support.

OK, but not all justice-system interactions happen within the ACT bubble. The ACT teams are about being proactive, managing clients’ illness to prevent problems from arising, or de-escalating them when they do. Uniformed patrol officers are more likely to get involved when things have gone sideways, when someone calls 911.

And no, it’s not always easy to separate police emergencies from mental-health emergencies, or to resolve them with textbook solutions. Real life is messier than that. The capital region has a specialized unit — the Integrated Mobile Crisis Response Team, made up of mental-health clinicians, plainclothes police, social workers and nurses — that can lend expertise in such situations, but it is only available from 1 p.m. until midnight. After that, patrol officers are on their own.

Overall, there simply aren’t enough resources to meet demand. There are far more people in desperate need of care than the 340 clients the four ACT teams have the capacity to serve. “I would say we need another five teams at least,” Hamilton says.

Those who don’t fall under the ACT umbrella often end up in the revolving door that spins them from shelter to prison to the hospital. Some just wander the streets for years, invisible and undetected because they don’t do anything to catch the attention of the authorities. At the other extreme, some are deemed too violent for ACT to deal with.

Even when ACT is involved, there are limits. “It’s the lack of drug treatment facilities,” Hamilton says. “To get them into treatment when they are ready for it is almost impossible.”

And even if clients do get into treatment — which usually means a trip to a facility in Burnaby — there’s little appropriate second-stage supportive housing available when they get out. They end up in the same old social-housing projects, where it’s all too easy to get sucked back into their old lives.

All this comes as the streets get rougher. Hamilton, who has been with VicPD for 27 years and ACT for close to six, says the past two or three years have seen a noticeable change. She has seen a rise in the number of substance users who are more volatile, have shorter fuses and exhibit more violent behaviour.

Overdose deaths get a lot of attention, deservedly, but the less-reported crisis has to do with the way crystal meth and other drugs are changing what’s going on inside users’ heads, damaging them long term. “It’s escalating year after year. It’s impacting their brains.”

These are the things that, as we look for solutions elsewhere, are going on in our own backyard.

jknox@timescolonist.com

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