Report on Deadly Encounters Between Police, People with MI: Field RespondsMental Health Weekly; 7/27/2015
The Washington Post headline is alarming: “U.S. Police Kill a Person with Mental Illness Every 36 Hours.” The July 6 article was responding to an analysis by the WP of all officer- involved homicides during the first six months of 2015. Of 462 fatal shootings, 124 involved situations in which the mental health of the victim appeared to play a role. In the weeks since the report, mental health experts and advocates told MHW that an expansion of Crisis Intervention Team (CIT) training across the country and more effective community collaborations are sorely needed.
According to the analysis, severely inadequate police training on how to deal with consumers who are “mentally unstable” and the fallout of budget cuts to mental health services across the country to the tune of over $4.5 billion in mental health services and programs are to blame.
According to the analysis, in 45 of the 124 cases between Jan. 1 and July 2, police were called to help someone get medical treatment, or after the person had tried and failed to get treatment on his own. Police increasingly acknowledge that they have few effective tools for handling individuals with mental illness. In interviews with the WP, current and former police chiefs said that without large-scale police retraining, as well as a nationwide increase in mental health services, these deadly encounters will continue.
“The Washington Post deserves major props for taking on this issue and doing a methodical job in looking at this,” Laura Usher, CIT program manager for the National Alliance on Mental Illness, told MHW. “The one-in-thirty-six figure does not surprise me at all,” she said. “This study involved shooting deaths by police but not individual shootings where the people survived. I hear about those estimates as well. The numbers are even higher of those shot but not killed.”
Usher noted that CIT trainings have been proliferating around the country since its inception in 1987 in Memphis. The innovative police- based, first-responder program provides law enforcement with CIT training for helping individuals with mental illness. The involvement in CIT is voluntary.
“There are currently more than 2,800 CIT programs nationwide,” said Usher. “The challenge is there are 18,000 law enforcement agencies in this country. Getting every single one of them involved takes a lot of time.” In situations where the police are called to assist someone experiencing a crisis, they’re often met with an “incredibly challenging scenario,” said Usher. Being loud and shouting commands do not work with people in crisis, she said. “That only increases the chance there’s going to be a violent reaction,” she said.
“One of the things we encourage that families keep by the phone is a list of all the things you should say when you call nine-one-one: the diagnosis; medication, whether person is on or off; physical description; whether that person has a weapon; how long the behavior has been deteriorating; and over what time period,” said Usher.
“There’s a lot of work to be done,” said Usher. “We’d love to see CIT programs in every community, along with a good collaboration of mental health agencies, individuals and families, and law enforcement to change our culture and change our community. The whole community needs to step up and work together effectively to change the situation.”
Spotlight on mental health
Ron Manderscheid, Ph.D., executive director of the National Association of County Behavioral Health and Developmental Disability Directors, said the CIT training for police is not extensive enough. “This is not simply an issue about police intervention with mental illness,” Manderscheid told MHW. “It’s broader [than that]; it’s about how well our mental health system actually functions.”
“Part of the issue is that I don’t think we’ve done a whole lot of work with the police, to be quite frank,” said Manderscheid. “In behavioral health, we’re so separate and for so long we’ve not been in touch with some of the people we should be working with. It’s not the fault of the mental health system.”
Manderscheid said he is encouraged about a number of positive programs being implemented, most notably the Stepping Up initiative, which aims to reduce the ranks of the more than 2 million adults with serious mental illness who are jailed each year in the United States (see MHW, May 11). The initiative is sponsored by the National Association of Counties, the Council of State Governments and the American Psychiatric Foundation.
Among its components, county elected officials will work with justice officials and community stakeholders to examine present service capacity in order to identify programs that can help individuals with mental illness and co-occurring substance use disorders.
“This has the potential to help improve county-based community mental health care,” he said. “Stepping Up clearly relates to what The Washington Post is doing.” Manderscheid added that 75 percent of all mental illnesses are based on trauma. “If you’re going to reduce trauma, you’ll have to invest in evidence- based care,” he said.
Respite beds and ambulatory care are all impacting treatment and inpatient supports in the short term; however, it’s important to build on the front end of crisis intervention services, said Manderscheid. Restoration centers are examples of emerging trends involving alternative places open 24 hours a day for people with mental illness and substance use disorders, he noted.
Alternative supports
While not as intensive as CIT training, another community training for officers is Mental Health First Aid for law enforcement, Dan Abreu, senior project associate for Policy Research Associates, which operates the Substance Abuse and Mental Health Administration’s GAINS Center, told MHW. The GAINS (Gathering Information, Assessing What Works, Interpreting/Integrating the Facts, Networking, Stimulating Change) Center provides technical assistance to the field.
A lot of communities are using the public service program, administered by the National Council for Behavioral Health, to help police officers respond appropriately and ensure individuals get referred to appropriate services, Abreu noted.
Abreu also noted that restoration centers are helpful as alternative sites for people in crisis. He pointed to a restoration model in Bexar County, in San Antonio, Texas, that is a nonhospital alternative for people who are experiencing a psychiatric emergency. Tucson, Phoenix and Salt Lake City also have robust programs, he said.
“A lot of communities don’t have that level of service,” he said. “Communities haven’t really embraced it. It’s a challenge to move from an ER to developing a whole new facility.” “It’s not just a police problem,” he said. More levels of capacity and care are needed to help out in a timely way, said Abreu. “More communities need to do this,” he said. “This is still a critical problem around the country.”
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