June 21, 2022 – The chances that police will become involved in the care of a
student who seeks help for their mental health on campus at an Ontario
university health clinic depends on which university they attend, according to
a new CAMH-led qualitative study published today in the journal CMAJ
The study is believed to be the first in the world to conduct in-depth
interviews with physicians to examine policies and processes for transferring
students experiencing mental health emergencies from university clinics to
hospital. Investigators found that some Ontario universities mandate the use of
police restraints in all circumstances when students need emergency mental health
hospital care, while others have policies that handcuffs only be used in rare
circumstances as a last resort.
wanted to identify university policies that facilitated most dignified
transfers to hospital from campus for students in need of emergency mental
health care. We hoped such policies could serve as models for other
universities,” said lead author Dr. Andrea Chittle, a family physician who has
worked in a university health clinic. “We learned that at some universities,
handcuffs are being used every time. It is routine to convey students to
hospital in handcuffs in all situations.”
work is especially timely, as mental illness among Canadian post-secondary
students is increasing and mental health transfers ー when
a student experiencing a mental health crisis is transferred from university
health clinics to hospital for emergency psychiatric assessment and/or care ー are
becoming more common.
authors conducted interviews with 11 physicians at nine university health
clinics in Ontario between July 2018 and January 2019. The interviews were
confidential and the clinics were not identified to allow physicians to speak
candidly about hospital transfer policies for students with mental health
emergencies. At five of those clinics, police were always called to assist when
a student needed to be transferred to hospital. At two of those clinics, police
policy was to routinely use handcuffs during transfers of students to hospital.
physicians at clinics where the handcuffing of students was common expressed
concerns that it was traumatizing for students in a way that could deter them
from seeking mental health supports in the future.
“To be taken in handcuffs and loaded up in a police cruiser seems brutal and traumatic for the patient and sends all the wrong messages about a caring, supportive environment,” said one interview participant.
study is the third collaboration of co-authors Drs. Andrea Chittle, CAMH
Emergency Department Psychiatrist Juveria Zaheer and Shane Neilson, a student
health clinic physician, examining mental health transfer policies at Ontario
universities. Their first paper identified the issue of police
handcuffing of students in mental distress as an area of concern. The second paper reviewed policies and
processes for transferring people experiencing a mental health crisis from
community-based clinical settings to hospital. This latest study examined the
decision to involve police and use handcuffs during mental health transfers,
and alternatives to that practice.
researchers found that the involvement of police and the use of restraints when
students are in need of a transfer to hospital for psychiatric assessment is
often due to non-clinical factors, such as understanding of staff roles and
responsibilities, human resources constraints, and staffing implications of
long emergency department wait times.
I was in the system, I didn’t realize how intertwined policing was with mental
health,” said undergraduate university student and study contributor Gina
Nicoll, who has lived experience of mental illness including being transferred
by police to hospital for assessment. “It just felt really disheartening and I
felt defeated and powerless. It made me feel I was doing something wrong just
by being unwell and I felt I was criminalized for it.”
authors conclude that routine police involvement in student mental health
transfers to hospital is harmful. They suggest engaging police only in rare
circumstances when the risk of a student fleeing or becoming violent during
transfer to hospital is assessed to be high. They recommend that province-wide
policies to minimize police use of restraints during mental health transfers
from Ontario university clinics be developed in collaboration with university
administrations, municipal and provincial governments, hospitals, police
departments, and people with lived experience of mental illness.
emergency department psychiatrist, I see people on the worst days of their
lives,” said senior author Dr. Juveria Zaheer. “People experiencing suicidal
thoughts. People experiencing psychosis. They may be afraid. They may have
trauma. They may not want to be there. Similarly, in university settings, we
have people presenting in distress and crisis in a myriad of different ways,
including students who are racialized and had experiences of oppression and
negative interactions with police. Although we can’t say that we never need to
use restraints, they need to be used rarely and judiciously as a last resort.
It should not be the default, because that is stigmatizing and frightening. We
need to be trauma-informed and safe and to minimize restraint, just as we need
to do in all healthcare settings.”
Dr. Chittle added that she hopes a public discussion over the role of police on campus will persuade universities to examine their policies and processes for students in mental health crisis. She notes that following her and her co-authors’ previous work examining the practice of routinely engaging police and routine use of handcuffs at the University of Guelph, a more flexible procedure for hospital transfers was developed. At the same time, changes to police policies enabled the discretionary use of restraints when police were engaged in transfers.
think we are seeing society move more broadly away from police involvement in
mental healthcare,” said Dr. Chittle. “There are some pilot projects being
undertaken that are non-policing models of mental health crisis care. My hope
is that this is where we are going to move towards.”
About the Centre for Addiction and Mental Health (CAMH)
Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health
and addiction teaching hospital and a world leading research centre in this
field. CAMH combines clinical care, research, education, policy development and
health promotion to help transform the lives of people affected by mental
illness and addiction. CAMH is fully affiliated with the University of Toronto,
and is a Pan American Health Organization/World Health Organization
Collaborating Centre. For more information, please visit camh.ca or follow
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Manager, Media Strategy
Centre for Addiction and Mental Health (CAMH)