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 officer 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. The following process governs police interaction with and apprehension of persons in crisis and their subsequent admission to psychiatric facilities.
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. In every encounter, the Service is committed to taking all reasonable steps to assess, de-escalate and safely resolve the situation.

Question 2

Supervision

Answer 2

 Supervisory Officer attendance mandatory for calls for service when there is information that a persons 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

Procedure - An eReport must be completed for

Answer 3

 all MHA apprehensions; and
 circumstances where the location of the person named on the Form – MHA is unknown and every effort to locate the individual has been made.
 Note: Officers may consider completing an eReport for any circumstances where the details of the incident would assist officers in resolving conflicts in any future crisis related contacts.

Question 4

Section 17 MHA – Action by Police Officer -
Section 17 of the MHA states that:

Where a police officer has REASONABLE AND PROBABLE 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 4

(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,

Question 5

Section 17 MHA – Action by Police Officer -
Section 17 of the MHA states that (2):

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,

Answer 5

(d) serious bodily harm to the person;
(e) serious bodily harm to another person; or
(f) serious physical impairment of the person,

Question 6

Section 17 MHA – Action by Police Officer -
Section 17 of the MHA states that (3):

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.

Answer 6

 Note: 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 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 7

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 7

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

Question 8

Safe Beds Program and Referrals to Community Supports - There are many community service providers available to assist police with persons in crisis. Members are encouraged to access the ______for information on the safe bed program, system navigators and other community referrals or supports available. Connecting community members to supports may improve their ______ they will require emergency services in the future.

Answer 8

TPS Mental Health Referrals Guide

quality of life and/or decrease the likelihood

Question 9

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 9

 any person over the age of sixteen (16) 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 10

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 10

 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

Note: 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. Prior to providing support, the person in crisis must voluntarily agree to the services being provided and any other required conditions for admittance (i.e. pandemic screening and testing, wearing of personal protective equipment, etc.).

Question 11

Safe Beds Program and Referrals to Community Supports - The CMHA also hosts a separate Referral Line that is accessible to the general public – (416) 248-4174. Officers may provide this number to community members who may benefit from CMHA programs …

Answer 11

(including safe beds), but who wish to do so on their own timeline.

Question 12

Mobile Crisis Intervention Team (MCIT) - The MCIT program is a collaborative partnership between participating hospitals and the Service bound through a ______. The MCIT program partners a mental health nurse with a police officer with additional training in _______ involving individuals experiencing a mental, emotional or substance use crisis.

Answer 12

Memorandum of Understanding

working with persons in crisis that will respond, or assist in the response to calls for service

Question 13

The MCIT response will assist with:

Answer 13

 assessing the situation
 attempting to stabilize and diffuse the crisis
 providing supportive counselling as needed
 connecting the individual to appropriate community services

Question 14

Mobile Crisis Intervention Team (MCIT) - When feasible and consistent with officer and public safety, members with MCIT training and/or additional mental health training should take

Answer 14

the lead role in situations involving a person in crisis.

Question 15

Race and Identity-Based Data Collection -
As outlined in Procedure 16–07, the Toronto Police Services Board Policy entitled “Race-Based Data Collection, Analysis and Public Reporting” requires the Toronto Police Service (Service) to

Answer 15

collect, analyze and publicly report on data related to the race of those individuals with whom Service members interact.

Question 16

Section 17 MHA – Police Officer - 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 16

s. 17 and s. 33 of the MHA.

Question 17

Section 17 MHA – Police Officer - When responding to a complaint of a person in crisis SHALL

Answer 17

 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 and comply with Procedure 05–21
 obtain the type of information contained in Chapter 5, Appendix A to help determine whether REASONABLE GROUNDS exist to believe there is a threat to safety
 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 Procedure 10–05, when:
 there is information that a person in crisis is armed or may be armed with a weapon
 background checks indicate that the person in crisis has a history of violence or use of weapons
 the incident involves a barricaded person
 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.)
 Note: 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.
 comply with Procedure 09–03, if applicable
 request to obtain sufficient backup officers

Question 18

Section 17 MHA – Police Officer - When encountering a person in crisis SHALL

Answer 18

 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
 Note: Keeping in mind officer and public safety, officers may use discretion when determining whether to handcuff an individual as it may not be practicable or necessary in all circumstances (e.g. due to a person’s medical condition, age, disability, pregnancy, or frailty).
 consult with the MCIT, if available.

Question 19

Section 17 MHA – Police Officer - When a person in crisis has committed a criminal offence SHALL

Answer 19

 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 20

Section 17 MHA – Police Officer - When attending a scene where the risk of contact with blood or body fluids exists SHALL

Answer 20

 take the necessary precautions to minimize the risk of exposure to communicable diseases
 comply with Procedure 08–07

Question 21

Section 17 MHA – Police Officer - If the person appears on CPIC in the Special Interest to Police (SIP) category as being the subject of an Ontario Review Board Warrant SHALL

Answer 21

comply with Procedure 02–12. NIP

Question 22

Section 17 MHA – Police Officer - When receiving a complaint or coming into contact with an elopee, including a person wanted for a terminated Community Treatment Order (Form 47) SHALL

Answer 22

comply with Procedure 06–05. NIP

Question 23

Section 17 MHA – Police Officer - When the person in crisis, is eighteen (18) years of age or older, and has not been apprehended under the MHA SHALL

Answer 23

 consider making a referral to a community support agency, after consent is received from the person in crisis,
 record the referral information
 in the memorandum book
 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
 comply with Item 19, if applicable

Note: Members are encouraged to access the TPS Mental Health Referrals Guide when considering a referral to a community support agency.

Question 24

Section 17 MHA – Police Officer - When the person in crisis, is sixteen (16) or seventeen (17) years of age, and has not been apprehended under the MHA SHALL:

Answer 24

 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
 in the memorandum book
 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
 comply with Item 19, if applicable

 Note: Members are encouraged to access the TPS Mental Health Referrals Guide when considering a referral to a community support agency.

Question 25

Section 17 MHA – Police Officer - When the person in crisis is under sixteen (16) years of age SHALL

Answer 25

 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)
 comply with Procedure 04–41, as appropriate
 in consultation with CAS, refer the child in need of protection to a community support agency as required
 record the referral information
‒ in the memorandum book
‒ in the eReport, including referral type and referral agency, if applicable

 Note: Members are encouraged to access the TPS Mental Health Referrals Guide when considering a referral to a community support agency.

Question 26

Section 17 MHA – Police Officer - When there are sufficient grounds to apprehend a person in crisis under s. 17 MHA SHALL

Answer 26

 comply with item 2, if applicable
 apprehend the person
 ensure the dwelling and any valuables are secured for safekeeping in compliance with Procedure 09–01, if
applicable
 transport the person to the nearest psychiatric facility listed in Appendix B
 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 attending physicians in their assessment
 comply with Procedure 09–03, (both NIP) if applicable
 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 27

Section 17 MHA – Police Officer - If the person is an outpatient of, or has recent history with a more distant psychiatric facility, may use

Answer 27

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

Question 28

Section 17 MHA – Police Officer - When detailed to apprehend a person in crisis under a Form – MHA SHALL

Answer 28

 obtain the original Form – MHA
 ensure the Form – MHA is still valid
 obtain background details from the complainant
 comply with item 2
 attend the address of the person in crisis
 comply with items 11 and 16
 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 29

Section 17 MHA – Police Officer - 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 29

complete the applicable eReports, including the applicable MO Detail page
complete the Missing Person Details page
 Note: Records Management Services – Operations (RMS – Ops) will enter the person on CPIC, and create and post a BOLO.
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 30

Section 17 MHA – Police Officer - If the person in crisis has been apprehended under a Form – MHA after an entry has been made in CPIC SHALL

Answer 30

 add supplementary information to the original eReport, detailing the circumstances of the apprehension
 complete the Located/Found section of the Missing Persons details page
 Note: Upon receiving and transcribing the person located/found update, RMS – Ops will cancel the BOLO, and the missing person from CPIC.
 comply with items 11 and 16

Question 31

Section 17 MHA – Police Officer - Upon arriving at the psychiatric facility SHALL

Answer 31

 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
 Note: 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.
 if items 14 and 15 do not apply, complete the applicable eReport, outlining the details of the apprehension and include the information contained in the TPS 710
 complete the applicable MO Detail page
 notify or arrange for notification of the next of kin

Question 32

Section 17 MHA – Police Officer - If difficulty is experienced when having a person examined/admitted to a hospital

Answer 32

 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
 Note: 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 33

Section 17 MHA – Police Officer - Where there are safety concerns for officers attending an address in the future SHALL complete a

Answer 33

TPS 228 to activate the Special Address System in compliance with Procedure 17–08.

Question 34

Section 17 MHA – Police Officer - Notify the Divisional Mental Health Liaison Officer (DMHLO) of any cases requiring further support or follow-up, including referral to…

Answer 34

Furthering Our Communities Uniting Services (FOCUS) Toronto

 Note: 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 35

Section 17 MHA – Supervisory Officer - Upon being notified that a call for service involves a person in crisis SHALL

Answer 35

 ensure notification and attendance of the MCIT, if available
 ensure compliance with Procedure 06-13, if applicable

Question 36

Section 17 MHA – Supervisory Officer - Upon being notified that a call for service involves a that is armed or may be armed with a weapon SHALL

Answer 36

 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 37

Section 17 MHA – Supervisory Officer - When attending officers have apprehended and transported an individual to a psychiatric facility, SHALL

Answer 37

ensure the prompt and appropriate relief is prioritized.

Question 38

Section 17 MHA – Supervisory Officer - When a call for service involves a traumatic critical incident SHALL

Answer 38

ensure compliance with Procedure 08-04

Question 39

Section 17 MHA – Divisional Mental Health Liaison Officer (DMHLO) - The DMHLO SHALL

Answer 39

 coordinate divisional community mental health needs through community service providers, including but not limited to a situation table such as a local FOCUS table
 coordinate with internal divisional resources and community mental health professionals to formulate a plan designed to support individuals identified as high frequency users of emergency services due to a suspected mental, emotional or substance use crisis
 review Mental Health related events and occurrences, and identify opportunities to make referrals to external community mental health agencies
 coordinate with the Divisional FOCUS representative (where one exists) to identify those situations that could be brought to the local FOCUS situation table
 coordinate with the Community Relations Officer (CRO) to engage the FOCUS table interim process to connect the individual to supports when in a division absent of a FOCUS situation table
 liaise with Community Partnerships & Engagement Unit (CPEU) – Vulnerable Persons
 ensure that hospitals within the division have a sufficient supply of blank TPS 710 forms

Question 40

Section 17 MHA – Officer in Charge - Upon being notified that a call for service involves a person in crisis SHALL ensure

Answer 40

compliance with Procedure 06-13, if applicable

Question 41

Section 17 MHA – Officer in Charge - 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 41

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

Question 42

Section 17 MHA – Officer in Charge - When in receipt of a TPS 228, or when notified of
 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

Answer 42

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 43

Section 17 MHA – Officer in Charge - 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 43

 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
 Note: It will be at the discretion of the Supervisory Officer – ETF as to whether they will attend.

Question 44

Section 17 MHA – Officer in Charge - Upon receipt of an original Form – MHA, which has not been executed SHALL ensure

Answer 44

 compliance with item 14
 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 45

Definitions - Community Treatment Order (CTO)

Answer 45

means 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 46

Definitions - Disorderly

Answer 46

means 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 47

Definitions - Divisional Mental Health Liaison Officer

Answer 47

means the police officer responsible for coordinating all Mental Health Act needs and/or concerns within the division; usually the Community Relations Officer or the FOCUS liaison officer.

Question 48

Definitions - Form 1 MHA

Answer 48

means 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 49

Definitions - Form 2 MHA

Answer 49

means 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 50

Definitions - Form 9 MHA

Answer 50

means 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 51

Definitions - Form 47 MHA

Answer 51

means an Order for Examination issued by the physician who issued the person a Community Treatment Order (CTO) and
a) Has REASONABLE CAUSE TO BELIEVE the person has failed to comply with the conditions under the CTO,
b) 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 52

Definitions - Mental Disorder

Answer 52

means 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 53

Definitions - Person in Crisis

Answer 53

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 Mental Health Act.

Question 54

Definitions - Physician

Answer 54

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

Question 55

Definitions - Psychiatric Facility

Answer 55

means 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.

Question 56

Definitions - Traumatic Critical Incident

Answer 56

means any incident during which a member experiences, witnesses, or is confronted with serious injury, death, or mass casualties; any incident in which the member’s life has been imperilled or threatened; or any situation which is recognized at the time to have the potential to significantly interfere immediately or at a later time with a member’s ability to function professionally or personally.