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'Handshakes and hugs, not handcuffs': Cop-nurse team tackles mental-health calls

Const. Tristan Williams and nurse Chris Nagainis belong to the Co-Response Team, a brand new VicPD/Island Health unit tasked with handling police calls with a mental-health component.

Squatting on the sidewalk, a man in a white hoodie smokes meth from a glass pipe while grooving to the tunes pounding out of his music player.

Were he in the doorway of a Government Street business, he might get shooed elsewhere, but he’s on The Block, as this tented and tattered stretch of Pandora Avenue is known.

Besides, Const. Tristan Williams and nurse Chris Nagainis are otherwise focused. They’re looking for a young man whose brother has just died suddenly. Next-of-kin notifications are already one of the grimmer tasks police do, but in this case, there’s worry that the news might tip the surviving sibling, a serious drug abuser, over the edge.

That’s why the job has fallen to this cop-and-clinician pairing. Williams and Nagainis, a nurse with long experience in mental-health and emergency-psychiatric care, belong to the Co-Response Team, a brand new VicPD/Island Health unit tasked with handling police calls with a mental-health component.

They find the man they’re looking for in a shelter in another part of the city. The news of his brother’s death hits him hard, but he says he wants to stay strong for their mother, which is one of the factors Williams and Nagainis take into account when assessing his state.

They don’t get a chance to write up their file notes, though, because a call comes in about a man who has bolted from a care facility.

He’s paranoid, delusional and has been talking about harming himself.

Williams and Nagainis pile into their unmarked SUV and cruise the streets looking for him, only to get interrupted by yet another call about a woman who, after a couple of days of heavy meth use, is in the grips of full-on drug-induced psychosis.

Joined by a couple of uniformed officers, they converge on the parking lot outside her building, where her worried roommate is rocking back and forth in his stocking feet, brow furrowed.

The officers are in the middle of assuring him that he was right to call 911, that they’re treating this as a health matter, not a criminal one, when the woman bursts out of the building, stark naked, waving her arms over her head.

Frightened, frantic and shivering in the wintry cold, she doesn’t protest when blankets are wrapped around her, or when she is ushered into the SUV.

“You’re safe,” Williams repeatedly tells the woman, who has tightened herself into a ball. “You’re not in any trouble.”

They prepare to take her to Royal Jubilee Hospital for assessment while the uniformed cops, looking relieved to leave her to Williams and Nagainis, head off to deal with the next crisis in the queue. Elsewhere in the city, a man has been stabbed in the neck.

This is, Williams will later say, pretty much the sort of day the fledgling Co-Response Team has come to expect in its two months of existence.

As calls come in to police, the CRT picks off those that appear to have a mental-health component.

Maybe that means responding to a call about an agitated man standing in the middle of Johnson Street, oblivious to the passing cars. Maybe it’s the arson file that morphed into a health matter, with the fire-starter transferred from cells to the hospital instead.

The idea is for the CRT units, each with an officer and a mental health clinician partnered in an unmarked vehicle, to respond to crises traditionally handled by uniformed police alone.

Similar teams have been used, with slight variations, for years in a few other places around B.C., including Nanaimo in recent times. The model works well, supporters say, and fits the belief that police shouldn’t be the only answer to calls that are primarily about mental health.

We’re likely to see an expansion of these initiatives — in the recent provincial budget, the government set aside money for more such teams, as well as teams wholly comprised of civilians.

At VicPD, the CRT is among five units that work out of a single office overseen by Sgt. Jeremy Preston.

The CRT members — two cops, two registered nurses — have desks next to those of the department’s three community-resource officers.

The room also houses the officer attached to the five Island Health-led Assertive Community Treatment teams — made up of psychiatric nurses, addiction-recovery workers, registered nurses, social workers, and so on — who care for well over 300 people, most of them in Greater Victoria’s core, whose severe mental illness is often compounded by substance abuse.

There’s also an officer dedicated to at-risk youth and another assigned to the Integrated Mobile Crisis Response Team, which responds to individuals with urgent mental health and addiction-related issues on the south Island.

The units that share the VicPD office all have different missions, but there’s still some crossover, as well as a sameness of approach. “Handshakes and hugs, not handcuffs,” is Preston’s shorthand description.

Of course, it can get more complicated than that once they leave the building. Some people argue police shouldn’t be the ones to respond to mental-health calls at all, but at ground level, the lines between public-safety matters and health matters aren’t always so clearly defined.

“In reality, they intersect,” Preston says. There’s overlap, particularly when the people in question are at risk of causing harm to themselves or others.

The law itself is a factor in the role police play. Only police have the power to bring disturbed people in as ordered by the courts or a physician, or to “section” them — that is, to apprehend them under section 28 of the Mental Health Act — and take them to the hospital for psychiatric assessment.

A lot of patrol cops groan at that prospect, if only because the law requires them to wait at the ER until the person is assessed by a doctor, something that can leave the officers cooling their heels for hours when they’re needed on the street.

The wait times have fallen in recent years (and a just-announced change gives nurse practitioners the power to assess patients in emergency rooms, too, which should further speed the process), but they still leave uniformed officers idled long enough — maybe an hour or two, or longer if the subject needs to sober up before being assessed — that it’s a problem when the 911 calls are stacking up and there’s crime to be fought.

There’s another issue, too: The uniforms don’t have as much expertise and information as the CRT members do.

As Williams drives to the call about the woman experiencing psychosis, Nagainis, tapping on his keyboard, brings up health records that give the two men a much more complete picture of who they’ll be dealing with, what the complicating factors might be, and what might lead to a better outcome.

That sort of access to information can make a big difference. When a pedestrian was found crying in traffic recently, Nagainis burrowed deep into the man’s health file to find an old note containing the name of a woman who worked at his group home.

Once contacted by the CRT, she brought the man the meds he needed. No need to force him into hospital for assessment.

Clinicians also know what probing questions to ask, what signs to look for.

For example, a CRT team was asked to check on a woman who takes prescription drugs for a psychiatric disorder. Nothing seemed untoward to the cop, but when the woman mentioned that she had been treating her back pain by smoking shatter — a cannabis product with a high concentration of THC — that set the nurse’s radar pinging.

Shatter can trigger psychotic episodes for someone in the woman’s position. “You should probably switch back to regular marijuana,” the nurse told her. Clinicians also have a good handle on what follow-up mental-health supports are available for those they assess.

The new approach is a learning curve for everyone. Even as a cop who has long gravitated to mental-health calls (“You get the chance to proactively help people”), Williams has found the CRT way of doing things an adjustment.

Recently they showed up at a supportive-housing site armed with a judicial warrant to take a resident to hospital.

Look, the resident said, can you give me a couple of hours to shower and change and get ready?

Normally that would be a hard no; cops don’t want to give someone in her position the chance to barricade herself in her apartment, possibly leading to the emergency response team getting called out for hours of high-tension drama.

This time, though, the CRT figured it would be better for everyone if they did as she asked and waited until she was in a better frame of mind. “It’s all judgment-based,” Williams says. “I was relatively sure that she was not high-risk.”

He says this while wearing a sort-of half-uniform: civilian trousers and jacket, but a gun on his hip and the word POLICE on his vest.

Nagainis, the nurse, wears a vest under his civvies and a portaple radio. (When they showed up at Royal Jubilee, the ER nurse was surprised by the comprehensive medical report given to her by Nagainis, whom she assumed was a plainclothes officer.)

This is new territory for all of them, figuring things out as they go along, but it seems like so far, so good.

The big question: If this one-year pilot project works, what comes next?

The CRT is made up of just four people — two nurses, two police officers — who take turns providing coverage from 8 a.m. to 8 p.m. each day. Their footprint is limited to VicPD territory, which means Victoria and Esquimalt.

What happens if the crisis happens after 8 p.m., or in, say, Saanich or Oak Bay?

If the CRT proves a success, there will be pressure to expand the model.

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