Who identifies problems and addresses them at the metropolitan scale? No one, at least when it comes to mental health-related police shootings
The DC metropolitan area is made up of DC, and parts of Maryland, Virginia, and West Virginia, according to the definition by the US Census. If you count the DC-Baltimore region as defined by the Census, it also includes a bit of Pennsylvania.
In any case, each area, DC and Baltimore, has its respective organization of governments, in DC, it is the Metropolitan Washington Council of Governments and in Baltimore, the Baltimore Metropolitan Council.
I don't pay as close attention as I should to these organizations, but it's not like they have units comparable to the Municipal Research and Services Center in Washington State or the Independent Budget Office in New York City, not to mention various advocacy groups or think tanks or university research centers, that monitor various issues and produce reports.
In some areas, the leading newspaper has a role as a kind of system integrator. Newspapers that come to mind that have written important series that lead to major changes in their communities include the Orange County Register, San Diego Union-Tribune, and the Boston Globe.
I wrote a few months ago ("Police response to mental health matters") about a set of police shootings in the Washington area, where people who were mentally ill ended up being killed. I mentioned how the Orange County Register had written a series of investigative articles about the County's mental health system and the gaps that contributed to similar killings there, and how, while it took awhile, the County is setting up special mental health units at key hospitals.
Fairfax County Police released surveillance video, edited for length before its release to the public, showing the fatal shooting of Jovany Amaya Gomez by sheriff’s deputy Patrick McPartlin on Aug. 15, 2016, outside of Inova Fairfax Hospital. Gomez was mentally ill. (Fairfax County Police) Via the Washington Post.
I bring this up again because the Washington Post reported ("Fairfax prosecutor says shooting of mentally ill man outside hospital was justified") that the police officer involved in the incident in August that led me to write the blog post was exonerated. Interestingly, in something that I don't think was reported earlier, it seems like the hospital "dropped the ball" equally. From the article:
While the report means no criminal charges will be filed in the case, it reveals some challenges in how Fairfax County law enforcement officials deal with the mentally ill, particularly those among the county’s growing immigrant population who don’t speak English.More recently, the Boston Globe has done a similar series of articles ("Spotlight: The desperate and the dead") about the gaps in mental health related care in Massachusetts, and the last piece in the series, "San Antonio became a national leader in mental health care by working together as a community," focuses on the system that has been created in San Antonio/Bexar County, Texas to address the problem.
On the sweltering day of the shooting, Amaya, a Honduran national, initially approached a county police officer sitting inside his cruiser off Little River Turnpike in Annandale, according to the report.
Unable to understand the Spanish-speaking immigrant, the officer used his cell phone to call up Google’s language translation application, which helped him determine that Amaya wanted to hurt himself.
The officer had Amaya transported to the hospital with the intention of taking him to the county’s Merrifield Center for mental health treatment if tests showed signs of mental illness.
But a Spanish-speaking nurse said Amaya complained only of a stomach ache and did not appear to want to hurt himself. Amaya was discharged with a doctor’s instructions to return for a follow-up examination.
What stuck out to me is how the San Antonio Police Department has created a special mental health response unit and they've created an "Involuntary Outpatient Treatment Program," to address providing help to people who need but refuse it. From the article:
... But this peaceful, mediated outcome is why the mental health unit exists. They want people in crisis to submit to help, and to see police as partners in making that happen.Even though the Washington Post reports on police shootings of people in mental health distress across the metropolitan area on a regular basis, it's clear that a systemic, structural, and improved approach is nowhere on the horizon.
The seven-person police unit is just one piece of a larger behavioral health care system in San Antonio and surrounding Bexar County that’s widely considered to be a national model. Over the past decade and a half, San Antonio community leaders, government officials, law enforcement, judges, medical institutions, and the county mental health authority have made tremendous strides together in identifying and treating people with mental illness.
Note that the UK has a community nursing program that functions on an outpatient basis similarly to the San Antonio Police Department's Mental Health Unit, but in the face of the UK national government's systematic cuts to local budgets and to the National Health Service, that system is breaking down ("For the first time in my nursing career, I think: I can't do this any more," and "Social care: why are we 'beyond the crisis point'," Guardian).