“More Can Be Done” to Train Police about Mental Illness

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pdavis@providencejournal.com

WOONSOCKET — A few weeks ago, Woonsocket police Sgt. Michael Villiard tried to reason with a man who had threatened someone with a knife.

Villiard knew the man was dealing with mental illness. Can you leave your house Villiard asked. He was outside the home and talking to the man on a phone. I won’t arrest you, he promised.

The man surfaced and a rescue team took him to a hospital.

“In the past, he would have been arrested,” says Villiard, one of about 135 Rhode Island police officers who have taken classes offered by the Rhode Island Council of Community Mental Health Organizations.

Villiard and other officers say the training helps them navigate difficult situations involving people coping with depression, paranoia and other disorders.

But some mental health advocates say the training isn’t enough.

Instruction should not just involve experts working with the police, but also people struggling with mental illnesses and their families as well, they say. And the training that officers receive — from police academies and other groups — should be uniform.

“Some training is better than no training,” says Chaz Gross, executive director of the Rhode Island chapter of the National Alliance on Mental Illness. “But it’s a small fraction of what we could be doing and what we should be doing.”

Some advocates want Rhode Island to adopt a nationally recognized Crisis Intervention Team training program, a model used by more than 2,600 communities throughout the United States. Those advocates met in Cranston on Wednesday to voice their concerns.

Too many people living with mental illness end up in court and prison, where they don’t belong, says James McNulty, head of the Mental Health Consumer Advocates of Rhode Island. “It’s insane.”

Without the right training, experts say, it’s hard for the police to identify people who might be mentally ill. Their actions “can be seen as dangerous and hostile,” says John Head, a spokesman for the Bazelon Center for Mental Health Law, a Washington, D.C., advocacy group.

Such encounters can turn deadly.

Although no one collects national data, informal reports and accounts suggest that at least half the people shot and killed by the police each year have mental health problems, says a 2013 report by the Treatment Advocacy Center and the National Sheriffs’ Association.

According to the Bazelon Center, the rate of arrest for individuals with mental illness is roughly 4.5 times higher than the arrest rate for those in the general population. Many are not for violent crimes but minor offenses such as loitering, sleeping in abandoned buildings or using drugs.

“The sad reality is that the police are the first-line responders to people in crisis,” says Ronald S. Honberg, director of policy and legal affairs at the National Alliance on Mental Illness.

“The police are trained to be aggressive, to surround a person and to speak loudly.” That’s like putting gasoline on a fire when you are dealing with someone with a paranoid or delusional illness, he says.

 

‘Hot topic’

All new police officers in Rhode Island receive some kind of mental health training, but it varies from organization to organization.

Municipal and state police officers get at a minimum of 15 hours of mental health training, and the state’s police academies will soon add new topics and experts, says Captain Joseph P. Philbin, who oversees the Rhode Island State Police Training Academy and the Rhode Island Municipal Police Training Academy.

Providence police officers receive 30 hours of training.

Says Philbin, “Mental health is the hot topic now.”

Some police departments also work with local mental health centers and other groups, including Family Service of Rhode Island and the Providence Center.

Finally, the police can get training through the Certified Crisis Responder Program, offered by the Rhode Island Council of Community Mental Health Organizations. The three- and four-day courses, offered every fall at the New England Institute of Technology, were developed in 2008 by mental health expert Richard Crino and then-Coventry Police Lt. Robin Winslow.

They started the program after three men with mental illness died in police custody in 2008. One, Mark Jackson, who had schizophrenia, died after a struggle with the police in West Warwick.

About 135 police officers — including university, capitol and state police — have taken the course, which includes role playing. Of that number, nearly 50 officers have been certified as mental health trainers. In addition, 500 officers have received four-hour blocks of training from certified officers and Community Care Alliance trainers.

During the role-playing part of training, police officers encounter “difficult situations,” Crino says. They may be asked to deal with a bipolar man waving an American flag, a suicidal woman holding a knife or a veteran with a gun struggling with posttraumatic stress disorder.

The course, which is free for the officers, is paid for through a grant from the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

But some police departments say their departments cannot afford to lose an officer for several days of training or pay them overtime to attend class.

Less than 10 percent of the state’s law enforcement officers have undergone training in Crino’s courses. Instructors and officials hope more will sign up for classes.

“Every police officer should receive this training,” says Deborah Harig, director of training at the Rhode Island Council of Community Mental Health Organizations.

 

Different models

Nationwide there is no rule for how much training, or what kind of training, officers should undergo.

But since the mid-1980s, increasing numbers of departments have adopted the nationally recognized Memphis model. The Crisis Intervention Team model, or CIT, was created after a Memphis, Tenn., police officer in 1987 shot and killed a man who was cutting himself and threatening others.

According to the University of Memphis, only four states have not adopted the Memphis program: Alabama, Arkansas, West Virginia and Rhode Island.

The program requires the police to work with mental health care experts and others to make sure that those with mental illness get help and don’t end up in the criminal justice system.

The program has been adopted by the Portland police in Maine and the New London police in Connecticut.

Some police departments work more closely with mental health experts than others. In Portland, for example, experts are part of the department and often respond to calls along with the police.

“There are different approaches to training police, but CIT is the model that works best,” says Honberg at the National Alliance on Mental Illness.

“It doesn’t mean other models aren’t good,” but studies have shown that the Memphis model, which includes 40 hours of training, “greatly reduces deaths and makes police safer.”

Crino and Harig disagree. They say the Rhode Island program, designed to meet the needs of local police departments, is as good as the national one. They argue that it’s similar to the Memphis model.

“I would put our system up against any model,” says Crino, vice president of acute services at Community Care Alliance and the author of “Finding Common Ground: Mental Illness Recognition and Crisis Response for Law Enforcement.”

Rhode Islanders living with mental illness are no longer dying in police custody, Crino says. Instead, officers are helping the mentally ill get the help they need. “We are making an impact.”

Woonsocket Police Officer Joseph Zinni recently relied on Crino’s training program to deal with an agitated man in an apartment.

“He was upset the minute we came through the door,” says Zinni, who noticed the doorknobs in the apartment were covered in aluminum foil.

Zinni called a rescue team and started talking to the man in a low tone. “I told him my friends were coming to help him.” The approach worked, Zinni says.

“The biggest thing I learned in training was to be honest with people. You want to create a rapport and gain a person’s trust,” he says.

All training is helpful, but training alone is not enough, says Sam Cochran, a retired police officer who helped develop the mental health training program in Memphis.

What’s really needed are community services where people with mental illness can get treatment and support they need. That is why the Memphis model is so successful, he says. The grassroots approach involves not only police officers but mental health experts, advocates and state and local officials.

“It’s not a law enforcement program. It’s a community program. Training is an important part of that, but the community must address the issue by providing more hospital beds, more services and more housing for those dealing with mental illness,” he says.

“When a person is in a crisis at 10 o’clock at night, where can they go? You have to have an address. And not just jails and not just psychiatric hospitals. Maybe they need a day treatment center, or peer counselors or jobs,” he says. “This is not a problem that’s going to be fixed with a good training program.”

MHA of RI Forum: Criminalization of Mental Illness

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PROVIDENCE — As public psychiatric hospitals across America closed from the 1960s into the 1990s, a “transinstitutional shift” occurred that has resulted in record numbers of people with mental illness being imprisoned — often for such petty crimes as trespassing and shoplifting, and sometimes for no offense worse than annoying behavior.

That was a dominant theme Monday during a forum at Butler Hospital that attracted a standing-room-only crowd of mental-health professionals and advocates, and representatives of law-enforcement agencies and state departments. The forum, “Criminalization of Mental Illness,” was sponsored by the Mental Health Association of Rhode Island.

Madelon Baranoski, associate professor of psychiatry at Yale University and a national authority on the issue, spoke of the era of deinstitutionalization, when patients discharged from state hospitals did not receive the support they needed.

“When people were released to the community, resources didn’t follow,” she said. “Housing didn’t follow, jobs didn’t follow, and enough supports didn’t follow. The shift without resources contributed to increased stigma.… The result was a transinstitutional shift to jail. And it’s pretty dramatic.”

Baranoski projected a series of slides showing patients in now-closed psychiatric hospitals, many notorious for their abuses, with others showing inmates in contemporary prisons: except for the uniforms, both groups looked strikingly similar.

She also presented damning statistics.

“In 1960, one in every 300 Americans was confined in a mental hospital,” she said. “Now, one in every 200 Americans is caught up in the criminal justice system: either incarcerated, on probation, on parole, or pretrial. And in some communities, the numbers are much, much greater.”

In Rhode Island, an estimated 15 percent to 17 percent of the approximately 3,200 inmates at the Adult Correctional Institutions have been diagnosed with severe and persistent mental illness, according to the Department of Corrections.

Although Rhode Island initially succeeded better than most states in providing community resources as it moved toward closing its public psychiatric hospital, the old Institute of Mental Health in Cranston, the statewide community system in recent years has suffered. Legislative leadership on mental-health issues has been lacking, as has broad cooperation among state and local agencies and departments. Funding has been cut.

And all too often, here and in other states, people who don’t belong in prison are sent there because they become a “nuisance” to others.

“One big shift was people who were struggling against the burden of mental illness in the community without the resources ended up violating social propriety — often in very, very small ways — but repeatedly,” Baranoski said.

Outreach and diversion programs that substitute treatment for incarceration, the Yale professor said, can prevent unnecessary imprisonments. So can training police officers in the proper approaches to people living with mental illness — approaches that can drive down arrests.

She gave the example of a man in New Haven who cycled in and out of jail before a diversion program was established in the city.

The man, she said, “was in and out of jail for simple things but very annoying things. Like moving mailboxes. Like walking into Dunkin’ Donuts and when someone went up to get a doughnut, drinking that person’s coffee. It wasn’t violent, but it disrupted business.”

Since the program opened, she said, the man has not seen the inside of a cell.

“We can do better,” Baranoski said, “but it takes ingenuity, creativity, tolerance and a lot of money.”

Also speaking at Monday’s forum were A.T. Wall, director of the state Department of Corrections; Craig Stenning, director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals; John Head, director of communications for the Washington, D.C.-based Bazelon Center for Mental Health Law; and Jo Freedman, mental health coordinator with the Portland, Maine, Police Department.

On Sunday, as part of its ongoing series, Mental Health in Rhode Island, The Journal will publish an in-depth story on people with mental illness in prison.

Article originally appeared December 8, 2014 in the Providence Journal.