How do we fix a broken system?

At the next HCLDR tweetchat, we welcome some very special guests from Canadian College of Health Leaders. They will be leading us in a very important topic around public health + public safety + policing. You definitely won’t want to miss it.

Below is an amazing post from Eileen Pepler who sets up the discussion beautifully. I’m really excited for this chat on March 16th.


Post by Eileen Pepler, PhD

Join us on March 16th at 8:30 PM EDT (for your local time click here) as we explore how public health and public safety overlap in responding to people experiencing a mental health crisis. We will be joined by Eileen Pepler, PhD and author of ”Mental health and policing: Picking up the pieces in a broken system” from the March edition of Healthcare Management Forum, the peer-reviewed journal of the Canadian College of Health Leaders. Colin Watson, Deputy Chief Constable of the Victoria Police and Keith Lindner, Inspector, recently retired after 35 years.

Police have long been the informal first responders of Canada’s mental health system, mainly by default, as the expansion of community supports has not kept up with cuts to access to services and long-term psychiatric beds. According to the Canadian Mental Health Association BC Division, nearly 33% of people with serious mental illness have contact with police when trying to access mental healthcare for the first time. They are also more likely than other Canadians to be detained involuntarily in hospitals, arrested, or die in those interactions.

Yet, most mental health crises do not require a police response. For example, police are often called to assist individuals in distress, intoxicated or respond to reports of a disturbance, where there are no immediate concerns related to risk to the individual or others. Moreover, calls are increasingly for the police to locate individuals who have gone AWOL from hospital or have not attended their medication or assessment reviews.  The steady demand in mental health crisis calls combined with the increasing community voices to shift funding from policing to mental health supports, is the catalyst to acknowledge that our existing system is broken.

Today’s pressures of police and ambulance services, supporting people with mental health, continues to make the police the service of first resource, long after the chances of effective prevention have been lost.  It has been declared by many, that this is not an optimal way to treat vulnerable people who need care and long-term supports and help. Until mental health is given the same priority as physical health in funding, resources, and access to integrated data to develop targeted approaches to address these systemic issues, the police will continue to play too large a role dealing with people with mental health problems.

The emerging agenda regarding the intersection of policing and public health is that a holistic approach will generate the best results, but it seems extremely hard to achieve this approach in practice.  The gap is increasing between knowledge of actions necessary to deal with complex mental illness and social problems—both in policing and public health-and what can be achieved, which is related to the mismatch between funders, providers and not-for-profit agencies and the increased demands for policing and health. The police are not delivering what is expected of them, including protecting vulnerable and at-risk populations. From the public health perspective, it is unsatisfactory that the majority of advances in this field are offset by, for example, an increase in mental health problems in the population or the failure to prevent domestic violence.

If we care about public safety, fairness, and cost effectiveness, we need to better understand how the existing physical and mental health systems will deal with the demand for protecting the vulnerable or persons with mental illness. Protection of the vulnerable has several implications for the police and other agencies, especially those working where policing and public health overlap. Since protection tends to go beyond the traditional remit of the police, the police have to engage with the appropriate political leaders, provider groups and agencies, to work together to understanding current and future demand.

This requires a different mind-set as well as a different set of skills, which in turn, calls for (1) a clearer understanding and more consistent picture of demand that recognizes how communities are changing, and the key levers that may enable police services to more accurately, predict the future demand for mental health crisis and safe place supports, and (2) a population health approach to address the full range of factors that influence the system for the health and well-being of people with mental illness including the wider social determinants of health to align with specific community needs. Instead of different agencies working separately on the basis of separate goals and funding, the police and other public services should be joined up around shared system-wide outcomes. Taking this approach ensures system goals and outcomes go beyond monitoring individual activities and outputs.

Only by breaking down data silos among agencies that serve vulnerable populations can we begin to address the root causes of behavior and prevent individuals from cycling through multiple systems. The potential that integrated data holds to shift both policy and practice is possible only through collaboration and data sharing among the agencies that serve individuals and families that overlap multiple systems.

For too long, the health and social care systems have relied on police to respond to mental health crises in the community. Transformative change not in behavior but in the use of analytics, scenario planning and simulation tools to seek out new strategies and operational plans, to enable police and others to come together to co-design ‘what if’ models and test the choices using evidence to inform the decisions for transformative change. This is needed to support a new way forward.  People with mental illness and their families deserve better.

We will discuss the following topics:

  • T1: Police are routinely the first line of response for situations involving mentally ill people in a crisis. Should they be responsible to connect that person to the appropriate services or should there be a different first response?
  • T2: What population health or other care models could be deployed to help people with mental illness from falling through the cracks and ending up in distress where police need to be called?
  • T3: What is required to provide adequate and appropriate community support for people experiencing a mental health crisis (different housing, more funding, safe rooms at hospitals, interagency training and communication)?
  • T4: What have health leaders in your communities done (or could they do) to remove barriers between health agencies and law enforcement?


Healthcare Management Forum article (open access until March 31 – abstract below): ”Mental health and policing: Picking up the pieces in a broken system”

Healthcare Management Forum podcast (open access): The Pepler Group: “Mental health and policing: Picking up the pieces in a broken system”

Healthcare Management Forum – Workplace Mental Health, March 21, 2020


Mental health and policing: Picking up the pieces in a broken system

Abstract: A key theme of this article is the need to view the intersection of public safety and public health through a new lens to break down the traditional information silos of the many agencies that serve vulnerable populations and the impact of inadequate community-based mental health services that contribute to the increasing number of calls to police in responding to people in or approaching a mental health crisis. The manifestation of this crisis in the community is that the police are too often the first port in the storm. This article suggests the system is broken and needs fixing. Implementing a population health approach to identifying the high utilizers in the community and building a case for sustained funding, partnerships, resources, and accountability together with data sharing agreements, community partners and police collaboratively design and evaluate outcome approaches aimed at prevention and recovery to minimize contact with the police.


Eileen Pepler, PhD, is an Associate Professor at the Athabasca University Faculty of Business, Adjunct Professor at the Factor-Inwentash Faculty of Social Work at the University of Toronto and President of The Pepler Group.  Her research and consulting engagements focus primarily on policy initiatives related to mental health and addictions for children, youth, adults and seniors.

Eileen’s Twitter handle: @peplerei

Colin Watson M.O.M., MPA, LL.M, CPHR, Deputy Chief Constable for the Victoria Police Department with over 23 years of service.

Colin’s Twitter handle: @dcccolinwatson

Keith Lindner, Inspector, recently retired after 35 years. Keith spent time as a patrol officer, plain clothes drug investigator, major crime investigator, member of the Emergency Response team, Crisis Negotiator and Internal Investigator.

Keith will be joining Eileen’s conversation.

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