Providing High-Quality Police Service for Mentally Distressed People - Essay Example

Challenges of providing high quality police service for mentally distressed people are many Attitude of the police officers towards who those are mentally distressed: "Psycho", "Freak", or "Jason from the horror movie", are some of the answers that counselor Habsi Kaba gets from Miami police officers when asked to describe people with mental illness. Such stereotypes are surprisingly common, says Kaba, and not just within law enforcement. But these misconceptions are especially dangerous when they are held by police, who are often forced to make split-second, life-or-death decisions about mentally ill suspects. Kaba says that, ("The worst thing you can have is power and lack of knowledge". M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.) It is also a know fact that, most police officers do not enjoy working with what used to called "mentals". Most prefer to avoid dealing with mental health and psychological emergencies. Up until 1996, Oregon law enforcement recruits were trained in the academy to think of people in "colorful" terms such as "criminals", "know it all's", "busy bodies", and "mentals." The FBI used to train recruits to think of people in terms of "criminals", "crusaders" and "crazies". This use of language has been changed as well. (Michael G. Conner, Use Of Police And 911 For Mental Health And Psychological Emergencies) Mike, has experienced this first-hand, he is 31 years old and suffers from schizophrenia, bipolar disorder and depression. Since Mike was 17 years old, the Los Angeles native has been repeatedly arrested during psychosis for nuisance crimes like disturbing the peace, only to serve his time, fall off his medication and get arrested again. On three separate occasions, his hallucinations were so severe he tried to commit suicide by provoking the police to shoot him. Though he is receiving treatment, rising health care costs and declining federal help mean Mike will likely end up in jail again. (M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.) For example, ninety two percent of the San Francisco police force is not trained to recognize a mental health episode. In fact, the San Francisco Police Department fought fiercely for years against any notion of police crisis intervention training. The San Francisco Police Department was never clear on specific reasons why police crisis intervention training was needed. The Department simply did not think training to recognize mental health episodes was necessary, even though one out of every four persons officers come in contact with a person that suffers with mental illness. In fact, a person who has a mental episode has a better chance of winning the Super Lottery than having a police officer dispatched to the scene of the episode because only 24 police out of 2,200 San Francisco Police Officers have completed the training program that was shoved down the throat of the Department by the Board of Supervisors. (Kaponda, July 2001, POOR Magazine) Impact of Hurricane Katrina: - Mental health problems soared after Hurricane Katrina, while New Orleans's ability to handle them plummeted, creating a crisis so acute that police officers say they take some disturbed people to a destination of last resort: jail. Due to the storm damage, only two of New Orleans' eleven hospitals are fully functioning. What's more, one of the closed facilities is the sprawling Charity Hospital, which police officers had relied on to drop off people at any hour. James Arey, a psychologist who commands the police crisis negotiation team says that, "You knew they were safe. You knew they would get the care they needed. You don't know either of those things now. People who need medication can't find it or can't afford it, and the storm's aftermath has made life more stressful, as well. Life is hard in this town now." A federally funded study published in the Bulletin of the World Health Organization found that mental health problems in the region roughly doubled in the months after Katrina, to 11.3 percent. Take the example of Kenneth Breaux, who said he was diagnosed with a form of schizophrenia years ago. Breaux, 44, was jailed in June 2005 but got caught in the judicial vacuum following Katrina and languished behind bars until last April, when he pleaded guilty to simple criminal damage and was released for time served. Advocates say Breaux hasn't been able to get the medication he's taken for years because he's been homeless and unemployed since the storm, and he cannot find family members. Getting help has perhaps never been more challenging. Before Katrina there were 480 psychiatric beds in the New Orleans area. Now there are perhaps 200, said Dr. Jeffery Rouse, deputy psychiatric coroner for Orleans Parish. The downsized police force finds itself shopping for hospitals willing to accept the mentally distressed among five area hospitals with working emergency rooms, one in New Orleans and four in neighboring Jefferson Parish. None specializes in mental crisis, and officers say most appear hesitant to deal with mental cases. Arey says that, although federal law requires hospitals to examine and stabilize people regardless of ability to pay, it's frequently ignored. "We routinely have officers sitting in these hospitals two, four, six, eight hours trying to talk some nurse, with her arms folded, into taking this patient". Complicating the problem, Arey said, is that many people handled by police, especially the poor, do not have health insurance. Often, he said, they are discharged by hospitals without long-term treatment. The problem for emergency rooms is just as tough, said Dr. Richard Manthey, an emergency room doctor at Ochsner Hospital in Jefferson Parish. Before Katrina, his emergency room examined about one patient a day undergoing a psychiatric crisis, Manthey said. Now, it frequently sees 12 a day. "The amount of upheaval it causes is pretty dramatic," Manthey said. "These are disruptive patients, often violent, usually loud, yelling, not wanting to stay in a room." Without Charity Hospital, police can book a psychiatric suspect into Orleans Parish Prison. While it keeps someone who is potentially harmful to themselves or others off the street, it doesn't guarantee they'll get the proper treatment. A prison spokeswoman said the jail spends $10,000 to $12,000 a month on psychiatric medication, about 21 percent of the total it spends on pharmaceuticals. There are one full-time, board certified psychiatrist, and two part-time psychiatrists to treat 2,000 inmates. (Associated Press, November 2006, FOX News Network) Bad to Non-Existing Mental Health Care Services Due to Lack Of Funds: - Steve Leifman says that, "If you think health care in America is bad, you should look at mental health care". He works as a special advisor on criminal justice and mental health for the Florida Supreme Court. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers. In fact, the country's largest psychiatric facility isn't even a hospital; it's a prison: New York City's Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be. Leifman says, "The one institution that can never say no to anybody is jail. And what's worse, now we've given [the mentally ill] a criminal record. It's the one area in civil rights that we've gone backwards on. He asks us to note, that nearly half of the nine floors in Miami-Dade's County Jail are mental health wards, even though the building is "more like a warehouse than a facility." He decries the conditions that these inmates face, including vermin-infested, decrepit buildings that lack adequate ventilation, lighting and water supplies. Leifman also laments the amount of taxpayer dollars used to fund such an inadequate system. Taxpayers in Miami-Dade County spend $100,000 each day to house the mentally ill in prison; moreover, studies show that people with mental illness stay in jail eight times longer than other inmates, at seven times the cost. "We can't really build our way out of the problem. It's not just about state hospital beds or jails," Leifman says. "We need to really take a hard look at how we're dealing with the problem overall." (M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.) Unprofessional and Uncooperative Community Mental Health Programs and Hospitals: - There are other reasons why many officers prefer to "catch" other calls. In many cities, the reason is based on how badly and unprofessionally hospitals and community mental health programs treated police officers and consumers in the past. This behavior can go one in some areas for years and has a significant impact on the attitude of police officers. Recent efforts have been made to change this in many cities. Still, most officers don't like dealing with mental illness, alcohol or drug affected behavior, or facing people who are strange and make them feel uncomfortable. The level of support and respect officers received in the past was simply awful. (Michael G. Conner, Use Of Police And 911 For Mental Health And Psychological Emergencies, May 2007) Limited Information: - Also the amount of factual information and the observations necessary for an officer to take action will vary significantly. Some officers are strict in their interpretation of their general order and their job description and will do everything they can to clear the call and get back to "real police work." In addition, there are many instances in which the lead officer who is responsible for handling the call will take minimal action where as the cover officer at the scene would have done a lot more. This attitude is not common and is no longer encouraged or reinforced.) (Michael G. Conner, Use Of Police And 911 For Mental Health And Psychological Emergencies, May 2007) What Is Being Done About It and How It is Being Taken Care of: - Officers in some law enforcement agencies are trained to respond and handle mental health and psychological emergencies. In some cities the police have specially trained officers to handle these calls. There could be a world of difference between officers who are trained and want to work with mental health and psychological emergencies and those who don't consider it "real police work". (Michael G. Conner, Use Of Police And 911 For Mental Health And Psychological Emergencies, May 2007) Public Awareness about the condition of mentally distressed people: - L.A. Police Lieutenant Richard Wall told Mike's story to members of the House Judiciary Committee in March, in support of the 2007 Second Chance Act, which aims to reduce recidivism, in part with better mental health treatment for prisoners returning to society. Prisons, Wall testified, have become the nation's "de facto" mental health care provider. According to the Federal Bureau of Justice Statistics, there are currently 1.25 million inmates like Mike, with debilitating disorders ranging from schizophrenia to post-traumatic stress disorder, abandoned in the U.S. prison system instead of receiving treatment in hospitals. (M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.) Crisis Intervention Teams (CIT): Most police officers aren't trained to deal with people suffering from severe mental illness. But because they are the first to respond to calls involving psychiatric crises, police are in a unique position to fix the crippled system. That effort is now under way, thanks to Crisis Intervention Teams (CIT), which is being adopted by a growing number of police departments across the country. The concept was pioneered by the Memphis Police Department in 1988 after an officer shot and killed a person suffering from schizophrenic hallucinations. Working with the National Alliance for the Mentally Ill and two local universities, Memphis police trained and organized a unit of officers specifically to deal with people in psychosis, which is a mental state commonly suffered by patients with severe mental illness in which their thoughts don't match up with reality. In these cases, normal police procedures often increase the chances of violence, confusion and even death. So, police officers are taught to approach psychotic suspects in a different way: by speaking softly, rather than shouting commands, repeating phrases, holding hands palms-up instead of holding a gun or badge, and wearing plainclothes instead of uniforms. Counselor Habsi Kaba who is the CIT training coordinator for the Miami Police Department say that, these actions may seem minor but they go a long way in breaking down the barriers, psychological and otherwise that often exist between the mentally ill and police. The ultimate purpose of the CIT program is perhaps empathy. Using a device called Virtual Hallucinations, officers can begin to understand what it's like to be in the grip of a severe and untreated mental illness. Made by the pharmaceutical company Janssen, the rig and headphones simulate the disturbing and disorienting environment of a psychotic episode. After using the rig, Lieutenant Wall of the Los Angeles Police Department says he was struck by the idea of being exposed to such chaos all the time. "It's just a scary thing," Wall says, "I can do it and walk away from it." Those with serious mental illness, however, cannot. Community members like John Kowal, 54, work with CITs to provide officers with a more intimate knowledge and understanding of psychosis. Kowal, who suffers from bipolar disorder and alcoholism, has been working with Miami's Police Department and inmates as a "peer specialist." His duties range from consultant to mediator to companion. "I can bond with [mentally ill inmates]. I can say, 'Hey, I was in jail. I take medicine. It's worth it,'" Kowal says. "I don't go by a book. I'm like a friend." Likewise, the program challenges stereotypes of law enforcement officers as trigger-happy bullies. "Just like police don't understand people with mental illness, we don't understand them," Kaba says. "They're social workers, they're brothers and sisters, they're priests. They play every role out there." Some officers initially dismissed the CIT program as run-of-the-mill sensitivity training or extreme political correctness, but Cindy Schwartz, director of Florida's Eleventh Judicial Circuit Criminal Mental Health Project, says those same officers now marvel at the program's success. The CIT model has received numerous awards from nationally recognized mental health organizations, law enforcement agencies, and humanitarian groups for treating mental illness as a disease, not a crime. Such change cannot come too soon. (Canadian Mental Health Association, BC Division, Police Interventions with People with Mental Illness: A Review of Challenges and Responses) Lawsuits and Bills in Favor of the mentally distressed: - Last December, the Advocacy Center for Persons with Disabilities filed a federal lawsuit against the state of Florida, alleging that it was violating the civil rights of hundreds of mentally ill convicts and inmates awaiting trial by leaving them jailed and without treatment. "We reached a crisis point," says Leifman, the Florida judge, of the state's inability to address mental illness. "We have hundreds of defendants languishing in jail." It got so bad that, two mentally ill inmates in a Pensacola, Florida jail died after being brutally subdued by guards. And in Clearwater, Fla., a schizophrenic inmate gouged out his eye after waiting weeks for a hospital bed. In June, New York legislators passed a bill outlawing solitary confinement for mentally ill inmates after a study found that such isolation - to which mentally ill prisoners are often subjected - worsened psychiatric symptoms and often led to self-mutilation or suicide attempts. (M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.) My Opinions: According to me, the personality and attitude of police officers dealing with mental health and psychological emergencies is absolutely critical. For one thing, a police officer must be able to recognize and overcome the fear, anger and insecurities that their uniform and demeanor can inspire in some people. Like Rocah, who worked for the Department of Justice's police misconduct unit, and other criminal-justice observers, I too believe that police need to try harder to avoid situations in which they have to use deadly force. Some officers are better at understanding the impact they have on different people and are outstanding in their ability to read people, manage a crisis, and determine the best course of action. There are clearly officers who have greater interpersonal skill and the ability to deal with people in crisis. Many are more highly skilled in facing and calming people in crisis than most people in the mental health profession. These types of police officers should be appointed the task of dealing with mentally distressed people. Since the first CIT program began in Memphis, Tennessee, it has now spread to most major cities and over 2300 law enforcement agencies around the country, this process should continue. According to me, the CIT program can be further improved, thus it can benefit the mentally distressed people even more, and some points of improvement are as follows: 1. Careful selection of a core group of specialized officers, who can hone their skills, and be the first responders in situations involving people who have a mental illness. Dupont & Cochran note that not all officers are suited for work with people who are in distress and, therefore, should be screened for their suitability to work with people who are in need of crisis intervention skills. 2. Providing specialized and ongoing crisis intervention skills training to the core group, the CIT members. The training is aimed at developing the skills for officers to carry out a staged intervention continuum, making use of non-violent crisis intervention skills as a key element. I strongly advocate against one-time training sessions that lack experiential components and they question the likelihood that limited exposure to content and skills will significantly impact performance. 3. Having a specialized system of dispatch including training for dispatchers. 4. Having good information systems in place. When police look at who they are serving, as much as 40% of police work involves people in crisis or people experiencing a mental illness. However, this is often not apparent because there are usually no systems for tracking this information. 5. Having an accessible point of entry where coverage is available throughout the week, and throughout the geographical area in question. 6. Developing protocols for achieving close collaboration with mental health services, and for addressing the barriers to mental health care, including no-reject policies that improve access to hospital and other mental health services, and access to services for co-occurring mental illness and substance use problems. I also believe that police stations should not be routinely used as "places of safety" under sections 135 and 136 of the Mental Health Act, 1983, unless there is no other alternative. In the meantime, hospitals rather than police stations should be used as "places of safety" and the facilities for receiving people with a severe mental illness. Mentally disordered people in custody have access to nursing care and to their medication that they have already been prescribed, and their time in police stations is kept to an absolute minimum. Also when a psychiatric hospital is used as a "place of safety", there should be separate areas for service users with police escorts. There should be joint local arrangements between the police and health and social services for taking people with a severe mental illness to a "place of safety", with a close working relationship and a regular review of the arrangements. (Canadian Mental Health Association, BC Division, Police Interventions with People with Mental Illness: A Review of Challenges and Responses) List of References: - 1. M.J. Stephey, De-Criminalizing Mental Illness, Time Inc.: http://www.time.com/time/health/article/0,8599,1651002,00.html 2. Michael G. Conner, Use Of Police And 911 For Mental Health And Psychological Emergencies, May 2007: http://www.crisiscounseling.com/Crisis/Police911.htm 3. Kaponda, July 2001, POOR Magazine: http://www.poormagazine.org/index.cfmL1=news&story=409 4. Associated Press, November 2006, FOX News Network: http://www.foxnews.com/story/0,2933,228225,00.html 5. Canadian Mental Health Association, BC Division, Police Interventions with People with Mental Illness: A Review of Challenges and Responses: www.cmha.bc.ca/files/policereport.pdf Read More