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Mental Health 911

Police are increasingly on the frontlines of dealing with people with psychiatric problems. But they're often not adequately trained to de-escalate potentially violent encounters.

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Mary Hogden was outside a New Mexico convenience store in 2004 when police officers approached her. She was homeless and in the middle of a psychiatric episode. One of the cops asked to search her, saying she was loitering near the store, but she refused his request. "The police officer became very angry and upset," she recalled in a recent interview. "He ended up throwing me on the ground, putting my hands behind my back with handcuffs. He dragged me across the parking lot. He hurt me. He psychically hurt me."

Later, Hogden went to an abandoned trailer and attempted to set it ablaze. The officers who arrived on the scene took her to the hospital for a psychiatric evaluation. After she was released, she hitchhiked to the Bay Area. But not long after arriving here, she had another breakdown. Once again, the first person to evaluate her mental health and take her to the emergency room was a cop.

Hogden's story is becoming increasingly common. Over the past few decades, cuts to mental health services and programs have put police on the frontlines of dealing with people with psychiatric problems. Law enforcement data shows that police interactions with mentally ill people have skyrocketed in recent years, particularly in the East Bay. And sometimes those encounters turn deadly.

In 2015, a quarter of the nearly 1,000 people killed by police officers in the United States had a history of mental illness, according to a Washington Post analysis. The large numbers of killings by cops nationwide have also highlighted the lack of police training. Currently, the typical American police officer receives only eight hours of training on how to de-escalate tense situations, and just eight hours learning about dealing with people who have mental health issues. By contrast, police cadets receive an average of sixty hours of training on how to handle and shoot guns.

In recent years, some police departments have been working harder to teach cops how to prevent volatile situations from escalating. And a new state law requires California police academy recruits to receive at least fifteen hours of behavioral health training. Prior to the law's passage, they were required to have only six.

These days, Hogden helps provide training to East Bay police officers on coping with and helping people with mental health problems. Experts say that more such training is necessary, but they warn that most departments are still not doing nearly enough to prevent violent interactions between police and the mentally ill.


Following the nationwide shutdown of mental health hospitals in the Sixties and early Seventies, police began encountering more severely mentally ill individuals on the street. In 1967, the Lanterman–Petris–Short Act gave police in California the power to take an individual to the hospital against his or her will if a cop believes a person is dangerous.

By the Eighties, many mental health experts viewed deinstitutionalization as a major failure. According to estimates in the late Eighties from the National Institute of Mental Health, between 125,000 to 300,000 severely mentally ill individuals were living on the streets.

One shooting-death in Memphis, Tennessee in 1987 brought the issue into sharp focus. Memphis police responded to a call about a mentally ill man with a large knife cutting himself and threatening his family. Officers arrived and then shot and killed the man. Community members demanded a change in the way police responded to and understood mental illness. One year later, the city introduced Crisis Intervention Training (CIT), a forty-hour crash course on de-escalation techniques and dealing with people with mental illnesses.

"It takes a crisis before people wake up. So things go along, and until something bad happens, people don't put pressure to change," said Thomas Kirchberg, a director at Crisis Intervention Training International, a nonprofit devoted to spreading CIT training to other agencies. "We go along until it's on our front door step, and then we have to do something about it."

Other police departments have slowly followed, and now more than 2,500 law enforcement agencies nationwide offer the Memphis model of CIT training. But there are still no federal or state laws requiring CIT training, and many states only have one or two counties that provide the training on a voluntary basis. In 2001, the San Francisco Police Department adopted its own version of CIT training. San Mateo County followed in 2005, and by 2011, Alameda County launched its CIT training course.

But it wasn't until last year, when the Washington Post and the Guardian began reporting the number of people shot by police in the United States each month that state legislatures started to seriously push for mandatory mental health training requirements for police. Last year, the California Legislature enacted Senate Bill 29, which requires field training officers to receive twelve hours of behavioral health training. Separate legislation — SB 11 — increased mental health training hours in police academies from six to fifteen hours.

"It's just a way of reducing problems like we saw in Ferguson, in Chicago, in Cleveland — all those situations we read about where we wonder why the officers acted the way they did," said Senator Jim Beall, D-Campbell, referring to officer-involved killings. Beall sponsored the two Senate bills. "In the academy, you weed out bad candidates, so we're hoping to weed out candidates who are not up to dealing with people with mental health issues."

Beall said in an interview that he wanted to double the number of mental health training hours required in his legislation but that the Commission on Peace Officer Standards and Training, or POST, which sets the requirements, opposed his plan.

In response to my email, Ralph Brown, legislative analyst and spokesperson for POST, explained the group's reasoning: "The hours issue equates to finance. Senator Beall did not offer a funding mechanism for the additional hours. To add more hours without a funding source would be similar to asking you to work more hours without paying you overtime."

And despite the increase in the mandated hours for police training on mental and behavioral health, California still does not require CIT training. Currently, only about one-quarter of local police departments nationwide offer an in-depth CIT training course, according to the US Bureau of Justice Statistics and the California Institute for Behavioral Health Solutions.


But the number of police encounters with the mentally ill continues to soar. From 2009 to 2014, the number of mental health-related calls made to the Oakland Police Department jumped by roughly 50 percent. And Police Officer Jeffrey Shannon, Berkeley's CIT training coordinator, said the number of calls to the Berkeley Police Department that resulted in an involuntary psychiatric hold shot up by 43 percent from 2009 to 2014.

Mental health experts attribute the rising numbers to a combination of too few hospital beds, not enough funding for mental health services and programs, and a rise in Alameda County's population. According to US Census estimates, the county added 100,000 residents from 2010 to 2014. But the number of available beds at Alameda County's psychiatric hospital, John George, has stayed at 69.

"The population has increased, so there are more mentally ill people, but [fewer] treatment beds than there were thirty years ago," said Millie Swafford, former criminal justice mental health director for Alameda County. "They don't have enough beds for people, so they have to figure, 'Who can we justify keeping, and who can we just let go?'"

Alameda County's John George Psychiatric Hospital has a 15.8-percent admission rate, so the vast majority of individuals who are taken by police to the facility end up getting released without any help waiting for them when they get out.

"From the law enforcement perspective, we're in the community, trying to get people help, and somehow the system kicks them right back out again," said Doria Neff, an Oakland police officer and Alameda County CIT coordinator. "It's our job to get them to the hospital, and if that doesn't work, we need to take them to the hospital again."

The increase in mental health calls to the Berkeley Police Department also correlates with a significant rise in the number of homeless people in the city. According to a survey from nonprofit homeless advocacy organization EveryOne Home, Berkeley's unsheltered homeless population swelled by 53 percent from 2009 to 2013.

And many of these homeless individuals are mentally ill. According to EveryOne Home, the number of homeless people with mental illness in Alameda County increased by 35 percent from 2011 to 2013, rising from 818 to 1,106.

"For folks with serious mental illness, if they do lose their housing, returning to housing is much more challenging, even if we have subsidies targeting that population," said Elaine deColigny, executive director of EveryOne Home. "There are the personal challenges they struggle with — plus landlord hesitancy to rent to them."

Berkeley resident Patricia Fontana-Narell knows this well. Her son has been homeless for the past eight years, largely the result of his bipolar disorder. Because he rejects treatment, the only people she knows who can help her son get treatment are the police. "I've had doctors tell me, 'If you really want him to get help, why don't you get your son arrested? Then you can get him help.' There's nothing for him in the mental health system."


East Bay police departments have responded to the increase in mental health related calls by slowly accepting their dual role as law enforcement agencies and social service providers. Officers in the Oakland Police Academy now get twenty hours of training in mental health issues. They can also take an optional CIT training course available for all officers in Alameda County nearly every month.

In the forty-hour CIT course, officers learn to de-escalate situations with mentally ill people who pose a danger to themselves and others. They also learn about the different mental health services offered throughout the county. In the CIT course, there are classes on cultural responsiveness, excited delirium, and making effective 5150 decisions (5150 refers to the section of the California Welfare and Institutions Code that allows law enforcement officers and healthcare workers to hold a person against his or her will when they deem a person to be dangerous).

Since December, the Berkeley Police Department has been training its officers in an abbreviated, eight-hour version of the CIT course. And the Oakland Police Department recently started a pilot program called the Mobile Evaluation Team, or MET, in which police officers team up with a clinician to respond to mental health emergencies. Right now, the MET team is able to respond to six to eight emergency calls per day. But the team is overwhelmed, because OPD receives roughly thirty mental health-related calls each day. Contra Costa County, meanwhile, has a Mental Health Evaluation Team, called MHET, but it's a follow-up team that arrives after a crisis is over rather than responding to the emergency.

These pilot programs are extremely limited in terms of how many individuals they can reach each day. That's why many police agencies want all their officers to take the forty-hour CIT training course. The local training, which is held in Oakland, is in such high demand that each police agency in the county can only send three officers at a time. Oakland, the county's biggest department, gets to send five. "I need a ballroom with one hundred seats to be able to accommodate everyone," Neff said. "Right now, we're heavily, heavily overbooked. We have a lot of people who can't even get into the training from our own county, let alone outside of the county."

So far, roughly 130 members of OPD have taken the course. At the current rate of five officers who complete the training each month, it would take about a decade to train the entire 700-plus member department.

Michael Leonesio, a former police officer, Taser safety expert, and use-of-force consultant for various Bay Area police departments, said he doesn't think agencies are committed to the training, because if they were, there would be more funding for it. "Unfortunately, in a lot of cases, it's just looked at as liability insurance," he said. "So they can say, 'Yeah, we sent a CIT officer [on a mental health-related call], and yeah it went bad, but it wasn't for a lack of trying.'"

Defense attorney Michael Haddad, who has been involved in a number of deadly police use-of-force cases in the Bay Area, said he doesn't think police response to the mentally ill has gotten much better, even with more training. "It's not something exotic, or like we're asking something too much of police," Haddad said. "Paramedics, social workers, special ed teachers — they all receive similar training, and it works. There's the toolkit analogy, but if the only tool you ever use is a gun, it's not doing much good at the bottom of the toolkit."

When Mario Woods was shot by police officers late last year while he was armed with a knife in San Francisco's Bayview District, three of the five officers on the scene had received CIT training. According to San Francisco Police Chief Greg Suhr, more training wouldn't have changed the officers' response. "You can't expect an officer, CIT trained or not ... if the person is actively engaging in seriously injuring, or attempting to kill somebody, you've got to make sure that stops first," Suhr said.

Some police watchdog groups also don't think that more training is the solution. In fact, they believe police should not be the first responders to calls involving people with mental health issues. "I don't think we should be relying on police to deliver mental health services," said Andrea Pritchett, an activist with Berkeley Copwatch. "I believe police need training to manage a difficult situation, but I don't think they'll ever be a replacement for a professional therapist or a professional mental health expert."


Another drawback of police training is that there is no concrete evidence that it actually works. Amy Watson, an associate professor at the University of Illinois at Chicago who has been studying Crisis Intervention Training for years, acknowledges that there hasn't been evidence-based research to prove that it's effective. Nonetheless, she contends that CIT is a best practice model for law enforcement. She noted that research in some police agencies has associated CIT training with reduction in arrests and police use of force for people with mental illness. "It may reduce use of force, depending on what study you look at," Watson said. "So, it seems like a reasonable way to go."

Jim Bueermann, president of the Police Foundation, a nonprofit organization dedicated to improving policing through research, added that he thinks police have no choice but to embrace CIT, because there is no better training program available. "The police don't have the option of waiting years to study a program," he said. "People are calling 911, and the police have to respond. You don't have the luxury to wait years for a scientific evaluation. If CIT is the best model you can find, then you use it."

Joel Fay, a retired police officer who has taught CIT classes in about fifteen counties in California, said he knows it's not the perfect solution, but argues that there are many issues beyond police training that are playing a role in making the situation worse. "What about the politicians who refuse to make mental health laws tougher so we can hold people longer? What about the substance abuse programs that don't have enough beds?" he asked. "All those systems have failed, and we'll keep responding, but unless the system changes, the number of calls will continue, and there will still be bad outcomes, even with the best of training."

Mary Hogden, however, is convinced that more police training will help. During training sessions in Oakland she gives police officers tips on how respond to a person in crisis.

"Talk to me in a calm voice, and tell me what you're going to do to me, step by step," she explained to officers during a recent training session. "Ask me what's going on. Sometimes people in crisis can't understand what the officer is saying. We have so much noise going on in our brain. Don't take what I say personally."

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