By Nick Greco for Calibre Press
Those who know me know that I like to study history. I’m not limited to books or Internet searches either. In fact, I do enjoy watching old television shows to glean some perspective of what life was like in the past. One such television show that I have recently gotten the bug to start watching is one that has been highly regarded as one of the more realistic shows about police officers – Barney Miller. Now before you pass this off as me simply being nostalgic for simpler times, hear me out. Beyond the fact that it’s free to watch with my Amazon Prime subscription and a good incentive to watch on the treadmill, the show was well written, and the actors brought the characters to life. The day-to-day cases that the detectives of the 12th Precinct dealt with were not much different, and in many ways identical to what cops are dealing with now. There are budget cuts, community issues, riots, protests, pay issues, as well as discussions on officer health and wellness and officer suicide. A couple of the detectives’ spouses were even in a Spousal Support Group in the show.
The point I’m trying to make is that what officers are dealing with now is not new. I am reminded of something a retired friend of mine said to me about officer wellness. He said that he thought we would have had all this officer wellness and suicide prevention figured out by now. Think about that. The same problems repeating themselves again and again. Why?
Oftentimes there is a lack of a succession plan when people leave an agency. Once they leave, so does the program and the momentum that kept it going. The other main issue is usually funding. So, 5-10 years later someone newly promoted comes along and has a “great” new idea, but it’s not new. It’s been done before, but the programs ran out of money or staffing, and went away. Consider this; the very first episode from 1975 deals with Captain Miller talking down a distraught suspect in the squad room who disarmed another detective and now has his gun. Barney de-escalates the situation using all the techniques being taught and used today. He uses a softer tone of voice, he paraphrases, reflects, allows the suspect to vent, reasons with him, gives him options, and uses time and distance effectively. Remember, this is 1975. This is 13 years before the start of Crisis Intervention Team (CIT) training in Memphis in 1988.
People often ask me why police officers respond to so many mental illness calls for service. Why are those with mental illness first encountered by police officers? Why are so many people put back on the street?
The short answer is lack of funding. Mental illness in the community is not new. Sadly, neither is underfunding of community mental health centers and the lack of resources for individuals suffering from mental illness. Prior to 1954, psychiatric medicine had a limited number of options to treat mental illness. It wasn’t until 1954, with the introduction of the first antipsychotic, Thorazine, that psychiatry had a reliable medication. This was the beginning of psychopharmacology and a host of medications soon followed. These medications were a breakthrough in the treatment of psychiatric illness. Unfortunately, starting in 1955, these breakthrough medications also helped usher in what became known as deinstitutionalization. One of President Kennedy’s last acts in office was to sign the Community Mental Health Act of 1963. On paper, deinstitutionalization sounded wonderful. Patients would receive medications upon discharge and follow up with soon-to-be-built outpatient community mental health centers. States would save huge amounts of money by reducing the number of inpatients while giving patients back their autonomy in a least restrictive setting. The money the states saved would help fund building new community mental health centers. The states emptied out their institutions and asylums, but they also shut down these facilities without providing enough of the various community resources for those with mental illness.
The reality was an influx of people who, lacking supervision to take their medications, either forgot to do so or did not want to take their medications due to the nature of their illness. With nowhere to go, they began to flood general medical hospitals seeking treatment, others were simply homeless, and still others began to be picked up and hauled off to jail. By 1980, the U.S. had less than half of the community mental health centers needed and has only continued to get worse over the years. In fact, the Mental Health Systems Act of 1980, which would have provided grants to community outpatient centers, was repealed in 1981. Cities and towns across this country “balance” their bloated budgets at the expense of the mentally ill. With not enough community resources, patients and their families turn to the ER and inpatient hospitalization for assistance.
Without reliable safety nets for the mentally ill, the police continue to assist with mental illness. The introduction of Crisis Intervention Team (CIT) training in 1988, also known as the Memphis Model, was the official beginning of training for officers on how to interact with those safely and appropriately with mental illness. CIT is a tremendous training and resource for officers and the community. However, it deals with the crisis at that moment, not the needed resources once someone is brought to the hospital and the necessary aftercare. The mental health system is broken, and the politicians have failed the mentally ill for years since deinstitutionalization in the 1960’s. Community mental health centers are bursting at the seams, there are 3-6 month waiting lists for county services, there are less mental health hospitals, and the average age of a psychiatrist is 55-56 years old in this country. Sadly, the three largest institutions for mental health are jails – Cook County, LA County, and Rikers Island. We have essentially gone back to institutionalizing the mentally ill, but rather than a hospital, we are using jails.
While politicians, activists, and the community call for more officers to be Crisis Intervention Team (CIT) trained, officers need to have places to bring those with mental illness to for treatment. The analogy here is training everyone on CPR and having no emergency room to take the cardiac patient to. This is where we are at in many cities and towns across the U.S.
Let’s look at what occurs when someone needs mental health care.
If a person is admitted to a psychiatric hospital say for 3-5 days, once discharged, they need to follow up as an outpatient with a psychiatrist or with someone at a community mental health center. Some patients follow-up, but many do not. This brings us to a scenario that plays out every day in cities and towns across this country with police departments and individuals in need of mental health assistance. Police are called by a family member to the home of a person with mental illness who is not taking medication, they may be using illicit substances, and they may have the potential to harm themselves or others. Officers arrive on scene, begin to talk with the individual and in a best-case scenario, the person agrees to go to the hospital for evaluation. Other times, officers may need to fill out, what we call in Illinois, a Certificate and Petition Form for involuntary commitment if the person is a threat to themselves or others. The petition is filled out by the officer, and the certificate is completed by the physician at the hospital. The person is then transported by the officer or by ambulance depending on the department guidelines.
Upon arriving at the nearest hospital, the ER physician usually provides some medication to the person. If the hospital has a psychiatric unit, the psychiatrist or psychiatric resident is called and will come down to evaluate. If the hospital has no psych unit, they may have to call a mobile assessment team or call a psychiatrist at the nearest psychiatric hospital, which may be the only one depending in the county you are in. Hopefully, this psychiatric unit will have enough open beds as well as staff that evening, otherwise, the person may need to go to the nearest state facility. In any case, by the time the person gets evaluated, the medication has taken effect, the person is much calmer, and recants any suicidal or homicidal thought which takes involuntary commitment off the table. While the person would benefit from being admitted, he or she refuses voluntary admission, and there is nothing for the physician to admit them on. They receive referrals and are discharged back home. Thus, the cycle repeats again a day or two later when the police are called once again.
Many officers can relate to what I just described because it happens all too often. Other times, the person is still deemed a threat to themselves or others and is involuntarily admitted to the psychiatric unit. Staff will work with the patient to ask them to sign themselves in voluntarily. Most psychiatric hospital stays can be anywhere from 3-7 days, depending on insurance of course. Once discharged with 30 days of medication, the person needs to follow up with a psychiatrist or a community or county mental health center that may have a long waiting list. What will happen between the time of discharge and the next appointment? Who will refill the prescription when it runs out in 30 days when the next appointment is not for 2-3 months? Will the person even take the medication between discharge and the next appointment? By now you see the vicious cycle that law enforcement finds themselves in.
COMING NEXT WEEK: Part 2: Realistic solutions that will help reduce the burden on law enforcement to respond to repeated mental illness calls and strategies for effectively providing the mentally ill with the help they need.
Thoughts, ideas or insights to share? E-mail us at: editor@calibrepress.com
About the Author
NICHOLAS GRECO IV, M.S., B.C.E.T.S., C.A.T.S.M., F.A.A.E.T.S., is President and Founder of C3 Education and Research, Inc. Nick has over 25 years of experience training civilians and law enforcement. He has directed, managed and presented on over 700 training programs globally across various topics including depression, bipolar disorder, schizophrenia, verbal de-escalation techniques, post-traumatic stress disorder, burnout, and vicarious traumatization. Nick has authored over 325 book reviews and has authored or co-authored over 45 articles in psychiatry and psychology. He is a subject matter expert for Police1/Lexipol and Calibre Press as well as a CIT instructor for the Chicago Police Department, CIT Coordinator and Lead CIT Trainer for the Lake County Sheriff’s CIT Program as well as other agencies. Nick is a member of the International Law Enforcement Educators and Trainers Association (ILEETA), IACP, IPSA, LETOA, and CIT International, Mental Health Section Chair for IPSA, Co-founder of Protecting the Guardian, and a member of the Wellness support team for Survivors of Blue Suicide (SBS).
