Thursday, October 27, 2016

On Policing the Mentally Ill.

It has become abundantly clear to just about everyone that there is something mightily wrong with our mental health system. As LEO’s, we don’t spend much time in places where things are going splendid. We spend are time in broken places. And, so it is with the mental health system.

Police executives have been wringing their hands, asking how in the world we can manage the tidal wave of mentally ill subjects in crisis our officers are interacting with. According to the Treatment Advocacy Center, a full half of everyone with a serious mental illness in this country receives no treatment whatsoever. None.

Allow me provide a little historical context to this. What LEO’s are facing today is a case of the chickens coming home to roost. In the 1950’s and 60’s the general public (the “general public” will come back into this story, so remember it) collectively decided to close the state mental institutions. Society said, “These hospitals are inhumane, no one should have to live in these conditions!” So, JFK went with the tide, promised to fund the public mental health system, and  the hospitals starting shuttering their doors.

Well, then this really weird thing happened: a politician didn’t keep his word. Just as quickly as state mental hospitals closed, with no funding at the community level, very sick, unmedicated, and unsupported, people began surfacing in towns and cities across the country. The chickens began coming home.

Fast forward fifty years and we have a situation where, nationally at least 10% of all our calls for service involve someone with a serious and persistent mental illness. While I don’t have the stats to back this up, I think that percentage is much higher in urban areas. And when half of those people we contact with serious and persistent mental illness are receiving no treatment whatsoever, what do you think the outcome is going to be? Yep, 25-50% of all the people we kill have a mental illness (again, Treatment Advocacy Center).

Usually after a LEO kills or seriously injures someone with mental health challenges, the family comes forward to sue. With blood in the water, the local and national media love tag lines like, “[Your local city here] Officer Shoots/Kills mentally ill Teen.”

The mental health system is “mightily wrong” because it isn’t properly resourced. Period. Having worked as a non-profit mental health professional for many years, I can tell you with certitude that this isn’t a problem of lazy, incompetent people IN the system. The vast majority of your community mental health providers are trying to do the right thing, just like you. We naturally want to blame the “mental health system” for our current predicament but it’s not the system that’s at fault here. More on that in a minute.

Though well intentioned, the general public (remember them) believe that the problem of police officers using lethal force on mentally ill subjects can be answered with more training (e.g., Crisis Intervention Training).
Sheriffs and Chiefs across the country have seized on this, some righteous believers, others just forecasting civil litigation. I believe this sort of training has benefit. I myself am a CIT de-escalation instructor. But a lack of training cannot be blamed for most of the bad outcomes involving police and mentally ill subjects, and sending an officer kicking and screaming to the “hug a thug” training surely doesn’t ensure a better outcome down the line.

Several classes of victims have risen out of JFK’s failed experiment.  First, there is the sufferer. People don’t choose to be mentally ill. Without treatment they suffer greatly. The woman you see talking to herself every day, unkempt, and surrounded by what looks like garbage, is suffering. Mentally ill people can get better. They can. With advances in antipsychotic medications, social support, and housing, people get better.

Another victim in this mess are the family members, caregivers, and friends of those with mental illness. There exists a sea of traumatized, indignant parents across our country who have absolutely been victimized by an underfunded mental health system. As the CIT Coordinator of my department, I’ve received far too many calls from concerned parents asking for advice. Their stories are remarkably similar.

My son was a straight A student in high school. He played sports and had friends. He was a happy kid. Now in his second year of college, he’s becoming psychotic and I need help.

My daughter has been hospitalized three times, but they release her right back to the street. She uses alcohol (or weed, or meth) when she starts hearing voices. How can we keep her in the hospital until she gets the long term care she needs.

Most parents are terrified to call the police because they worry their loved one will be killed. Yet, because of a lack of viable mental health resources, that’s exactly what they have to do. Most people have the luxury of not knowing just how skeletal our mental health system is. When it’s your son (God forbid) who needs emergency mental health services, however, that’s when the bubble bursts for parents. That’s when the national crisis we’re experiencing dawns, crystal clear on them. From the reports I hear, it can be a life-altering experience.

And, yes, our police officers, sheriff’s deputies, and custodial staff are also victims. We’ve been thrust into the fore, why? Because something broke. In this case, it’s the mental health system, and we’re left holding the bag.

Spending more time each week responding to calls for service involving the mentally ill involve more liability. Officers, by the way, who actually want to help people and do the right thing. But, we see the liability which has arisen from several fronts.

First, there are the expectations of the community, who have swallowed the media’s message that law enforcement officers are slaughtering mentally ill people. Any officer involved in an OIS (Officer Involved Shooting) involving a mentally ill subject should expect to be sued. That’s kind of off the top.

And, how are we to know the subject holding the knife in front of us is mentally ill? The courts have given us really no direction here. Case law over the last fifteen years produced an elevated standard for officers with regard to our interactions with mentally ill subjects, while providing no account for how that standard is to be met. No good deed goes unpunished, right? LEO’s across the country are doing the right thing by putting our fingers in the dike of the mental health system, but we’re getting sued left and right because of it. We’re getting injured more, we’re having to manage more post traumatic stress, we’re being scrutinized more.

The vexing problem of officer’s encounters with the mentally ill has occupied a lot of police executives’ time. Here’s a message I would suggest they send to their troops:

The current mental health crisis we’re dealing with has been caused by the general public’s lack of concern for the plight of the mentally ill. If the general public really wants to get that homeless encampment off their block, they will begin to support funding for the mental health system. Like so many other entanglements we get ourselves into, this is not a police problem. It is, rather, a natural extension of the general public’s lack of interest in seeing mental health as just as important as physical health.

So, when is this situation going to be better? It’s going to get better when the general public realizes that the “problem” of mental illness in their community is not a police problem, but a community challenge: “What legislation can I support that provides for a robust mental health system?” The “problem” of police interactions with the mentally ill was created by the general public. Appropriately then, it can only be corrected by the general public.




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