Table 4:

Quotes supporting themes

Theme; subthemeRepresentative quote*
Police and restraints cause harm to students experiencing a mental health crisis
Police involvement is problematic generallyA lot of people have had some very negative interactions with the mental health care system and the justice system, that’s for sure. (Participant C1)
People already have enough trouble being in hospital, but to have to be taken in handcuffs … out of the building and loaded up in a police cruiser and taken half a block, it seems brutal and traumatic for the patient, and sends all the wrong messages about a caring, supportive environment. (Participant C1)
Police involvement may interfere with future treatmentThey [patients] are very suspicious and hard to engage. (Participant C1)
The idea that you’re breaking trust with a vulnerable person can have huge impacts on care down the road. (Participant D)
We have run into people who have either come back for another reason and are clearly unwell, or who have come back with significant reluctance, saying … “I am only here for X, Y, Z; I am not going to tell you all this because of what happened last time.” … Having been placed on the Form 1 and transferred sometimes will, I think, prevent people from coming back. (Participant D)
Police involvement and restraint use are justified on the basis of patient considerations
[We are] balancing the safety of the student with what’s going to be most comfortable for them and finding the right balance there. And I know it is potentially not a great experience to be escorted by police, but definitely when it’s really necessary for their safety, then it really does make sense. (Participant C2)
If we have any indication that someone may be violent toward other people or is actively psychotic … we engage the police at all times. (Participant J)
Paramedics aren’t really trained to go after a patient and chase them down. Not that that is something that happens frequently, but it’s still something … you have to be concerned about, in potential worst-case scenarios, and how that could turn out. (Participant B)
Transfer processes are often informed by extramedical factors
Rationale for police involvementI think there may have been some concern based on … union responsibilities and roles for the staff that were involved, that it was outside of their roles. (Participant E1)
I think the main risk is if the student decides to flee the situation and our staff wouldn’t really be able to make them go to [the emergency department]. And then … if something went wrong and the student ended up hurting themselves, how would that affect the staff that was unable to really do that job properly? (Participant C2)
In the past, we used to send a counsellor or a nurse with them [the student] in a taxi, and we found that to be too time-consuming because they might end up in the emergency department for 5 hours waiting to be seen. So, they [clinic administration] changed that policy to us calling 9-1-1. (Participant H)
We’re quite busy in our clinic … so … one part of it is, do we have staff that can leave, and usually they [staff] will wait with the students until the students get seen. (Participant C2)
My feeling is that police probably are the right group to do the transfer. … The reason I think police [is] just because I think it’s faster, and sometimes that’s important because it’s not a pleasant experience often for patients to be sent to hospital on a Form 1. (Participant I)
Extramedical rationale for restraint useIt was really just concerns from the police standpoint of their liability, and that was the main issue. (Participant J)
They [police] mostly … 9 times out of 10, will apply handcuffs to a patient, which can be a very traumatic experience. And so discussions that we have had with the constables about whether or not that should be done are typically met with, “You know what, we have to cater to the highest potential risk.” (Participant D)
The campus police say that they are following the guidelines of [municipality name] Police Service, which say, “Use restraints every time.” And my impression — this has not been said to me, but my impression is — that they are always supposed to use restraints, but there are a few officers who go against … the commanding officer’s request. They make a decision in the moment, and … I am not sure that that would be supported by their organization. (Participant D)
  • * Participants coded with the same letter represent the same clinic.