Who Can I Call? Gathering the Evidence on Crisis Intervention, Questioning Involuntary Treatment, and Minimizing Harm

Current crisis response frameworks typically rely on police intervention, often leading to the criminalization or unnecessary hospitalization of individuals experiencing mental health crises or substance use-related distress. These approaches fail to address the complex social and economic factors that contribute to crises, particularly for people who have historically been underserved in society. Our proposed research seeks to explore alternative crisis intervention models that prioritize non-medical, community-led responses without police intervention, thereby addressing a significant gap in policy and practice. The increasing frequency and intensity of crises in Ontario stem from multiple structural issues, including a worsening housing crisis, a growing opioid epidemic, and insufficient financial support for disabled individuals. Additionally, rising xenophobia, hate crimes, and economic precarity contribute to heightened distress among vulnerable communities. Many individuals in crisis experience multiple intersecting challenges, such as mental distress, substance use, financial instability, and social exclusion. Current crisis response strategies disproportionately impact racialized and disabled individuals, who are also at the highest risk of being harmed or killed during police interactions. Despite widespread recognition that law enforcement is ill-equipped to serve as first responders for mental health and substance use crises, Ontario continues to rely on punitive measures, such as involuntary treatment programs and the closure of supervised consumption facilities, rather than evidence-based, rights-centered interventions.

This research project is based on a research collaboration with the CERC in Health Equity and Community Wellbeing at Toronto Metropolitan University and the Gerstein Crisis Centre. With a 35-year history of providing 24/7 crisis intervention services, the Gerstein Crisis Centre (GCC) ensures that individuals experiencing a mental health crisis receive immediate and compassionate support. A 2023 case study by Human Rights Watch pointed to Gerstein Crisis Centre as an exemplar of community-based mental health crisis support.

Our study aims to improve knowledge of non-medical crisis interventions and highlight effective community-based alternatives. The first stage of the project has four key objectives: (1) to build an evidence base on crisis interventions that do not involve police; (2) to identify the key characteristics of successful non-medical crisis response models; (3) to collate existing evidence on the harms and benefits of involuntary treatment for mental distress and/or substance use crisis care; and (4) to analyze internal data from the Gerstein Crisis Centre to better understand the experiences of people who access non-medical crisis services. 

We are conducting (1) a scoping review of alternative crisis interventions; (2) a literature review on involuntary treatment; and 3) an analysis of case files and survey responses from the Gerstein Crisis Centre. Our findings will contribute to evidence-based policy discussions and provide GCC with valuable insights to enhance their exemplary crisis support services.

Our project employs critical qualitative research methods, to analyze internal crisis service data and conduct a scoping review of international peer reviewed and grey literature, to examine the effectiveness of opposing approaches to crisis intervention. Through analysis of case notes and partner patient survey responses from the last five years, the project will generate de-identified narrative profiles which will provide insights into service user experiences, intervention outcomes both immediate and long term, and existing and continuity of critical gaps in crisis response. To build rigor and depth into the case note analytical profiles, a scoping review will be conducted using the PRISMA-ScR framework to systematically identify, document and map the existing literature on non-medical crisis interventions. This will include peer-reviewed academic literature and gray literature, such as policy reports, community-based research, and program evaluations, to ensure a broad and inclusive evidence base. A literature review will consider recent literature on the purported harms and benefits of involuntary treatment for mental distress, crisis, and/or substance use. This study is grounded in anti-racist feminist theory, Mad Studies praxis (Costa & Ross, 2023) and survivor research ethics (Faulkner 2004; Landry 2017), emphasizing the lived experiences and agency of those impacted by crisis interventions. Additionally, critical criminology and qualitative health research methodologies will guide our analysis, challenging medicalized and carceral approaches to crisis response while highlighting structural and systemic factors influencing harm reduction and service accessibility.