working collaboratively to support those in crisis · 2. is apparently a person with a mental...

Victim Services SymposiumApril 21 2017

Staff Sergeant Lynn NoftleMental Health Portfolio

Working Collaboratively to Support those in Crisis

• Vancouver’s Mental Health Crisis

• Mental Health First Aid

• VPD Collaborations• Programs• Data Trends• Ongoing Projects

Outline

Provincial Mental Health Act Apprehension

Section 28 Mental Health Act:• A police officer or constable may apprehend and immediately

take a person to a physician for examination if satisfied from personal observations, or information received, that the person:

1. is acting in a manner likely to endanger that person’s own safety or the safety of others, and

2. is apparently a person with a mental disorder.

Form 4 Medical Certificate Form 10 Judicial Warrant Form 21 Director’s Warrant for Elopee or

Recall from Extended Leave

Vancouver Downtown Eastside

Vancouver’s Mental Health Crisis

• 2008 VPD Lost in Transition

2014 VersadexInnovation Award

Vancouver’s Mental Health Crisis

• 2010 VPD Beyond Lost in Transition

“… a lack of capacity in the mental health system is failing Vancouver’s mentally ill and draining police resources.“

Vancouver’s Mental Health Crisis

• 2011 November VPD-VCH-PHC Project LINK

Project LINK: 2015 recipient of the Dr. Nancy Hall Award for leadership in public policy, Canadian Mental Health Association, BC Division

Vancouver’s Mental Health Crisis

• 2013 The Hotel Study

• 30% adequate• 40% inadequate• 30% no care

Vancouver’s Mental Health Crisis

“We believe the current situation regarding untreated, severely mentally ill people is on par, if not more serious than, what Vancouver faced over a decade ago. The ‘public health crisis’ is now a ‘mental health crisis’.”

• 2013 VPD Mental Health Crisis Report

Vancouver’s Mental Health CrisisMayor’s Task Force on MH&A

Mental Health First Aid

Mental Health First Aid

Stigma Awareness Confidence

• A Assess risk of suicide and/or harm

• L Listen non-judgmentally

• G Give reassurance and information

• E Encourage the person to get appropriate professional help

• E Encourage other supports

Mental Health First Aid

• Substance Related Disorders

• Mood Disorders

• Anxiety Disorders

• Psychotic Disorders

Mental Health First Aid

• Substance Related Disorders

• ‘Substance use disorder’ includes abuse and dependence.

• ‘Substance-induced disorder’ includes intoxication, withdrawal and substance-induced mental disorders

Mental Health First Aid

• Depressants: Alcohol, barbituates, benzodiazepines, inhalants, opiates

• Stimulants: Amphetamines, caffeine, cocaine, nicotine

• Hallucinogens: cannabis, LSD, PCP, mushrooms

• Mood Disorders

• Depressive disorder• Bipolar disorder

• Symptoms of major depression:• Unusually sad mood most of day and nearly every day.• Loss of enjoyment of activities previously enjoyed.• Significant change in weight.• Slow moving or agitated and unable to settle.• Lack of energy.• Inappropriate feelings of guilt and worthlessness.• Difficulty concentrating/making decisions• Thoughts of death

Mental Health First Aid

• Mood Disorders

• Depressive disorder• Bipolar disorder

• Symptoms of mania:• Increased energy and over activity• Elevated or elated mood• Needing less sleep than usual• Irritability• Rapid thinking and speech• Lack of inhibitions• Grandiose delusions• Lack of insight

Mental Health First Aid

• Anxiety Disorders• Generalized Anxiety

Disorder• Panic Attack• Agorophobia• Specific Phobia

Disorder• Social Anxiety Disorder• Obsessive-Compulsive

Disorder• Acute Stress Disorder

and PTSD

Mental Health First Aid

• Anxiety Disorders

• Symptoms of Generalized Anxiety Disorder:• Excessive worry• Irritability• Restlessness• Feeling on edge• Difficulty

concentrating• Mind going blank• Sleep

disturbances

Mental Health First Aid

• Anxiety Disorders

• Symptoms of Panic Attack:• Intense fear• Sweating• Trembling or shaking• Feeling of choking• Chest pain or discomfort• Nausea or abdominal distress• Feeling of unreality or detachment• Feeling dizzy, unsteady, light-headed or faint• Fear of losing control or going ‘crazy’• Fear of dying• Numbness, tingling sensation• Chills or ‘hot flashes’

Mental Health First Aid

• Psychotic Disorders: changes in emotion and motivation, thinking and perception, and behaviour.

• Schizophrenia• Schizoaffective disorder includes a mood disorder• Psychotic depression• Substance-induced psychotic disorder

• Phases of a psychotic episode:• Premordid• Prodrome: symptoms vague

and hardly noticeable• Acute• Recovery

Mental Health First Aid

• Psychotic Disorders• Symptoms of schizophrenia:

• Delusions: fixed false belief not culturally sanctioned.• Hallucinations: perceptual experiences in which a person

sees, hears, smells, tastes or feels something not there.

• Loss of drive• Blunted emotions• Social withdrawal

Mental Health First Aid

• A Assess risk of suicide and/or harm

• L Listen non-judgmentally

• G Give reassurance and information

• E Encourage the person to get appropriate professional help

• E Encourage other supports

Mental Health First Aid

• Overdose (substance related)

• Suicide (mood)

• Panic Attack (anxiety)

• Acute Stress Reaction (anxiety)

• Psychotic Episode (psychotic)

Mental Health First Aid

• Overdose (substance related disorder)• Unconscious

• Ensure personal safety• Place in recovery position• Call 911• Determine substance if possible• Keep person warm

• Conscious• Call 911• Don’t give food or water• Reassure help is coming• Determine substance if possible• Keep person warm

Mental Health First Aid

• Suicide (mood disorder)

• Ask about suicide

• Explore risk• Plan• Prior suicidal behaviour• Support

• Engage the person in a plan for safety

Mental Health First Aid

• Panic Attack (anxiety disorder)

• Call 911• Move to a quiet location if

possible• Encourage slow breathing• Listen without judging• Explain that it could be a panic

attack and not life threatening• Stay with person until help

arrives

Mental Health First Aid

• Acute Stress Reaction (anxiety disorder)

• Let person tell their story • Be empathetic• Validate normal responses to abnormal events• Encourage personal supports where appropriate• Avoid use of drugs or alcohol• Encourage professional help

Mental Health First Aid

• Psychotic Episode (psychotic disorder)

• Ensure personal safety• Call 911• Try to create a calm and non-threatening atmosphere• Express empathy

Mental Health First Aid

• A Assess risk of suicide and/or harm

• L Listen non-judgmentally

• G Give reassurance and information

• E Encourage the person to get appropriate professional help

• E Encourage other supports

Mental Health First Aid

VPD Collaborations

• Car 87/88• Assertive Community Treatment

Team• Assertive Outreach Team

• 24/7• For non-urgent and non-emergent intervention• Comprehensive assessment to determine care

pathway

VPD CollaborationsCar 87 Access and Assessment Centre

• Client-centered, recovery oriented service delivery model

• Most seriously addicted and mentally ill who have NOT benefitted from traditional programs

VPD CollaborationsAssertive Community Treatment Team

ACT One Clients (n=67) last quarter 20161 Year Current

POLICE• Mental Health Act apprehensions -45% -62%• Negative police contact -30% -48%• Violent offences -20% -47%• Charges and convictions -27% -45%

HEALTH• Visits to VGH & SPH EDs -37% -52%• Acute MH&A bed days -21% -56%

VPD Collaborations: Cohort DataAssertive Community Treatment

VPD CollaborationsAssertive Outreach Team

Project Link:

• Identified a ‘gap’ in MH service delivery for clients transitioning from health and/or criminal justice to community.

VPD CollaborationsAssertive Outreach Team

• Recipient of the 2015 IACPMotorola/Webber Seavey Award for innovation and quality in policing

AOT Clients (n=47) last quarter 20164 Weeks Current

Police• Mental Health Act apprehensions -23% -73%• Negative police contact -33% -67%• Violent offences -79% -100%• Charges and convictions -39% -56%

Health• Visits to VGH & SPH EDs -25% na• Acute MH&A bed days -14% -38%

VPD Collaborations: Cohort DataAssertive Outreach Team

VPD CollaborationsAssertive Outreach Team

• Sam• Bill• Alison• Todd

VPD Collaborations: System DataMental Health Factor

VPD Collaborations: System DataForm 4, 10, 21 Apprehensions

VPD Collaborations: System DataHospital Wait Times

VPD Collaborations: System DataMental Health Interactions

Ongoing Projects

• Saint Paul’s Hospital HUB

• Youth ICM team

• Teletriage

• VGH Triage Pilot

Ongoing ProjectsSaint Paul’s Hospital HUB

Reference:• 89% increase in MH&A over 5 years• ED 33 beds

• MH occupies 17+ more than 50% of the time

• Housing and social support• St. Mike’s Transitional Centre 70%

decrease in 30-day readmits

Reduce:• ED congestion by redirecting 54% of

patients • Inpatient bed days• Police wait times

Partnership with VPF, VCH, Addiction and Urban Health Program, Emergency Medicine, City of Vancouver and the Department of Family Practice

Ongoing ProjectsYouth ICM Team:

Ongoing ProjectsTele-Triage Project:

• 60% Section 28 discharged (over 1800/year)

Partnership with VPF, Doctors of BC, CARMHA

Ongoing ProjectsVGH ED and Psychiatry:

• Opportunity: waiting for medical to be completed before psychiatry

• Anticipated ED wait greater than 1 hour

• MHES and ED Charge nurse

Ongoing Projects• VPF CMHA VSB

Peer-2-Peer• Public Safety

Canada• SFU CARMHA CIHR

PHSI• UBC Hotel Study• UBC Cheque Issue• Crosstown Clinic• MTF Collective

Impact

Victim Services SymposiumApril 21 2017

Staff Sergeant Lynn NoftleMental Health Portfolio

Working Collaboratively to Support those in Crisis