Mental-health services offered too late, experts say, after uptick in violence

Recent cases of violence across Canada demonstrate a clear need to treat mental illness early instead of waiting until a serious crime happens, says an executive with the Canadian Mental Health Association.

Jonny Morris, the CEO of the B.C. division of the association, said the emphasis now is on people having to reach a particular point in their illness before receiving treatment.

"We want to be able to intervene early and actually prevent crisis – including a crisis where violence is present – from ever happening in the first place."

His comments come after apparent random violence in Ontario, B.C. and Alberta, including stabbing deaths.

Calgary police Chief Mark Neufeld told a news conference following two transit attacks in the city this month that police leaders across Canada have cited an increase in calls related to mental health.

He said there has been a recent focus on treating the calls as public-health issues rather than criminal justice matters, but police are now seeing it "manifesting" as crime.

"I think there's a lot of promise with respect to a lot of the policies and things that have been done, but what we've seen is an entrenchment to violence and individuals who are resistant to the services right now,"he said on April 13.

However, Janice Abbott, the CEO of Atira Women's Society, a non-profit housing provider working in Vancouver's Downtown Eastside, said she has not seen such a reluctance.

"I see help not being available to women who want it," she said in an interview."You fight, and you fight, and you fight and try and get support to women, and often it's too late by the time the support arrives."

Morris cautions that falling back on mental illness as a "catch-all" for why random acts of violence occur creates unwarranted stigma and may prevent people in crisis from seeking help.

"It's really important in the current context, where there have been a number of violent incidents, to absolutely not immediately draw the conclusion that mental illness is a factor that needs to be thoroughly investigated and only then might there be a claim to be made," he said.

Amanda Butler, a criminologist and health researcher, said studies show most acts of violence are not committed by mentally ill people and that they are more likely to be victims of violence or of self-harm.

The issue is much more nuanced, she said.

"It is also true that there is a small number of people with more serious mental-health conditions that are at elevated risk of being involved in violence perpetration," she said in an interview.

And when serious mental illness interacts with a drug addiction, that can elevate the risk for violence, she said.

Butler and former Vancouver deputy police chief Doug LePard co-authored a report for the provincial government last year examining prolific criminal offenders.

It found that B.C.’s non-violent crime severity index score went down by 7.55 per cent in 2021, while its violent index score went up by 4.32 per cent.

Stranger attacks in Vancouver increased by 35 per cent between 2020 and 2021 when compared with 2019, it said.

Twenty per cent of police encounters with those who live with mental illness concerned violent crime, another 40 per cent was about non-violent crime and the remaining 40 per cent was for calls about behaviour unrelated to crime, the report said.

"The vast majority of people with mental illness will never be involved in crime or violence. However, there appears to be a moderate but significant association between psychotic disorders and violence," the report said.

Butler also cited a 2009 study published by the American Medical Association titled 'Schizophrenia, Substance Abuse, and Violent Crime' that found the association between schizophrenia and violent crime is minimal unless the patient is also diagnosed as also having a substance-use disorder, increasing the risk of violence fourfold.

"We've seen a really big increase in the number of people who are being detained, but for shorter periods of time, so people are getting these kind of short-term stabilizations and then immediately released, which is, we know, not helping them and in fact, it might actually be exacerbating their risk."

Butler said it's important to reduce stigma, but the "eagerness" to do so may also lead to professionals inadequately addressing violence among that population.

Her report into repeat offenders made 28 recommendations.

While the B.C. government has made "significant strides" on some of those, such as civilian-led mental-health crisis teams, she said there needs to be more movement in areas that would directly curb the issue of violence.

Butler said a key recommendation in the report is for the creation of crisis response and stabilization centres.

Such a service would offer "no wrong door" access to mental-health and substance-use care that accepts walk-ins, as well as people being transported by ambulance, fire and police, the report said.

The province did not immediately respond to requests for comment about whether it intends to implement the recommendation.

Morris said the earlier people get help, the easier their illness is to treat and the less likely it will result in violence.

He said the solution is threefold: provide access to affordable, safe housing; close care gaps that exist between early and late stages of mental illness; and provide civilian-led response for those in crisis.

"The key message here (is that), left untreated, without support, without care in the community, there is perhaps an increased risk of violence," Morris said.

Involuntary treatment is "adefault strategy" and should not be "seen as the panacea given we don't have lots of voluntary care available," he added.

Butler agreed, saying the focus should rely most heavily on a poverty reduction solution.

"We know that if we were to ensure that people had their basic needs met, that would take care of a lot of the risk," she said.

"The starting point needs to be pulling people out of these really desperate positions that they're in that inevitably do increase the risk of deterioration and increase the risk of violence."

This report by The Canadian Press was first published April 25, 2023.