WESTBOROUGH, MA May 5, 2018 When people are in crisis law enforcement officers respond to the call for help. Because of a spate of police officer involved shootings there is a call for less police violence. Yet in fact, it is the primary action of the citizen the evokes the lethal response by police. Those who call for “more police training in mental health counseling and less training in the use of firearms” have never been faced with the life or death conundrum – kill or be killed. Meanwhile, police officers are being called upon to de-escalate hazardous encounters daily using skills taught to them in the academy or in-service training. A detective in an urban department recently told me that the majority of their calls for service are for people exhibiting signs of mental illness.
The Department of Justice published a BJA Spotlight on Safety article entitled Defusing Difficult Encounters that essentially teaches officers to slow down the scene by projecting calmness and establish rapport. This is done by asking open-ended questions, e.g. “tell me what happened today”? Constantly assess the dynamic, changing threat by using communication strategies, defusing strategies, and mindfullness. Finally, take action using the minimum about of force needed to bring about a peaceful outcome. Taking action does not necessarily mean the subject is arrested or goes to hospital. In my experience if family members are actively engaged in the person’s life they may assist with aftermath intervention such as detox, rehabilitation, or hospitalization, if needed. Ultimately, the use of force continuum follows the principle of causation by guiding police decision making based on the level of threat in any police encounter.
There are two dominant approaches to encounters of police and persons with mental illness. The first involves having mental health clinicians either ride along with patrol officers (or detectives) and roll on calls that involve someone exhibiting signs of mental illness. In some cases clinicians are housed at police facilities and interview subjects once they are brought in for determination of needs – rather than simply sending the person to the local emergency department. The second method of police-mentally ill interaction teaches LEO’s to directly engage the person using skills they are taught such as empathic listening, establishing rapport, defusing emotional crises, and initiating treatment options e.g. hospitalization, medication management, return to psychotherapy, detoxification, 12-step AA or NA meetings. Family members are encouraged to facilitate some treatments and I believe play a large role in keeping family members sober. The drug or alcohol abuse often makes the mental illness more unpredictable and unstable. Significant threats to public safety and direct risk to police officers can be mitigated if the abuse of drugs and alcohol can be managed by members of the immediate family.
Crisis Intervention Training (CIT) for police officers is an expensive and ambitious program that teaches first responders how to recognize and engage citizens exhibiting signs of mental illness. I have seen this for myself work smoothly in San Antonio, Texas in 2017. The SAPD is using a program developed by police and mental health professionals in Memphis, TN in the early 2000’s and adopted by SAPD in 2003. I was fortunate enough to ride with two of the department trainers Officer Ernest Stevens and Officer Joseph Smarro. I was shown the MH intake facility and met Roberto Jimenez, M.D, the program medical director who began his career at Boston City Hospital as I did. I visited the entire continuum of services including Bexar County sponsored housing and career development programs. It was quite an experience and I remain in contact with the unit to this day. Some believe that this “sensitivity training” will reduce the number of officer involved shootings with those who are known to be mentally ill. CIT training offers plenty of practice role-playing scenarios that come directly off of the call sheets affording a reality-based training opportunity.
In something of a contrast many department utilize the service of a mental health expert – usually a clinical social worker or licensed mental health counselor, to provide the de-escalation intervention, dialogue and liaison with mental health services to reduce the need for jail and the risk to everyone involved from escalating behavior and missed understanding. I have spoken to police officers accustomed to this method who believe it works well. They develop a rapport and trust in the mental health clinician who comes on the scene only when it is safe to do so to begin their assessment. This too is designed to reduce the risk of unintended consequences and divert individuals away from jail and into treatment programs. Given the speed at which violent encounters take place I believe there are risks to everyone involved using this model of de-escalation. When an officer has one instant of hesitation he or someone else may be victimized in the time it takes to make contact, size up the call, and gain compliance.
The NYPD uses a clinician model that tracks hospital discharges and uses a preemptive strategy meeting with mentally ill persons prior to any growing crisis. Their belief is that by keeping them off the police radar they reduce the likelihood of an acute crisis and divert potentially lethal encounters.
“Steve Coe, the CEO of Community Access, an organization that advocates for the mentally ill and works with the NYPD training officers on how to treat that community, said he hopes the task force focuses on creating a system that also would dispatch social workers to emergencies involving the mentally ill.” according to a report in the Wall Street Journal – April 21, 2018