Jackie Lake Kavanagh, Newfoundland and Labrador's child and youth advocate, says first responders need better training to respond to children dealing with mental health distress.
Lake Kavanagh's office called an investigation after a seven-year-old girl was placed in handcuffs at a crisis shelter for victims of family violence, and after receiving the police force's "official position that the action of handcuffing the child was justified."
"When you're looking at traumatized children and mental health episodes it's really, really important that children's best interests are first and foremost in responses and decisions that are being made," Lake Kavanagh told CBC News.
"With those professionals who are responding, and they're being tasked with going into these very delicate, difficult, sensitive situations, every effort must be made to ensure that they're properly trained."
In a 20-page report released Wednesday titled Handle With Care, Lake Kavanagh wrote that staff at the crisis shelter described the young girl as dealing with an escalating and aggressive mental health crisis. Staff, and the girl's mother, agreed she needed a hospital assessment.
An ambulance was called to transport the girl to the hospital. Paramedics then called the Royal Newfoundland Constabulary's mental health crisis response team for assistance, according to the report.
The report says a uniformed officer arrived and spoke to the mother and the staff. The officer requested the assistance of the mobile crisis response team after hearing the mother's account of her child's history and possible diagnosis.
Shortly after the mobile crisis response team arrived, the child threw a small object that struck an officer, according to the report.
The response team officer and the uniformed officer placed the girl in handcuffs to protect others in the room and shelter property.
The report said the child was described as being compliant when being handcuffed and remained bound until being placed into a waiting ambulance. The report said the handcuffs were then removed.
The office of child and youth advocate found in its investigation that a joint law enforcement and health care response was neither proportional nor responsive to the particular needs and rights of the young girl.
The report said, specifically, a seven-year-old victim of violence, who was experiencing a mental health or behavioural episode, was handcuffed "in the context of a mental health response, and accompanied to the hospital by an armed uniformed officer."
"In the course of the response, there were shelter staff, the child's mother, paramedics, a uniformed police officer, and the mental health crisis team responders (clinician and plainclothes officer) present. This was likely overwhelming for a child in crisis and distress," the report reads.
Lake Kavanagh made two recommendations.
The first recommendation is that regional health authorities, the RNC and the RCMP collectively review and revise the training program for mobile crisis response teams to include trauma-informed approach for children, strategies and interventions for best practices for intervening with children in crisis, professional development for team members about the cognitive, emotional and social development of children, and guidance and education on children's rights.
The second recommendation is for the Department of Justice and Public Safety and the Department of Health and Community Services to engage regional health authorities and the province's police forces to determine scope and intent of mental health crisis response teams in responding to young children, and to determine if alternate responses and resources are necessary.
"Right now, we know that they will respond to any age group," Lake Kavanagh said of police mobile crisis response teams.
"But, what we know also, is that there's very few calls for service for young children. So there's very little experience there, and very little training in terms of focusing on children."