Dealing with the mentally ill

[Glenn E. Meyer]

http://www.nytimes.com/2016/04/26/he...er=rss&emc=rss

Thoughts on this? The results may be mixed as the article suggests. Having lived in Portland, there certainly were lots of folks out of control in certain areas.

[voodoo_man]

This entire topic is a huge double edged sword.

They use the example of the guy with a sword on a beach at 230am. Yeah, cool leave his ass there without a soul for miles. Same concept with a guy in the woods. Few issues - he dies for whatever reason or he kills/attacks someone for whatever reason, guess who gets sued? The officer's who responded, policy or not. There is also a moral/ethic issue here. Am I going to leave this mentally ill person, who has a weapon or may have other considerations (failure to self care, other medical issues which are not apparent) because policy said so? Hell no. He is coming with us, one way or another.

I deal with EDP's all the time, literally sometimes every single day. They come in many forms, from older citizens who suffer from dementia/schizophrenia which may be aggravated by alcohol/narcotics. To regular persons who are so high at that moment they fit into the EDP criteria. I've been a CIT officer for a few years now, was one of the first to go through it. I do not carry a taser because our policy limits our use of it and its just extra crap on my belt - other officers do carry it though and while a taser may be the easy button, it does not always work and it does not always provide the level of control we want.

What works the best? Get a bunch of officers, like 6-10 to show up, and just muscle the person to the ground, handcuffing them and transporting them to the local hospital for treatment. That has, by far, been the most successful interaction with EDP's I have been a part of. Sometimes we end up committing them for psychological evaluation, sometimes we just let the hospital keep them until they can get them stable on meds.

Whenever we come across someone who is armed with a weapon, its all about distance and time. I want the general public to be out of harms way, I want more officers to show up and I want several officers with tasers to show up. If I cannot talk the EDP down from whatever they are doing or considering doing (like stabbing someone) then its taser time. One officer will deploy at taser, another officer is standby with another taser just in case it doesn't work and I usually am out of the holster in case they both fail and the EDP decides its time to go big. Rarely happens, but when it does we have exhausted all possibilities. We spray, we use ASP's to knock the weapon out of their hand and taser to gain physical compliance.

What the general public seems to not want to understand is that sometimes EDP's get the drop on officers. EDP's may appear normal to the naked eye and often times they do not begin to show their obvious mental state until several sentences in. If a person has a weapon and begins to be aggressive with an officer, example being quickly moving towards them, weapon in hand and saying all types of crazy things, what exactly is an officer supposed to do? Deploy a taser? Run away? No. Equal or greater force to meet and overcome the threat, which means that officer's end up shooting people who are EDP's and the officer would have no way of knowing. This is a fact of life and something the emotionally charged people who want "hands off" policy will never understand.

[Hambo]

Don't harm the the mentally ill. That's all cool until you get one like this guy, who managed to make international news.

http://www.dailymail.co.uk/news/arti...cDonald-s.html

[pablo]

They use the example of the guy with a sword on a beach at 230am. Yeah, cool leave his ass there without a soul for miles. Same concept with a guy in the woods. Few issues - he dies for whatever reason or he kills/attacks someone for whatever reason, guess who gets sued? The officer's who responded, policy or not. There is also a moral/ethic issue here. Am I going to leave this mentally ill person, who has a weapon or may have other considerations (failure to self care, other medical issues which are not apparent) because policy said so? Hell no. He is coming with us, one way or another.

There's no liability in that. The police have no obligation to protect any individual member of the public and police inaction rarely qualifies as a state created danger. That's part of the problem, it's placing liability above the safety of the general public. Portland would rather chance decent people getting killed later than deal with an immediate problem.

Poor police management is to blame for a lot of these problems, there is huge police overreach and criminalization of being mentally ill. IMO 9 out 10 police interactions with mentally ill individuals shouldn't happen. The person is just being a nuisance, he poses no immediate and obvious danger to others, and the police shouldn't dealing with him. "Danger to self" is a bunch of bullshit that's used to justify the police over reach. Police management decided that they would adopt that baby, that never tell anyone "no" mantra, have gotten in over their heads, and the public is less safe for it.

[voodoo_man]

There's no liability in that. The police have no obligation to protect any individual member of the public and police inaction rarely qualifies as a state created danger. That's part of the problem, it's placing liability above the safety of the general public. Portland would rather chance decent people getting killed later than deal with an immediate problem.

Poor police management is to blame for a lot of these problems, there is huge police overreach and criminalization of being mentally ill. IMO 9 out 10 police interactions with mentally ill individuals shouldn't happen. The person is just being a nuisance, he poses no immediate and obvious danger to others, and the police shouldn't dealing with him. "Danger to self" is a bunch of bullshit that's used to justify the police over reach. Police management decided that they would adopt that baby, that never tell anyone "no" mantra, have gotten in over their heads, and the public is less safe for it.

It is going to vary in jurisdictions. Where I work, we have had officers jammed up for not taking action after they let an EDP go that needed to be taken to a hospital and that EDP attacked someone. So different places different ways to go about it.

I agree that it is a brass problem. They don't give a shit as they aren't out there and make policy that's difficult to follow.

[AMC]

I work in the world's biggest outpatient clinic. It's called San Francisco. I doubt there's any other region in the country that deals with the mentally ill than we do on a routine basis. Most of our interactions are as Pablo describes, and involve "nuisance" behavior, though that can mean defecating in front of a packed restaurant at noon, and then smearing it all over themselves. That said, I disagree that "danger to self" is always BS. When the Lanterman-Petris-Short Act revised our statewide policies for dealing with the mentally ill (enacted by the Democrat controlled Legislature the year BEFORE Reagan became Governor), we lost the ability to commit people long term, really. A large number of these people cannot be effectively treated on a voluntary basis...and they are a danger to themselves and anyone around them. Hell, it's sad but true that psychiatry is nowhere near as effective as they want you to believe, even with medication. I don't see this as "police over reach". More like the refusal of our society to actually address this issue, because hurt feelings.

We adopted the CIT "Memphis Model" several years ago, and in the process abandoned our own superior program, with it's goal of universal training for our cops. Now we have "CIT" officers....who are virtually never helpful in dealing with folks in mental health crisis, even though we're mandated to call and use them. Almost all are brand new....as in less than 3 years in. But, the program had a spiffy "name" attached to it. "Memphis". Elvis is from Memphis! Cool!

As for the liability thing: in California, you could potentially be liable if you have established a "special relationship" under Tort Law, by interacting with said folks. While I have over the years walked away from situations involving the mentally ill, none of those involved armed subjects. This is fundamentally about the "Doctrine of Competing Harms". Is it worse to have some early morning dog walker be an unwitting extra in "Surf Ninja 2", or to take a chance that the armed and erratic mental patient may get hurt? Right now, society is confused about that choice, I'm not. I agree that an armed mentally ill subject is not the same animal as an armed violent criminal, but their actions might be the same, and therefore my response may have to be. We can do better dealing with the mentally ill, but only if they let us, sometimes.

[voodoo_man]

I work in the world's biggest outpatient clinic. It's called San Francisco. I doubt there's any other region in the country that deals with the mentally ill than we do on a routine basis. Most of our interactions are as Pablo describes, and involve "nuisance" behavior, though that can mean defecating in front of a packed restaurant at noon, and then smearing it all over themselves. That said, I disagree that "danger to self" is always BS. When the Lanterman-Petris-Short Act revised our statewide policies for dealing with the mentally ill (enacted by the Democrat controlled Legislature the year BEFORE Reagan became Governor), we lost the ability to commit people long term, really. A large number of these people cannot be effectively treated on a voluntary basis...and they are a danger to themselves and anyone around them. Hell, it's sad but true that psychiatry is nowhere near as effective as they want you to believe, even with medication. I don't see this as "police over reach". More like the refusal of our society to actually address this issue, because hurt feelings.

We adopted the CIT "Memphis Model" several years ago, and in the process abandoned our own superior program, with it's goal of universal training for our cops. Now we have "CIT" officers....who are virtually never helpful in dealing with folks in mental health crisis, even though we're mandated to call and use them. Almost all are brand new....as in less than 3 years in. But, the program had a spiffy "name" attached to it. "Memphis". Elvis is from Memphis! Cool!

As for the liability thing: in California, you could potentially be liable if you have established a "special relationship" under Tort Law, by interacting with said folks. While I have over the years walked away from situations involving the mentally ill, none of those involved armed subjects. This is fundamentally about the "Doctrine of Competing Harms". Is it worse to have some early morning dog walker be an unwitting extra in "Surf Ninja 2", or to take a chance that the armed and erratic mental patient may get hurt? Right now, society is confused about that choice, I'm not. I agree that an armed mentally ill subject is not the same animal as an armed violent criminal, but their actions might be the same, and therefore my response may have to be. We can do better dealing with the mentally ill, but only if they let us, sometimes.

Only 3 years? What did you guys do before CIT?

[Coyotesfan97]

Only 3 years? What did you guys do before CIT?

He said SF had their own program that he thought was better and would train everyone.

[Lon]

I think he meant that the CIT officers are essentially rookies with less than 3 years on the job.....

We deal with mental health crisis' on a regular basis since we are the county seat and many of the mental health services are based in our city. Ohio law is fairly specific about who can involuntarily commit someone and when they can do so:

5122.10 Emergency hospitalization.
Any psychiatrist, licensed clinical psychologist, licensed physician, health officer, parole officer, police officer, or sheriff may take a person into custody, or the chief of the adult parole authority or a parole or probation officer with the approval of the chief of the authority may take a parolee, an offender under a community control sanction or a post-release control sanction, or an offender under transitional control into custody and may immediately transport the parolee, offender on community control or post-release control, or offender under transitional control to a hospital or, notwithstanding section 5119.33 of the Revised Code, to a general hospital not licensed by the department of mental health and addiction services where the parolee, offender on community control or post-release control, or offender under transitional control may be held for the period prescribed in this section, if the psychiatrist, licensed clinical psychologist, licensed physician, health officer, parole officer, police officer, or sheriff has reason to believe that the person is a mentally ill person subject to court order under division (B) of section 5122.01 of the Revised Code, and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination.

A written statement shall be given to such hospital by the transporting psychiatrist, licensed clinical psychologist, licensed physician, health officer, parole officer, police officer, chief of the adult parole authority, parole or probation officer, or sheriff stating the circumstances under which such person was taken into custody and the reasons for the psychiatrist's, licensed clinical psychologist's, licensed physician's, health officer's, parole officer's, police officer's, chief of the adult parole authority's, parole or probation officer's, or sheriff's belief. This statement shall be made available to the respondent or the respondent's attorney upon request of either.

Every reasonable and appropriate effort shall be made to take persons into custody in the least conspicuous manner possible. A person taking the respondent into custody pursuant to this section shall explain to the respondent: the name and professional designation and affiliation of the person taking the respondent into custody; that the custody-taking is not a criminal arrest; and that the person is being taken for examination by mental health professionals at a specified mental health facility identified by name.

We work pretty well with our local mental health professionals and rarely have to get physical with any of their "clients". Most of our guys are CIT trained now and it's been a good thing. I'm torn about some of the mental health aspects of police work. Like suicidal people who want to kill themselves and they are inside their house not bothering anyone else and aren't threatening anyone else. Why rush in to save them and escelate the situation? How many times have we killed someone in an attempt to "save" them from themselves? Too many.

The other thing that kills me is the lack of state sponsored mental health facilities in OH. They have done away with most of the state mental health facilities over the last 20 years. We deal with plenty of people who should be locked up in a mental health facility, but aren't because there are no beds for them in the few places left. So we deal with them and they are "treated" sporadically on an outpatient basis.

Where we run into problems sometimes is with the staff at the ER. They'll call us when someone walks away from the ER and tell us to bring them back. The problem is when we find them they do not exhibit the behaviors necessary for us to pink slip them (what we can an involuntary commitment). We ask the hospital if they've pink slipped them and they'll tell us no. Then they get upset when we let them walk.

Anyway, the bottom line is this: there are some times when rapid aggressive action is necessary to stop a mentally unstable person from doing harm to other people. For many cops, quick and decisive action is what we do best or are most comfortable with. Because we have to do something, right? But that is contrary to how most mental health calls need handled. And some cops don't do that well. We need to be a jack of all trades, master of all of them. And it's just not realistic to think everyone can do that.

Sorry for rambling.

[voodoo_man]

He said SF had their own program that he thought was better and would train everyone.

I read what he posted. I was asking what they did different.