Promising Practice: Gerstein Crisis Centre: Mobile Crisis Team

What you need to know

The Mobile Crisis Intervention Team is a non-police crisis response team, based out of the Gerstein Crisis Centre. Gerstein Crisis Centre has been providing 24/7 community-based crisis intervention services to individuals living in Toronto for over 30 years. Police are not attached to these services. The Centre serves individuals who are 16 years of age and older and living with serious mental health and/or substance use issues and are experiencing a crisis. They are a community-based, stand-alone centre and operate separately from the hospital and from the police, providing an alternative approach to crisis services when emergency responses are not needed or can be avoided.

Individuals experiencing a mental health and/or substance use crisis can call their telephone crisis line and receive telephone or virtual support from qualified professional crisis workers including people with lived experience 24 hours a day, 7 days a week. Along with this crisis line, a mobile crisis team can visit people in their home or at a safe location in the community and connect people to a variety of community-based crisis beds and crisis follow-up services. While most of the crisis calls resolve over the telephone, the Mobile Crisis Team travels to the client when an in-person intervention is needed or at the request of the caller. The need for a Crisis Stay will be determined through the mobile visit and follow-up services can be provided at any juncture.

The problem

Many individuals do not know where to turn to when they, or someone they are worried about, are in crisis. Individuals are unable to find services and resources early on before a crisis ensues, during a crisis and following a crisis. The Mobile Crisis Team focuses on the client in crisis and their expressed needs, providing low-barrier access to services and non- intrusive interventions in which collaboration and client choice are at the core. Referrals are accepted but not required. Clients retain autonomy in making decisions that will support their recovery process and improve health outcomes. Callers can use service once and never again or whenever they need to.

Building trusting relationships with clients works effectively and can often help avoid a crisis from developing. This can also lead to quicker de-escalation of crises if these do take place. Crisis intervention in the community also has the added benefit of reducing unnecessary interactions with the police and hospital system. The Mobile Crisis Team works with the individual and those concerned about them to support their needs and provide interventions and options that help people make decisions about what is best for their own mental health and well-being. The team does not use a one-size-fits-all strategy.

How it works

What services are provided?

With a combined understanding of psychiatric diagnosis and harm-reduction practice for substance involvement, the approach of the Mobile Crisis Team is trauma informed, strength-based and utilizes anti-racism and anti-oppression frameworks. Crisis intervention is a collaborative between the Mobile Crisis Team and the individual in crisis and/or the support system who may have called on their behalf.  Situations are resolved in a low stigma, non-intrusive and non-threatening manner where greater safety is achieved by deescalating the situation through engagement, listening and collaborative problem solving. While the focus of engagement is improving health outcomes by assisting someone to cope more effectively with the immediate stress they are experiencing, the individual is recognized as a whole person living as best they can within a wider context that includes all of the social determinants of health.

The Mobile Crisis Team provides services directly to the individual to help them to regain their equilibrium and safety without involving the police. The team will involve emergency services if the individual is in imminent danger and is unable to work with the team toward their safety.  Involving police is only done as a last resort and The Mobile Crisis Team remains in place with the person in crisis whenever possible and can offer support afterwards, once safety has been regained.

The Mobile Crisis Team is made up of a team of four Crisis Workers who are available 24-hours a day, seven days a week. They work with other teams and service providers within Toronto during the day to ensure timely services are provided pre-crisis, during a crisis and post-crisis. The Mobile Crisis team responds to calls in pairs. In order to be discreet, reduce fear and stigma and minimize power dynamics between service providers and service receivers, while the crisis workers do carry identification, they do not wear any specific attire or uniform or travel in a vehicle with logos or markings that suggest they are from the Gerstein Crisis Centre. The Mobile Crisis Team meets with an individual wherever they feel most comfortable: at a coffee shop, in a hospital emergency room, in people’s homes (if safe to do so), or anywhere in Toronto. The team spends time listening to the individual and works to understand what the issue is from the individual’s perspective, allowing them to openly express how they feel before the team moves to help generate solutions to the situation. The team also makes sure the individual has a safe warm place to stay and enough food. The support provided is immediate and for some the follow up will be offered on a short-term basis over 3–5 days, and for others, it may be longer-term with up to 30 days of follow-up depending on the needs and issues being addressed. Referrals to ongoing services are made wherever appropriate and available.

The Mobile Crisis Team is focused in Toronto but will not turn away any individual who is calling into the telephone crisis line or who might need someone to talk to. In terms of mobile visits out of Toronto, they collaborate with crisis teams in other regions to direct individuals to the right services and resources in their area. If an alternative is not available, the team will invite someone into the catchment area and at times may provide supports slightly outside of their catchment area. Wherever possible and or available, the individual in crisis will be referred to their local team.

While police are not directly involved in the crisis team, the Gerstein Crisis Centre partners with police through Situation Tables that are formed in many Police Divisions across the City. The goal of these tables is to divert people who are at risk of criminalization or in elevated risk situations to needed services they can benefit from. Gerstein Crisis Centre works with many partners at this table and often takes the lead in the initial engagement with the person in crisis, building connection and rapport to help connect the individual to ongoing supports like housing, case management, income supports and other beneficial services. Gerstein Crisis Centre also offers Mental Health and Justice Short Term Residential Crisis Beds in the City of Toronto and through a network of beds will hold a crisis bed available for police referral at all times.  This is again in an effort to divert people from the criminal justice system to more beneficial health and social services.

The Centre also has crisis beds available within Toronto that are safe and provide a non-medical environment where the individual can stay in a calm, home-like environment. They are able to connect with others and receive 24-hour support from the Mobile Crisis Team. The continuity of care received makes individuals feel like they don’t have to tell their story repeatedly to someone else at every stage of the intervention. Everything is integrated and the individual can receive support at any time. The crisis beds provide a soft place to land where an individual can gather their thoughts, regain their emotional equilibrium, have access to 24/7 support, get and take care of much needed basics like food and sleep and are connected to resources that help them transition back to the community when they leave. Some individuals need to get away from their current living situation where the environment might not be safe and is under-resourced, or they want to be away from others in their environment to work on their own mental health and well-being. Supports are provided based on the individual’s need at that moment, providing opportunities to connect with others and with services they might need during and post-crisis. Crisis beds operate at over 90% capacity.

Annually, the Gerstein Crisis Centre handles over 35,000 phone calls through their telephone crisis line, approximately 2,000 individuals are seen by the Crisis Mobile Teams (approximately four-six mobile visits in a day and even higher when other mobile teams are included), and close to 600 individuals stay in the Gerstein Centre Crisis beds offered at their two main locations and through partnership at two additional locations.

Gerstein Crisis Centre has targeted access for populations that are underserved and often marginalized. The crisis beds are located in the following locations across the city:  

  • Six beds – University Health Networks Withdrawal Management Services
  • One bed – Eva satellite location for transitional age youth
  • Five beds – Gerstein on Bloor site for women who are homeless and experiencing serious mental health issues
  • Nine beds – Gerstein on Bloor site for those coming through the justice/court system or a correctional facility who are homeless and experiencing serious mental health issues
  • Lumenus/Mental Health, Developmental & Community Services also provides support to those with dual diagnosis. Gerstein Crisis Centre assists with the Safe Bed Support Network and Urgent Response After Hours.

During COVID-19, the Centre initially saw a decrease in the number of mobile visits and house stays. However, to address community need for alternate approaches, capacity was increased over their telephone crisis line and virtual options including face-to-face visits and virtual groups were added to increase access to needed crisis services including scheduled follow-up and wellness. During the Pandemic, Gerstein Crisis Centre also saw an increase in the number of phone calls handled, at times 100 % greater than pre-COVID.

Who are the staff members?

The Gerstein Crisis Centre team brings a wide range of experience to their work. They have a strong background and understanding of mental health and substance use issues and approaches that go beyond their academic background and crisis training. People with lived experience are valued and equal members of the team. Each Crisis Worker has at least three to five years of work experience in providing mental health services to vulnerable populations before working at the Centre. The Gerstein Crisis Centre recognizes that different experiences, backgrounds and knowledge brought by the team members is valuable to people in crisis.

They understand the broad issues that impact a person’s mental health, look at the whole person understanding the impact of social determinants of health and the health and social inequities that exist. The team takes a trauma-informed, harm reduction approach that values the individual’s right to dignity, respect and self-determination.

The Centre provides their staff training in crisis intervention, suicide intervention, de-escalation, trauma-informed care, and harm-reduction approaches. Strong analyses of anti-racism and anti-oppression inform and guide this work. In addition, the Centre provides space for people to share their stories and context through narratives that help individuals understand aspects of their experience with mental health that might not easily be understood otherwise.

Why this initiative is promising

The Gerstein Crisis Centre is a community- based crisis intervention organization. Their model is unique with a strong peer component and a non-police mobile crisis response team that works collaboratively but stands separate from the traditional medical model. The Centre works with police and hospitals using these approaches when needed but is not dominated by fixed or traditional modalities that opt for either as a first point of assistance when mental health crises arise. Instead, the Gerstein Crisis Centre focuses on the strengths and self-determination of the individual in crisis and their support system, working together to provide client-centred interventions that make use of a range of skills and modalities that make sense for the individual to reduce crisis and increase safety wherever they are along the spectrum of crisis need.  

About the researchers

  • Susan Davis, Executive Director
  • Elaine Amsterdam, Coordinator of Crisis Services

Acknowledgements

This knowledge exchange activity is supported by Evidence Exchange Network (EENet), which is part of the Provincial System Support Program at the Centre for Addiction and Mental Health - “CAMH”). EENet has been made possible through a financial contribution from the Ministry of Health (“MOH”). The views expressed herein do not necessarily represent the views of either MOH or of CAMH.

Further reading

For more information about the Mobile Crisis Team at the Gerstein Crisis Centre, please visit their website: https://gersteincentre.org/