For Police, a Playbook for Conflicts Involving Mental Illness

PORTLAND, OR – The 911 caller had reported a man with a samurai sword, lunging at people on the waterfront.

It was evening, and when the police arrived, they saw the man pacing the beach and called to him. He responded by throwing a rock at the embankment where they stood.

They shouted to him from a sheriff’s boat; he threw another rock. They told him to drop the sword; he said he would kill them. He started to leave the beach, and after warning him, they shot him in the leg with a beanbag gun. He turned back, still carrying the four-foot blade.

In another city — or in Portland itself not that long ago — the next step would almost certainly have been a direct confrontation and, had the man not put down the weapon, the use of lethal force.

But the Portland Police Bureau, prodded in part by the 2012 findings of a Justice Department investigation, has spent years putting in place an intensive training program and protocols for how officers deal with people with mental illness.

At a time when police behavior is under intense scrutiny — a series of fatal shootings by police officers have focused national attention on issues of race and mental illness — Portland’s approach has served as a model for other law enforcement agencies around the country.

And on that Sunday last summer, the police here chose a different course.

At 2:30 a.m., after spending hours trying to engage the man, the officers decided to “disengage,” and they withdrew, leaving the man on the beach. A search at daylight found no signs of him.

People with mental illnesses are overrepresented among civilians involved in police shootings: Twenty-five percent or more of people fatally shot by the police have had a mental disorder, according to various analyses.

In Chicago, for example, police officers killed a 19-year-old mentally ill man, Quintonio LeGrier, in December after the police said he had come at them with a baseball bat. In Denver, Paul Castaway, 35, who had a history of mental illness, was fatally shot by the police last year after they said he moved “dangerously close” to them, holding a knife to his own throat. Similar encounters have occurred in Albuquerque, Dallas, Indianapolis and other cities.

In response to public outcry, many police departments have, like Portland, turned to more training for their officers, in many cases adopting some version of a model pioneered in Memphis almost three decades ago and known as crisis intervention team training, or C.I.T.

Studies have found that the training can alter the way officers view people with mental illness. And the approach, which teaches officers ways to defuse potentially violent encounters before force becomes necessary, is useful for officers facing any volatile situation, even if a mental health crisis is not involved, law enforcement experts say.

Whether the training leads to less use of force by officers, however, is still an open question: The findings of studies have been mixed, although one study to be published later this year suggests that Portland’s program, which is based on C.I.T., is having an effect. And training alone is not enough, experts say. For the approach to be effective, it needs the full backing of a police department’s leadership, continual checks on its effectiveness, and collaboration with the mental health community.

“The training is great, but it’s not magic,” said Laura Usher, coordinator of crisis intervention team training for the National Alliance on Mental Illness. “The thing that actually transforms the way the system works is when everyone gets together.”

Debate Signals a Culture Shift

The decision by the Portland police to leave the sword-wielding man on the beach was controversial within the department. Some officers argued that more should have been done: What if the man had injured or killed someone?

Others countered that it was late and that the secluded area was deserted. The man had committed no crime. And a confrontation could easily have ended with him or the officers being harmed.

But the discussion itself, some officers said, was a sign of change.

“Ten years ago, we would have been more proactive in dealing with him at the start,” said Officer Brad Yakots, a specialist in mental health issues who was called to the scene. “It’s a new way of looking at it.”

As in other cities, change in Portland began with a fatal encounter: On Sept. 17, 2006, James Chasse Jr., 42, a singer in a local band who had schizophrenia, died after a confrontation with police officers.

Mr. Chasse’s death outraged the public. The Police Bureau, in response, revised policies and required all its officers to complete 40 hours of crisis intervention training.

But after more troubling instances involving the mentally ill, a Justice Department investigation concluded in 2012 that the Police Bureau had shown “a pattern or practice of unnecessary or unreasonable force during interactions with people who have or are perceived to have mental illness.”

This time, the Police Bureau’s leadership responded far more aggressively. In addition to the mandatory training for the entire force, a group of about 100 patrol officers signed up for 40 extra hours of instruction to handle more complex calls involving mental illness or drug and alcohol addiction.

Teams of officers were paired with mental health clinicians to follow up on cases. New protocols were put in place. And the police connected with housing and mental health organizations to help further.

“It’s really about a culture shift,” said Lt. Tashia Hager, who heads the unit that coordinates the department’s mental health response.

She noted that in cases like that of the man with the sword, “there’s a potential negative outcome regardless of the decision we make.”

In the past, she said, officers were taught, “If you do this, I’m going to do that.” Now they are encouraged to question whether “that” is really necessary.

‘A Fractured Mental Health System’

Officers need to be educated about mental illness, many criminal justice experts say, because cutbacks in financing for mental health services have put them on the front lines of dealing with many people who have psychiatric disorders.

Jails around the country have filled with mentally ill inmates who, unable to obtain treatment in the community, are arrested time and again for minor offenses like disorderly conduct and petty theft. Police officers have been forced to play dual roles as law enforcers and psychiatric social workers.

“We are working in the backdrop of a fractured mental health system that has gotten worse and worse,” said Portland’s police chief, Lawrence O’Dea III.

Yet many police officers know little about mental disorders, and what they do know is often shaped by stigma. Bizarre behavior is often interpreted as a prelude to violence. And routine police actions aimed at control — placing a hand on a person’s shoulder, for example — can backfire with someone with a severe mental illness.

“Instead of being calming, it can trigger them to either pull away or resist,” said Matthew Epperson, an assistant professor of social work at the University of Chicago. The officers, in turn, can misinterpret such responses as resistance or an attempt to flee, he added.

In the crisis training, officers learn about psychiatric medications, role-play various scenarios, and have opportunities to interact with people who have a mental illness when they are not in crisis.

The officers are told, among other things, to use distance and time to try to defuse potentially violent encounters.

About 2,700 law enforcement agencies around the country use some form of the approach, said Ms. Usher, of the mental illness alliance, and that number is growing as more departments have come under pressure to change police behavior.

In January, responding to a series of high-profile shootings across the country, a group of law-enforcement leaders urged departments to adopt higher standards for the use of force than those set down by the Supreme Court, and to adopt methods to defuse volatile situations and avoid violence.

Some departments require crisis training for all their officers. But Maj. Sam Cochran, who coordinated the first crisis intervention program in Memphis and now consults with other departments, said he believed the training worked best when departments trained a smaller group of volunteers who then took the lead on police calls involving mental health issues.

“There’s all kinds of specialization in law enforcement,” Major Cochran said. “We’ve got bomb technicians, narcotics, robbery. I want all the officers present at a scene to understand that this C.I.T. officer is the leader. That represents clarity, and responsibility brings about a level of accountability.”

Officers Adapt to New Reality

In a draft report released this month, outside monitors concluded that the Police Bureau in Portland still had more to do, including keeping better track of how many police contacts involved mental health issues.

But the bureau, the monitors said, had made “substantial progress” in improving the way they dealt with the mentally ill.

And the study of the Portland police that is to be published later this year found that the use of force by officers had decreased by 65.4 percent from 2008 to 2014, as measured in quarterly reports. The researchers attributed the drop in large part to increased training and oversight in recent years, although the study did not specifically look at interactions with the mentally ill.

Police shootings, the researchers found, had also dropped, averaging three a year from 2007 to 2014, compared with eight a year from 2002 to 2005.

And allegations of excessive force by citizens declined by 74.2 percent from 2004 to 2014, a decrease that Tim Prenzler, an adjunct professor of criminology at Griffith University in Australia and the lead author of the study, called “a remarkable achievement.” The research will appear in Journal of Criminological Research, Policy and Practice.

Officer Yakots, who has been on the force for nine years, said he thought that the department’s efforts to shift course had been largely successful. But he added: “Do things fall through the cracks? Yeah, it’s not perfect. A lot of times we have limited resources.”

It was a Monday night in late February when he and his partner, Officer Michael Hastings, were making the rounds of makeshift homeless camps and downtown street corners, listening for radio calls that might require their presence.

An adolescent girl was on an overpass, threatening to jump. A college student had called his mother in another city and told her he was going to kill himself. A 38-year-old woman was standing outside a mental health treatment center demanding to be taken to the hospital because, she said, “I am suicidal and homicidal.”

Officer Hastings said that before the department changed its approach, the attitude was “enforce, enforce, enforce, arrest, arrest, arrest.”

But taking people to an emergency room or putting them in jail did nothing. “These people, they’re out within four hours most of the time,” he said.

At least in Portland, Officer Hastings said, most police officers had accepted that part of their job was now dealing with mental illness and helping to find longer-term solutions.

“We’ve realized that it is what it is,” he said, “and we’re the ones that are going to be responding to that.”

From The New York Times

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