The committee met at 9:01 a.m.

[D. Routley in the chair.]

D. Routley (Chair): Good morning, everyone. My name is Doug Routley. I’m the MLA for Nanaimo–North Cowichan and the Chair of the Special Committee on Reforming the Police Act, an all-party committee of the Legislative Assembly.

I would like to acknowledge that I am joining today’s meeting from the traditional territories of the Malahat First Nation.

I would also like to welcome those who are listening and participating to this meeting.

Our committee is undertaking a broad consultation with respect to policing and public safety in B.C. We are taking a phased approach to this work and have been meeting with subject-matter experts, community advocacy organizations, Indigenous communities and others.

We also invite British Columbians to provide written, audio or video submissions. We will review those submissions with a view to inviting individuals and organizations to present to the committee at a later date. Further details on how to participate are available on our website at www.leg.bc.ca/cmt/rpa. The deadline for submissions for this phase of the consultation is 5 p.m. on Friday, April 30.

Today we’ll be hearing from health authorities to discuss the intersection of health and policing. Each presentation will be 30 minutes long, followed by time for questions from committee members. We have a timer on the screen available to assist us. All audio from our meetings is broadcast live on our website, and a complete transcript will also be posted.

Now I’ll ask members of the committee to introduce themselves.

K. Kirkpatrick: Good morning, everybody. I’m Karin Kirkpatrick. I’m the MLA for West Vancouver–Capilano.

We are located on the traditional territories of the Tsleil-Waututh, Musqueam and Squamish First Nations.

I’m so glad that you’re here. I’m looking forward to hearing from you.

D. Davies (Deputy Chair): Good morning, everyone. Dan Davies, MLA for Peace River North.

I live in Fort St. John, up in the Dane-zaa territory.

R. Glumac: MLA Rick Glumac from Port Moody–​Coquitlam.

I am on the traditional territory of the Coast Salish peoples.

R. Singh: Good morning, everyone. Rachna Singh, MLA for Surrey–Green Timbers.

I am joining you today from the Coast Salish territories of the Kwantlen, Semiahmoo, Katzie and Kwikwetlem.

H. Sandhu: Good morning, everyone. I’m Harwinder Sandhu, MLA for Vernon-Monashee.

I’m joining you today from the unceded territory of the Okanagan Indian Nations.

Thank you. I look forward to hearing from you.

G. Begg: Hi, everyone. I’m Garry Begg. I’m the MLA for Surrey-Guildford.

I’m proud today to be joining you from the traditional territories of the Coast Salish people, including the Kwantlen, Katzie and Semiahmoo First Nations.

T. Halford: Hi. Trevor Halford, MLA for Surrey–White Rock.

I’m joining you from the traditional territories of Semiahmoo First Nations people.

[9:05 a.m.]

A. Olsen: Hey, good morning. Adam Olsen, MLA for Saanich North and the Islands.

I’m pleased to be joining you from my home village of W̱JOȽEȽP in the W̱SÁNEĆ territory.

D. Routley (Chair): Thank you, all.

Today the committee is assisted by Karan Riarh from the Parliamentary Committees Office and Billy Young from Hansard Services.

Now I’ll turn this over to our presenters from Island Health for their introductions and their presentation.

Presentations on Police Act

ISLAND HEALTH

L. Murphy: I can go first. Lisa Murphy. I’m a director with mental health and substance use in Island Health.

I am calling in today from the traditional territory of the K’ómoks people.

Thank you for this time to present.

D. Leik: Good morning, everyone. Thank you for your time today. My name is Dana Leik, and I am the operations director for Central Island mental health and substance use.

I am calling in from the traditional and unceded terri­tory of the Snuneymuxw people, where I am grateful for the time that they have spent caring for our lands.

S. Thomas: I’m Shane Thomas. I’m the practice lead for mental health and substance use in the Mount Waddington region.

I’m coming to you today from traditional Kwakiutl territory in Port Hardy.

J. Huston: Good morning, everyone. I’m Jessica Huston, manager with Cowichan Valley mental health and substance use services.

I’m calling in today from the unceded traditional territory of the Cowichan people.

I’m looking forward to this.

D. Routley (Chair): Go ahead with your presentation.

L. Murphy: I’ll draw your attention to the PowerPoint. I’ll be starting us off. The first one you’ll see is simply our cover sheet, identifying this as the presentation to this important work. I will then ask you to move to basically the second one. We did gather input and feedback from a wide range of clinical front-line staff in communities across Vancouver Island. We’re really happy to have both Shane and Jessica with us to speak to the experiences and thoughts of our front-line MHSU staff.

The third one really just outlines the breadth of the services that Island Health provides, to put it in context, really, a large health authority across many urban and rural and remote communities. If you look at the picture of the Island, it identifies Island Health as serving at 150 sites, privileged to serve 57,000 Indigenous people, and looking at a population of 850,000. Again, to set some context, 23,000 staff, 4,000 volunteers, 2,500 medical staff. Then it speaks to the acute, long-term care and home health visits.

Right in the middle is the mental health and substance use beds. If people are interested, we can break that down further. We certainly would not want to leave people with the impression that it’s 1,400 acute care beds. It’s about 100, and if people need accuracy on that number, I’m happy to share that. That 1,400-plus number reflects housing and tertiary, as well as in-patient beds — substance use recovery beds, that kind of service. You can see the breadth of services that Island Health provides across Vancouver Island.

The next one is a map. I won’t go into this in any depth, but it breaks it down by community for a mental health and substance use perspective.

[9:10 a.m.]

If we look just to one, say right at the bottom, under “Oceanside,” it speaks to the services that are available in the Parksville-Qualicum-Errington area. So counselling, case management, outreach, substance use outreach, some housing units and overdose response. Then you could look across to…. I know some of you are calling in from Island communities. You could look to see, high level, what’s available in those communities — just again, to give people some supporting information.

Core services are available in each community, each of the larger communities, medium- to larger-sized. Those would include case management for people who live with significant and persistent mental illness, counselling services, outreach services, outreach for substance use services and crisis services.

If you look to the bar graph, what we are seeing is increasing service demand. Certainly, we see increasing service demand for in-patient beds, for counselling services, for eating disorder counselling services and, certainly, increasing demand for people, where we might work closely with police or RCMP around people who are perhaps entering in or living in crisis in community, particularly in the intersection of people living unsheltered, people struggling with substance use and who might have behavioural challenges associated with that — multi­layered challenges.

I’ll speak just quickly to the police–Island Health partnerships. In many places, those partnerships are very much active and very productive and positive — executive and leadership tables, strategic planning and priority-setting at regional, local and community levels. Many communities have active places that these conversations happen, and we work closely with the RCMP. Our outreach staff and crisis staff have been doing this work for many years in different ways across different communities.

The community action teams. Many of you would be aware that through the opioid crisis, community action teams were struck and funded in a number of communities, and that creates a cross-section of community support organizations — health, RCMP — to focus on substance use and particularly the poison drug crisis, the opioid use.

Local partnerships. We’re going to speak to those a little bit more, but some examples would be Car 60 in the Cowichan area, integrated mobile crisis response in the south Island, Victoria Integrated Community Outreach and the assertive community outreach in Victoria. We’ll speak more to the work that’s being done around situation tables.

I’ll stop there and pass it over to Dana.

D. Leik: Good morning, everyone.

Thank you, Lisa.

The next phase of our slides will be moving into some specifics around success stories that Island Health has experienced as well as some foundations of how we’ve achieved those successes and then recommendations going forward. As Lisa mentioned, this has been a collaboration, and collaboration has formed the structure of the PowerPoint. That collaboration has included dialogue sessions with our front-line staff, who have contributed to the presentation as well as shared some of their experiences. And, equally, having Shane and Jessica joining us today will allow for some more fulsome dialogue post-presentation.

If you flip to slide 7 in our deck, the first success story we will speak to is our Car 60 structure. This is a partnership with North Cowichan RCMP and Duncan MHSU, which started in 2017.

[9:15 a.m.]

The outcome that we have experienced from the partnership has been an increased collaboration between RCMP and Island Health mental health. We’ve fostered improved communication in the way that we assist vulnerable and at-risk individuals in our community. There’s been a demonstrated reduction in emergency department presentation. The partnership has allowed for the addressing of stigma within MHSU staff attending with RCMP — so providing those opportunities for that dialogue to promote the destigmatization between the responses and the interactions in our communities.

The approach for our clients has been a less authori­tative and more supportive stance, which also allows for that familiarity between both the RCMP and the population in our communities, whereby there is a sense of comfort and safety as opposed to authoritarian and fear. The community sees a positive partnership between MHSU and the RCMP, and the community partners now call for and specifically request Car 60. Again, it really speaks to that consistency and the partnership.

One of the things that has been really brought to our attention is that where there is consistency and sustain­ability in the partnership and not just a “lucky we hap­pened to get this particular individual to respond,” the outcomes have been far more positive in terms of the interaction and the next steps forward, whether it is assistance with sheltering or assistance in navigating services for the indi­vidual.

Slide 8. This is the success story around the integrated mobile crisis response team. This model has been serving south Vancouver Island since 2004 — so, much more longevity in the south Island. It involves four municipal police and three RCMP detachments, and the model is based on the premise of plainclothed police working with health crisis teams, and it’s been going for a minimum of two years. The team is responsive to people of all ages, seven days a week.

The outcomes that have been noted, to date, have been that the police share the knowledge of the system, the services available for people. They share the knowledge around the stigma that continues to be perpetuated in the community and then within services. The police share knowledge of a trauma-informed approach with their colleagues, so that knowledge exchange amongst department members, particularly around a trauma-informed approach, has been far more sustainable. It has provided a less-intrusive option around our interactions and our engagement in situations that can be quite escalated and crisis-driven, and it has increased crisis interventions with health providers since 2012.

Slide 9. This moves us into a summary or a synopsis of what we have discovered have been the foundations for success, the first one being the relationships — the collaboration between the police and mental health and substance use staff, with clients and with community agencies. This allows for those connections without crisis. It promotes and supports confidence and trust. The relationship and that continuity also allow for shared learning and that knowledge exchange amongst members. And that position of champion within the detachment and within our local MHSU services really promotes that ease of being able to share learning and that knowledge exchange.

[9:20 a.m.]

The demonstration of ability to be creative and collaborative between the police and MHSU with few resources and complex scenarios. The trauma-informed approach and services have been significant in terms of that initial engagement with people in our community that are struggling with mental health and substance use concerns as well as behavioural complexities.

Crisis intervention and de-escalation training and skills. Again, that ability to share knowledge and support amongst both the MHSU clinicians and professionals with the local detachments. And the sharing of the knowledge and understanding of the Mental Health Act.

Moving to the next slide, slide 10, rural Indigenous policing strategy has allowed for an increased capacity to build community connections. It has enhanced a proactive approach in our communities, and it has improved connections with our local support teams. The collaboration between MHSU and police work has allowed for a reconciliation lens, which is crucial, as Indigenous people are disproportionately impacted and have higher rates of interactions with our emergency services.

The next slides will summarize some recommendations that, from a collaborative standpoint, have come forward from our service providers spanning the entirety of the Island. The first recommendation…. It’s in no particular order of priority.

Increase education on the Mental Health Act and police role in apprehensions. It’s something we feel continues to be a need in terms of that partnership. Increased training on supporting complex mental health and substance use individuals and harm reduction approaches. A standardized interprovincial tool and checklist on the Mental Health Act apprehensions and a framework for measuring outcomes. A police and mental health and substance use coeducation model around trauma-informed approaches with priority populations — rural, remote — and high levels of new staff.

The next slide, 12, further recommendations. An enhanced integration and connection with Indigenous policing for trauma-informed and cultural safe approaches to support reconciliation. A collaboration to enable the continuity of learning and sustainability of approaches. A shared police and health system commitment to appropriate resources.

That concludes our slide deck. At this time, we would like to thank you for allowing us the opportunity to share. We are open to any questions.

D. Davies (Deputy Chair): Good morning. Thank you for the presentation. I see lots of great partnerships, which is wonderful to see, across the Island. We’ve been hearing a number of these partnerships that have been very successful around the Car 60 and the teams approach, which has been great to see.

We have heard from a couple of groups, though — this is coming from the other side — that there have been some criticisms around possibly having members of the police force arriving at a health check or something — that that also provides a barrier. I’m just wondering if you can speak of any instances or situations — this question is broadly to all of you, I guess — where you may have seen that or you dealt with improving how, maybe, the response is done or if you’ve seen any of these issues.

L. Murphy: I could maybe start us off. I think it brings me back to the idea of a structure and an opportunity to build relationships with care providers — sometimes physician outreach — and with RCMP in the areas where I work in.

[9:25 a.m.]

For people who are very vulnerable and have learned that systems haven’t been such that people could trust them easily, when those providing health and policing services show up together, I think people sense and do understand when that partnership is strong and there’s almost a synergy between those teams. I think that is best built on those ongoing relationships. So I think it’s what happens in the background.

For people who don’t know each other to show up together, maybe a client with some instability…. People could be picking up on the newness of the relationship and feel particularly unsettled by that.

G. Begg: Thanks, everyone, for the presentation. You seem to indicate that everything is going well, your program particularly. You have what you consider to be a good and collaborative approach with the police.

I’m wondering if we can focus for a bit on those areas that you think require some enhancement. I urge you to think aspirationally here. Are there other things, other ideas, other practices that you’ve heard of, other jurisdictions that you’ve looked at that you think could further enhance your already successful program?

D. Leik: I can jump in. One of the threads that we’ve really highlighted…. Certainly, not all areas within Island Health have these same structures and success stories. We really are hoping and advocating for that consistent role, within the detachment, of the mental health liaison.

We’ve recently had a position start in Nanaimo. Literally, we’re six to eight weeks in. The team’s response to having that consistent person that they link with, as Lisa has spoken about, has been tremendous and has allowed for a greater opportunity for that individual to influence members of the department who perhaps don’t have that same lens.

Let’s just be honest here. Not every member does come with that same toolkit around the trauma-informed and the understanding about the approaches from a relational security standpoint in terms of crisis intervention. Prior to having that link, it’s very difficult for our teams to have any influence over the detachment for fear of any sort of tension that may form between…. An us-and-them approach. I’m just speaking really frankly. It’s hard for a mental health and substance use outreach worker to say: “Let’s take a step back. Trust me on this one. I know how to guide us forward.”

However, having someone within the department be able to provide that feedback when it’s not a crisis situation has been far greater. So I would be strongly advocating that we see that as a consistent team member within all detachments so that we have that sustainability.

The other thing — and I’ll turn to my colleagues in the north end of our Island — is that rotational element. I’m sure there’s nothing we can do to influence that, but when new members are constantly coming through a small community, it’s very challenging to ensure that those familiar people and those connections can be made so that approaches can be tailored specific to what that community’s needs are.

Shane, did you have anything that you would like to add to that from a more rural standpoint?

S. Thomas: Just to say that we’ve at times had excellent partnerships in our local areas with police, but it has been very personality-dependent, and when that changeover happens, then you’re back to ground zero.

[9:30 a.m.]

As well, rural and remote areas tend to have newer grants for both health care and policing. So you have a lot of folks who are newer to the professions and challenging new demands with additional distances. Also, the reality in rural and remote areas is that we’re often not fully staffed for either policing or health care.

So exactly what Dana was talking about — those approaches to be able to support each other and work in get built up, and then they get lost and built up and lost in challenging environments with new staff. Having a way to maintain and build those relationships across time, so we don’t have to rebuild them on a consistent basis, would actually allow for a kind of continuity that would support folks who are experiencing crisis, to have the stability of those relationships to de-escalate crises and for crisis intervention.

G. Begg: Do you see a way, particularly in rural and remote communities, where there could be…? Do you see a way for that situation to resolve itself through the staffing process? I assume that not only are the mental health workers not consistent, but the police are not consistent.

In the rural and remote areas, how do you envision we could make recommendations that would help to solve that? First of all, there’s this shortage of police, and there is also a shortage of mental health workers. Should it be regionalized, or should there be some policies put in place so that police members who are assigned to rural and remote areas receive additional training on crisis intervention, de-escalation and that sort of thing?

L. Murphy: Maybe I’ll jump in quickly. I think it could be that. It could be training and time to build relationships. I think it could also be looking really in-depth at what brings people to those communities and, more importantly, what would keep people in those communities.

If you look to Tofino, for example, Ucluelet, we have vacant positions because there is no housing that’s affordable for even a well-paid health care worker to come into the community. Campbell River and the Comox Valley are other communities where housing is extremely hard to find. So people sometimes are never able to really situate themselves in the community for a long period of time. It creates that turnover.

I don’t know, Shane, whether you would agree with that. I think small communities do attract new grads, but we don’t seem to keep people in those communities the way we maybe did ten or 20 years ago.

S. Thomas: I agree remote retention is a large, complex topic. I think that if there were some kind of consistent table and commitment and a baseline of shared education, that table would provide the consistency and the culture for being ranked into the region — in fact, just an expectation of how we work together and that being modelled from the get-go so that we could hold onto the good relationships that we’ve built and model those as cultural organizational expectations.

R. Singh: Thank you to the presenters for the presentation. Some of my questions have been answered, and it is on the collaborative model. We have heard, even before from different presenters, about how well it is working in the communities and the need for it.

I just want to check. You touched on two things, like the GAT. But what we have seen, especially in the Lower Mainland, is that we have Car 67, but there is a long wait-list for that. It is like when people are asking for it, they don’t get it. Do you face a similar problem with Car 60?

J. Huston: In Cowichan here, where we have Car 60, I would say that there are not particularly wait-lists for Car 60. It’s a sort of ad hoc service. The challenge we noticed was with the onset of COVID. Certainly the service basically went to nil because of all the restrictions.

[9:35 a.m.]

Then they had to kind of get creative around how they would go out and how they would connect in with people. They eventually started to move on up and do that. But it’s now still very ad hoc, where the crisis nurse will come with the police officer and go out as needed to crisis calls.

We’re trying to get back to that model of moving out into the community, the nurse and the officer, in that therapeutic manner, to just really get to know folks in a non-emergency way, a non-urgent way — really kind of connecting, building relationships. Then when they need somebody in that crisis situation, there’s familiarity and comfort and a sense of safety, hopefully, right?

At this point, we haven’t had wait-lists per se for Car 60.

R. Singh: Just one more question. What we have been hearing…. Obviously, police is the first resort for people to call, because that is the 24-7 service. One thing that is emerging, with our presentations, is that there needs to be…. Either the 911 dispatcher is more equipped to gauge whether this is a mental health crisis…. And different supports for that. Do you feel that need? Like sometimes how that call is assessed and how those services are provided — there needs to be some change there?

J. Huston: I can speak to that again. I would say that, yes, certainly, there is always room for education. Like others have stated, whether it’s with any area of health care or police work or what have you, there’s a lot of turnover. So you’re always having new people. Yes, absolutely, always having a strong orientation and education package for anywhere a person is working is going to go a long way.

We’ve had to script staff around, “You need to say X, Y and Z” — if you’re calling in to try and get police support at the site, for example, or if staff are out in community or they see something going on. We have to script them about how to speak to dispatch in order that the urgency is conveyed, which is interesting.

I think, probably, yes — some education and support. I think, too, that linkage and that support with having…. As Dana mentioned earlier as well, when you have somebody that is struggling to…. A mental health worker or a nurse out there in the field trying to connect with the police and say: “Actually, we need to do this, and this is why. My assessment has determined that we need to bring this person in under section 28” — or whatever it is…. That feeling, that confidence to be able to share and having the police be receptive to that — the expertise of the mental health worker, right? And then having us being able to trust that the police know, also, their role and their job and that they can be supportive and bring the person to hospital if needed, or wherever.

I think it becomes that mutuality.

R. Singh: Yeah. Thank you so much. That is very helpful.

A. Olsen: Thank you for your presentation. I guess I’m a little bit on my back keel on this presentation, to be honest with you. I think that there’s an opportunity to present the intersection between the mental health services and policing.

I see in your presentation today — I’m just going to speak frankly here — a lack of introspection, a lack of an introspective approach. You have given us a few slides here on what’s working. But it’s been very, very public that there’s a lot that’s not working in this right now, and there are a lot of challenges. We keep hearing this raised in the Legislature and around.

I’m just wondering. Some of your best material has been when you’re answering these questions about — in the recommendations, directly — needing to have more consistency, needing to ensure that people stay in their jobs and that there is a transfer of knowledge. Those messages have come through very clear. However, this presentation, which presents everything that is working, is missing the opportunity to bring to a table of legislators the things that are not.

[9:40 a.m.]

I’m quite concerned, and I hope and encourage Island Health, in your written material, to please bring to us the things that are not working so well so that we can address those in legislation or make recommendations to our colleagues with respect to the health care system and the mental health care system as they intersect.

I appreciate and recognize that there are aspects of this that are working. However, it’s really important that we as a legislative committee hear the things that are not and that the health authority takes the time to look internally at how it can improve its delivery — the stories that we’re hearing — as well as how it can improve its relationship with….

I’m quite surprised not to hear about the key moment at which a police officer arrives at one of your facilities and then has to stay there for hours. These are stories that we’ve heard where a police officer hands off somebody to the mental health services. We hear nothing about that interaction in this presentation, and I’m disappointed to not hear how we can make recommendations to perhaps improve those aspects of the relationship.

L. Murphy: I can pick up on that. I certainly apologize for not digging into that further. I think that’s partly where we were going with that increased education on the Mental Health Act. Certainly, we do hear from the RCMP, for example, of working hard to bring a person to the emergency department and then they’re not held because they don’t meet the stringent criteria under the Mental Health Act. Definitely, we hear those concerns, particularly when people come to an emergency department.

We certainly could have strengthened the information that’s in that recommendation about the Mental Health Act. The Mental Health Act and its ability to be used around people who are struggling with substance use has lots of questions. We have lots of internal dialogue about that as well.

A. Olsen: Thank you, Lisa.

If I may just make one statement. I would just say that I think while we are focused pretty intensively on the Police Act, there is an opportunity, in the written comments provided by Island Health, to specifically highlight recommendations that we might be able to pass along to the Minister of Health or the Minister of Mental Health and Addictions.

They might not lead directly to a Police Act change; however, it’s not possible for us to do this work without acknowledging all of the intersections. This is a key intersection where we can collect this information and pass it along to the Minister of Health and the Minister of Mental Health and Addictions.

L. Murphy: I would add just one quick point: the concerns that we also hear from families that the bar around the Mental Health Act is very high and that families feel like we’re not able to step in quickly and consistently enough for their loved ones.

R. Glumac: I have a couple of questions. Just picking up on what Rachna was saying, we have heard from E-Comm that there are other jurisdictions, like New Zealand, where they have a dedicated mental health line, basically, staffed by mental health professionals. It’s sort of a first point of contact for people calling in. They’ve had some success, I think, with de-escalating situations and things like that, even before needing to call out a team to come out.

I never heard a direct answer on that. Would you see this kind of a concept working well in your region?

[9:45 a.m.]

J. Huston: I could speak to that. I’ll try. Certainly we have, of course, the crisis line, where people can call 24-7 to speak. I’m not familiar with the New Zealand model per se, but the crisis line is 24-7. People can call in, and then they would get directed to a crisis nurse. In Cowichan, for example, five days a week we have a crisis nurse available who can then have that conversation with a person that’s struggling and try and navigate and mitigate those risks before needing to deploy police or others to the site where the person is.

We also have outreach teams that are seven days a week that are going out and connecting with people, the really underserved population, really connecting in with people and meeting them in those crisis moments as well.

I think it always becomes…. It doesn’t always. There’s that little tricky piece around not everyone having a phone or access to a phone in our underserved population.

R. Glumac: I don’t assume, at this time, that 911 connects to the crisis line. If someone calls into 911, it doesn’t necessarily go to the crisis line at this point, right? Okay.

I just wanted to dig in a little bit. Just for the benefit of people that might be listening in, what’s the difference between Car 60 and the integrated mobile crisis response team?

L. Murphy: Dana, do you want to speak to Car 60? I think they’re both locally developed innovations, basically. But Dana, do you want to speak further to the differences?

D. Leik: When I think about the differences between Car 60 and the integrated mobile crisis response team, I think about the size difference, in particular, of the response team. As Jessica has mentioned, in Cowichan Valley, it’s comprised of literally a crisis response nurse and a local police officer. Whereas the IMCRT team is a more robust team of a variety of disciplines, whether it’s nursing, community mental health workers, as well as the police.

Other than that, I’m not as familiar with IMCRT in south Island. I’m not sure if Jessica or Shane have more knowledge — or even Lisa, if you do.

J. Huston: I do know that IMCRT has been established since 2004, I think it was. It’s been around a long time. It absolutely is that collaborative model with police attached to it, so every day, it’s consistently there. They’re part of that team every single day. It’s a dedicated few officers that are with that team and move about the communities of greater Victoria and have access to whatever is needed for supporting a person if they need to be brought in or if they just need that crisis call in the moment or what have you.

I believe their referrals are crisis call–based and also outreaching-based. It’s that collaborative model that’s at least, I think, five days a week if not seven days a week, whereas here, it’s ad hoc, in Cowichan.

R. Glumac: I see. Just one final question. We’ve heard a lot about the need for a trauma-informed approach. You’re saying one of the successes of IMCRT is that this knowledge is shared. Just the way that it works, I guess, is a police officer…. You said that they work with this team for a minimum of two years — that’s two years full-time — and then they rotate out, and that knowledge kind of gets shared that way on an ongoing basis.

[9:50 a.m.]

I think that’s a really interesting approach to it, because we have heard the need for more of that ongoing training rather than just a course and then move on, that kind of thing. This is a way to keep it current. I just wonder if there’s anything more that you can share on the success of that particular aspect, where you may have heard or have any anecdotes or stories of other police officers that have benefited from their colleagues going through this program.

L. Murphy: I think what I could add is that we are entering into some innovations around resilience training for our staff. I think the RCMP and the police are doing similar things. I think we can absolutely train people, and should, in trauma-informed practice. But if we’re not providing that ongoing support that you just spoke to — opportunities for debrief and an increasing resilience across the team, rather than as individuals — then it becomes harder to maintain that level of trauma-informed practice.

When asked earlier about innovations, I think the innovations are also about how we support individuals doing this challenging work, a relationship across the multilayered teams, and then on how we continue to maintain that — with, sometimes, a special focus on areas where staff are newer to the practice, but also not assuming that people who have been doing this work for ten and 20 years aren’t affected by the tragedies that they see, sometimes on a daily basis.

D. Routley (Chair): We have about eight minutes left and two more questions, if you could keep that in mind.

T. Halford: It may have been answered already. Just on the Car 60 program.

One of the things that I’ve noticed in my community — I’ve talked to police about it — is that when there is mental health that arises, and then they are transported to the hospital, a lot of times the police are having to stay at the hospital for quite a lengthy amount of time while the person is assessed or receiving supports. Maybe it’s not something that you’re able to comment on, but I am a big proponent and an advocate for what the car does. It’s just that there is, obviously, a severe lack of them in the program right now.

Also, if you’re able to comment on how they are actually structured. I know they are only going at certain times, but we’ve heard from some people that have presented to us that they’re going at times that aren’t ideal. It’s never ideal to have a mental health situation, but they’re happening at times where those calls aren’t as frequent as they would be on a weekend or in the middle of the night or at certain times during the week.

J. Huston: I can speak a little bit to that, Trevor. It is an absolute challenge. We don’t necessarily have Car 60 deployed to bring people under section 28 to hospital. It would be any police officer needing to do that in our community.

There is a real challenge related to the systems process and legislation around how police officers are held to wait in emergency rooms for lengthy times until they can be relieved by a physician under the Mental Health Act. I think that’s something to certainly consider if we’re looking at both our Mental Health Act legislation and the Police Act legislation — looking at, really, how we figure that out.

It’s not ideal. I have heard police express frustration with the process and the system. They’ve expressed frustration about bringing somebody to hospital, having them wait there and then having to see that half an hour later, this person is back out on the street doing whatever. That is frustrating. It’s a lot of repetitive education around: “This is why; this is why.” The Mental Health Act is very, very specific — and Lisa spoke to that earlier, as well. Our Mental Health Act does not cover folks that are substance affected in the same way. Does that make sense?

[9:55 a.m.]

H. Sandhu: Thank you, presenters, for the presentation. Some of my questions are answered, but I wanted to get your thoughts on….

You mentioned about education — the need for education. What I’ve noticed, over the years, is there is a lack of encouragement towards health care or mental health staff to report when there is discrimination or discriminatory behaviour witnessed. It’s still happening in all these places, and there’s often a fear of repercussions if staff witnessed or noticed it. It could be during their response to the call. It could be in the health care setting.

Adding that piece and having that open dialogue between all the health authorities, among staff — “It is okay to report, and we encourage you to report; you’ll be safe if you report, and you can stay anonymous” — I think, is something to be noted.

The other thing is the retention of mental health staff. I know that one of your recommendations mentioned adding more resources in rural settings, where we know that the need is big. We need that. What are your thoughts about retention, especially when we were talking about building that trust, familiarity, safety and comfort? Some approaches work, and some don’t. Can you share what worked better?

What are your thoughts about a retention relocation bonus, along with the contract term — you know, that this is the length of contract you’ll have to stay? I know that years ago Northern Health did that, and it worked. What are your thoughts? Are we still doing that? Will that be helpful?

D. Leik: I think that those are all really excellent points. One of the things that we have consistently struggled with — it’s not just around the staff reporting assaults or discrimination — is really supporting our teams to go forward with that, even going as far as laying charges. Certainly, in some of our tertiary facilities, we have had staff who have had significant injuries coming out of assaultive behaviours. That is one of the things that we do support our staff to do.

In terms of retention, we’ve been working very hard to get creative around that. Really, what we’re noticing — I’m sure all the health authorities are the same — is that it’s literally a lack of bodies. We are having such a hard time just filling baseline lines in our mental health teams, both acute and in communities. Yes, we’re looking towards creative ways to attract people and retain people. To speak more to Jessica’s point — about when the police bring individuals into acute settings, for example — in Cowichan, we’ve had a significant psychiatry shortage. It’s also a factor in terms of the time in which somebody could be seen for a psychiatric assessment.

Speaking specifically to promotional ways and bonuses, I’m not able to comment on that. I certainly can take that away. I don’t know, Lisa, if…. You’re familiar with relocation, I know, in our communities. The only last thing I just want to add, in speaking to Mr. Olsen’s comments, is that yes, there are definitely lots of recommendations we can make when things have not gone so well. My frame is, in large part, in our tertiary facilities, like Seven Oaks, for example.

One of the things that we are really promoting — I think it’s something that is also something for our police — is around the concept and the prioritization of relational security, as opposed to what we’re used to around policies, locks, fences, swipe cards and those sorts of things and, perhaps, even force. It’s more around that relational component to interactions. Certainly, we’re seeing some tremendous improvements in incidence of violence, within our highest level of facilities within Island Health, by going with that relational component to our structures.

[10:00 a.m.]

H. Sandhu: Thank you. One last comment I wanted to make. Given the historical systemic discrimination and the history of police and RCMP, some stakeholders recommended not to have police with programs like Car 60 or 87. Then, at the same time, we had other presenters who are concerned about the safety of mental health workers or health care workers. So I think that drawing that line is very crucial when we’re doing this work.

Have you had any incidents where there was a threat to a health care worker or a mental health care worker’s safety when they responded, or are there police always present? What are any experiences that were reported or not?

J. Huston: I can try to answer that. I certainly haven’t heard of any experiences that were alarming recently, but certainly police will ask the nurse to wait if there’s anything.

I did, many years ago, have an experience when I was working in Victoria and went on a ride-along with IMCRT, actually. We had to enter a house where there were possible firearms, so the police had to go in and clear it first. They made me stay outside with the other mental health worker and throw on a vest, just in case. That was really interesting, and I think that’s when you really need to have that collaboration and that support.

It’s not something that happens all the time. It’s not alarming. Certainly on the Island, it may be different than the Lower Mainland, but it is, I think, important. I think it is important when we’re looking at developing those relationships and having the public trust the police again, in a different way, so that it’s not just that authoritative power-over kind of model that it historically has been.

I wanted to just speak to your other comment there, really quickly, too, if that’s okay — about retention. I think there is something to be said about…. The police used to move through rural areas every five years. Apparently that’s been lowered now to two or even three — I think it’s even two years — that they only need to stay in a community. I think that that’s a bit of a disservice if we’re looking at how we build relationship. Two years is not a long time. If there’s that kind of a turnover….

In Cowichan, I’ve noticed there has been a lot of new and very fresh young officers come into town lately, which is wonderful, but to just think they’re only here for two years and then gone again, I don’t know how…. Then they’ll go wherever, or they’ll go to a larger centre and so forth, where it’s more, maybe, appealing. I think that retention piece, around how long a person stays in a community, is maybe important.

H. Sandhu: Thank you. I was referring to both police and health care workers even so. That trust — when it’s there, then the situation is much calmer. Thank you again for answering all these questions.

D. Routley (Chair): Thank you, everybody. Thank you for your questions, and thank you, presenters, for your presentations. As always, I ask that presenters be generous with their opportunities for us to reach out if we have to seek other information. As has been suggested, we certainly welcome any contribution that you’d like to make further to this.

With that, I think I’ll recess the committee, but only for two minutes, Members. We’re actually going into the time of the next presenters, so let’s be back in two minutes. See you then. The committee is in recess.

The committee recessed from 10:04 a.m. to 10:08 a.m.

[D. Routley in the chair.]

D. Routley (Chair): Welcome back to this meeting of the Special Committee on Reforming the Police Act. I’ll ask members of the committee to introduce themselves, starting with MLA Kirkpatrick.

K. Kirkpatrick: I’m Karin Kirkpatrick, and I’m the MLA for West Vancouver–Capilano.

We are located on the traditional lands of the Mus­queam, Squamish and Tsleil-Waututh First Nations. Thank you so much for being here.

T. Halford: Trevor Halford, MLA for Surrey–White Rock.

I amcoming to you from the traditional territory of the Semiahmoo people.

A. Olsen: Adam Olsen, MLA for Saanich North and the Islands.

I’m coming to you today from my home in the W̱JOȽEȽP village in the W̱SÁNEĆ territory.

H. Sandhu: Good morning, and welcome.

I’m Harwinder Sandhu from Vernon-Monashee, which is located on the unceded territory of the Okanagan Indian Nations.

[10:10 a.m.]

G. Begg: Hi, Tina. Good morning. You’ll know that I come from the best part of Surrey, which is Surrey-Guildford.

I’m also on the traditional territory of the Coast Salish peoples, including the Kwantlen, Katzie and Semiahmoo First Nations.

R. Glumac: I’m MLA Rick Glumac, coming from the best part of Metro Vancouver, Port Moody. I’m the MLA for Port Moody–Coquitlam.

I’m on the traditional territory of the Coast Salish peoples.

D. Davies (Deputy Chair): Hi. Good morning. Welcome. I look forward to your presentation, Tina.

My name is Dan Davies, Peace River North.

I live in Fort St. John, coming to you from the Dane-Zaa territory.

Welcome.

H. Sandhu: I can mention that I’m coming to you from the beautiful Okanagan as well.

R. Singh: Hi. Rachna Singh, MLA for Surrey–Green Timbers. Good to see you all. Looking forward to the presentation.

I’m joining you from the Coast Salish territories.

D. Routley (Chair): I’m Chair of the committee, Doug Routley, the MLA for Nanaimo–North Cowichan.

I’m coming to you from Malahat First Nations territory.

With that, I’ll hand it off to our presenter. We’ve got 30 minutes for the presentation and then questions from members after that.

I also will remind everybody that the audio from all of our meetings is broadcast live on our website, and a complete transcript will also be posted. I’ll hand it now to Tina Baker from Fraser Health.

Welcome, Tina.

FRASER HEALTH

T. Baker: Thank you for having me today. I really appreciate the opportunity to talk to you guys.

I’m a registered psychiatric nurse. I’ve been practising nursing for 16 years, all within Fraser Health. In that 16 years, I’ve had quite a bit of experience in different realms of my practice.

I initially started working in the in-patient units. Most of my career has been at Surrey. From there, I joined some community programs in Langley and in Delta and did some case management work with clients there.

I also worked for EPI, which is the early psychosis intervention program, and the ACT team, doing some outreach for clients that are harder to manage in the communities, and for the last ten years of my career, I’ve been working for Car 67. As of late, I pick up in Surrey emergency as well and work casual. I’ve just come off a night shift, so I’ll have to apologize if I seem a little sleepy today. I’m ready to go to bed.

A little bit about Car 67. We’ve been going strong since November 29, 2000. Our program operates under a memorandum of understanding with the RCMP and Fraser Health. We’ve been having the same MOU. Everything has been going really well.

What had happened and how Car 67…. I’m just going to go through, because I’m the front-line staff…. I notice that you have the directors from the other authorities. So it’s just me by myself. What had happened back in 2000 and prior to that is we had an after-hours program. How that worked was mental health offices were open on a Monday-to-Friday basis. After the offices would close, a lot of people would be going into crisis or need some extra support, and all that was there was the emergency department for these clients and mental health after hours.

Clients would call in to mental health on their own accord, and there were two nurses that worked there. If they felt somebody needed to see the nurse more in person, they would go out to this person’s location, and they would deal with them and help them get through their crisis. What had happened back then was one of the clients that they did go and see ended up chasing the nurses down the hallway with a knife. They were alone. They didn’t have anybody there to protect them. From there, the police started going out with the nurses if they felt that they needed some support.

[10:15 a.m.]

It’s kind of how Car 67evolved from that, because there were a lot more phone calls to the police to have them join, to keep the peace while the nurses did their assessment. That’s kind of how Car 67 came to be.

How it works, and what I usually like to tell everybody, is Car 67 is basically like a mental health ambulance, if you can think of it that way. When we go out and do our assessments, we are doing that, and we are deciding what option is best for them. But once we assess a client and take care of them in whatever way and capacity — that looks like Car 67 is done with serving that client at that time. We’re managing a crisis. We’re making sure that they’re safe and in the appropriate environment. Then that’s us done.

How we work when we do this is we pair ourselves with a uniformed police officer — and us, as the psychiatric nurses. There are three of us that work the car. We’re in an unmarked vehicle, so whenever we’re attending a scene, we’re not in a police car. We don’t come lights and sirens. We’re in an unmarked Tahoe — us as the nurses and the member that we’re with. We do need police to come sometimes. But we always park away from the home, and we’re trying to give people as much confidentiality and everything, in that way.

The role of us is to respond to any person in a mental health crisis. We play the important role in assessing them, managing them and the disposition of the client that’s experiencing this mental health crisis. We’re able to liaise with community mental health teams, the hospital, community psychiatrists. Then we are trying to come up with the least intrusive resolution in the emergency situation they’re experiencing, and we’re trying to avoid taking them to hospital, if we can do that.

The management and the disposition of individuals experiencing this perceived mental health crisis doesn’t necessarily mean that that person needs to be taken to the hospital. The process for us is the RCMP will receive a phone call, usually 911, non-emergency. It could be a family member or somebody in the community. It could be a mental health care worker. But they’re calling in because somebody is in a crisis and somebody is in distress.

From that, a police file gets generated. Then what they do is the police officers have to go first to the scene before we, as the nurses, can come. We don’t have any protection to protect ourselves, so the members have to go there — when I say members, I’m referring to the RCMP — and ensure that the scene is safe for us to attend.

Once that’s done, and they’ve ensured a safe scene for us, then we, as the Car 67 team, will go. Then we will do our MSE, mental status exam, on the client. We can do those anywhere, from in an individual’s home, in the community. We’ve been at the mall. I’ve been in shelters, in the middle of the woods. It’s just wherever they are, that’s where we go.

When I first started working there, I showed up wearing runners and pants. They just thought: “Those runners are going to last you about five minutes.” It wasn’t long before duty boots came on, and I was neck-deep in mud sometimes. We just don’t know where we’re going to be.

When we go to scenes, we can be assessing anybody from children — the youngest person I’ve seen is five — to youth, adults, elderly, anybody experiencing, and not limited to, psychotic disorders, depression, suicidal and homicidal ideations, hoarders, people with brain injuries, substance abuse. As I said, all of our assessments are done in all different settings, so private dwellings. We go in the community, group transition and recovery homes, shelters, schools and also Surrey cells. We do quite a bit of assessments there as well.

The hours we work are one o’clock in the afternoon to one o’clock in the morning, seven days a week. We’re not 24-7, but we are seven days a week. So holidays, everything — we’re there.

What works well? The best for us is the Car 67 team has a well-established partnership with the community of Surrey. Our relationship, as psychiatric nurses, with the health authority allows us to bridge that gap between law enforcement and the acute care settings. So that’s the hospital and the community mental health services. The police really aren’t familiar with health care and the way it works, so it’s very helpful for us to help explain that to them, because it decreases a lot of frustration that they usually do have.

[10:20 a.m.]

The nursing staff on the car program. We have access to the health authority database. We actually have our own computer when we are out on the road. We can access…. We call it Meditech here. That gives us all hospital presentations, and any time they’ve been in, we can read psychiatric notes. We can read the assessments that have been done.

We have access to PharmaNet. So we’re able to do a pharmacology review of these clients, because a lot of the times — I’d say 80 percent of the time — it’s a big medication component for us. Having access to PharmaNet on the road allows us to really see what’s going on with their medications. With that, as I said, we can do a comprehensive mental status exam and ensure that they’re compliant with their medications. We’re assessing for side effects as well, and we’re assessing lab values, because there are some medications that people can be on that, if they’re overdosed or they’ve taken too much or not enough, can put them into a physical crisis as well.

Another thing I notice that works really well is when we’re going to scene, we just come with a different lens as nurses than the police officers do. The police officer is coming as public safety, ensuring that nobody’s at risk and that nobody’s getting hurt, whereas we, as the nurses, are coming and we’re looking at more clinical needs and to see what these clients are going through. It’s a very good balance. I can be out there doing my assessments, and I know I don’t have to worry. I can purely focus on the client that I’m walking with, and I don’t have to worry about my safety because I know the police officer is there.

When we’re engaged in this assessment with the client, the police officers and the partners that we’re with are really good about not interjecting and just letting us do our job. If things do end up spiralling out of control, we always take a step back and then the police will take over. It has happened.

Again, continuing on what works well is the combination of medical records and the RCMP crime files. A lot of the times, clients we see will have a lengthy history with the police as well as with the health authorities. Being able to accumulate all that information prior to arriving to a file is really helpful for us. It gives us a bigger picture on the situation. Some of these clients are somebody that we see constantly. All of this information allows us, as the nurses and the RCMP, to make the most informed decisions on how to be serving this client.

It also gives us the opportunity to help the members that are on scene with that client prior to our arrival. There are a lot of triggers that clients are dealing with and a lot of things that can get them really upset. To help keep that environment as calm as we can, we can help those members out that are waiting for our arrival.

Our purpose is just to make sure that the clients are in a period of wellness in the community. We’re trying to divert them from going to the hospital and into the emergency department. As I said, I do work emergency, so I do see a lot of apprehensions, section 28, coming into the hospital and that, if Car 67 had been involved, probably wouldn’t have needed to come. Again, that’s when we’re probably not on shift. Or there’s one of us only for all of Surrey, and Surrey is a very big jurisdiction.

When we do arrive on scene and are approaching the scene, sometimes these clients are very agitated and upset. It’s actually pretty amazing to see that when we get to scene and they see the nurse come, you can almost feel that tension level drop. When we do come to scene, we wear vests that say “nurse” on the front and “nurse” on the back, so we’re very well identified when we get to scene. We hadn’t done that prior. But because we have to wear bulletproof vests underneath, and all this, we were getting mistaken for a plainclothes police officer. We just knew that wasn’t going to be the best way to serve these clients.

Once we made sure we had all of that identification on us, as I said, as soon as we come up to somebody’s home, nine out of ten times, you can feel that tension just decrease. I feel that they probably don’t feel as intimidated. We’re non-threatening. They know we’re not there to…. They’re not in trouble. We’re there to help them, and I think they really feel that when we arrive.

[10:25 a.m.]

Another thing that Car 67 dos. We have a mental health forum. Once a month we have a multi-disciplinary team that meets. Again, that’s the psychiatrists from community, psychiatrists from the hospital, B.C. Ambulance, parole officers, emergency staff, community staff, Car 67. We will all attend. We discuss the clients that we’re dealing with more frequently — frequent hospitalizations, frequent calls to the police. We help come up with ideas and ways to help manage these clients, with everybody giving a piece to the puzzle.

We’ve been doing that for a few years now, and I feel that that has also made a really big difference. When people are seeing them, it’s kind of like a uniform approach. It’s always kind of the same idea, right? So these clients aren’t getting one person coming and it’s done one way, and then another member is coming and it’s done another way. It’s a consistent approach. That helps tremendously with these clients.

As I said, we’re only 12-hour coverage. When we’re not on duty, the RCMP will go out and attend these calls — more often than not, they’re probably going to be apprehended, because they don’t have us to come and do the mental status exam. But if they go to a call and they feel that the client doesn’t meet the criteria to be apprehended under the Mental Health Act, they can send us emails when we’re off shift to follow up with that client the next day. That’s something else that we can do, and it has been quite helpful.

The only problem that we ever have with those types of things is that we lose the clients to contact. Sometimes we aren’t able to find them, unfortunately. That’s the only downfall to that. We always say that 24-7 coverage would be the best. But it’s just a wait. Again, if they’re not in crisis, they will send a follow-up to us.

Surrey RCMP has…. It’s called PMHOT, the police mental health outreach team. That consists of regular RCMP officers. Again, it’s not 24-7 coverage. I believe it’s from 6 a.m. until they finish at midnight. They’re doing a lot of work with the clients.

We call it the strip. It’s in Whalley. It was a tent city for a long time. They tend to stay around that area. They’re going to homeless camps. They’re just making sure that a lot of these clients are linked up with services. If not, then Car 67 is also called to there.

We did a lot of work with them when we were dealing with the tent city on the Whalley strip there — the 135A. With us all working collaboratively, we did a really good job, once the tents had to go down, getting them into the modular homes. With everybody working as a team, it worked out really, really well. A lot of the clients down there were used to seeing Car 67 down there, and they knew the members. The relationship was really important, and it really made a big difference.

Another thing that was asked was just how we feel that Car 67 can be improved. I guess we all agree that everything has room for improvement. I’m really proud of the way the car runs. As I said, I’ve been here for ten years. I don’t think I’d have been here this long if I didn’t love it. But again, always room for improvement. So more coverage — if we could have that 24-7 coverage, or more than one nurse covering all of Surrey. Surrey is, as I said, a very, very large community.

The other thing we were really hoping that we can do in the future is to liaise more with B.C. Ambulance and the fire service. They often go to calls and don’t realize that we have the service available to them. So they try to manage, and then these clients can also fall through the cracks as well. It would be really nice to incorporate more emergency services into our program and increase that knowledge base for them so they know how to reach out. That was one of our big things.

Again, with the front-line workers and the RCMP, we’d like to continue to reach out to as many of them as we can. I think it’s also important that we keep at that. We have these general duty members. They’re the ones that are seeing our clients in crisis, more than anybody else. As long as we keep that relationship with the general duty members that are front line — they’re calling us, and we’re helping them out — I think that’s the best way to keep the car running like it’s running.

As I said, it’s been 21 years. We’ve been through a lot; we’ve seen a lot. We’ve been through a lot of changes. They’ve all been positive changes.

[10:30 a.m.]

You know, when I started working the car in 2011, I went to work and I was sitting in an office all by myself. I’d wait for the police officer to come and pick me up. We’d hit the road, and it was just the two of us. Now we have a larger team, and there are at least eight of us on the road that are just specifically here to do the mental health component, and one nurse. A little bit more in nurses, a little bit more coverage, would be the best.

I thought it would be best, probably…. I don’t have stats or anything like that; I was just kind of told to get a presentation together, so I did. I think it’s really helpful just to have questions and just have a dialogue, more than reading off my sheets. Really, that’s the basis of the car. I’d love to just answer questions and have more of a back-and-forth, because I think that would be really helpful. Hopefully, I can answer all your questions.

D. Routley (Chair): Thank you very much. We appreciate that.

R. Singh: Thank you so much, Tina. I really, really appreciate your coming in after your night shift. I know how difficult this work is, and how hard it is. Especially as I am an MLA for Surrey, we have heard such good things about Car 67 — not just from Surrey residents but from a number of presenters. You have set up an example that many other communities want to follow. Thank you for all that you do.

You had talked about the gaps and the barriers. That’s what I would like to explore a little bit. You talked about the 24-7 service and that it is not available 24-7. Have the Car 67 people…? I’m sure that like this, you are letting us know. Have you advocated for this 24-7 service?

T. Baker: We have. I think it was about last year — with COVID, it just seems like we lost a year, so it was probably the year prior to that — that they were looking at getting a day car on the road. It was in the works. I can’t answer a lot. As I said, I’m your direct-care one-level nurse. So whatever happens up with the directors and such, I don’t know.

I do know that it was in the works, to the point we’d actually come up with scheduling. It still wouldn’t have been 24-7 coverage — we would have overlapped a bit — but we wanted a 6 a.m. start, till one in the morning, to start. However, with whatever happened there, it didn’t come to fruition. Again, that’s not a question I can answer, as to why, but we got that close, and then it got pulled back. As I said, I don’t know the whole reason why, but we were very excited.

R. Singh: Also, you talked about the coordination between the paramedics and the fire. It’s the 911, usually, that people call. I asked a similar question to the presenters before you. What we are hearing are some examples, not here in B.C. or in Canada, but some examples coming out of Europe and also from New Zealand, about the service — we are so used to 911 — that there should be a service just for mental health issues, mental health crises. Do you think that would be a good solution?

T. Baker: Honestly, I really do believe the way we’re doing it is the best. The one thing…. I couldn’t do this job without the police; I couldn’t. I get to go to a scene, and when people are in a crisis, especially a mental health crisis, it can be very volatile. You know, we can have people that are really super aggressive. I mean, I’ve had a 6-foot-5 man in handcuffs try to chase me down and just throw his body weight on me. If I didn’t have a police officer there, I would have been underneath him in a split second. So I really do think the way we respond is a good way.

I used to work for an ACT team, which was assertive case management, prior to doing this work. I look back now and think of the situations I would go into by myself, and I couldn’t imagine doing that now.

One example: I used to give long-acting injections to clients, and I’d see the same clients all the time. I went into this one gentleman’s home — I used to see him all the time — and when I went in there, he had a party going on, and they were all snorting cocaine off of his coffee table. I took him into the bathroom, I gave him his long-acting injection, and then I left. I don’t know who those people were. Looking back now, that was frightening.

[10:35 a.m.]

It’s nice for me to be able to go to these files and sit with a client and 100 percent focus on them. I don’t have to worry about a smash, a bang or anything that’s going on around me. I can just focus, because I know I’m safe.

R. Singh: Right. On that part, I completely get it. It is just the assessing part — like when the call goes, that the assessment is done right. Do you feel there are some gaps in the assessment that need to be filled, or do you think that is fine?

T. Baker: I don’t understand what you mean by….

R. Singh: Like if a call goes to 911, and for them to realize that it is a mental health issue, and it is the Car 67 that needs to go.

T. Baker: I see what you mean. That can be a problem for sure. We do have calls that come in, that we look later, and we’re like: “That was for us.” A prime example — as I said, I’m working in emergency department as well, and last night we had two clients come in, and I thought: “That would have been a perfect Car 67 call.” If we would have gone out to see that client, they wouldn’t have come into the emergency department. So yes, it’s an ongoing battle with that.

We just try to educate the RCMP as much as we can. We kind of try to monitor the calls that are coming in, but due to COVID right now, we’re kind of trying to work remote and practising a little bit different, which is not the best practice, but we’re usually monitoring files. Maybe that RCMP officer isn’t going to think “that’s mental health,” but we’re going to see that. So yes, there is a bit of a gap there, for sure.

R. Singh: Thank you so much Tina. Thank you for this. I just don’t have enough words to thank you for the work that you’re doing in the community of Surrey.

T. Baker: It’s not just me. I can’t do it without my co-workers.

R. Singh: The Car 67’ers too.

D. Davies (Deputy Chair): Well that was good timing, I just got my Internet connection back after about 30 seconds. Thank you Tina, very much, and thank you for your service to your community. It’s greatly appreciated. A couple questions, and I hope I didn’t miss it while I was in Internet la-la land there for a moment.

We have heard about the successes with the team’s approach, the Car 67s and such. What more do we need to do? What are the challenges that…? We’ve heard this, and this is, I guess, kind of maybe a loaded question. I mean, we’ve heard a lot of the pieces. But you, as a psychiatric nurse, on the streets…. What more do we need to do as communities, as a province, to move forward around mental health and addictions, around some of our mandate, the systemic racism that we’ve been seeing. What more do we need to do to improve things? What do we need to fix?

T. Baker: I think every community should have a car program, first and foremost. I know that’s not feasible. There’s a lot of mental health clients out there. Again, with the RCMP managing these mental health clients, that’s not what they’re trained for. They’re trained to serve and protect. They’re not trained to be out there and figuring out who has a mental health issue and who doesn’t have a mental health issue. That’s what we do.

I really think that the Car 67 program in Surrey…. We’ve just constantly been evolving in a positive manner. For us, I can say that we just keep rolling, and we just keep improving. Doing that is all of us working together. It’s Fraser Health. It’s the RCMP. It’s the community. We’re all liaising together. I did mention that we do a forum every month, so we’re meeting with parole officers, psychiatrists. B.C. Ambulance comes to the table. It’s quite a large group of people.

For Surrey, I feel that we are really doing a good job. It’s just we would need more coverage. That’s kind of where we’re lacking. As for other communities that don’t even have a Car 67 program, they need to start from the ground up. It’s a very, very successful program.

I don’t know if I answered that well enough. As I said, Surrey’s just constantly evolving and improving. Over the ten years I’ve been there, there’s been a big shift and a big change. Definitely more coverage, more 24-7, all those type of things would be a definite improvement.

I think he lost his Internet connection again.

[10:40 a.m.]

H. Sandhu: Thank you, Tina. I really appreciate that you reminded me of staying awake for nights. You and I probably were the new grads. I started nursing in B.C. 17 years ago…

T. Baker: There you go. You’re as old as me.

H. Sandhu: …and working in community too. I didn’t work with Car 88, but when you were talking about walking into situations, I remember calling my husband — after the client was abusive to me over the phone — and saying, “This is where I will be going if I don’t come home” — 7:30 in the evening, wintertime. So thank you for all you do. I appreciate it.

One of my questions is answered, because a lot of presenters, Tina, mentioned not having any police presence. Being in health care for years, I know the violence in health care has increased. I, personally, got punched, kicked and even came home with nail scrapes on my arms and whatnot. I often wondered what would happen…. But you kind of answered that you wouldn’t be able to do your job.

You were responding to much more intense situations than us, than we did, in community — just walking into the situation. We’re often told that you leave the situation. I was in that situation one time — there was substance use happening, unsafe, and the room was full of smoke, but then, being a nurse, you’re like: “No, this person needs wound care or otherwise they’ll go septic.” But I quickly…. You do your task, and you’re just literally, inside, shaking, but then you’re being told: “Oh, you could have left.” But it’s not always possible. So thank you for highlighting that, and sharing.

So that’s what my question was: what are your thoughts about going there without police? Which you answered. I really echo the 24 hours because, in emerg here, too, we notice a lot of times that it’s not just patients having to go to emergency, I’m sure you know. Then they end up in regular units, whether it’s surgical, medical, because we have a limited number of mental health beds. And they’re in those beds for days, sometimes weeks, before they get the actual care they needed. So if we had the mental health supports out in the community, they could get the care right away.

The importance of your work and your team…. The drug interactions, you know, sometimes they could cause behavioural problems as well, and having that overdose. So thank you so much. And, again, you answered my question: that you believe the police presence is very, very important.

T. Baker: Absolutely. Absolutely.

H. Sandhu: Kudos to you, and thank you for all you do.

T. Baker: Thank you so much.

R. Glumac: A couple of questions. Again, to follow up with Rachna, and just for your knowledge, we have talked to E-Comm about their experiences, and they mentioned a program in New Zealand where 911 calls get directed to mental health professionals if there’s a mental health challenge.

Now, do you feel that a number…? Do you feel like it would make an impact if there were an opportunity for a mental health nurse to talk to somebody that’s in a crisis, and do you feel like that could reduce the need to actually attend on scene?

T. Baker: Usually, when it’s a 911 call, it’s very difficult to be comfortable trying to do that on the phone and then disengage with them and know that they’re safe, because usually a 911 call is a heated crisis. So it’s hard to say that we wouldn’t want to go because, more often than not, we need to see them and ensure the safety.

A lot of the times…. Fraser Health has a crisis line, so clients actually utilize that quite often and then, from there, if they feel that the client is still at risk and needing us, they usually are calling 911 to do that.

I think that that reflected our after-hours program, before the Car kind of took shape. I think, again, having that, where we can interact with them on the phone, is a good thing, but at the same time it’s sometimes not always feasible. As I said, with COVID right now, we’ve been off the road. I mean, we’re still going out to calls, but we’re just not driving around doing more outreach, just for safety purposes and COVID.

[10:45 a.m.]

So it has really proved to us that it’s actually more detrimental for us to not be out on the road for our whole shift and actually in the community. People know our vehicle. We can be out walking and…. I’ve been asked, just walking down a street, to come and help somebody.

I think it is more beneficial that we actually are out on the road. Doing phone assessments leaves a little bit more liability issues, I believe, also, for us, because a lot of our assessments are not just based on the conversations we’re having. It’s the environment. It’s how the client is presenting. What do they look like? What’s going on?

For example, I could talk to somebody that’s living ceiling-deep in a hoarding mess, but talking to them on the phone, they can tell me a completely different story and I’d have no way to know the environment which they’re in. So that’s a huge part of our assessment too — not just speaking with the client but seeing what their environment looks like, how they’re living. We’ve gone to some places where it’s just…. That speaks more than…. I mean, we’ve apprehended just based on walking into their home and seeing what it’s like.

We can do some stuff on the phone, but more often than not, with the car, we’re definitely out, on scene, with a presence and face to face.

R. Glumac: Good. Thank you. One other question. We just spoke to Island Health. They talked to us about their integrated mobile crisis response team and some of the benefits of that approach being that it gives an opportunity to share knowledge about a trauma-informed crisis with other police officers. The police officers attend, I guess, in plain clothes. I don’t know if being in uniform is a challenge for people in a crisis. I imagine it would be.

T. Baker: Yes.

R. Glumac: Also, they said that they work with a very diverse team, and there’s a larger team. Then, there’s a Car 60 program on the Island. I’m wondering if you have any knowledge about this approach and any feedback on that.

T. Baker: We have a large team now too. As I said, when I first started the program in 2011, they were 11 years into it. That’s when we would go to work. We were just one nurse. A member would pick us up, and off we’d go. From there, fast-forward to today. We have four members on a day shift, four members on the evening shift that are PMHOT members, the police mental health outreach team, and then Car 67 as well. So we do have more of a team approach, for sure, in that regard. A lot of these members that are working in the police mental health outreach team are there for a minimum of at least a year, so they’re getting used to the clients, because we’re seeing a lot of the same people.

Another thing with uniforms, like you said: it is a trigger. I did find that a lot when we were working a decade ago. I mean, a yellow stripe down the side of a pant leg would just send people into a tailspin. So we went to plain clothes for the members. They were just wearing plain clothes — T-shirts, jeans — because we thought that would be a better approach.

But from there, if we had clients in the hospital and if they had to be more physical with these clients — take them down because something happened in the emergency department — we were having a lot of people that were just regular civilians thinking: “Why is this person that’s…?” They didn’t know they were a police officer. They were taking these people out, and they’ve got a gun on the side of their head.

So we changed again from that. Now they wear a muted uniform. There’s nothing that stands out when they’re wearing it. The yellow stripe has gone off the side. They’re just wearing blue cargo pants and a blue shirt, so they’re kind of all blended in, and then they have a big badge on the front that actually says: “Mental health.”

We’ve found that that’s been quite beneficial when we’re going to scene, because it’s just a less threatening approach for these clients to see that. I mean, they see police and they think they’re in trouble, first off and foremost, and it’s that fight or flight that they get into sometimes, which can cause a scene to get really, really messy, really quick.

I’ve definitely found that the approach of us all approach­ing them in muted uniforms…. We’re not threatening. They’re very much more relaxed with us, and as I said, you can see that. The general duty members have to go first to ensure it’s safe, because my member is looking after me. But you can tell when we get to scene. You can feel it. It’s palpable. You can feel that tension level decrease.

[10:50 a.m.]

We also have family members that can be there too. We can have anywhere from one client that we’re dealing with to ten people, because we’ve got family members that are really upset too.

D. Routley (Chair): Thank you.

We’ll go, for a follow-up, to Dan, who is back with us.

D. Davies (Deputy Chair): Hopefully my Internet stays connected here again.

I did have just a follow-up question. Not a follow-up, it’s a new question. I know that Surrey is in the middle of some sort of transition to a different policing model, police force. Do you know if Fraser Health has had any discussions with the municipality about carrying on these programs? I know that’s a big question, and that might be way above your pay grade.

T. Baker: I’ll be the last one to find out. Let’s put it that way. I will show up to work every single day until they tell me that they don’t want me. I really don’t know. Usually we are the last to find out, so I don’t know. I can’t see…. I hope not, because Surrey needs us. Fingers crossed, that’s not the case. I really don’t know the answer to that.

D. Davies (Deputy Chair): Great. Thanks, Tina.

A. Olsen: Thank you for your presentation, Tina. I really appreciate you sharing your experiences, the on-the-ground experiences that you’ve had.

I’m just wondering. You’ve made a couple of statements that every community needs a car like the one that you work in or a program like the one that you work in. Recognizing that there’s a need to expand this program, or you’ve made the request that this program be expanded for a community like Surrey, I’m looking at the very other end of the spectrum, which is the very smallest communities, the rural and remote communities across the province and the challenge that they might have in being able to bring together resources, considering that Surrey needs more, and just the impact across the province.

Then, as well, you also said that it’s really important that a police presence is with you. I’m just wondering if maybe you could comment on if there was a paramedic or a firefighter or police — whether or not it’s the type of training that’s with you that presents…. I’m just thinking. Would there be a remarkable difference between a police officer showing up and someone from a volunteer fire department or someone from the B.C. Ambulance Service?

I recognize I’m asking you to answer a hypothetical question, but because you have that experience on the ground, I just would like some kind of an indication as to whether or not the expertise of the police is what you’re speaking to or the presence of another person there to support you and maybe to make a bigger presence than perhaps just you showing up at a site.

T. Baker: Again, the police are definitely…. One, if we’re ever apprehending a client under the Mental Health Act, the police are the only ones that have the authority to do so. I don’t have that authority. The fire department would not. The B.C. Ambulance would not. When we’re going to files, we’re trying to not apprehend the client. That’s our goal. But a lot of the times we are doing apprehensions. The police have to be there to do that apprehension.

Again, a lot of the 911 calls that are coming in that we’re dealing with are definitely situations where it’s more intense. We have people that are psychotic. They’re out of touch with reality. They could be quite combative. You don’t know what’s going to happen. To be honest with you, I would not feel safe doing my job without a police officer present.

Saying that, it’s also…. I want a police officer with me that has a genuine interest in mental health and has a genuine…. That compassion is there. Police officers are going to be police officers to serve, to protect and to do that job. They’re not there to do mental health and to be doing a nursing role, but there are a lot of them that are very interested in that, and those are the ones that we’re working with.

Again, when we’re going to files, sometimes these police officers that attend first can agitate the situation and make it worse, but not deliberately. They just don’t know how to manage.

[10:55 a.m.]

Now, when I’m coming in with my police officer…. It’s safety. We couldn’t do this job without the police officer being there. As I said, I’ve been chased. I’ve had interactions where it’s kind of started to go sideways. But I know I’m safe, so I can keep pressing on. I don’t have to worry about my safety.

I’ve been doing it and the police officers are picking up on cues that I’m not picking up on. I’ve had members grab me by the back of my vest and just kind of pull me back. They’re seeing things that I’m just not seeing. They’re trained that way, where fire departments are not. Ambulances are not. But we need them too.

I find, when we’re out on the road and we’re working, we’re all working together. We work with the ambulance. We work with fire. We’re all bouncing off each other. We’ll be to files where all of us are there. But to do my job, absolutely, with the police is the only way we can safely do what we do.

A. Olsen: If I may, Chair, just make a comment. I don’t think I’ve got another question.

I really appreciate your insights into that, Tina. I guess what I’m exploring here is, in recognizing the dramatically limited resources across the province in small and remote, rural communities, if there is a recommendation that we could put together of a program that would say…. What kind of training would need to be put into place so that we could deploy a collection of resources, whatever it is that the community has?

I think you’ve been very direct. I appreciate that. I think that there’s an opportunity here for the committee to explore some kind of recommendation to say that there are resources in communities that, if they’re assembled properly and trained properly and have the right kind of support, perhaps we can get a similar kind of outcome in a more rural community.

I’ll just leave it at that.

G. Begg: Thanks, Tina. In deference to your need for sleep, I’ll make these short. Hopefully, you have the information.

In your experience, and this can be empirical or anecdotal, how frequently do police have to intervene? In other words, how frequent is it that police have to do police stuff when you attend a call?

T. Baker: They’re always turned on. Like you say, we go there, and they’re in crisis. It’s hard to just give a number off the top of my head, but I must say that when we’re at the files, they’re doing police work. They’re at the scene. They’re ensuring that everything’s safe. They’re clearing the residence for us. They’re making sure that they’re not going to have Joe Blow coming out of the kitchen with a knife and surprising me halfway through my assessment.

As I said, I could be asking questions to clients or my colleagues. We don’t know what’s going to trigger them. We don’t know what’s going to set them off. We can be quite intrusive with having to ask these questions. If they’re psychotic, they’re not in touch with reality. They don’t understand what’s going on.

A lot of the times, when we’re going to these files and we have more police officers, we try to get rid of as many as we can and allow us just to be with the client to decrease that level of agitation. But yes, they’ve had to step in a lot.

G. Begg: Thank you. One other short question. The percentage, number of times, where an apprehension has not been needed — in other words, treatment at the scene was sufficient. The number of times that your presence and your work has obviated or negated the need to take the client to emergency.

T. Baker: Quite often. I don’t have stats or percentages, but quite often, especially now. I’m sure you’re familiar with that urgent care response centre now. I think that’s been about two years we’ve been up and running, which has been amazing for us as well. There have been clients who I would have apprehended, like three years ago. But now, I can call up the urgent care centre, and sometimes I luck out. I get a psychiatrist to see them within a half-hour. We’re very fortunate to have that.

With Surrey, we have such a wonderful wealth of resources for mental health clients in the community. We’re very, very fortunate with that. That allows us, as the nurses, to liaise with those community resources while we’re on scene, and phone, and see what we can do. When we’re not there, the RCMP don’t have that. So they are apprehending, because they’re not thinking of these things, but that’s not what their role is.

[11:00 a.m.]

I’ve noticed, especially with the UCRC, that it has definitely decreased, with us being able to liaise with all the community resources. Having that laptop, with all of the information at our fingertips, on the road has been amazing.

G. Begg: Thanks very much.

D. Routley (Chair): Now I’ll go to the extremely patient MLA Halford, who happens to be the opposition critic for Mental Health and Addictions.

T. Halford: That’s okay. I just want to say thank you. I mean that. You’re on the front lines. You’re seeing this; you’re living it. You know what? You guys are making a world of difference. We need more of you out there, in every community. Surrey is the fastest-growing municipality in Canada. We need to make sure that we’re advocating for resources for you. We’ll continue to do that because what you guys are doing is changing lives. So no question, just thank you very much. We’ve got to keep giving you what you need.

T. Baker: I appreciate that. I do, and my colleagues do as well. Stacy and Ashley are amazing nurses. It’s not just me. It takes a big village of us to do this.

T. Halford: Yeah. Well, get some sleep.

T. Baker: I will after this, I promise.

D. Routley (Chair): Thanks, Trevor. Thank you, everyone, for your questions. Finally, thank you, Tina, for the excellent presentation.

T. Baker: Thank you for having me. I really appreciate it.

D. Routley (Chair): Thanks. I ask all the presenters if they’d be willing to be contacted if we need to reach out for your experience again. We also invite any other contribution that you might want to make.

T. Baker: Absolutely. I’m very passionate about this — ten years in, absolutely, 100 percent. I’m always here; I’m easy to find.

D. Routley (Chair): It’s very clear. Your passion for it is very clear. Thank you very much.

H. Sandhu: Thank you so much.

D. Routley (Chair): Committee members, we will take a five-minute recess now. I will be back with you at 11:07.

The committee recessed from 11:02 a.m. to 11:11 a.m.

[D. Routley in the chair.]

D. Routley (Chair): Welcome, everyone, back to this meeting of the Special Committee on Reforming the Police Act. I’ll ask all members to introduce themselves prior to our next panel, starting with Deputy Chair MLA Davies.

D. Davies (Deputy Chair): Hi, good morning. Dan Davies, MLA for Peace River North in Fort St. John.

I am on the Dane-zaa territory.

T. Halford: Hi. Trevor Halford, MLA for Surrey–White Rock.

I’m on the traditional territory of Semiahmoo.

K. Kirkpatrick: Hi there. I’m Karin Kirkpatrick. I’m the MLA for West Vancouver–Capilano.

We are located on the traditional territories of the Musqueam, Tsleil-Waututh and Squamish First Nations.

R. Singh: Good morning. Rachna Singh, MLA for Surrey–Green Timbers.

I’m joining you from the shared territories of Kwantlen, Katzie and Kwikwetlem people.

H. Sandhu: Good morning. I’m Harwinder Sandhu, MLA for Vernon-Monashee.

I am joining you today from the unceded territory of the Okanagan Indian Nation.

Thank you for joining us.

R. Glumac: MLA Rick Glumac from Port Moody–​Coquitlam.

I’m on the traditional territory of the Coast Salish peoples.

A. Olsen: Hey, good morning. Adam Olsen, MLA for Saanich North and the Islands.

I’m working today from my home in W̱JOȽEȽP village in the W̱SÁNEĆ territory.

G. Begg: Morning. I’m Gary Begg. I’m the MLA for Surrey-Guildford.

I’m proud today to be coming to you from the traditional territories of the Coast Salish people, including the Katzie, Semiahmoo and Kwantlen First Nations.

D. Routley (Chair): I am the Chair, MLA Doug Routley of Nanaimo–North Cowichan.

I'm coming to you from the territory of the Malahat First Nation.

Thank you for joining us. The meetings and presentations here will be limited to 30 minutes. We have a timer available to help us. I’ll also remind everyone that all the audio from our meetings is broadcast live on our website and a complete transcript will also be posted.

Our next presenters are from Interior Health. I’d like to welcome Debi Morris and Roger Parsonage to make their presentation. Go ahead.

INTERIOR HEALTH

D. Morris: Thank you very much for having us this morning. I am Debi Morris.

I am very privileged to be joining you this morning from the traditional, ancestral and unceded territory of the Secwépemc Nation. Beautiful day here on the edge of the Shuswap.

I am currently the director for the mental health and substance use network. I am a psychiatric nurse of around 20-plus experienced years, including in England, where I was originally trained, and here in Canada. I’ve had many years of working in different models of crisis service, so really interested to be part of this conversation and work today. Thank you.

R. Parsonage: I’m Roger Parsonage. I’m the interim vice-president of clinical operations for Interior Health North. In addition to having operational responsibility for some of our mental health and substance use services, I am also our strategic lead for mental health and substance use.

I’m speaking to you today from my home in Vernon, on the traditional territory of the Syilx people.

[11:15 a.m.]

Thank you again for the opportunity to address the committee. There are four points that I want to speak to today, the first being that stigma continues to be a fundamental issue facing people with mental health and substance use disorders. We know that it limits their ability to both seek and to receive quality care. It also limits the ability of communities to come together in addressing some of the root causes of issues.

The second point is that mental health and substance use disorders exist on a continuum of severity. Our response must also be on a continuum, from prevention to saving lives to long-term treatment and recovery.

My third point. We are working, at a system level, to ensure that every door is the right door. What I mean by that is…. The system can be confusing and difficult for people to understand. Often when people are experiencing a mental health or substance use disorder where their family is trying to get help, it can be a scary and a confusing time.

People aren’t always sure where to reach out for help, and they find the system confusing to navigate. We want to make it our job, as a health care system, to receive people however they come in contact with us and then ensure that they are seamlessly transitioned into the care and services that they need.

My final point is that community-level collaboration between health, policing, local government and community response agencies is essential.

I want to move to page 3 of the presentation we provided. This provides multi-year data on the illicit drug toxicity death rates in B.C. I suspect it’s data that all of you are very familiar with.

We are now coming up, very soon, on five years since the public health emergency was declared. While we saw progress through 2018 and 2019 in the declining death rate, unfortunately, those gains have now completely been wiped out through the COVID pandemic. Through January and February of this current year, we were up to an average of 5.4 deaths per day in B.C.

Despite the staggering toll that this emergency continues to have, as a health authority, we are facing local, public and political opposition to some of the very services that we know would save lives. This opposition, at a local level, is very concerning to the extent that policing priorities are influenced, to some degree, and directed locally.

Moving on to page 4, I want to highlight one of our major strategic focus areas. It’s what we call primary and community care transformation, which includes the development of specialized community service programs.

In many cases, our hospitals are seen as the anchor of health care in communities. People present to an emergency department for care often as the default option, not necessarily because they need emergency-level care but because no other help is available. The purpose of primary and community care transformation is, in part, to ensure that we have comprehensive and coordinated community services that are available to shift care away from an acute care setting.

There are four patient populations that are the focus of this work. One of those is people with moderate to severe mental health or substance use disorders or concurrent mental health and substance use disorders.

Slide 5 talks a little bit more about what we are seeking to achieve with this work. As I alluded to earlier in speaking about access, we know that our existing services aren’t always as well coordinated as they should be. Communication between different service providers, particularly between primary care and health authority services, is often inadequate or certainly not seamless. As I said, people don’t always know where to reach out when they need care.

System accessibility and care coordination across services are major focuses of our improvement efforts. However someone comes in contact with the system, we want to make it our job to get them the right service and ensure that there’s a seamless transition between those services.

Slide 6 provides a snapshot of the spectrum of mental health and substance use services that Interior Health currently offers. It is complex, but to some degree, it represents the complexity of mental illness. It can range from psychosis to dementia, eating disorders, depression and things like alcohol use disorder, as examples.

[11:20 a.m.]

This reflects a continuum of care of increasing specialization. Generally, moving left to right on the page, the services become more specialized. But it’s important to note that this represents our service structure. People can come in at many different points in the system, and they can be enrolled in multiple services simultaneously.

To give you a couple of examples, research has shown that depending on the setting, anywhere from 20 percent to 80 percent of clients can have co-occurring mental health and substance use disorders. We have found of our clients represented in community programs — so those that are registered in community programs — about 19 percent of those are also enrolled simultaneously in substance use services.

I want to draw your attention, in particular, to the second column. I’ll be speaking a little bit more about crisis and hospital services as well as our substance use services, which are on the right-hand side, a little bit later in the presentation.

Moving to slide 7, this speaks a little bit more about some of the underlying principles to our service delivery. I want to share with you a quote that I came across recently that was provided as part of an ethical review of one of our substance use services. It’s this: “An ethical society has an obligation to provide appropriate and effective health service in a way that maximizes benefits and minimizes harm to its members.” One of our overarching goals is to address the role of stigma and racism in health care generally and in our mental health and substance use services more specifically.

I often, in thinking about this, reflect on a story that one of our primary care providers told me. This is a physician that provides care in a clinic that serves vulnerable people. She told of a client who came in who had experienced a serious injury. In fact, his injuries were life-threatening. He told them that he needed to go to the hospital and get hospital-level care. He refused. He said he would rather die than go to the hospital. I think of that story often as I think about the kind of system that we want to design that ensures that we are safe and welcoming for anyone that comes in our door to seek our care.

The other point that I want to make with this slide is that we have recently conducted a review of people who died of an illicit drug toxicity death in Interior Health. Over a three-year period, between 2017 and 2019, there were more than 260 files that were reviewed. The preliminary results have found that 70 percent of those people were in contact with health services in the three months prior to their death. For most of them, 60 percent, that care was in the emergency department. So it is critically important that we design a health care system that welcomes people, however they come into it, and then ensures that they get the care that they need.

The final piece that I want to mention here is team-based care. We are increasing our investment in team-based care across our health authority, putting integrated teams out in the community consisting of nurses and social workers supported by psychiatry and addictions medicine and informed by Aboriginal Elders and peers — people with lived experience — and taking our services out to people who may have difficulty engaging or for whatever reason, including transportation barriers, are unwilling or unable to access traditional services. This model also helps to avoid some of the concentration of services at a location that can cause local concern.

[11:25 a.m.]

Moving on, slide 8 provides some current examples of successful community collaboration that is occurring in our health authority — community action teams focusing on substance use and situation tables focusing more generally on the vulnerable population. I just want to point out that there are 60 municipalities in Interior Health, 54 First Nations communities and 15 Métis chartered communities, and most are not represented here.

Now, I will say that informal collaboration with police at the local level, particularly when there is a police liaison officer that has an interest in mental health, has worked and serves us and the population extremely well.

Slides 9 and 10 speak to the relationship between policing and some of our services, specifically harm reduction and supervised consumption, or overdose prevention. These are some of our most visible and also our most controversial services in communities. In fact, we can and do experience pressure to introduce additional barriers to these services, which would serve to further marginalize an already vulnerable population. I will just say that the practice of policing can interfere with these services, which speaks to the need for that strong local collaboration.

There was a review done of harm reduction services in B.C. that found between April 2016, when the current emergency started, and December 2017, it is estimated the actual death rate was 60 percent lower than it would have otherwise been had the harm reduction initiatives that ramped up during the emergency not been put in place. In other words, the actual death rate would have been more than double what it was if not for these initiatives.

Slide 11 describes the components of crisis response in Interior Health. It is important to define a “crisis” as a personal experience that is different from normal in which someone feels overwhelmed and their usual coping stra­tegies are insufficient. It is highly variable. It depends on the person. It depends on their context. What constitutes a crisis for someone may not constitute a crisis for someone else.

I think it’s important to note that crises are not an inevitable consequence of mental health issues alone, and a crisis is not necessarily an emergency. The difference between a mental health crisis and a mental health emergency is the degree of urgency, although crises can certain­ly become emergencies without an appropriate response.

Slide 12 provides more information about a co-responding police and health service. In Interior Health, in Kelowna, it’s known as the police and crisis team, or PACT, and in Kamloops, it’s referred to as Car 40. A little bit of information on this slide about those services.

There is interest from police and local government in both those communities to expand. Based on our analysis of the numbers, as well as the cost to do that, the business case to expand just isn’t there. In fact, almost half the calls to these services are for consultation, which suggests that there is an underlying need to provide information to responding officers that could much more efficiently be addressed through expanding a virtual service.

We sometimes hear about these teams transporting people to the hospital, and the relatively high proportion of hospital admits coming from that, as an indicator of success. The challenge with that as an indicator is that it is somewhat contrary to the direction we’re taking related to primary and community care transformation, which seeks to shift care outside of the hospital, and the approach to team-based care that we’re trying to provide, to provide that comprehensive, longitudinal care in a community that reduces the need for both emergency department visits and acute care admissions.

Slide 13 describes some of the areas we are exploring to enhance our crisis response based on early consultation with police and community partners. This is a priority for us, and we are engaged in ongoing discussion about the current needs and about how we can respond. This is preliminary work, so I can’t speak definitively, but I do see an opportunity, both in leveraging our community outreach teams as well as on building on the advantages of virtual care.

[11:30 a.m.]

One of the upsides of the pandemic, if there is an upside, is the expansion and significant uptake in virtual care in mental health and substance use services, which has allowed us to reach clients and to reach areas of our health authority that have traditionally been problematic. We see opportunity to leverage that success in enhancing our overall crisis response services.

Now, I will point out that the options that we are looking at are all within the constraints of our current system. There is a larger public policy question around who should take the call when someone is experiencing a crisis and who should respond.

I want to mention slide 14 just briefly. We have a strong focus in Interior Health on peer empowerment, engagement and employment — peers being people with lived experience with mental health and substance use disorders. We currently have 47 peers, including nine who self-identify as Aboriginal, who are part of our peer advisory group. They give us advice as we develop programs and services, and we are incorporating peers directly into some of our services to help us reach people more effectively.

I want to share with you a recent quote from one of our peers related to crisis response: “If someone is having a mental health crisis, the absolute last thing they want to see is a gun. Police being the first responders to a mental health crisis is not appropriate. Most of the time, it shouldn’t be a police officer who responds.”

Finally, slide 15 comes back to the issue of stigma. We have created four videos that are available on our website that tell the story about people in our region who have been directly impacted by substance use. It is a powerful reminder about the words that we use and taking care of our words when we’re talking about mental health and substance use disorders.

With that, I’d be happy to take your questions.

D. Routley (Chair): Thank you very much.

T. Halford: Thanks for the presentation. I appreciate it.

A couple quick things. Just in terms of…. You highlighted, at the beginning, political opposition. Just maybe if you can expand on what your definition of political opposition is, that would be helpful.

We have recently talked a lot, specifically, about Interior Health and some of the issues that we face there with the closing of Pathways. I know we’re talking about the Police Act, but just in regards to the closing of Pathways, do you guys consult with first responders — whether they’re police, firefighters, paramedics — on some of those decisions?

Maybe if you can expand, too, in terms of how you guys are viewing bringing a lot of those services in-house and how you think that’s going to offset or benefit where we are with mental health and addictions, specifically in the Penticton area.

R. Parsonage: Thank you. The short answer is yes, we do consult. As I alluded to in the presentation, we have regular, both formal and informal, consultation, particularly with local RCMP and through local governments.

In terms of the Pathways contract, it really speaks to some of the issues that I talked about around access to services and care transition. Recognizing that people are often enrolled in multiple services, both mental health and substance use, there is a need to ensure that we are providing integrated care and can ensure that there is a seamless transition between services. All of those reasons underlie the decision to bring that contract in-house and to incorporate it, as we do in other communities, with the broader suite of mental health and substance use services that we provide.

[11:35 a.m.]

In terms of community opposition, I will just say that we have been challenged, particularly with overdose prevention services. I think our experience in Vernon has been a good example, but there are certainly others where it has been difficult to find a location that has a level of community support that would allow us to provide an overdose prevention service, in particular.

D. Davies (Deputy Chair): Thank you for your presentation. Just want to mention, your brother and family were my neighbours up here in Fort St. John, so we have a connection as well.

I just want to touch base quickly on…. You were talking about the virtual crisis response, virtual health care. What does that look like? I’ve heard this a couple of times, from a couple different presenters. I’m just trying to wrap my head around what that even looks like, when someone is in crisis and reaches out. How does that unfold and turn into a virtual care model?

R. Parsonage: I’ll speak, just at a very high level, and then maybe ask Debi to talk in a little bit more detail.

With the pandemic came a very rapid implementation of virtual care technologies — because, first and foremost, we couldn’t provide in-person care in some of the cases that we would have, previous to the start of it — either through telephone or through Zoom, in particular. Some of the traditional barriers to doing that were quite rapidly resolved. Out of all of our health services across the health authority, the largest uptake in virtual care has been through mental health and substance use services.

Debi, did you want to speak a little bit more to some of the specifics?

D. Morris: Yeah, absolutely. Thank you.

I think we have a real opportunity. As a health authority, we do serve across a vast geography, and we have many communities that are very rural and remote. Access is an ongoing challenge. I think, to your question around virtual care and where it sits in that care continuum, we’re really seeing that opportunity. We actually have online behaviour therapy courses, etc., but really when people are in a crisis, very often what they need is that [audio interrupted] point of connection.

It doesn’t necessarily, to Roger’s comments in the slide show, always mean that somebody…. Their crisis may not always need that urgent or emergent response, but it needs somebody to walk beside them, to help reframe. We know prognostically people do better, actually, if they are able to be supported to walk through their own crisis and come through the other side with new coping skills. Using platforms, such as we’re on today, gives us that opportunity.

I would also say we’ve seen a real shift in having our psychiatrists, our addiction medicine consult and physicians stepping into the virtual world, as well, which has, again, allowed us to give the multiple kind of disciplinary care that we wouldn’t normally have had prior to this increase. We opened doors to our new communities to actually bring the team into somebody’s home.

Again, even things like child care issues, people’s confidentiality…. We’re actually hearing people give us feedback that they really like this platform.

A. Olsen: I guess I just want to start by raising my hands up to you for first, I think early on, addressing the stigma from an institutional perspective. I think that it’s really important that, just as we do the territorial acknowledgements, our health authorities and our provincial institutions and agencies are recognizing some of the biggest challenges that we face are the stigma and the cultural aspects within these organizations.

As well, I want to acknowledge and raise my hands up to you for expressing vulnerability and the fact that, I think, you may be the first organization of your kind, I’ll say, to just straight outright acknowledge that you have done some good things but you also have a lot to learn. I really appreciate that approach. It’s not lost on me, at least, and I want to acknowledge you for that.

[11:40 a.m.]

I’m just wondering. I saw in the…. It just caught my attention. This is more about the opioid poisonings. There seem to be two health authority regions that have seen numbers drop within their health authorities. Do you have any indication as to what you might be doing, as a health authority, differently than others?

I recognize this is outside the context of the Police Act, but it caught my attention that Island Health and Interior Health had both seen decreases.

R. Parsonage: Thank you for the comment, and also for the question.

Debi, I wonder if that’s something you could address a little bit more.

D. Morris: Yes, I’d be happy to. Probably the short answer to that, I think, is taking a real multi-pronged approach. We’ve certainly developed…. Interior Health has its own task force that has recently formed, and we are seeing, similarly, across different kinds of geographical areas within Interior Health. We have some of these local tables that look at different community-level needs. It really is around, I think, being able to move quickly, to look at different opportunities to respond and to stay with the program.

I think one of the things that we are doing — and we’re being recognized provincially — is not just, as Roger references, the peer work, but we do embed that lived experience in all of our system planning. We are really trying to work on a different approach, using epidemiological data, to target those that are most affected. Traditionally, those are not always people that are walking through our doors easily. So we have developed newer teams with different approaches that really take the services out of the workplace, so to speak, and get into the community.

That wasn’t such a short answer. But really, a multi-pronged approach, I think, is the short answer to that.

A. Olsen: Well, it’s certainly not an easy question. I recognize that this response isn’t going to solve the problem. But it just caught my attention as you were passing by, in the slides.

I’ll just ask one other question, around the Car 40 impact. In your slide presentation, it showed that for about $1.4 million annually, you could double the impact of these two programs. I think that was the comment on the slide. I’m just wondering what the service area for that would be. Interior Health is a large geographic area. That number seems like a relatively good investment. I’m just wondering what kind of expanded services that would provide, and how much coverage.

R. Parsonage: Yeah, thank you. As you say, $1.36 million would give us 24-7 coverage in both Kamloops and Kelowna. [Audio interrupted.] But it would only be, on each shift, a single RCMP officer and a single health worker.

I think the bigger difficulty with that service is that from our analysis of current levels, the nurse in Kelowna, over a three-month period, was seeing, on average, just three people per shift. From what we are seeing in the utilization numbers, there is a much larger demand, with about half of the calls for service related to consultation or information-sharing.

I think it speaks to an underlying need that the RCMP feels, having as much information as they can as they go into a situation, and an opportunity for us to provide that much more efficiently, if it is in fact a need for information.

As a health authority, when I look across our entire geography and all of our programs and services, there is a need to ensure that we have a level of crisis response across all of Interior Health.

R. Singh: I would really like to echo what MLA Olsen has said. Your presentation, I would say, was a very empathetic presentation. You talked about all the good things that are working, and also about the challenges that the health authority is facing.

[11:45 a.m.]

Just something that you mentioned about racism…. We have seen a report about racism in health care. I would just like to know from you, with the people who are facing mental health and addictions — from the intersectional point of view, of mental health and addiction coming from a marginalized community — do you think that impacts the kind of service that they get?

R. Parsonage: The short answer is yes. I do think it has an impact. We know from the stories that we’ve heard that people who have mental health or substance use disorders can feel stigmatized, and it affects their decisions in whether or not to seek care. In some situations, it affects the quality of care they receive.

The In Plain Sight report tells us something very similar about racism and the experience of Aboriginal people when they seek care. My concern is that we know Aboriginal people are disproportionately affected. I think when we put stigma and racism together, then it makes it even that much harder for somebody that is Aboriginal to receive — well, first to seek, and then to receive — high-quality care.

This will be a major focus of the health system as we seek to respond to the In Plain Sight report and, in Interior Health, as we try and address stigma in our health care settings.

R. Singh: Thank you so much for this. Also, just on the comment…. You talked about the integrated services, the integration with the police, the coordinated approach — for example, like Car 40. Where you don’t have these kinds of services — especially within Interior Health, in very, very remote areas, where you don’t have this kind of coordination — have you heard about the challenges that communities are facing?

R. Parsonage: Debi, I wonder if that’s a question you could respond to?

D. Morris: Yes, absolutely.

Yes, again, is the short answer to that. As we’re a doing our review of our current crisis services across Interior Health, we are recognizing that we are not always consistent, in terms of the services we offer. Many of our services have, for various reasons, shifted to be more kind of hospital- and emergency-based.

Again, going back to the comments earlier, we really want to be able to offer that service at a point in care before people have to walk through emerg. We know emergency isn’t always the best environment for somebody that’s in a crisis.

Certainly in my own experience of working in more rural models, the liaison role and the relationships between our mental health and substance use teams and our local RCMP are integral. We have many opportunities…. If we’re going into somebody’s home to do a crisis assessment, we have RCMP that attend with us. Really, who takes the lead depends on what you find when you get into that situation. But you do that best through relationship and collaboration for sure.

R. Singh: Thank you so much. I really appreciate that.

H. Sandhu: Thank you, Roger and Debi, for your very, very nice presentation and for highlighting a couple of the key points.

First of all, I would also like to echo other committee members in thanking Interior Health for being champion by starting the diversity and inclusion committee to address the racism in health care. That’s something I’m quite proud of.

Roger, you highlighted the actual, given COVID…. We were making good gains, but then COVID came. I appreciate your highlighting that the actual death toll would have been doubled if these services were not in place, which again highlights the importance of investments in these services. Thank you for thinking outside the box, to shift away from acute care. As we have seen, it wasn’t working, and clients weren’t getting the help they needed, sometimes for days and weeks.

Can you tell the committee members a little bit more about the peer advisory groups — how they work and what the feedback is and if we need to add more similar services?

[11:50 a.m.]

R. Parsonage: Debi, would you like to speak to that?

D. Morris: Yes, absolutely.

We’re actually very proud of this work, I would say. We have a coordinator that works specifically to both engage and to make sure that we are offering a safe environment for our peers to provide their reflections and reviews. That may be from working with a policy or a piece of literature for a review. It may be actively sitting in on and being part of a committee or a table. We have opportunities to bring those voices in, in many different ways. We’ve built a whole network and community of practice.

Again, we’ve really been able to enable safe practice and connections amongst the peers themselves, so that they feel supported to bring forward their best voice. We are really looking at methods of recognizing different levels, even, within our peer structure. What I mean by that is we are setting up either honoraria or, in some cases, even positions that are paid positions to do this work. It really kind of gives us a fulsome perspective on how we make sure and always have a safe space but a good strong voice as we move forward with our services.

H. Sandhu: Thank you, Debi. One comment I wanted to make, on the increase in team-based approach. From my experience working in health care, I really appreciated when I heard, and then there was more explanation and clarification provided by Interior Health. When I hear that — some opposing opinions — I really wish that people looked deeper into or even asked people who are working in the system.

I really appreciate you highlighting, again, why there was a need, because we can all tell that there is no room for the gap when it comes to accessing those services. We have seen the devastating effects when a person is on track for accessing services, but then there is this gap. They fall back, and all the work that we’ve done is gone. It has just disappeared.

I really, again, appreciate the thinking outside the box and highlighting the need. I have personally also heard, in the area, that there’s quite a good, positive response, more so from the workers and the people on the receiving end. So I want to say kudos to you and your team.

D. Routley (Chair): Thank you.

I don’t see any other questions at this point. Anyone else?

All right. Thank you very much for your presentation. We deeply appreciate your help, Roger and Debi. It’s at this point where I ask presenters if they’d be willing to be contacted should the committee have further…. Of course, we ask for that. Also, we invite any other contribution that you might want to make to the committee, going forward, as a written presentation, perhaps.

Thank you, Members, for the great questions.

Thanks, presenters, for the information. It has helped us so much today.

R. Parsonage: Thank you.

D. Morris: Thanks very much.

Other Business

D. Routley (Chair): Members, we don’t have a lot of time left for deliberation. That’s no surprise. I really appreciate the way everybody makes these meetings go. I really appreciate that I don’t have to intervene too much. I hope everybody’s okay with that. It’s hard to do that with some of these presentations. It’s not the same as a lot of other committees that I’ve worked on.

With that, I’d ask you if maybe we should look for a meeting to spend an hour on deliberation coming up, because we’ve taken in a lot of presentations now without that opportunity.

Karan, can you help look for an opportunity for us to get together for an hour?

K. Riarh (Clerk to the Committee): Yeah. I’ll just flag that we have three meetings scheduled next week. I do anticipate, based on the scheduling we’re working with now, that we will have time in those meetings. So I don’t think additional time will be required, but I’ll circle back if that’s not the case.

D. Routley (Chair): Okay. Well, why don’t we leave it, then, to see how much deliberation we get next week, if we can make that time work. Otherwise, we’ll schedule something.

Okay. With that, a motion to adjourn from Adam and seconded by Karin.

Motion approved.

The committee adjourned at 11:55 a.m.