06-04 Persons in Crisis

Question 1

What is the Rationale?

Answer 1

The Mental Health Act (MHA) provides for the treatment and apprehension of persons in crisis. While it is not the role of police officers to diagnose mental health or substance use issues, it is their role to respond appropriately to the behaviours and circumstances they observe. This Procedure addresses situations where officers observe verbal cues, behavioural cues or other behaviours that provide them with reasonable cause to believe a person is apparently experiencing a mental, emotional or substance use crisis.

A person in crisis means a member of the public whose behavior brings them into contact with emergency services, either because of an apparent need for urgent care within the mental health system, or because they are otherwise experiencing a mental, emotional or substance use crisis involving behavior that is sufficiently erratic, threatening or dangerous that emergency services are called in order to protect the person or those around them. This includes persons who may require assessment under the MHA.

The Toronto Police Service (Service) is committed to preserving the lives and well-being of people who may be experiencing mental health and/or substance use issues, while working towards the goal of zero deaths and ensuring the well-being, safety, rights, and dignity of individuals and communities.

Question 2

What is the Supervision?

Answer 2

• Supervisory Officer attendance mandatory for calls for service when there is information that a person in crisis is armed or may be armed with a weapon
• Supervisory Officer notification mandatory if detained at a psychiatric facility for more than one (1) hour

Question 3

Section 17 MHA – Action by Police Officer

Section 17 of the MHA states that where a police officer has REASONABLE and PROBABLY GROUNDS to BELIEVE that a person is acting or has acted in a disorderly manner and has REASONABLE CAUSE to BELIEVE that the person,

Answer 3

(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself.
(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or
(c) has shown or is showing a lack of competence to care for himself or herself, and in addition the police officer is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,
(d) serious bodily harm to the person.
(e) serious bodily harm to another person; or
(f) serious physical impairment of the person,

and that it would be dangerous to proceed under section 16 (Justice of the Peace Order for Examination, Form 2), the police officer may take the person in custody to an appropriate place for examination by a physician.

Question 4

Section 17 MHA – Action by Police Officer

• There is no longer a requirement for a police officer to actually observe the person’s behaviour and may use information obtained from a third party in order to form

Answer 4

REASONABLE AND PROBABLE GROUNDS for apprehension. Police officers should obtain and record as much information as possible in situations involving third party reports and request that the complainant sign the officer’s memorandum book.

Question 5

Section 33 MHA – Duty to Remain and Retain Custody

Section 33 of the MHA directs a police officer or other person who takes a person in custody to a psychiatric facility SHALL

Answer 5

remain at the facility and retain custody of the person until the facility takes custody of him or her in the prescribed manner.

Question 6

Safe Beds Program and Referrals to Community Supports

Members are encouraged to access the TPS Mental Health Referrals Guide for information on

Answer 6

the safe bed program, system navigators and other community referrals or supports available. Connecting community members to supports may improve their quality of life and/or decrease the likelihood they will require emergency services in the future.

Question 7

Safe Beds Program and Referrals to Community Supports

Officers have access to assistance from the Canadian Mental Health Association (CMHA) via their Community Referral Police Access Line – (416) 248-0200. This line is for police officers only, and is available 24/7 to provide officers with assistance when dealing with:

Answer 7

• any person over the age of sixteen (16) years who is believed to be experiencing a mental, emotional or substance use crisis
• has become involved with police and/or is at risk of involvement with the criminal justice system; and
• who has not been apprehended under the MHA.

Question 8

Safe Beds Program and Referrals to Community Supports

When making a referral for a safe bed through the Community Referral Police Access line SHALL:

Answer 8

• proceed only on the consent of the person in crisis
• with the consent of the person in crisis, provide only the name, date of birth and phone number of the person being referred to the call taker. The CMHA will obtain all other personal information directly from the person being referred to their services upon arrival at the central intake location.
• provide any information that could impact the safety of staff and other patrols while at the safe bed location
• provide transport for the person being referred to the safe bed location
• remain at the safe bed intake site until CMHA staff complete the triage process
• The CMHA will accept individuals who can be safely supported in the community. This means that the individual does not pose a threat to the safety of the public or is not at serious risk of harming themselves or others.

Question 9

Police Officer

1. Where a police officer investigating a person in crisis observes verbal or behavioural cues (e.g. mute, passive, suicidal, yelling, hearing voices) OR receives information that would lead the officer to believe that a person is apparently experiencing a mental, emotional or substance use crisis, they SHALL be guided by

Answer 9

s. 17 and s. 33 of the MHA.

Question 10

Police Officer

2. When responding to a complaint of a person in crisis SHALL

Answer 10

• request notification and attendance of the MCIT if available
• conduct a Person Query, including a CPIC and CFRO check
• determine if the person in crisis owns, possesses or has access to weapons, firearms, ammunition, explosives or the related authorizations, licences, certificates or permits
• request the attendance of a supervisory officer when there is information that a person in crisis is armed or may be armed with a weapon
• request notification of the Specialized Emergency Response – Emergency Task Force (ETF) in accordance with Procedures, when:
  o there is information that a person in crisis is armed or may be armed with a weapon
  o background checks indicate that the person in crisis has a history of violence or use of weapons
  o the incident involves a barricaded person
  o the incident involves a person who by their position has placed themselves or others in immediate jeopardy (i.e. person located at height on a balcony, bridge, etc.)
• It will be at the discretion of the Supervisory Officer – ETF as to whether they will attend.
• consider using the search and seizure provisions contained in ss. 117.04(2) CC to minimize any subsequent risk to the person in crisis or any other person.
• request to obtain sufficient backup officers

Question 11

Police Officer

3. When encountering a person in crisis SHALL

Answer 11

• take all necessary steps to ensure the situation is safe
• determine the need to immediately apprehend under the MHA or arrest under the applicable statute
• consult with the MCIT, if available.

Question 12

Police Officer

4. When a person in crisis has committed a criminal offence SHALL

Answer 12

• assess the surrounding circumstances
• consider charging the person under the applicable statute
• if no charges will be laid complete the applicable eReport outlining the details of the offence
• complete the applicable MO Detail page

Question 13

Police Officer

5. When the person in crisis is eighteen (18) years of age or older, and has not been apprehended under the MHA SHALL

Answer 13

• consider making a referral to a community support agency, after consent is received from the person in crisis,
• record the referral information
  o in the memorandum book
  o in the eReport, including referral type and referral agency, if applicable
• comply with direction contained in the Safe Beds and Referrals to Community Supports section of this Procedure, if making a referral for a safe bed

Question 14

Police Officer

6. When the person in crisis, is sixteen (16) or seventeen (17) years of age, and has not been apprehended under the MHA SHALL:

Answer 14

• make a referral to a Children’s Aid Society (CAS) while in the presence of the youth.
• in this age range, CAS involvement is on consent only, however, CAS will follow up if the youth does not want immediate support from their agency.
• follow the direction provided by the CAS social worker.
• if no immediate action is to be taken by the CAS, advise the youth that the CAS social worker may follow up with them at a later time and how they can reach the CAS if they would like assistance.
• if the CAS does not provide direction, make a referral to a community support agency, after consent is received from the person in crisis, and record the referral information
  o in the memorandum book
  o in the eReport, including referral type and referral agency, if applicable
• comply with direction contained in the Safe Beds and Referrals to Community Supports section of this Procedure if making a referral for a safe bed

Question 15

Police Officer

7. When the person in crisis is under sixteen (16) years of age SHALL

Answer 15

• record the information in their memorandum book
• determine if this is a child in need of protection under the Child, Youth and Family Services Act (Contact the CAS)
• in consultation with CAS, refer the child in need of protection to a community support agency as required
• record the referral information
  o in the memorandum book
  o in the eReport, including referral type and referral agency, if applicable

Question 16

Police Officer

8. When there are sufficient grounds to apprehend a person in crisis under s. 17 MHA SHALL

Answer 16

• apprehend the person
• ensure the dwelling and any valuables are secured for safekeeping
• transport the person to the nearest psychiatric facility
• take any medications currently prescribed to the person and turn over to the nursing supervisor upon arrival at the psychiatric facility
• notify the next of kin or public trustee, if necessary
• recommend next of kin attend the psychiatric facility to provide additional information regarding behaviours and symptoms that may assist in their assessment
• complete the applicable eReports
• complete the applicable MO Detail page
• add the next of kin information as an alias/associate in the entity section of the eReport

Question 17

Police Officer

9. If the person is an outpatient of, or has recent history with, a more distant psychiatric facility, may use

Answer 17

discretion and transport the person to that psychiatric facility where practicable.

Question 18

Police Officer

10. When detailed to apprehend a person in crisis under a Form – MHA SHALL

Answer 18

• obtain the original Form – MHA
• ensure the Form – MHA is still valid
• obtain background details from the complainant
• attend the address of the person in crisis
• give the original Form – MHA and a list of any medications currently prescribed to the person to the nursing supervisor at the psychiatric facility

Question 19

Police Officer

11. Where the location of the person named on the Form – MHA is unknown and every reasonable effort to locate the individual has been made SHALL

Answer 19

• complete the applicable eReports, including the applicable MO Detail page
• complete the Missing Person Details page
• scan and attach the Form – MHA and relevant memorandum notes to the original eReport
• submit the original Form – MHA and eReport number to the Officer in Charge

Question 20

Police Officer

12. If the person in crisis has been apprehended under a Form – MHA after an entry has been made in CPIC SHALL

Answer 20

• add supplementary information to the original eReport, detailing the circumstances of the apprehension
• complete the Located/Found section of the Missing Persons details page

Question 21

Police Officer

13. Upon arriving at the psychiatric facility SHALL

Answer 21

• complete a TPS 710 and provide the report to the nursing supervisor
• remain with the patient until the psychiatric facility accepts custody
• advise a supervisory officer if detained or expect to be detained at the psychiatric facility for more than one (1) hour
• Custody occurs when the hospital arranges for their staff to take charge of the individual, or when the person is taken for an assessment. With a supervisor’s approval, a police officer may remain at the psychiatric facility if it is in the public interest, requested by hospital staff or charges against the person are being considered, and a decision on whether or not to admit the person has yet to be made.
• notify or arrange for notification of the next of kin

Question 22

Police Officer

14. If difficulty is experienced when having a person examined/admitted to a hospital

Answer 22

• may request a second opinion from another physician or psychiatrist on call
• may attend another hospital, if necessary
• SHALL submit a TPS 649 to the Unit Commander detailing the problem
• Within reason, an officer may transport the person to more than one (1) psychiatric facility if the officer feels it is in the public interest to do so. Officers must be prepared to articulate their reasons for taking this course of action.

Question 23

Police Officer

15. Where there are safety concerns for officers attending an address in the future SHALL

Answer 23

complete a TPS 228 to activate the Special Address System

Question 24

Police Officer

16. Notify the Divisional Mental Health Liaison Officer (DMHLO) of any cases requiring

Answer 24

further support or follow-up, including referral to Furthering Our Communities Uniting Services (FOCUS) Toronto.

• All information about a person’s psychiatric or medical condition is classified as personal information and cannot be disclosed or used for an unrelated purpose.

Question 25

Supervisory Officer 17. Upon being notified that a call for service involves a person in crisis SHALL

Answer 25

* ensure notification and attendance of the MCIT, if available

Question 26

Supervisory Officer 18. Upon being notified that a call for service involves a person in crisis that is armed or may be armed with a weapon SHALL

Answer 26

* attend the scene as soon as possible * provide guidance and assistance through the course of investigation * ensure the ETF has been notified in accordance with Item 2 criteria, if applicable

Question 27

Supervisory Officer 19. When attending officers have apprehended and transported an individual to a psychiatric facility, SHALL

Answer 27

ensure the prompt and appropriate relief is prioritized

Question 28

Officer in Charge 20. Upon becoming aware that a call for service involves a person in crisis that is armed or may be armed with a weapon, SHALL

Answer 28

ensure a supervisory officer has been notified and attends the scene as soon as possible

Question 29

Officer in Charge 21. When in receipt of a TPS 228, or when notified of

Answer 29

* an MHA apprehension * the location of the person named on the Form – MHA is unknown and every reasonable effort to locate the individual has been made SHALL o ensure all required reports are accurately completed and submitted o approve and sign completed forms, as necessary o ensure every effort has been made to locate a next of kin o ensure appropriate entries are made in the Unit Commander’s Morning Report (UCMR

Question 30

Officer in Charge 22. When requested by the Toronto Emergency Medical Services to transport a violent person in crisis from a residence or hospital to a psychiatric facility SHALL ensure

Answer 30

* an Application for Admission (Form 1 – MHA) has been signed by a physician * sufficient police escort * the ETF is notified prior to the officers attending the address

Question 31

Officer in Charge 23. Upon receipt of an original Form – MHA, which has not been executed SHALL ensure

Answer 31

* every effort is made to apprehend the person in crisis named in the Form – MHA * the original Form – MHA is maintained at the front desk until the person in crisis is apprehended or until the Form – MHA has expired

Question 32

Definitions 06-04 Community Treatment Order (CTO) means

Answer 32

an order with conditions issued by a physician to a person which provides that person with psychiatric treatment in the community that is less restrictive than being detained in a facility.

Question 33

Disorderly means

Answer 33

behaviour that appears to the police to be “to some extent irrational although not unruly”. [Source: R v. O’Brien (1983), 9W.C.B. 270 (Ontario County Court)].

Question 34

Form 1 MHA means

Answer 34

an Application by Physician for Psychiatric Assessment signed by a doctor within seven (7) days of examining the person, giving any person authority to take the person named on the application to a psychiatric facility. A Form 1 is valid for seven (7) days from and including the day it was signed.

Question 35

Form 2 MHA means

Answer 35

a Justice of the Peace Order for Examination directing police officers to take the person in custody to an appropriate psychiatric facility where a physician may order the person detained for examination. A Form 2 is valid for seven (7) days from and including the day it was signed.

Question 36

Form 9 MHA means

Answer 36

an Order for Return of an elopee issued by a psychiatric facility which authorizes a police officer to return the person without their consent to the psychiatric facility. A Form 9 is valid for a period of one (1) month after the person is absent without leave

Question 37

Form 47 MHA means

Answer 37

an Order for Examination issued by the physician who issued the person a Community Treatment Order (CTO) and * Has reasonable cause to believe the person has failed to comply with the conditions under the CTO, * the CTO subject or substitute decision–maker has withdrawn consent to the CTO and the subject fails to permit the physician to review their condition within seventy-two (72) hours and the physician believes the subject may cause harm or suffer deterioration. A Form 47 authorizes a police officer to take that person into custody and return them to the physician promptly and is valid for a period of thirty (30) days.

Question 38

Mental Disorder means

Answer 38

any disease or disability of the mind. [Source: Mental Health Act, ss. 1(1)] A person suffering from a mental disorder may have to live with a long–term breakdown of coping skills including perception, decision making and problem-solving abilities.

Question 39

Person in Crisis means

Answer 39

a member of the public whose behavior brings them into contact with emergency services, either because of an apparent need for urgent care within the mental health system, or because they are otherwise experiencing a mental, emotional or substance use crisis involving behavior that is sufficiently erratic, threatening or dangerous that emergency services are called in order to protect the person or those around them. This includes persons who may require assessment under the Mental Health Act.

Question 40

Physician means

Answer 40

a legally qualified medical practitioner. [Source: Health Protection and Promotion Act, ss. 1(1)].

Question 41

Psychiatric Facility means

Answer 41

a facility for the observation, care and treatment of persons suffering from a mental disorder and designated as such by the regulation contained in the Mental Health Act. See Procedure 06-04, Appendix B for a list of designated psychiatric facilities.