Partners in community crisis response

Cota's MCIT follow up case management program: ARCS-MCIT

The purpose of this article is twofold; to outline the role of the Toronto Police Mobile Crisis Intervention Team (MCIT), while providing context and information about one of Cota’s newest partnerships, ARCS-MCIT.

Through highlighting how ARCS-MCIT enhances the existing MCIT service, it is evident that the program has successfully addressed the need for accessible, follow-up case management services.

Skyline of Toronto

What is MCIT?

The history of the MCIT, a service that combines Toronto Police officers and nurses in responding to mental health crisis calls, is longer then one may expect… it proudly enters its 21st year in 2021.

In 2020, over 33,000 mental health calls were made to Toronto Police Service. MCITs are co-responders and can be assigned to emergency calls either after a Primary Response Unit (PRU) deems it safe for the team, or alongside the PRU. From adults with complex mental health challenges, youth on the Autism Spectrum and seniors with dementia, MCIT clients are as diverse as the city itself.

Being a rapid response program, MCIT assistance comes as quickly as possible, and they begin taking appropriate actions, based on the interprofessional analysis of these two distinct professions working together as a team. The MCIT program functions throughout the City of Toronto, currently with 10 teams (each designated to specific police divisions) and is associated with six major hospitals.

MCIT’s objective is to make an immediate on-site assessment of the situation, deescalate or defuse the crisis, and, if necessary, assist in removing the individual from serious harm to themselves or others. At times, MCITs assist in peaceful apprehension under the Mental Health Act and facilitate transporting that individual to the nearest emergency department for further psychiatric and/or medical assessment. However, in approximately 60% of cases, the person remains in the community and MCITs assist in arranging mental health treatment through referrals to an appropriate agency.

Unfortunately, per their mandate, MCIT’s involvement ceases after their response to the crisis. They do not provide ongoing follow-up support services. At times, the absence of such follow-up support services has resulted in individuals experiencing continued challenges and in repeat 911 calls or MCIT involvement.

How ARCS-MCIT began

In acknowledging feedback from both service users and providers alike, the opportunity for community mental health organizations to offer follow-up individualized support, particularly short-term case management, was identified. This spurred the partnership between MCIT and Cota Health (Cota).

The MCIT Steering Committee selected Cota to assist in creating a pilot follow-up support program for the MCIT affiliated with North York General Hospital. The decision to choose Cota as a partner was influenced by the fact that the Cota had a pre-existing relationship with the hospital through a similar program called Access to Resources and Community Support (ARCS). 

With ARCS, Cota had already been offering community-based follow-up supports to people who present with mental health challenges at the Emergency Departments of North York General Hospital and/or Humber River Hospital. It provides a short-term follow-up support service to help people get their mental health and other needs met in the community. It was felt that this type of community-based service would also be helpful to some people whom MCIT encounters.  As a result, the concept of ARCS – MCIT was born and proposed as a pilot project.

Funding for the pilot project was secured, and ARCS-MCIT formally launched in October 2019.  Initially offered to the MCIT affiliated with North York General Hospital, ARCS-MCIT is now also receiving referrals from Humber River Hospital’s MCIT.

Lisa, MCIT Nurse

Having a direct partnership with a community health organization […] has been so beneficial from a service delivery perspective. The mental health landscape is very fragmented, and this was an opportunity to work together across sectors and provide holistic care. (MCIT) nurses feel better knowing that they have case management support for the clients that stay in the community

– Leah Dunbar, Project Manager, Toronto MCIT Program

There are several virtues of both programs being mobile services. A primary one is that MCIT is able to initiate service by going directly to the person needing support. This approach allows the nurse and police officer team to safely observe and engage with the client wherever they are in the community, often in their home environment. This is both more convenient for those experiencing crisis, and helpful in offering context and insight into that individual’s daily life. If the MCIT team determines that the person does not need to be taken to the hospital for treatment, but rather that community-based supports are most appropriate, that’s were programs such as ARCS-MCIT can begin to provide services.

How ARCS-MCIT works in the community

In North York, if the client remains in the community following an interaction with MCIT, they have the option of being connected to Cota’s ARCS-MCIT follow-up service comprised of a case manager and a peer support specialist. This service connects with people within 48 business hours of their encounter with MCIT. Cota’s service providers then work with clients on a short-term basis, listening to their experiences, assessing and providing assistance to address their immediate needs. They work collaboratively with each individual to develop personal goal plans, all while facilitating connections to appropriate services and/or re-establishing the individual with pre-existing services to ensure a continuum of support.

Alenka, Case Manager & Lisa, MCIT Nurse

Cota service providers are pleasant, positive and eager to help. (They have) a firm belief that immediate care during a crisis is important and follow up care builds rapport for future help. Each and every positive memory builds on the partnership. The community support element has been amazing- (they have) have a wealth of knowledge and community resources […] helping with both mental health and psycho-social concerns”

North York MCIT Team

The program has seen notable success, with the overwhelming majority of MCIT callers offered ARCS case management services accepting the support, and the average period of Case Management/Peer Support service being 77 days.

What clients are saying about the program

Preliminary data, coupled with client testimonials, demonstrate how the ARCS-MCIT program is effective in curbing hospital and emergency room visits, while also releasing pressure on the justice system. With clients receiving active support while remaining in their home, they have a better chance of stabilization and recovery on their own terms. “I think it is more convenient and welcoming […] no one wants to be in a hospital, especially not now.” – ARCS-MCIT client.

The effects of the Covid-19 pandemic on mental health has resulted in a marked uptick in crisis calls across the board. While juggling multiple responsibilities leading into the initial Covid-19 lockdown in March 2020, an ARCS-MCIT client shared their thoughts and feelings around the support they received from the program and community-based approach to mental health care.

I had a busy schedule. I was in the midst of finishing school. I had a lot of things on my plate. In February I managed to hold down two jobs. That ended during lockdown. (It was) easier having someone come to me. […] I had a therapist but had to schedule around my work life. I wish there were more services like this that are accessible. People just think go to hospital for things – but there is not enough accessible or mobile services. Most people who are struggling are not available all the time – they are working or have children or something filling their schedule. […] I think you just need someone who can help you manage your mental health. […] When your caretakers aren’t in a position to take care of your mental health, you may not seek out help. And you are scared to talk about how you feel. Not everyone will reach out – they are embarrassed or stigmatized. They want services in their own home. In a hospital, you feel like a number. Cota’s care feels one on one, feels safer for the client. For them to express themselves

ARCS-MCIT Client

Another client of the program found themselves overwhelmed with multiple life stressors and mounting tensions and issues at home. There was a crisis with their spouse and MCIT was dispatched, coming to their home and deescalating the crisis. “(MCIT) asked if I wanted a worker. I felt supported and relieved”. After being referred to an ARCS case manager, the client and their spouse were both given support and over time goals were set, which the case manager says “prevent(ed) some potential hospitalizations during Covid”. The assistance they received through Cota assisted the couple in feeling supported to explore their goals; including finding new living arrangements together and their overall situation has been more stable since.

Future plans for ARCS-MCIT

There is a strong sense of hope that collaborative programs like this will continue to be funded and grow into much larger initiatives. Leah Dunbar comments, “With additional funding, we would definitely have capacity to scale across Toronto and offer it to all MCIT clients […] we’d love to see it grow across Toronto. We’ve met with representatives from the Province and all the partners would love to see it expand”.

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