The "Équipe de soutien aux urgences psychosociales", (Support Team for Psychosocial Emergencies, or STPE) is composed of police officers from the Service de police de la Ville de Montréal (SPVM) and social workers from the Jeanne-Mance Health and Social Services Centre (HSSC) who patrol in mixed teams and intervene directly on the front line with people who are in a crisis situation or suffering from mental illness. The team has been on call seven nights a week, 365 days a year since June 6, 2012, and is dispatched by the SPVM's emergency call dispatch centre or is simply called by police officers who are on service calls that involve individuals overcome by mental health problems. The support team's mission is to promote multidisciplinary collaboration and to support police work with interventions for people in a crisis or mental health situation, in order to improve access for these individuals to services, whether they be legal services, or health and community support services. In fact, the STPE allows for the better evaluation of situations encountered during police involvement with these individuals once the sites are secure. The team adapts the response so that these individuals receive the necessary support for their situation. Having an officer and a social service worker present allows for these two intervenors to fulfill the roles associated with their respective missions, based on each situation.
This initiative has several objectives:
Innovation and operational practice process development service
Community groups: consultative involvement.Agence de la santé et des services sociaux [Montreal health and social services agency (MHSSA)]: direct involvement.
The STPE has been in place since June 2012.
The mobile multidisciplinary team has for many years been identified as a promising avenue with regard to individuals in a crisis or mental health situation. The opportunity, however, was not always present for these teams to be developed. The desire shared by the SPVM and the MHSSA to create these teams in the field came from a situational analysis and the needs of both organizations for assistance in responding to these situations appropriately. There was a need to improve police response, particularly in helping to guide individuals quickly to the services that would be most beneficial to them. On the side of social services and health, the teams meet the need of providing access quickly to clientele that are in a crisis and would otherwise not have been directed to aid services. This is listed in their responsibility to the public for reaching out to these individuals and offering them services that are adapted to their situation.
The costs associated with this initiative are associated with three police officers being assigned to the team, as well as physical resources and necessary materials (office, telephones, marked vehicle, etc.).
The project is a component of several other SPVM initiatives relating to police interventions with individuals in a crisis or mental health situation. The maintenance and expansion of the team is dependent on identified needs and available financial resources.
The STPE was created with a dynamic of continuous improvement of practices. However, the project sets itself apart, since it has improved police practices by reconciling mandates and very different approaches, directly on the front line, with team members participating in mixed patrols. More specifically, with regard to mental health, the STPE is improving the ability of police officers to help individuals who are in crisis situations or mentally distressed, and respects the rights of individuals, within the framework of social and health services, to consent or refuse help, including treatments, outside of emergency situations, even if care needs are apparent. In fact, the pairing of a social worker and a police officer, directly on the front line at police intervention sites, promotes more beneficial resolutions for individuals who are mentally distressed, since these resolutions will increasingly be based on the situation and the person's state. More specifically, during interventions, the members of the STPE share tasks based on their respective expertise:
The STPE is the result of a desire shared between the SPVM, the MHSSA and the Jeanne-Mance HSSC to improve their practices by improving their collaboration through the creation of mixed mobile teams on the front line. In fact, its main advantage appears to be to respond more efficiently to an operational reality that never stops calling upon patrol officers, while remaining within a public safety mandate. This efficiency is particularly due to the fact that this team has the expertise to better understand the problems of mentally disturbed individuals, to allow for a better evaluation of the situation, to facilitate establishing contact with this individual and to decide on the most appropriate option under the circumstances (e.g., referral, transport, etc.).
The project's first beneficiaries are definitely the people with whom the team members intervene. The police intervention to which they are subject is more adapted to the situation and to their health condition. Citizens also benefit from the STPE, since the police intervention allows the SPVM to fulfill its main duty even better, which is to ensure the public's safety and quality of life, maintaining order and ensuring public peace. In fact, the team's objectives help to better frame the responsibility of police officers to act, and allow for particular intervention methods with these individuals, in order to obtain the expected results, while ensuring the safety of the whole public. There are numerous other benefits from involving the STPE in this field, in addition to those that are common with the project's other involved partners. Firstly, the work of frontline patrol officers is better supported, since members of the STPE often play an advisory role with them. This then stimulates the development of new practices so that police interventions are better adapted to the needs of individuals in a crisis or mental health situation. Finally, let us highlight that because the project came from a close partnership between the SPVM and the Jeanne-Mance HSSC, the work of the STPE has even led to the creation of a multitude of other collaborations between health network and social service partners, beyond this initial partnership. In fact, one of the objectives of the STPE is to promote and complement police service interventions with health network and social service partners who intervene with individuals in a crisis or mental health situation, and strengthen the numerous links between partners who assist these individuals. These numerous partnerships are as much institutional as they are community-based.
Follow-up indicators are gathered manually for each of the interventions of the Support Team for Psychosocial Emergencies. They provide the SPVM with information on the reasons for events, the involved individuals, their mental and physical conditions and the resolution of interventions. Information is also gathered on the time and place of events. For example, we know that over the last 18 months, the Support Team for Psychosocial Emergencies has performed 2,091 interventions. To this number we can add all other interventions that the team has done informally. Of these interventions:
With ESUP, several obstacles to cooperation have been eliminated. Its work has had an impact on service continuity between the public safety and health sectors. Situations are now being documented better and shared between the authorities involved (e.g., from the police to social and health services, from health services to the courts, etc.). This is being done entirely within the legal boundaries for sharing personal information and respects the rights of the people involved in interventions. This enhanced sharing has been made possible with a lot of the reticence that once existed in such collaborations having dissipated and everyone now better understanding how everyone else's work can be completed. In fact, greater mutual trust has developed given the proximity of the partners and everyone now works in developing a common understanding of the problems being encountered. This avoids having the same intervention occur over and over with the same individual. By improving the continuum of services for people in crisis or who are mentally disturbed, there is not only a drop in the number of interventions that result in visits to emergency departments, but there is also a drop in the total number of such interventions since they are better adapted to the situation and there is better follow-up, making the cost per intervention more affordable.