top of page
Paramedic with patient

Background: Crisis Care Context

For people experiencing a crisis or mental health emergency in the community, the response they receive and their options for support and care profoundly affect their immediate wellbeing [1-3] and future interactions with mental health supports [4]. In Ontario, current responses to crisis or mental health emergencies may involve 9-1-1 dispatchers, paramedic services, police services, hospital emergency department (ED) services, and a variety of other community services that differ by region and population.[2,5-7] As demand for emergency mental health care increases, concerns are growing for the substantial, and potentially life altering consequences of these responses both in Canada and internationally [2,8-11]. 

 

Within the Ontario context, in 2020, the deaths of two people, Regis Korchinski-Paquet and Ejaz Choudry, each during mental health crises, stimulated increased calls for a change in response to mental health crisis. Within Toronto, these events contributed to the piloting and ultimately development of the Toronto Community Crisis Service [12]. Many current responses to mental health crisis throughout the province however, consistently fail to adequately meet the needs of individuals experiencing a mental health crisis, leaving people with unmet needs, a lack of connection to appropriate supports, and lacking follow-up care [2,8-11,13].

Police interacting with public

Challenges with crisis responses include: paramedics and police often lack adequate training to address mental health emergencies [2, 14], hospital EDs frequently serve as the only available destination from which to seek support or continuing care [2,7,14], and gaps exist in community-based mental health care intended to provide ongoing care and support [14-16], among others. Paramedics and police, while available 24/7 for rapid response may have a different approach for meeting community needs than community-based organizations and differ in both level of training and organizational mandate. Many people experience repeated interactions with emergency services, repeat visits to the ED, and experience violence and coercion when receiving emergency mental health services [3,17-18]. 

 

Further, despite dominant narratives and public perceptions that people experiencing mental health challenges are violent, evidence indicates that those experiencing mental health challenges are more often the victims than perpetrators of violence  [5, 19-21]. A number of systematically marginalized groups face higher rates of disproportionately negative interactions with first responders. These include racialized, Black, Indigenous people, Two-Spirit, lesbian, gay, bisexual, trans, queer + (2SLGBTQ+) people, people with limited economic resources, and those with mental health diagnoses, among others [10, 22-27]. Within many communities in Ontario, police and paramedics remain the only options when experiencing crisis.

training_image12.jpg

The upcoming content is drawn from our research study that involved interviews with 53 participants, 60 open-ended surveys, and document analysis. The findings and stories you will see come from a range of perspectives in the community. See the different roles that participants held in the box below:

Participants represented roles such as:

  • People with lived experience of mental health crisis

  • Family of people with experience of mental health crisis

  • Paramedic

  • Police

  • Dispatcher

  • Emergency department nurse

  • Emergency department physician

  • Social worker

  • Peer support worker

  • Housing and shelter service worker

  • Harm reduction worker

  • Psychologist

  • Psychiatrist

  • Crisis response team member

  • Leaders or managers of organizations

  • Front line workers

bottom of page