“Prior to the creation of the Assertive Outreach Team a little over a year ago, this type of model didn’t exist anywhere in Canada and we’ve experienced great success. In fact, we’ve found that, overall, there’s been a reduction of 51 per cent of Mental Health Act apprehensions for clients post-AOT program, compared to pre-program. We’ve also seen a 54 per cent reduction in acute bed days for AOT clients and a 62 per cent reduction in urgent Emergency Department visits. That shows the program is working and working well.” – George Scotton, Manager of VCH’s Assertive Outreach Team, five Assertive Community Treatment teams and Mental Health Emergency Services

Jack* was homeless, addicted to crystal meth and had his share of police interactions and apprehensions over the past five years related to his addiction and mental health challenges.

One of the first Assertive Outreach Team (AOT) clients, AOT began working with Jack and, through daily visits, the team began the engagement process that would set the foundation for ongoing intervention and treatment. AOT worked in partnership with the Vancouver Police Department (VPD) and collaborated with other agencies that interacted with Jack. He was eventually connected with mental health services at Downtown Community Court and began clinical treatment with the AOT team and psychiatrist. The intensive program for Jack lasted a little more than the average 28-day program. A little over a year since the team’s intervention, Jack has not returned to hospital nor had any police contact related to aggression, mental health or substance use.

Another client, Sam*, was a crystal meth user with a history of aggression, paranoia and a criminal file to match. AOT initiated daily contact, going to where Sam was to build engagement with him – either at home, in food line-ups or on the street. Following several apprehensions to the hospital, Sam was started on antipsychotics that significantly decreased his paranoia and psychotic symptoms. Once stabilized and receiving the treatment he needed, Sam decreased his meth use and the AOT team noted a significant increase in functioning. Transferred to an Assertive Community Treatment team, Sam continues to be treated, is engaged and now takes part in social and recreational groups. Sam continues to make progress since his first interaction with AOT last summer.

Helped over 400 people

These are just two of the successes the joint VCH/Vancouver Police Department AOT program has experienced over its first year. In fact, since AOT was created to meet the needs of clients who did not fit well into previous service delivery models, the program has helped over 410 people with addictions with or without mental health issues and concurrent disorders, who have high police involvement, are challenging to engage, high-risk and have complex care needs.

AOT provides around 28 days of intensive outreach support through a team of seven full-time clinicians, two psychiatrists and four police officers, who bring dedication, skills and adaptability to their work with clients.

Every week, AOT receives a weekly list of people that VPD have identified as having police encounters related to mental health and/or addiction issues. AOT screens the top 50 people to determine what factors are leading them into contact with police. Reasons vary, and could be an indicator that they are decompensating, that it is a one-off incident or there is a need for clinical intervention. If the person is already connected to services, the team will contact that care provider and work with them to help get the client back into care. If the person is not connected to services, they are taken on by AOT. The intervention focus is then on intensive treatment where the team will meet the client where they are, have daily interactions and build relationships based on trust. The team will create a customized care treatment plan for the client and ensure they get the medications they need as well as set up with services for long-term treatment. The team also stabilizes the client which sometimes involves hospitalization. Once clients have completed the program, the team will transfer the client to a mental health or addictions team and match them to the appropriate level of supports needed to help the client experience long-term success.

A successful balance

Britton Low, Assertive Outreach Team Clinical Supervisor, says, “The team supports a successful balance between both health and policing, where our clinical staff have the opportunity to really assess the underlying condition and what’s actually going on with the client from a mental health and addictions perspective. We can then share that knowledge with our police team partners and work together to look at the heart of why these clients keep reoffending. That way, we can help support the person towards stabilization and then set them up for success long after they leave the program.”

Inspector Howard Tran of the Vancouver Police Department agrees. “The AOT is unique in that it is a true partnership between health and police. The VPD has a dedicated group of officers attached to this specialized unit who work in collaboration with the program’s clinical staff towards the goal of helping clients get treatment for their underlying condition and go on to experience success instead of seeing them in a revolving door of arrests and police contact.”

“Better flow and faster treatment”

An essential part of AOT’s success is access and timely response. George Scotton gives an example of a woman who has complex mental health and addiction care needs, has extensive police contact and more recently, has developed a serious cardiac condition that requires aggressive medical treatment. She was not able to engage in the medical treatment due to the level of chaos in her life at that time, and people involved in her care were desperately seeking assistance. The AOT received a call asking if they could take her on at 10:55 a.m. By 10:59 a.m., she had been picked up by the team who were actively developing an intervention plan to connect her back with treatment that same day.  “It’s this quick, same-day response that leads to better flow and faster treatment for the client in crisis,” Scotton says.

Inspector Tran adds, “When we started working with VCH on this program, no one could have prepared us for the overwhelmingly positive results we’ve been seeing. For example, we’ve had a 41 per cent reduction in negative police involvement, and violent offences have gone down by 56 per cent for clients, post-AOT. We’ve also seen a 43 per cent reduction in street disorders and 29 per cent reduction in criminal justice involvements post-AOT intervention. These are results that speak for themselves.”

What started out as a pilot a little over a year ago has been made a permanent program, is being recognized as innovative and ground breaking across the province and country, and has shown itself to be the ‘program that could’.

*Not the client’s real name.