Car 88: Understanding Vancouver's Mental Health Response

In the complex landscape of urban emergency services, a growing recognition exists for the need of specialised responses to situations involving mental health crises. While the immediate thought for many might turn to traditional law enforcement, the reality on the ground often demands a more nuanced, health-oriented approach. This is precisely where initiatives like Vancouver's Car 87 and its newer counterpart, Car 88, step in, aiming to bridge the gap between policing and compassionate mental health care during moments of profound distress.

For families like Shirley Chan's, who navigate the challenging waters of supporting loved ones through severe mental illness, the existence of such a specialised service offers a beacon of hope. Yet, as Chan recounts from her multiple emergency calls, the promise of Car 87 or 88 doesn't always translate into a tangible presence at their doorstep. Her experiences, where urgent requests for the mental health team are met with apologies of unavailability and the eventual arrival of uniformed police, highlight a critical disparity between the ideal and the operational reality. This article delves into the purpose, structure, challenges, and ongoing evolution of the Car 87 and Car 88 programmes, shedding light on their vital role and the pressing need for enhanced resources.

The Genesis of a Specialised Approach: Car 87 and the Arrival of Car 88

The concept of a specialised mental health response team is not a new innovation in Vancouver. The Car 87 programme has been operational in various forms since as far back as 1978, predating much of the contemporary discourse around mental health and policing. Its enduring presence underscores a long-standing understanding within the community that certain emergencies require more than just a standard police response. The core philosophy of Car 87 involves pairing a plainclothes police officer with a registered nurse or a psychiatric nurse. This unique partnership is designed to provide on-site assessments during a mental health crisis, focusing on de-escalation, immediate care, and appropriate referrals rather than immediate enforcement.

However, as the demand for such services has steadily increased, the limitations of a single team became painfully clear. Recognising this burgeoning need, particularly within the last year, Vancouver saw the introduction of a second team, known as Car 88. This addition was a direct response to the overwhelming call volume and the inherent difficulties in providing timely service. With Car 88 now on the streets, the service hours have been extended significantly, allowing the programme to operate from 7 a.m. to 11 p.m., thereby broadening its potential reach and availability during crucial daytime and evening hours. This expansion represents a tangible step towards addressing the service's historical oversubscription, yet as community advocates point out, the journey towards adequate coverage is far from complete.

Operating Model: A Partnership for Person-Centred Care

The Car 87 and Car 88 programmes are a collaborative effort, jointly run by the Vancouver Police Department (VPD) and Vancouver Coastal Health (VCH). This partnership is fundamental to their efficacy, combining law enforcement capabilities with clinical expertise. When a call comes in, either directly to the police emergency line or through VCH's Access and Assessment Centre, dispatchers assess the situation to determine if a specialised response is appropriate. The plainclothes nature of the officers, coupled with the presence of a mental health professional, is intended to create a less intimidating environment for individuals in crisis, fostering trust and facilitating more effective intervention. The goal is to provide immediate support, assess the individual's mental state, and, where possible, connect them with appropriate health services rather than resorting to apprehension or arrest.

The role of the psychiatric nurse is particularly crucial. They bring clinical assessment skills, an understanding of mental health conditions, and the ability to administer immediate care or make informed decisions about hospitalisation or other forms of support. The police officer, while also trained in de-escalation, provides a layer of safety and has the legal authority to act if necessary, such as facilitating an apprehension under mental health legislation. This dual expertise is the cornerstone of the programme's specialised response, aiming to provide a holistic and compassionate approach to often volatile and sensitive situations.

The Chasm Between Expectation and Reality: Availability and Delays

Despite the thoughtful design and critical importance of the Car 87 and Car 88 programmes, a significant challenge persists: their availability. Service organisations and housing providers across Vancouver consistently report that the teams are rarely available when needed most. David MacIntyre, Executive Director of the MPA Society, a non-profit supporting individuals with mental illness, describes the service as "oversubscribed." This translates into significant delays, with calls potentially taking days to be addressed. The shocking revelation that an "urgent" response time for Car 87 was considered anything within 72 hours underscores the severe strain on resources and the potential for dire consequences.

Shirley Chan's repeated experiences are emblematic of this systemic issue. Despite her clear requests for Car 87, the team never arrived, leaving her to cope with highly aggressive and threatening situations with her daughter until uniformed officers were dispatched. Janice Abbott, CEO of Atira Women's Resource Society, confirms this pattern, stating that her staff have largely given up on calling for Car 87, being told instead to simply call 911 for a general police response. These accounts paint a stark picture: a vital service, conceptually excellent, is often out of reach when families and support workers feel they have exhausted all other options and are facing immediate danger.

The Unintended Consequences: When Specialised Care is Absent

The unavailability of Car 87 or Car 88 often means that general duty uniformed police officers are dispatched instead. While many officers are commendably compassionate and well-trained in de-escalation, their primary mandate remains law enforcement. This fundamental difference in priority can lead to outcomes that are detrimental to individuals in mental health crisis. Shirley Chan's experience perfectly illustrates this conflict: after arranging for her daughter's hospital admission, uniformed police arrived and, upon discovering a court order, took her daughter to jail instead. This incident highlights the profound risk of putting individuals who need healthcare into the criminal justice system, potentially exacerbating their distress and undermining their recovery.

This scenario underscores a broader societal debate about de-tasking the police. Advocates argue that police officers are being asked to perform roles for which they are not primarily trained, particularly in complex mental health situations. While they are crucial for safety when violence is imminent, their involvement in mental health crises without the accompanying clinical expertise can inadvertently lead to arrests, charges, or incarceration instead of the necessary medical attention and support. This not only places undue burden on the individual but also on the justice system, which is ill-equipped to handle complex health issues.

Advocacy, Progress, and Remaining Hurdles

The widespread concerns about Car 87's availability spurred significant advocacy efforts. In May 2019, David MacIntyre, on behalf of 19 Vancouver agencies, penned a powerful letter to the mayor and council, highlighting the risks posed by service delays and calling for a reduction in the "urgent" response time from 72 hours to 24 hours. The response was encouraging: the VPD and VCH formed a committee with housing providers and other stakeholders, actively reviewing individual cases and committing to adding resources. The subsequent deployment of Car 88 is a direct result of this collaborative effort, representing a tangible improvement in service capacity.

MacIntyre acknowledges that he has seen some responsiveness and improvement since these changes were implemented. However, the critical 72-hour "urgent" response time remains unchanged, indicating that while progress has been made, the programme is still not operating at the level required to meet the community's needs effectively. Police spokesperson Sgt. Steve Addison attributes the ongoing challenges to limited resource allocation. With approximately 200 calls per month for Car 87, and only two cars (Car 87 and Car 88) on the road at any given time, the teams are often occupied with other calls, hospital apprehensions, or are simply off-shift. This highlights the stark reality of demand far outstripping supply.

Comparative Analysis: Specialised vs. General Response

Understanding the distinction between a specialised mental health response team and a general police response is crucial for appreciating the value and necessity of programmes like Car 87 and Car 88. The table below outlines key differences in their approach and outcomes when dealing with mental health crises.

Frequently Asked Questions About Car 87 & Car 88

What is the primary purpose of Car 87 and Car 88?

The primary purpose is to provide a specialised, compassionate, and clinically informed response to individuals experiencing a mental health crisis, aiming to de-escalate situations and connect individuals with appropriate healthcare services rather than relying solely on traditional law enforcement.

Who makes up the Car 87/88 teams?

Each team consists of a plainclothes police officer from the Vancouver Police Department and a registered nurse or psychiatric nurse from Vancouver Coastal Health.

How do I request Car 87 or Car 88?

You can request Car 87 or Car 88 by calling the police emergency line (911) or by contacting Vancouver Coastal Health's Access and Assessment Centre. It's important to specifically ask for the Car 87 or Car 88 team.

Why is it so difficult to get Car 87/88 to respond?

The teams are often oversubscribed, meaning the demand for their services far exceeds the available resources. They may be on other calls, at hospitals, or off-shift. This leads to significant delays in response times.

What happens if Car 87/88 isn't available?

If Car 87 or Car 88 is not available, general duty uniformed police officers are typically dispatched. While these officers can be compassionate, their primary role is law enforcement, which can sometimes lead to outcomes like apprehension or jail instead of medical care, especially if there are legal complications involved.

Has the situation with Car 87/88 availability improved?

Yes, there has been some improvement, particularly with the addition of Car 88, which extended service hours. Collaborative efforts between the VPD, VCH, and community organisations have led to increased resources and ongoing review. However, significant challenges, such as the 72-hour 'urgent' response time, still persist.

What is 'de-tasking' the police in this context?

'De-tasking' the police refers to the idea of shifting responsibilities for certain non-criminal issues, such as mental health crises, away from traditional police forces and towards specialised, non-police professionals who are better equipped and trained to handle such situations. This aims to ensure individuals receive appropriate care rather than potentially being drawn into the criminal justice system.

The Path Forward: Investing in Community Well-being

The experiences of families like Shirley Chan's, coupled with the persistent advocacy from organisations like the MPA Society and Atira Women's Resource Society, underscore a clear message: while the Car 87 and Car 88 programmes are invaluable, they are currently insufficient to meet the profound and urgent needs of Vancouver's community. The commitment to a collaborative committee and the addition of Car 88 are commendable steps, demonstrating a willingness to address a critical service gap. However, the continued reality of a 72-hour 'urgent' response time for mental health crises is simply unacceptable and places vulnerable individuals and their caregivers at undue risk.

Ultimately, the solution lies in a significant increase in resource allocation. Expanding the number of Car 87/88 teams, extending their operating hours even further, and ensuring rapid response times are not merely administrative goals; they are essential investments in public safety and the humane treatment of individuals experiencing profound distress. Furthermore, the broader conversation around 'de-tasking' highlights the importance of re-evaluating how society responds to mental health emergencies. By empowering dedicated mental health professionals to lead these responses, supported by law enforcement when safety is a concern, communities can ensure that those in crisis receive the care they desperately need, rather than facing potential criminalisation. The ongoing evolution of these programmes is a testament to Vancouver's commitment, but a truly effective system requires a sustained, substantial commitment to its expansion and accessibility.

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