Abbotsford's nurse-and-cop team a 'gift'—but can only respond to one-quarter of calls

Abbotsford’s new nurse-cop teams aimed at de-escalating mental health calls are working and effective, but only helping a portion of people in crisis, according to police.

Abbotsford is one of only four BC communities with “mobile integrated crisis response teams” that pair psychiatric nurses with police officers to try to provide better—and safer—care to people in crisis. (Chilliwack is another.)

The program has been a “gift” to Abbotsford since it started, the city’s Public Safety Advisory Committee heard last week. But Abbotsford Police Insp. Kevin Murray said that limited hours and manpower means the plainclothes team is only helping one-quarter of those who might benefit from its help.

In November, the province announced that four municipalities would receive funding and support to set up “Car 87” programs—or, officially, Mobile Integrated Crisis Response teams.

The team consists of a plainclothes police officer and a psychiatric nurse with the training and ability to de-escalate a situation or resolve it in a way that doesn’t lead to the use of force. (The officer also gets extra training to deal with mental health calls.) They respond to mental health calls, including reports of people threatening to harm themselves, that would traditionally trigger a uniformed police response. The goal is to provide those in crisis with better, more appropriate care while lessening the likelihood that police will use potentially lethal force.

When the province announced the program in November, Minister of Mental Health and Addictions Jennifer Whiteside said the teams would provide extra support to individuals who need it. “With the new Mobile Integrated Crisis Response team in Abbotsford, people in crisis will be met with appropriate, compassionate and comprehensive care, and a clear path to the help they need, supporting them on their road to wellness,” she said.

(The concept and execution isn’t entirely new, though its roll-out in the Lower Mainland is. Prince George’s RCMP and health authority have operated nurse-police teams for more than nine years. https://bc-cb.rcmp-grc.gc.ca/ViewPage.action?siteNodeId=2100&languageId=1&contentId=49720)

Abbotsford received a team partly because of the police’s long-term relationship with Fraser Health, Murray told the committee last Thursday. The nurses’ time is paid for by the province. Murray said the project is being watched closely by provincial officials and Public Safety Minister Mike Farnworth, and that representatives from the four targeted areas meet monthly to compare notes and review what’s working.

“There are a lot of eyeballs provincially on the success and the rollout of this project,” Murray said.

Murray said the program represents a major change of thinking by police in how best to respond to mental health calls. He said it represents a relatively new willingness to step back from such incidents and allow others to take the lead.

“This is very much civilian led. I can tell you that when the police and nurse goes to the calls, the nurse is like ‘OK, I’ve got this’ and interacts with the individual and the cop sits there being ‘OK, do I have to do anything,’” he said. “We are taking a back seat as much as we can for the professionals—a psychiatric nurse—to engage with this person and figure out what’s going on.”

That attitude, combined with increased training and understanding of the nuances of how best to respond to different people in different mental health circumstances, represent “groundswell changes,” he said.

The teams are effective not just because of the personal expertise of the nurses, but because they have access to the medical history of patients, which can help inform responses—including decisions about whether a person actually needs to be apprehended. Reducing apprehensions, Murray said, can benefit patients, make violent confrontations less likely, and reduce the pressure on the health care system.

A part-time program

But the nurse-cop team only gets to about one-quarter of more than 300 mental health calls directed to police each month. Mental health patients in crisis late at night or early in the morning don’t get to talk to a Car 87 psychiatric nurse—at the moment, at least. And if there are multiple incidents at the same time, the car can’t get to all who might benefit from its nurse’s help.

“Each call takes 45 minutes to an hour,” Murray said. “These are not quick in-and-out scenarios because the whole purpose is to try to engage with the client.”

The workload demands also means the team only responds to calls, doesn’t take referrals from agencies, and doesn’t have the time to follow up with most patients.

“To be honest with you, there are so many mental health calls for service of a mental health variety in the city, it’s very challenging to have time to do any meaningful follow-up.”

Those pressures were underscored by statistics shared by Murray.

Abbotsford’s Car 87 team responded to 299 calls in November, December, and January. That case load, Murray said, was “by far” the largest of any of the four teams started last year. The figures are impressive considering the fact the team can only take one file at a time and are only available for half a day, Murray said.

But those deployments represent only about one-quarter of the 1,222 mental health calls received over those three months. Three of four people who generate a mental health call to police don’t get a visit from the Car 87 team.

Murray says the figures demonstrate the need for the teams to be available 24 hours a day.

“We’re pushing hard to become the pilot agency to run a 24/7 MICR team because we have the stats,” Murray said

The current 10am-to-10pm shift was influenced by statistics showing that is when most mental health calls in the region come in, Murray said. But one-third of all calls come in outside of that time frame, when no Car 87 team is available.

Even when a Car 87 team is operating, the demand is such that the pairing can only get to about half of all mental health calls.

The teams also spend several hours each week waiting with patients in Abbotsford Regional Hospital, the figures show. Over the three months for which data was collected, 70 people were apprehended and taken to Abbotsford Regional Hospital. On average, the nurse-police teams waited 103 minutes for a patient to be admitted. That works out to more than one hour a day, on average, that the team is waiting in hospital rather than available to respond to calls.

“Triage is the problem we have at Abbotsford Regional Hospital,” Murray said. “It’s not their fault, they just don’t have the capacity.”

Improvements

Murray said the province is aware of the challenges and issues in improving the efficiency of the program and reducing the hospital wait times.

The province is rolling out an app for police departments aimed at speeding up the triage process and reducing in-hospital waits. Murray said the app has helped reduce waits in Delta and Surrey and hopes the same will occur in Abbotsford.

And Abbotsford Mayor Ross Siemens said the hospital challenges are also related to staffing challenges. Fraser Health facilities in Abbotsford and elsewhere have increasingly been constrained from increasing services not by funding constraints or a lack of desire, but by a lack of available nurses and doctors and the demand for their services across sectors.

The Current asked for an interview with the Minister for Mental Health and Addictions on the future of the program and its prospects for expansion. The ministry said the minister was “not available,” though The Current offered to make itself available at any time.

In a written statement, the ministry spokesperson wrote that the province is “expanding mental health crisis response teams into more communities so people in crisis can get more supports from health care workers and community members.” The ministry said that the team in Abbotsford is new and “improvements will continue to be made to best serve people in the community.”

Current operating hours, the ministry said, is reflective of “local needs, available resources, and shift scheduling.”

The response alludes to potentially the biggest challenge in expanding the program: a lack of nurses. In 2022, Vancouver’s new mayor promised to hire 100 mental health nurses to staff a program similar to Car 87. A year later, the city had only been able to recruit 10 nurses.

A shortage of nurses across BC have hampered efforts to improve health care in a variety of settings. The shortage has led to intensified efforts to recruit nurses from other jurisdictions. On Friday, the province also announced it would be offering sizable bonuses to nurses who pledge to work in remote or rural communities.