Law enforcement and the mentally ill

Part of a Series

This week I picked up an envelope at the post office, that included information that I had requested on the department's mental health intervention training as well as copies of policies, procedures and statistics on the department's interactions with the mentally ill. It turned out that the police department had responded correctly to my CPRA request after all. After resolving the problem at the post office, I opened it. Receiving information from the police department through the CPRA process is like getting a letter back from a college or university after you have applied to it. Letters come in two forms, thin or thick. The thicker the letter, the better, in terms of receiving them from both educational institutions and police departments.

This particular letter was thin.

Inside it, were copies of two departmental polices, numbered #4.47 and #4.50 which addressed the seizure of deadly weapons from mentally disturbed persons and the custody and detention of mental patients respectively. Neither policy had been updated since at least 1996. In fact, if policy #4.50 were a car, it would qualify as a classic by now.

There was no written documents of any kind on mental health training given to law enforcement officers, nor were there any documents on any proposals, plans or outlines involving future mental health training in the department. There's a saying among people in management or so I have heard. If it's not in writing, it does not exist.

Hopefully, that is not the case with the police department when it comes to this issue. A department's mettle is often shown by its ability to respond to challenges it faces by implementing new training. That was a quality that State Attorney General Bill Lockyer hoped to see in this department after the dissolution of the stipulated judgment last March. This is the perfect opportunity for this agency to prove that Lockyer's faith was well placed and address a serious problem.

I had requested this information after looking back at the most recent officer-involved deaths, including that of Vaseuth Phaisouphanh, Terry Rabb, Todd Argow, Lee Deante Brown and Douglas Steven Cloud, which involved individuals who either were or may have been medically or mentally ill or impaired. Phaisouphanh had a history of mental illness, as did Lee Deante Brown according to people who knew them. Argow had once worked in several cities as a city manager before severe depression ended his career. Rabb suffered what Riverside City Fire Department employees referred to in their reports on the incident, as "hypoglycemic unawareness" on the day he died. Cloud was described by some witnesses as being "dazed" and unable to respond, after the car accident, a version that conflicted with that provided by police officers.

There is a lot of discussion that individuals should respond to orders from police officers and if they are lawful orders, that assertion is true. However, what is often avoided in these conversations or dialogues is what should be done if police officers are dealing with individuals who not only are unable to respond to their verbal orders, but they may have little awareness of what is going on around them. Individuals who are diabetic have told me that this is certainly possible if a diabetic has a hypoglycemic episode like Rabb did on the day he died. Each of them described similar episodes that they had experienced when their blood sugar levels fell and of how disoriented and confused they felt, so different from their usual state of being. They could put themselves in the shoes of a Terry Rabb.

Others related stories of knowing people who suffered from mental illnesses including schitzophrenia, bipolar disorder and organic brain disorders. Having to respond to disturbing and often violent behavior that arose from a biochemical origin, rather than a conscious decision let alone willful intent to be nonresponsive or combative. Many people can look at a Brown as someone they might know too.


The first law suit filed in response to the incustody death of Rabb was filed in Riverside County Superior Court this week. The case, Rabb v the City of Riverside (RIC 459245) was filed by his daughter Terre Rabb for monetary and punitive damages, as well as an injunction against the city authorizing, allowing or ratifying the practice by any city employee of failing to provide proper medical care or using unreasonable and excessive force against citizens. At least one other law suit is expected to be filed soon by other relatives of Rabb.

Rabb, 35 was a Black man who suffered from diabetes and other related health conditions. On Oct. 2, 2005, he suffered a severe hypoglycemic episode which left him unable to comprehend what was happening around him or to respond to both medical personnel and Riverside Police Department officers who were dispatched to Rabb's friend's residence on a 911 call that was dispatched as a 5150. Two officers, Camillo Bonome and John Garcia, attempted to restrain Rabb, but not before Bonome allegedly made comments in front of Rabb's friends that Rabb appeared to be under the influence of an illegal drug, naming crack and PCP. The allegations of the comments apparently went uninvestigated by the police department's Officer Involved Death Team but were investigated by the Community Police Review Commission's investigator who included the results in his report.

Bonome stated in his interview with department investigators that he had spun Rabb around and pushed him face first on the sofa because Rabb had been throwing punches in the air within several feet of the two officers. Bonome then attempted to apply a carotid restraint on Rabb but because Rabb's chin was tucked under, he was not able to complete it. The two officers assisted by one of the fire fighters handcuffed Rabb and sat him on the ground. Shortly after, Rabb went into cardiac arrest and stopped breathing. He never regained consciousness and died at a local hospital. The CPRC issued a public report on the shooting several months ago.

CPRC: Terry Rabb

Rabb's death was followed by the fatal shooting of another young Black man, Lee Deante Brown, in April this year. In that incident, Officer Michael Paul Stucker listened to his radio and heard accounts that Brown was acting "strangely". Stucker drove into the parking lot of a motel where Brown was lying on the ground. After Brown failed to respond to his verbal commands, Stucker tased Brown several times then was joined by Officer Terry Ellefson who also tased Brown at least once.

Within several minutes, Ellefson had shot Brown twice because Brown had allegedly grabbed his department issued taser and was advancing towards him with it, according to the police department's briefing on the shooting that it conducted at a CPRC meeting. Brown died soon after.

After the Brown shooting, the community began to have discussions about the police department's need to develop more extensive training for its officers, in terms of interacting and engaging with the mentally ill population as well as people suffering from medical illnesses, mental disabilities and other conditions that affected their ability to comprehend and respond to orders given to them by police officers.

The police department appeared to respond to those concerns but to date, nothing definite has been presented as even a work in progress by the department's leaders.

Many law enforcement agencies across the country have grappled with the same issue, involving policing the mentally ill as the population of those with mental illness grows, including those that are homeless. Many of these agencies have created various programs and training to address this problem, most of them under duress. Meaning that these programs were created after multiple shootings or other incustody death and injuries of individuals who were mentally ill or impaired had already happened. Often these incidents led to civil litigation and this litigation along with an outcry by community members led to pressure being placed on cities and counties to implement mental health intervention programs and training in their law enforcement agencies.

Not all law enforcement agencies created these programs by choice or even under duress. Several including the Los Angeles Police Department and Cincinnati Police Department created them as required under consent decrees imposed on them by the United States Department of Justice. Other consent decrees imposed on law enforcement agencies by the federal government have held similar requirements.

The LAPD had many fatal shootings of mentally ill individuals. In May, 1999, Margaret Mitchell, a homeless woman who was mentally ill was shot and killed by a police officer. Those including myself who knew and had interacted with Mitchell were shocked at her death. Two years later, the LAPD entered into its consent decree which included a requirement to implement and broaden its SMART program.

The Los Angeles Times published an article several years ago on how the LAPD policed the mentally ill and how its policing style contributed to a large number of onduty shootings of mentally ill people, according to its review. At the time, officers in that department received only about four hours of training including lectures and simulations of how to deal with mentally ill individuals, a level that matched the standards applied on that type of training by the state's Peace Officers Standards and Training(POST).

Inadequate training by the LAPD for dealing with mentally ill **

Psychological experts in the article stated that the strategies that police officers use to effectively detain and restrain rational individuals might have the opposite effect on mentally ill individuals who may not be able to understand commands and may distrust authority figures.

(excerpt)

Police who mistake that lack of cooperation as defiance or a threat may take steps based on their regular training and that could escalate the conflict, experts say.

"The police ability [across the country] to handle the mentally ill is almost in a prehistoric stage," says D.P. Van Blaricom, a law enforcement consultant and former chief of police who reviewed dozens of LAPD shootings as a consultant in a lawsuit against the Los Angeles police.

"They just don't get it," Van Blaricom said about police nationwide. "The training is so poor [that] they confront, and then they escalate and then they react with deadly force."

"When you are dealing with an irrational person," Van Blaricom says, "different rules come into play."

In an article in NurseWeek written by Beth Ulrich, Ed.D., RN, there is discussion about the benefits of the creation of a crisis intervention program like that utilized by Houston Police Department. Ulrich points out those positive attributes.

Enforcing Solutions

Experience shows that CITs are a highly effective best practice in several major cities. CIT police officers trained to quickly identify signs of mental illness can de-escalate mental health crises. If someone with mental illness is accused of a felony or any lesser offense, officers know how to communicate effectively with him or her to prevent or minimize negative behavior.

An unexpected benefit of the training is that officers in Houston have reported success in using their CIT communication techniques to help settle domestic disputes.

There is plenty of material written on this subject, both online and off as increasingly, more law enforcement agencies find that their officers are involved in more situations of interacting with the mentally ill, sometimes resulting in onduty shootings. In 2001, it was estimated that 1 out of every 10 encounters police officers had with individuals in the field involved the mentally ill. That number is probably greater today, five years later.

If the Riverside Police Department is at a loss of where to turn to in order to research its mental health program and training, below are a few sites in which to start the process already begun by many other law enforcement agencies. There is no excuse to sit and do nothing.

Law enforcement agencies with programs

Los Angeles Police Department(SMART):

Consent Decree Mental Health Project(pdf)

L.A. Network of Care

Los Angeles Police Commission: Analysis of Mental Health Audit(pdf)

Los Angeles County Sheriff's Department(MET):

LASD MET program receives award


Training:

Public Safety Research Institute(San Dimas, CA)

CIT training: Texas

Mental Health of Southwest Ohio


Program Types:

On the scene assessment

(excerpt)

1) Crisis Intervention Programs:

In a Crisis Intervention Team (CIT) approach found in the Memphis Police Department, uniformed officers, specially trained in mental health issues, act as primary or secondary responders to every call involving people with mental illnesses. CIT officers are available on every shift and are also available to mental health clients (consumers) and their families.

Examples of Law Enforcement Agencies:

Memphis, TN

Memphis Police Department CIT program

Memphis Police Department's CIT program: a practitioner's perspective

Albuquerque, NM

Albuquerque Police Department's CIT report card

Houston, TX

Houston Police Department's CIT program

Houston Police Department's CIT program bittersweet

Portland, OR

Portland(OR)Police Bureau's CIT

Portland Police Bureau struggles to train all officers

Salt Lake City, UT

Salt Lake City Police Department CIT

Roanoke, VA

2) Comprehensive Advanced Approach Programs:

In a comprehensive response, the Athens-Clarke County Police Department decided that its small size precluded the formation of a specialized team to respond to calls for service involving people with mental illness. Accordingly, the department decided that every officer would attend the advanced 40-hour crisis intervention training and thus be able to respond appropriately to these calls.

Examples of Law Enforcement Agencies:

Athens-Clarke County(GA)

3)Mental Health Professionals as Co-responders Programs:

Example: Birmingham (AL) Police Department

The Birmingham Police Department uses a Community Service Officer (CSO) Unit, which is attached to the Patrol Division. The unit is composed of social workers who respond directly to an incident location when requested by an officer. They serve a variety of populations, including people with mental illness. The CSOs are also certified law enforcement academy trainers and work closely with community groups and other components of the criminal justice system.

Example: Long Beach (CA) Mental Evaluation Team

In this program, a patrol officer from Long Beach Police Department is accompanied by a clinician to respond ten hours a day, seven days a week, to calls for service involving people with mental illness. The clinician provides on-scene assessment of the individual's mental health needs and ensures admission into a mental health facility, if necessary. This approach prevents unnecessary incarceration of people with mental illnesses.

Example: San Diego County (CA) Sheriff's Office

The Psychiatric Emergency Response Team (PERT) approach used by the San Diego County Sheriff's Office pairs a licensed mental health clinician with an officer or deputy in a marked car to respond to situations determined by the dispatcher or another officer to involve a person suspected of having a mental illness that is a factor in the incident. These teams conduct mental health assessments and process referrals to county providers if appropriate.

San Diego County Sheriff's Department PERT

4) Mobile Crisis Team

Example: Anne Arundel County (MD) Police Department

The Anne Arundel County Police Department has arranged for access to a team of crisis workers from a local mental health center that works seven days a week. The responding officer must determine if a Mobile Crisis Team is warranted at the scene and will call accordingly.