Gerstein Crisis Centre taking a call on their crisis line. Photo by Rachel Browne.
At her lowest point, Kaola Baird felt like she was living two lives. Things probably seemed fine from the outside: She had a circle of friends, an apartment, and was holding down a job in retail and as a fitness instructor.
But she was also wrestling severe depression and anxiety that stemmed from the trauma of the loss of a parent when she was a child. She was nearly unable to get out of bed let alone do well at work, she was facing eviction from her home, and she wasn’t taking care of herself.
The bottled-up feelings of despair became overwhelming and quickly pushed her to the brink. She wanted to end her life.
“I had really struggled and worked hard to keep things under wraps,” said Baird. “But I felt completely broken.”
For many, calling 911 or going to the hospital might seem like the only options in this situation. Instead, Baird and her family doctor reached out to the Gerstein Crisis Centre, a 24/7 support community and mobile team in Toronto for people experiencing addiction and mental health crises. It’s one of the only programs of its kind in Canada. They aren’t cops, doctors, or social workers. They’re trained in nonviolent de-escalation to help people find solutions in moments of peril and beyond. Many Gerstein staff are survivors themselves, peers who understand emotional crises firsthand.
While the centre has gained a solid reputation within health and legal circles in the 30 years since it opened, it’s largely flown under the radar. Those who work there haven’t spoken with journalists much before, but they are doing so now as debates over defunding the police and reimagining responses to mental health crises are taking place around the world. Gerstein’s services are in higher demand, and they see their model as a template as more and more cities look to reduce police involvement in mental health incidents and redirect police budgets into community resources.
When Baird reached someone on the other end of the line that day, they offered to send the mobile crisis team. She agreed and suggested they meet at the Tim Hortons nearby. A short while later, two crisis workers pulled up in an unmarked car wearing regular clothes, not a uniform or anything with logos. As far as anyone knew, they were all just friends having coffee. Yet they were about to save her life.
“I remember thinking that it was so wild that these people would actually come and just take the time to sit with me,” Baird recalled. “They didn’t do the impossible, they were just really genuine.” Eventually, they made her feel calmer. After an hour of venting and a whirlwind of emotions, the three of them formulated a plan for Baird to stay at the centre’s limited number of beds for short-term stays.
She was able to decompress, sleep and eat well, and get linked with programs and experts to help her cope and feel better. “I knew my life had changed,” she said.
Eight years later, she still struggles. But she says she’s in a good place and now teaches yoga at Gerstein’s wellness and recovery program run by and for people who experience mental health issues.
“When you treat people beyond what they're experiencing in their worst moments, you get to see what their gifts are and what they’re capable of doing.”
Policing mental health
The Gerstein Crisis Centre in midtown Toronto has a welcoming feel. The inconspicuous residence on Charles Street used to be the recreation space for Toronto Police officers when the old headquarters was up the road.
The centre was founded in 1989 by Dr. Reva Gerstein, a psychologist and community advocate who died this January at 102. Dr. Gerstein spearheaded pivotal shifts in mental health care in Canada, pushing for non-medical approaches beyond psychiatric hospitals and law enforcement. She also called for better supports for former psychiatric patients following the “deinstitutionalization” movement of the 1960s and 1970s in North America and Europe that opposed warehousing people with mental health issues in psychiatric hospitals, which had become more like prisons.
Patients were eventually released en masse. However, the patchwork of community-based treatments were never funded properly, and there’s been a shortage of in-patient beds ever since. Without proper support networks, many fall through the cracks and end up in a vicious cycle of poverty and jail.
Police officers also became first responders in mental health crises and so-called wellness checks, as their budgets continue to rise every year. Of the 30 people killed during police encounters in Canada during the first half of 2020, most of those killed suffered from mental illness or addiction, according to a CBC database. Calls to defund the police were amplified further following the recent deaths of Black and Indigenous Canadians during wellness checks by local police and the RCMP.
In the U.S., people with mental illness are 16 times more likely to be killed by police than others when stopped by law enforcement, according to a study by the Treatment Advocacy Center.
When police interactions result in violence or death, it disproportionately involves civilians who are Black, Indigenous, and people of colour. Violent altercations are also more likely to involve people who are poor and otherwise at the margins of society. Advocates say this all points to the need to take police out of the equation, or make them a backup option if necessary.
Non-clinical and non-coercive
“When people are dealing with a mental health issue, there’s this idea that they’re dangerous, they need to be medicated, or taken away,” Susan Davis, Gerstein’s executive director, said last week at the centre, which is filled with paintings by current and former clients on the walls.
“It’s not really a very clinical environment,” Davis said. “It’s focused on connection.”
A room at the back is where four people work the crisis phone lines, seated at long tables. They’re monitoring the phones at all times, but also balancing that with going out on mobile calls and supporting the people staying there.
During the peak of the pandemic lockdowns, the phone lines had never been busier, making it difficult to keep up. From March to June, Gerstein handled 13,128 calls to the crisis line, up from 7,000 calls during those same three months last year. Many of those involved follow-up calls or meetings if the caller requested it.
“Social isolation was a common theme among the spike in calls,” Davis says. “Covid amplified what we already knew about all the gaps and inequities within our system. We especially heard from a lot of seniors who had been almost completely isolated, were experiencing food insecurities and financial concerns.”
Typically, staff field more than 30,000 crisis calls to the phone line every year. The person might just want to talk. They may ask for the mobile team to come see them, or the phone line worker might make the decision to send the team. The mobile crisis team, made up of two people at a time, makes around 1,600 visits to people in the central Toronto area per year.
It’s rare for community services like this to be available at all hours of the day. Even the Toronto Police’s Mobile Crisis Intervention Teams (MCIT), made up of a police officer and mental health nurse, operates from 11 a.m. until 11 p.m. at the latest. As is the case with similar mobile teams in Canada and the U.S., civilians can’t reach them directly. Calls have to go through police, and teams are sent only after officers determine the incident is safe for them.
A Toronto Police spokesperson told VICE News that officers responded to around 30,000 mental health calls in 2019, a number that continues to climb, and only 6,000 of the 2019 calls were attended by its mobile crisis team.
Gerstein’s phone line isn’t linked to 911, so people have to find them directly. Their phone number is listed on many flyers and websites about mental health services in the city, or people hear about it through word of mouth.
“If I had a dollar for every time I said ‘Call the Gerstein…,’” said Toronto mental health lawyer Anita Szigeti, who frequently refers clients there. “They're not going to be forced-hospitalized, they're not going to be forced-treated. They're not going to be abused. They're going to retain some autonomy.”
How to defuse a crisis
Each crisis call is as unique as the person phoning in, so there isn’t a playbook. There’s no flowchart for dealing with complex emotions and mental health symptoms. Davis, the executive director, says it’s not easy to sum up what they do. “It can’t just be wrapped up in a bow.”
While all staff go through formal suicide intervention and crisis prevention training, as well as CPR and First Aid, it’s the seemingly simple act of listening that’s the best approach.
The caller might be feeling anxious and alone. Maybe they haven’t had any human contact for weeks. Or maybe they’re hearing voices or are in the throes of a psychiatric episode. What counts as a crisis for someone might not be one for someone else.
“The traditional way is to explain exactly what crisis is for them,” says Darna Savariau-Daley, a mobile crisis worker who’s been with Gerstein for 30 years. “That’s the neat thing about here is that we don’t define them. And they come up with what they want the outcome to be.”
Savariau-Daley says that when she and her partner are dispatched on mobile crisis calls, they try to make sure the person they’re meeting stays at the helm of the situation. It can take some time to build that trust, but they’ll make the time. They also aren’t coming in with the baggage of law enforcement or a psychiatric hospital.
Police and doctors are the only two types of people who have the ability to detain someone in Canada: either arresting them for an offence under the Criminal Code or holding them under the Mental Health Act.
“The police have certain authority. We’re seen differently,” Savariau-Daley said. “Imagine you have a police officer and a nurse show up at your door if you're feeling depressed. Right away, seeing that police officer, there’s stigma.”
It’s Savariau-Daley’s lack of power that gives her a better chance of successful de-escalation and connecting the person in crisis to services that could help them in the long-term.
Gerstein workers may, rarely, involve the police if the person is in immediate danger of harming themselves or someone else. And if they and the person in crisis decide that going to the emergency room would be the best way to help them manage their symptoms, the workers will stay with them in the emergency room to act as an advocate and a buffer.
“The reality of psychiatric hospitalization for most inpatients, particularly when they're acutely in crisis, is an extremely violent and invasive experience, and it imprints on their memory” said Szigeti, the mental health lawyer. “When the threat of coercion and that fear of violence is removed from the interaction, people can actually engage and de-escalate.”
More cash needed
On Tuesday, the Toronto Police Services Board unanimously passed 81 recommendations from the City of Toronto for how the force can address systemic racism and improve interactions with people in mental distress. One recommendation includes “the implementation of a City of Toronto Mobile Crisis Assistance Intervention Service.” The Board also reviewed a recommendation from its anti-racism advisory panel that encourages police to “make use of the Gerstein Crisis Centre police telephone line when interacting with a person in crisis.”
Any efforts to increase the centre’s involvement in the community is welcome, says Davis. However, lasting change can only come with more funding. Much to the chagrin of advocates, the Toronto Police Board’s recommendations do not include reducing the service’s budget, which is just over $1 billion, by far the biggest line item on the city’s operating budget.
Gerstein’s annual budget for all services comes in at around $4.6 million, much of which comes from provincial funding. None of its crisis services are funded by the City of Toronto. If Gerstein were to become a 911-like response to crisis calls across the city, Davis estimates that would cost around $18 million.
“We would never pretend to be the only thing that’s needed,” said Davis. “We'll step up and try to do what we can.”
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