Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Friday, September 02, 2016

Police response to mental health matters

Revised and re-dated due to addition of additional examples in Fullerton, CA and Manchester, NH.

The death of people in mental distress at the hands of first responders, usually police, is an issue that's been in the news for as long as I can remember.

Since "mental hospitals" started closing in the 1960s (e.g., "State mental hospitals were closed to give people with mental illness greater freedom," Boston Globe), despite the creation of the community mental health system, mostly it has been underfunded and people with mental health problems are mostly abandoned to the streets, where police are the primary maintainers of order.

When the primary tool of a first responder--a police officer--is a gun, it shouldn't be a surprise that lots of people having mental health episodes get killed by police officers ("POLICE CONFRONTATIONS: Families failed by a broken mental health care system often have no one to call but police," Boston Globe). From the article:
Nearly half of people killed by Massachusetts police over the last 11 years were suicidal, mentally ill, or showed clear signs of crisis, a Spotlight Team investigation shows. The deaths are the heavy human toll of an ongoing collision between sick people failed by the mental health care system and police who are often poorly equipped to help, but are thrust into this dangerous role.

Each death is unique, yet certain scenes replay: The suicidal man who steps toward police with a knife. The distraught young adult pointing a pellet gun that looks real. The troubled son, off his medication, swinging a machete, a screwdriver, a stick. Such provocations are motivated not by violent intent, typically, but rather by self-destructive despair or delusions. At least seven of those killed statewide from 2005 to 2015 yelled “Shoot me!” at officers, according to police reports. So did Robert L. Dussourd, 44, killed earlier this year by police in Braintree — one of at least four apparent suicide-by-cop attempts reported in and around Boston so far this year. ...

Recent efforts by journalists to count them, notably at The Guardian and The Washington Post, found that mental health was a likely factor in at least one-quarter of all fatal police shootings in the U.S. last year.
This happened last week in Fairfax County, Virginia. The person killed, Giovanny Martinez, had been admitted to a hospital but then released. Afterwards, he charged a police officer, who shot and killed him ("He sought an officer because he was suicidal, but was killed by a deputy. A family wonders: Why?," Washington Post).

St. Joseph Hospital of Orange's secured Emergency Clinical Decision Unit has 12 beds and serves as a holding area before placing psychiatric patients who are brought in to the emergency room.  Mindy Schauer, OC Register.

Creating mental distress units at local hospitals: Orange County, California.  Simultaneous with the local reports from Fairfax County (which has in the past few years experienced killings by police of at least two other people with mental health issues), last week, the Orange County Register reported ("County to get first emergency centers for psych patients, unburdening hospitals") on how special mental health units will be created at two hospitals in the county, to better address the needs of people in mental distress.

Apparently, this type of health service is widely provided in California. From the article:
Orange County is set to get its first emergency medical centers dedicated to treating people who suffer sudden psychiatric episodes, addressing a void that critics say long has burdened local hospitals and left mentally ill patients with inadequate treatment. ...

Hospital emergency rooms generally are ill-equipped and often lack the proper expertise to treat patients suffering psychiatric episodes, said Dr. Michael Brant-Zawadski, executive medical director of Hoag Neurosciences Institute. Likewise, those same patients often don’t need to be held at inpatient psychiatric facilities, which keep people for multiple days.

The county’s new “crisis stabilization program” will provide a middle-ground treatment method that currently is missing.

“Patients could be evaluated, discharged and transferred to the proper outpatient treatment program,” Brant-Zawadski said. “Other counties, like Alameda, already have a robust psych emergency program, where ambulance and cops take people who have mental issues to those places instead of emergency rooms.

“This is a great step forward,” he said.

Once the centers open, all Orange County police and emergency medical personnel will be told to take people suffering mental episodes or those under involuntary psychiatric holds to the new centers. Patients will be able to stay at the new facilities for just shy of 24 hours, at which point they’ll need to be released or transferred to an inpatient facility.
The response in Orange County was in part due to the OCR investigative series published on the problem in 2014 (e.g., ""A severe shortage of psychiatric hospital beds has turned Orange County emergency rooms into virtual boardinghouses for psych patients" and "The push to create Orange County's first dedicated psychiatric emergency centers") helped spur the County to action.

Street teams of police officers and crisis workers in Boston's Mattapan neighborhood. Separately, the Boston Globe reports ("Officers act as ‘guardians’ on the city’s streets") on a program where two police officers and a mental health crisis worker comprise a team that two days/week goes out into the field and aims to help people living on the street in proactive ways, rather than giving them tickets, arresting them, etc. From the article:
When Officers Michael Sullivan and Jeff Driscoll and senior crisis clinician Ben Linsky head out on their beat in Mattapan, they seek out the most vulnerable citizens: the drug-addicted, the homeless, and the mentally ill. Theirs is the only unit of its kind in the city, and its mission since it was started in February is to help, not arrest, people like Edward. 
...  Sullivan, Driscoll, and Linsky, who make up Mattapan’s “Operation Helping Hands,” spend two nights a week freed from dispatch calls. Instead, they get to know the people on the streets, figure out what services they need, and try to provide them.

“You’re one part social worker, one part cop, and one part older brother,” Sullivan said. ...
Linsky, 34, who works for the Criminal Justice Diversion Program through Boston Medical Center and the Boston Police Department, thought he would work with police only until he could get into medical school — but five years later, he hopes to become a police officer. When he’s not riding with Driscoll and Sullivan, he’s responding to 911 calls that involve people with mental health issues.
Apparently, Framingham was the first city in the state to develop such a program, and since then many other cities across Massachusetts have launched similar initiatives.

Fullerton California completely revamps use of force, training, and other practices after the after a police officer beat to death a homeless man.  After the fatal beating of Kelly Thomas, a schizophrenic (the city paid a big judgement to his family) rather than accept what happened as "an accident," the City of Fullerton evaluated various police processes and changed them, to reduce the likelihood of injury and death in interactions between the police and the public ("Here's how Fullerton police have improved since Kelly Thomas' death," Orange County Register).

The changes in practice were not limited to dealing with homeless people or people in mental distress, but in how all of the city's police officers interact with the public and how they are trained.

The police department has set a goal of being one of the best police departments in the country for its size, and measures its success in part   The OCR article reports on the most recent review:
The study offers a half-dozen recommendations – compared with 59 in its first review – that range from striving to use the least force necessary to more cautious foot pursuits. 
.. Four years ago, OIR Group recommended that officers – when safely possible – employ less force by increasing time and distance, using cover and concealment, creating barriers, and calling and waiting for backup. 

“The department,” the document says, “has substantially addressed many of the shortcomings we noted in our 2012 report.”

First, a new training room was built for officers to practice lesser-force techniques. Then, a video-based interactive training system was installed. It offers more than 200 bad-guy scenarios, and each one can be altered with the touch of a screen.

“These upgrades in training facilities,” the report concludes, “allow trainers to emphasize the importance of tactical alternatives to force, particularly deadly force.”

The training may be paying off. Citizen complaints have dropped from a high of 36 in 2014 to a low of 24 last year.

Still, the new report offers new suggestions. They include requiring incident reports to check off threat perception, least-use-of-force efforts, and adherence to reporting policies.
The process in Fullerton is appears to be a national model, unlike the whitewashes that seem to be happening in most other cities when it comes to evaluating police departments and officers in terms of excessive force and deaths at the hands of police officers.

-- Fullerton Police Department: Audit of Force Reviews and Internal Investigations, August 2016, OIR Group

Fire Department EMS officer Christopher Hickey, right, talks with a walk-in addict at the main fire station in Manchester, N.H., on Aug. 10. PHOTO: CHERYL SENTER FOR THE WALL STREET JOURNAL

Manchester, NH: fire stations as point of contact for help for drug addicts.  This isn't a first response to mental distress matter exactly, but, the Wall Street Journal reports, "Fire Stations Open Their Doors to Addicts" how Manchester, to deal with its rampant substance abuse problems--the city has about 8 deaths per month from drug overdoses--they have created an empathetic/non-judgemental response system where people seeking help can go to the local fire station without fear of being arrested, and then get help and referrals to nonprofit drug rehabilitation and other programs.  The city has provided funds to the nonprofits so they can provide the necessary programming.

Conclusion.  Clearly, programs like these are overdue for Fairfax County and many other communities.  It's not like there aren't proven better models for practice.

-- "After a year with no answers in Fairfax police slaying of John Geer ...," Washington Post
-- "James Bryant killed by police outside Fairfax County homeless shelter," WJLA-TV
-- "Fairfax jail inmate in Taser death was shackled," Washington Post

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At 6:19 AM, Anonymous charlie said...

Also see Lanier's exit interview in the post. (On mental health and the regulatory breakdown which means the police is the last part of the state)

As I keep saying, the biggest real life problem with lack of home rule is the US Attorney's office, and it gets zero coverage.

I might not trust the DC Mayor's office to run it but having it accountable to someone would make a difference.

At 2:06 PM, Anonymous Richard Layman said...

I will write about this briefly in a separate entry. I have a past entry about "for all the talk of big data, why not focus too on little data."

DC is small enough that there could be a great ongoing 'action research" project on crime, criminal justice, recidivism, etc. but focused, like "CompStat" on deeper, long term responses.

E.g. that FOIA request Diane Krepp has initiated about getting statistics from the US Attorney's office on arrest, convictions, etc.

2. U R right of course about the accountability issue. My hope as you know was/is that the DC AG would build competence, track record, etc., to justify getting criminal prosecution responsibilities devolved from the fed. govt./DOJ.

I am not attuned enough to how they're doing to know if that can come about.

3. The BLM people reacted negatively to the idea of probation officers riding with police, but that has worked well in other places like Boston, and is hardly a new idea. It dates back at least 15 years in Boston.

I know one of the problems with youth is that the city attitude kind of gives them a pass on a lot of crime unless it is very violent (murder, assault) until they "become of age."

Kids get the idea that they have a free pass, and this may well shape them into criminals.

But this is under the jurisdiction of DC, not a federal issue at all.

At the same time, as I have written a bunch, even though the MPD has a pattern crimes unit, I wonder how proactive they are in addressing persistent problems, be it lighting at night in the winter, or frequent burglaries in certain areas, etc.

At 10:15 AM, Blogger Richard Layman said...

apparently the UK has community nurses and community mental health nurses. Hard job. But that's another element of what could be done, and done better, than we typically do.

At 1:17 PM, Blogger Richard Layman said...

The Boston Globe has a series on how mental health institutions foster problems rather than cure them.

The Desperate and the Dead, part 5: The 'new asylums'
If you tried to design an environment where mental illness would thrive, it might look a lot like jail or prison. Yet this is where thousands of people with mental illness end up: locked in harsh correctional settings steeped in fear and violence, where drugs flow freely, overworked clinicians juggle 50 or more cases, and the favored punishment is segregation.

At least one-third of the 20,000 jail and prison inmates in Massachusetts have mental illness, and far more struggle with addiction. Yet the state has cut spending on prison mental health care, ensuring most incarcerated men and women get minimal treatment. Many emerge from prison sicker than when they went in — and more likely to commit new crimes.

At 12:19 PM, Blogger Richard Layman said...

This is about coordinated health care, not dealing with the mentally ill, but still interesting.

At 7:10 AM, Blogger Richard Layman said...

This NYT article about the killing by police officers of a person in mental distress mentions a report from the Inspector General, criticizing NYPD for not automatically sending officers trained in dealing with the mentally disturbed to these kinds of calls for service.

At 9:31 AM, Blogger Richard Layman said...

Involuntary commitment when homeless who are mentally ill and also gravely ill.

At 10:59 AM, Blogger Richard Layman said...

not mental health related, but Irvine police set up a "safe exchange" point for e-commerce transactions:

At 1:28 PM, Blogger Richard Layman said...

san diego county launches new program for substance abuse treatment and response:


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