Law enforcement's response to people with mental illness. (Police Practice).

In 1998, police officers shot a man who lunged at one officer who was trying to coax him from the roof of a building. Although the man had a history of mental illness, prior to its onset, he was a respected schoolteacher. This incident triggered a widespread controversy and received much coverage in the local press. The public debate over this and other similar cases led to an examination of the appropriate role for law enforcement agencies in dealing with people in a state of mental or emotional distress. Traditionally, law enforcement officers are the first to respond to crisis situations involving individuals with mental illnesses and, therefore, must receive training on how to resolve these situations more efficiently and with greater sensitivity.

ONE AGENCY'S EXPERIENCE

Monterey County, California, known for its scenic beauty, encompasses more than 2 million acres and has a resident population of more than 400,000. In addition to over 2 million visitors attracted to the county each year, estimates for the year 2000 included a homeless population of 2,915 men, women, and children, with a transient population of 6,835, and showed that approximately 22 percent of this homeless population had some form of mental illness. (1) The Monterey County Health Department serves approximately 4,000 residents with mental illness. Statistically, this figure represents 50 percent of the affected residents living in the communities of Monterey County. The county has 16 different law enforcement agencies, two state prisons, two federal police agencies, four state agencies that have patrol functions, a district attorney's office, and a county probation office. All of these agencies, subject to a mental health critical incident response requirement, have limited resources to deal with a mental health crisis situation.

The Response

The Monterey County Police Chiefs Association decided to combine their resources and create a standardized training program to develop a better response capability to mental health crisis situations. Members of the association recognized that addressing the training issues of first responders only represents a small component of having a better response capability. They involved the county health department as an equal partner in creating the countywide program. The association concluded that the program must contain three parts in order to be a success--a first-responder certified training program; agreements/protocols of cooperation between law enforcement and the local emergency medical services; and a medical doctor and a psychiatrist assigned to assist the commander on the scene. Without these three components in place and full agreement between agencies, a comprehensive plan to deal with mental health crisis situations could not be complete.

The Training Program

The committee reviewed a number of programs, including the Memphis model. (2) Three individuals from Monterey County, including an employee of the county mental health department, were sent to a critical incident training (CIT) academy developed by the San Jose, California, Police Department. Using this CIT as an outline, upon graduation, these key workers developed a similar training course specifically designed for the needs of Monterey County. They concluded that an integrated, countywide program would have to serve the various population centers and account for the distance between all agencies in Monterey County. They needed to adapt the San Jose training program to meet the specific and unique conditions of all jurisdictions in Monterey County. Consequently, an oversight committee, chaired by the chiefs association designee, was created and included the three graduates of the San Jose CIT Academy. Their task involved molding the Memphis/San Jose CIT model into a germane product for Monterey County to i ncorporate into the training protocol program that included the mental health community. The active support of the Monterey County Mental Health Department remained a keystone in the completion of this task.

The committee created a 40-hour intensive training program that included role-playing, interactive participation of people with mental illness (consumers), identification of various symptoms and types of medications used by consumers, crisis negotiation tactics, panel discussions, visits to interim-type housing facilities, suicide and crisis intervention training, and a review of all countywide protocols and incident response procedures. The team found that having more than 30 students in the class detracts from the interactive training experience. The training focuses on the most useful tool available to officers--their communication skills--and culminates with tests and feedback evaluations. All participating officers sent to the CIT academy volunteer to attend. Upon graduation, the officers receive a pin, designating them as CIT certified, that they can wear on their uniforms.

Multiagency Agreements

The training administrators created several multiagency agreements. The most important being a political commitment by the county and the cities to develop a comprehensive approach to mental health crisis situations. Monterey County considered numerous areas when they developed these agreements.

Transportation

A contract binds a single ambulance provider to facilitate all 911 ambulance services. The agreement requires that the ambulance service respond to all mental health crisis calls upon request of the agency. The ambulance can transport the individual to a mental health hospital facility without the need of a police escort. In the event of a medical emergency, the ambulance attendants can choose to transport the patient to the nearest emergency hospital facility.

Hospitalization 

The two major hospitals in the county agreed that one will accept all juveniles and senior citizens and the other will accept all remaining consumers. Unless otherwise necessary, the hospitals would not require the assistance of police officers. When needed, officers covering the hospital's jurisdiction would respond. Since the inception of this protocol in Monterey County, neither hospital has requested police response.

Medical Psychiatric Response

In most instances, merely having an officer trained in how to respond to critical incidents quickly resolves the problem. However, in cases where a consumer may hold themselves hostage, threaten only themselves or their property, or when a CIT officer cannot resolve the situation, officers may call upon a psychiatrist's services. The committee decided that a psychiatrist, available 24 hours a day, would prove essential. Therefore, they developed a mutual aid agreement with the two prisons in Monterey County that have staff psychiatrists with experience in dealing with people in crisis. In Monterey County, with a diverse population of one-half million people, an average of two to three such responses have occurred per year and the need for this component remains paramount.

Interaction of the Mental Health Department and Providers

Cooperation between the service providers, consumers, and the CIT officers will facilitate smooth interaction between the agencies that traditionally have little to do with each other. Ongoing training or interaction of the psychiatrists with the officers trained in crisis intervention also proves essential. Having participants either teach or take part in panel discussions or role-playing exercises can help accomplish this. Such a working relationship resolves many difficulties. In fact, Monterey County has found that these mental health agencies often call upon the CIT officers to help, which results in a mutual support system.

Mutual Assistance Protocol

Because the program has only 30 students per class and only three classes per year, an 8-year commitment exists to have all officers and supervisors CIT trained. Having all jurisdictions in Monterey County involved allows most agencies only one student per class, which leaves few officers available in a department to respond to crises. Consequently, the police agencies involved developed a mutual aid protocol to respond with a CIT officer to a crisis situation. The on-scene commander can make the request through the county communications center, which maintains a current list of graduates and would choose the closest CIT officer available. The responding CIT officer would assist the on-scene commander, yet apply the officer's own department's policies, such as using less-than-lethal force.

Documentation

Monterey County tracks all CIT officer responses, which allows them to receive feedback and monitor additional training needs. This also helps in any litigation from situations that may not be resolved nonviolently.

Ancillary Agreements and Protocols

Often, departments need additional protocols with agencies, such as the Salvation Army, which deal with the transient and homeless population, many of whom have mental illness and are not known to the law enforcement community. With this in mind, the Sand City, California, Police Department created a consortium with the Salvation Army and the Monterey County Health Department. The health department provides Salvation Army personnel training to provide referral service and assistance. If personnel of the Salvation Army identify an individual in need of assistance, but who refuses, the police department initiates commitment paperwork. In a case where an individual does not qualify for an immediate commitment, Salvation Army personnel notify the police department and can provide information to allied agencies in the event that the individual goes into crisis in another jurisdiction. Any additional available information may prove essential in providing crucial details to establish the probable cause for that inv oluntary psychiatric commitment. The Salvation Army in Monterey County has agreed to share information with their other facilities throughout the state regarding the transient homeless population who may have some form of mental or emotional illness. This ancillary agreement helps to provide a safety net for those individuals who normally would remain unknown to law enforcement.

The Monterey County Sheriffs Department is developing another program to help resolve the issues of incarcerating those individuals with mental illness who continually commit minor crimes. This program involves the county health department acting as a facilitator for treatment and creates a diversion program with the courts. The results will reduce overcrowding in jails and divert those individuals with mental illness to alternate treatment facilities.

CONCLUSION

In Monterey County, California, three separate crisis situations involving individuals with mental illness occurred the weekend after the first graduation of the critical incident training academy; all were resolved without the use of force. Since then, the county has noted numerous calls resulting in successful, nonviolent results. In fact, the training helped officers defuse other emotionally stressful situations that may not have been related to mental health issues, such as domestic disputes.

In some instances, having protocols, agreements, mutual aid assistance, or the assistance of a psychiatrist available still may not resolve a situation peacefully. However, having an extensive training and interactive working arrangement will give the first-arriving officer more tools for achieving a peaceful resolution to a mental health crisis situation and can help law enforcement and mental health officials bring about a positive change in law enforcement response to individuals with mental illness.

Endnotes

(1.) Based on information provided by the Monterey County Health Department.

(2.) The Memphis, Tennessee, Police Department established this mental health emergency response model that couples intense crisis intervention training for officers with a partnership between law enforcement agencies, mental health providers, advocates, and individuals who are mentally ill. Many law enforcement agencies throughout the country have adopted this model.

Chief Klein heads the Sand City, California, Police Department.