One evening in October 2019, third-year anthropology student Natalia Espinosa went to the counselling centre on campus at the University of Toronto for help coping with suicidal thoughts.
Shortly after arriving and speaking with a nurse, she says she was escorted past crowds of her fellow students, her hands restrained, and put in a campus police car.
Under Ontario’s Mental Health Act, a police officer (including campus police, such as in Espinosa's case) may take a person into custody and transport them for examination by a physician if the officer is "of the opinion that the person is apparently suffering from mental disorder” that could result in serious harm to themselves or others.
“When you go to ask for help, which already takes so much strength ... you expect people to offer you compassion.” Espinosa says. “But to have yourself (apprehended), it almost makes you feel like a criminal, (that) you’re doing something wrong (and) you deserve to be in that position.”
As the number of apprehensions of youth in mental health crisis spike across Canada, concern is growing over their impact on vulnerable young minds, an Investigative Journalism Bureau investigation has found.
Data provided to this investigation by post-secondary institutions and police forces show apprehensions and other mental health incidents spiking in jurisdictions across the country.
In Toronto, the number of young people apprehended by police under the Mental Health Act rose 30 per cent between 2014 and 2019.
Provincially, involuntary apprehensions of youth by the Ontario Provincial Police rose 40 per cent between 2015 and 2019.
In Vancouver, there has been a 49 per cent jump between 2014 and 2019 — roughly five times the rate of increase among the city's general population.
As the number of apprehensions of youth in mental health crisis spike across Canada, concern is growing over their impact on vulnerable young minds, an @UofT_ijb investigation has found. #GenerationDistress
On some of Canada’s college and university campuses, the story is equally dramatic.
At the University of Waterloo, there were 62 apprehensions in 2018-19 — a 417 per cent leap from 12 in 2014-15, with a total enrolment increase of 11 per cent in that time.
University officials say the spike “corresponds to a period of time where mental health concerns were a high priority on campus,” and that “all mental health service usage generally went up during this period and has stabilized since.”
McMaster University reported an approximate 76 per cent rise in mental health security calls (including those with and without apprehensions) between the 2014-15 and 2018-19 school years, to 60 from 34, with an enrolment increase of 10 per cent during that period.
The increase “reflects growing mental health awareness and training across the campus,” wrote a McMaster spokesperson in an emailed correspondence, noting “in a typical year we would see two or three cases that involve any type of apprehension under the Mental Health Act.”
At the University of Toronto, campus police reported 113 "Mental Health Act" incidents (which may, but do not always, include physical apprehensions) across the school's three campuses in 2019, up 38 per cent from 2014 with a simultaneous enrolment increase of roughly six per cent.
In a written statement, the university said the numbers fluctuate annually, and “given U of T has about 93,000 undergraduate and graduate students, the total numbers are quite low.”
U of T vice-provost of students Sandy Welsh noted in a separate statement that campus police become involved “only when an individual makes specific statements that indicate they have an intention to do harm such as suicide and are unwilling to go to the hospital. In such cases, we have a responsibility to keep individuals safe.”
Reconsidering the use of restraints
Apprehensions of young people in crisis by police or campus police are increasingly controversial.
“As human beings, why would you ever want a person under distress to be handcuffed, because of the criminalization of it, the stigma, the trauma?” says Juveria Zaheer, an emergency clinician and researcher at the Centre for Addiction and Mental Health (CAMH).
A 2019 commentary paper co-authored by Zaheer and two other Ontario researchers described the use of physical restraints for mental health transfers as “a systemic problem that causes harm.”
“In our experience, our patients at Student Health Services pose negligible risks to others,” it reads, adding “the routine use of handcuffs for transfer of such patients not only negatively affects health in the present, but also reduces the likelihood that patients will seek medical attention in the future when they are in distress.”
In June 2020, CAMH called for the complete removal of police as first responders in mental health crisis cases.
“For too long, the health-care system has relied on police to respond to mental health crises in the community,” the statement reads. “Recent events have exposed the tragic outcomes that can occur when people with mental illness experience a crisis in the community and are not able to get the care that they need. Racism and anti-Black racism compound these crisis interactions.”
Less than a month earlier, Regis Korchinski-Paquet, a 29-year-old Afro-Indigenous woman, fell to her death during an incident involving mental health with police present. In the days that followed, protesters held marches in Toronto.
A new model
Toronto is among several North American cities exploring a model for mental health crisis response.
This past February, Toronto city council unanimously approved the Community Crisis Support Service Pilot, investing an initially estimated $24 million over four years to test the effectiveness of a model that would send crisis workers from community health providers as first responders to some mental health calls.
“Typically, (Mental health workers) can do the assessment on the spot; they can determine whether someone actually meets the criteria for hospitalization,” says Rachel Bromberg, co-founder of the Reach Out Response Network, a mental health research and advocacy group that submitted a 92-page report to city staff on alternative crisis response models last year.
Bromberg says that sending mental health workers — including social workers, nurses and psychotherapists — can, in some cases, avoid the need both for trips to the hospital and the apprehensions they often involve.
“Instead, they just connect (people in crisis) with whatever resources they actually need.”
Alongside injections of funding, including to increase their staffing, a selection of mental health organizations will have some non-violent mental health cases routed directly to them, rather than police, possibly through Toronto’s 911 system.
A separate pilot by Toronto Police, which launched this summer, will see a portion of nonviolent mental health calls in three Toronto police divisions diverted to the Gerstein Crisis Centre, a crisis response service that has operated in the city for decades, and other community support agencies.
In a report presented to the Toronto Police Services Board in June, the chief of police's office wrote that the two pilots will "complement each other," expanding capacity for crisis response in the city and overlapping in areas with high demand.
‘It is unconscionable’
After her apprehension, Espinosa spent the night in hospital. In the morning, she spoke with a psychiatrist who helped her “get back on track,” she says.
“(Hospital) staff were just outstanding,” she says. “They did their best to take care of me, and to make sure I was safe, and make sure … I had the resources to get better.”
After leaving hospital, Espinosa and a friend visited University of Toronto-Mississauga professor Beverly Bain, a longtime scholar and activist on police issues, to tell her what happened.
Bain says she reported the incident to university officials, but “did not get a response that seemed to reveal that they understood how difficult this was, and how the criminalizing of students is something that we need to be particular about.”
“That was a major thing for me,” Bain said in an interview. “I was not about to let it go.”
Bain and a colleague co-wrote an open letter to the university’s administration calling for a written apology to Espinosa, a halt to the practice of involving police in apprehending help-seeking students at the counselling centre, and an end to mental health hospital transfers by police except in extreme cases, among other policy changes. The letter was undersigned by more than 100 people, including those identifying themselves as alumni, faculty and students.
“It is unconscionable that student services' response to vulnerable students creates further injury,” the letter concludes. “The university must do a complete overhaul to provide a caring and supporting environment for all of our students.”
Espinosa says she doesn’t blame the counselling centre staff. “I don’t have anything against the workers; I’m sure they’re doing the best they can,” she says. “Obviously, it was a problem that was systemic.”
The university’s own mental health task force has advocated a review of the practice.
In its December 2019 final report, the U of T’s Presidential and Provostial Task Force on Student Mental Health released a list of recommendations, including a review of the handcuffing practice and a call for a “trauma-informed protocol.”
“The university should also explore and consider whether alternative methods of transporting students to hospital for emergency psychiatric assessment can be used under certain circumstances,” the report reads.
U of T administration’s response to the report, released in January 2020, states that they “accept all of its recommendations wholeheartedly.”
In a May 2021 written statement, a U of T spokesperson told this investigation that the school is currently conducting a review of the role of campus police and safety services in student mental health crisis, and to “assess existing procedures and processes — including the transition to mental health services.”
“U of T is not alone in facing a growing number of students with mental health concerns. We recognize that student mental health is a shared responsibility, and working within U of T, with community partners, and with all levels of government, to address this issue is critical to support our students,” the statement reads.
As she prepares to graduate later this year, Espinosa says she is grateful for the emerging discussion over reforms to mental health apprehension policies.
“It’s definitely encouraging, any step, even if it’s a small step, towards changes to how we’re treating people with mental illness,” she says. “It’s nice to know that there’s still a community, and a sense of doing what’s right for mental health.”
— With files from Emma Renaerts / University of British Columbia
This story is part of a cross-border investigation into youth mental health involving the National Observer, the Investigative Journalism Bureau (University of Toronto’s Dalla Lana School of Public Health), the Toronto Star and NBC News in partnership with journalism faculty and students from the following universities: Stanford University, Temple University, University of Missouri, Syracuse University, City University of New York, University of British Columbia, Ryerson University, Carleton University, and the University of King’s College. For a look at the series, visit. ijb.utoronto.ca