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. By non-medical, we are referring to community-based practices using evidence-based crisis intervention, without state involvement, and which addresses crisis as multifactorial, and grounded in social and structural determinants of health. 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 communities made vulnerable through structural inequality. 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, Indigenous, 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.

This partnered 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 purported harms and benefits of involuntary treatment for mental distress and/or substance use crisis care; and (4) to conduct community crisis worker interviews and analyze client records, feedback forms, and aggregate reports from GCC to better understand the experiences of people who access non-medical crisis services. Research activities include: a scoping review of alternative crisis interventions, a literature review on involuntary treatment, an analysis of client records, feedback forms, and aggregate reports, as well as 15-20 community crisis worker interviews. Findings will contribute to evidence-based policy discussions and provide GCC with valuable insights to enhance crisis support services.

The partnership between CERC HECW and GCC is rooted in shared decision-making, knowledge exchange, and a commitment to advancing equitable mental health care. Gerstein, a leader in non-medical crisis intervention, brings decades of experience providing 24/7 support to individuals in distress. As an active partner in the research process, the Gerstein Centre will provide access to de-identified and aggregate service data, share best practices, and ensure that the study remains aligned with real-world challenges. Through this collaboration, the research will amplify the voices of individuals with lived experience, engage key stakeholders, and contribute to the development of humane, evidence-based community-driven crisis response policies and service models. The project seeks to create lasting change by strengthening non-medical crisis interventions and promoting non-policing alternatives that prioritize dignity, autonomy, and harm reduction.

Our project employs a) critical qualitative research methods to conduct and analyse community crisis worker interviews and internal crisis service data; and b) a scoping review of the international peer reviewed and grey literature to examine the effectiveness of various approaches to crisis intervention. The project 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. 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 grey 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 brings existing underutilized data from a range of sources, from Gerstein client case files and worker qualitative interviews, international peer reviewed articles and grey literature on alternative crisis intervention models into empirical dialogue to build the evidence base for alternative crises intervention community response models of service and care. As an outcome of this rigorous approach, envisaged benefits include: a) improved service models and practices of care and support for Gerstein service users, b) greater awareness of the implications of policing within community crises care more broadly; and c) increased policy responses to alternative models of care.