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    Mental Health Crisis Support Rooted in Community


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    Police emergency 378. Do you have an emergency?

    Darna Savariu, Crisis Counselor, The Gerstein Crisis Centre

    The police is somebody with power, you know with the ability to apprehend somebody and take somebody to the hospital, even against their will.

    Elaine Amsterdam, Crisis Service Coordinator, The Gerstein Crisis Centre

    If you’ve had poor experience with the police, if you’ve been marginalized, if you come from racialized communities, chances are somebody else could better respond to that community member in need.

    Nicki Casseres, Coordinator of Training and Community Education, Gerstein Crisis Centre.  And there’s a lot of opportunity that we don’t have to get to that end place where somebody is in such a desperate place that the only thing that they can do is call 911.

    Susan Davis, Executive Director, The Gerstein Crisis Centre

    Toronto police services respond to about 33,000 mental health crisis calls every year. We need to flip our system as it exists right now from a sort of default position where police are responding to mental health crisis and actually purpose-build a system that allows people to access mental health support when and where they need it.

    Kaola Baird, Former Client of the Gerstein Crisis Centre

    I’ve been battling chronic depression ever since I can remember.  This particular period in life, I was under a lot of stress.  I had been working, going to school but I was in the process of losing my apartment.  I learned about the Gerstein Centre while I was in counseling. I realize now that I’m lucky enough that at my lowest point, I can reach out for help.

    Darna Savariu, Crisis Counselor, The Gerstein Crisis Centre

    Gerstein Crisis Centre, Darna speaking. How can I help you today?

    Susan Davis, Executive Director, The Gerstein Crisis Centre

    Gerstein Crisis Centre provides a number of ways in which we respond to individuals in crisis. That includes a telephone crisis line, a mobile team that goes out into the community and sees people where they are, as well as we have a number of crisis beds that offer short stays to people.

    Darna Savariu, Crisis Counselor, The Gerstein Crisis Centre

    My approach to a client in crisis is to listen attentively to what the person is saying…

    And this is your first time calling? Yeah?

    helping them understand what resources are available

    Two of us can come meet you somewhere in the community, if that would be helpful

    Gerstein operates in a voluntary nature. Nobody is forced to do anything they don’t want to do.

    Elaine Amsterdam, Crisis Service Coordinator, The Gerstein Crisis Centre

    In the last year, we had 42,000 phone calls and I can tell you that that was double the number of the year before.

    Nicki Casseres, Coordinator of Training and Community Education at Gerstein Crisis Centre

    And we say, when you are going through a difficult time, you can contact us. You don’t have to wait until it gets so bad that you have to call 911 or you end up in the hospital.

    TEXT CARD

    The Toronto police recently started initiated a pilot project with the Gerstein Crisis Centre to co-locate a crisis worker within the 911 call centre.

    911 operators transfer callers with non-emergent needs to the crisis worker, diverting the call away from a police reponse.

    Nicki Casseres, Coordinator of Training and Community Education, The Gerstein Crisis Centre.  And so when people call 911 and then get diverted to talk to a crisis worker, and they can get follow up and we can connect them into the right services. 

    Kaola Baird, Former Client of the Gerstein Crisis Centre

    My first stay at the Gerstein Centre , it didn’t make the immediate crisis go away, but then you can see clearly so you can make decisions. You can make better decisions.

    Susan Davis, Executive Director, The Gerstein Crisis Centre

    Individuals need a rights-based approach to their health care. They need to be able to have access to the supports and services they need without losing their autonomy. Our commitment at Gerstein Centre is to really listen to and hear the voices of people with lived experience of mental health and substance use.  At least 30% of people on our board and our staff are people with lived experience.

    Kaola Baird, Former Client of the Gerstein Crisis Centre

    My gratitude to those that helped me at Gerstein helped me appreciate what other people are going through.

    Kaola Allison Baird, F.R.E.S.H. worker

    Today, we’re playing bocce ball. It’s one of the many activities being offered through FRESH. The FRESH program stands for “Finding Recovery through Exercise, Skill and Hope. “ It’s an opportunity for people who’ve had lived experience to come out and learn a skill, be active in a very welcoming, supportive environment.

    Elaine Amsterdam, Crisis Service Coordinator, The Gerstein Crisis Centre

    What we really want to do is to help people develop some strategies that can help them survive the moment and bring them forward because something that works now, may work again.

    Susan Davis, Executive Director, The Gerstein Crisis Centre

    A non-police non-coercive crisis response is so essential for being able to really provide an option to people that they in that moment make use of and feel like it could be helpful to them.

    Kaola Baird, Former Client of the Gerstein Crisis Centre

    We’re more than what goes wrong in our life and I feel thankful that I’ve had the experiences I’ve had. Since I’ve started paddling, I’ve had a renewed sense of confidence. Realizing your own strength, realizing your own abilities. And every time you go out on the water, it’s a test. So it’s like a victory every day, every time. 

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    (Toronto) – Governments should invest in mental health care services that help people in humane and rights-respecting ways, Human Rights Watch and Gerstein Crisis Centre said today, releasing a model for community-based mental health crisis response. The case study can serve as a roadmap to support people experiencing a mental health crisis without resorting to policing, involuntary hospitalization, and forced treatment.

    Systemic inequities, coercive practices, and police violence remain globally pervasive problems that put people experiencing a mental health crisis at particular risk. This is especially true for Indigenous, Black and racialized groups, and Two-Spirit, lesbian, gay, bisexual, transgender, queer+ (2SLGBTQ+) people. The common practice in many countries of sending police as first responders, including for “wellness checks,” increases the risk of injury or death. Even nonpolice responses to people in crisis can excessively pathologize people and lead them into coercive or forced treatment.

    “In many communities, people who experience a mental health crisis are confronted with police or coerced into treatment against their will, and there’s another way,” said Samer Muscati, associate disability rights director at Human Rights Watch. “Governments should invest in effective responses that are based on a person’s right to direct the type of support they receive and decide what’s best for them.”

    To demonstrate an effective, alternative approach, Human Rights Watch partnered with Gerstein Crisis Centre, a community-based mental health crisis response center in Toronto that provides services that are consent-based, nonmedical, trauma-informed, and focused on harm reduction. The 33-page case study, “Mental Health Crisis Support Rooted in Community and Human Rights,” presents a viable, replicable framework for a holistic approach to mental health crisis response that supports the autonomy of the individual in crisis.

    The case study lays out a rights-respecting and community-based alternative to over-medicalized and police-led responses. It provides a detailed description of the Centre’s approaches and includes lessons learned and good practices from decades of mental health support.

    “Over three decades of community-based support for people experiencing mental health crisis has proven the effectiveness and importance of accessible and noncoercive pathways to address the health and wellbeing of our communities,” said Susan Davis, executive director of Gerstein Crisis Centre. “There is more to do to improve our health and social systems and that includes investments and coordinated mental health and addiction strategies at all levels of government.”

    The case study offers an example of what has worked well in Canada’s largest city with the principles of autonomy, dignity, and non-policing applicable to communities and countries around the world.

    Since 1989, Gerstein Crisis Centre has offered communities in Toronto safe, humane, equity-based crisis services. This framework includes free and confidential 24/7 tailored support services to individuals experiencing a mental health or substance use crisis, including thoughts of suicide, all of which may be exacerbated by or emanate from trauma, housing insecurity, and poverty, among other factors. The aim is to provide individuals experiencing mental health crisis timely support, connect them with other services they need, and divert them from unnecessary interactions with police and hospital emergency rooms.

    The case study documents the lived experience of Kaola Baird, a woman who received support at the Gerstein Crisis Centre and continues to work as a peer to support others experiencing mental health crisis.

    “I think when you’re going through a crisis … sometimes you lose a sense of who you are,” she said. “And I think there’s a lot to be said for not wanting to be seen as your crisis because there’s still a person underneath. And by going through it myself, I think it just gives you that deeper understanding … I have a lot of empathy … I try to give back what I received and still do receive. You just go full circle, but for me, I always think the circle gets larger.”

    The Centre employs about 100 people, the majority of whom have lived or living experience with mental health conditions or substance use.

    Gerstein Crisis Centre runs a 24/7 telephone crisis line available to community members. The Centre also operates a mobile crisis team that follows up on calls in the community upon the caller’s request. Crisis workers dress in regular clothes to ensure privacy and to reduce stigma and power imbalances that uniformed or logoed apparel might evoke.

    The Centre hosts crisis beds in private rooms in two houses that provide a safe and supportive environment, staffed around the clock, designed for short-term stays of up to 30 days. The Centre’s team provides short-term follow-up support, including referrals to other health and social services, as well as recovery programs led by individuals with experience of mental health, substance use, and the criminal legal system.

    The case study incorporates guidelines from the World Health Organization (WHO), including details about informed consent in mental health crisis response, treatment and recovery plans led by the person in crisis and focusing on their strengths, as well as understanding power relations and strategies to avoid and defuse conflict.

    According to the WHO in 2019, an estimated one in eight people globally – 970 million people – was living with a mental health condition and yet, on average, only two percent of national health budgets were dedicated to mental health.

    Mental health services frequently fail to comply with international human rights standards due to stigma, the use of coercion, and power imbalances between the service provider and the person seeking or receiving support. In many jurisdictions, inadequate legal and policy protections reinforce discrimination and abusive treatment of people with mental health conditions. The situation is particularly dire for individuals experiencing mental health crises, including in circumstances related to substance use, suicidal thoughts, trauma, housing insecurity, and poverty. It is especially so for Indigenous, Black, racialized, and 2SLGBTQ+ communities, who continue to experience inequitable access to health care and are overrepresented in judicial systems.

    According to Human Rights Watch and Gerstein Crisis Centre, mental health service provision can – and should – respect the human rights of people seeking or receiving care. The necessary components of mental health services that respect human rights include informed consent, respect for individuals’ wishes and perspectives, as well as the availability, accessibility, acceptability, and quality of mental health services. Human Rights Watch and Gerstein Crisis Centre urge governments to examine this case study to design and fund their own programs to provide community-based and rights-respecting support to people experiencing mental health crises.

    The case study is part of an initiative by Human Rights Watch to promote solutions-oriented approaches as a way to encourage governments and community-based organizations to develop policies and practices that respect human rights and comply with the principles in the UN Convention on the Rights of Persons with Disabilities (CRPD). As the first part of this series, Human Rights Watch documented the innovative approach of TANDEMplus, a mobile team in Brussels providing mental health services to people with psychosocial disabilities in their homes or a place of their choice, where they work hand-in-hand to find solutions and help the person regain control over their everyday life.

    “Police responders and coercive treatment have been the priority response for people experiencing mental health crises,” said Muscati. “Governments should make a paradigm shift and take a new rights-respecting approach that centers the dignity, expertise, and autonomy of people living with mental health conditions.”



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