A person runs away while surrounded by large armed police officers
Illustration by Hunter French

Police Are the First to Respond to Mental Health Crises. They Shouldn’t Be

"This is the only medical illness that we use criminal justice to respond to."
June 23, 2020, 2:00pm

On October 13, 2016, 20-year-old Calvin Clark was pulled over on the side of Interstate-5 in Washington State, fast asleep.

Earlier that day, he had packed up belongings from his home in Vancouver to move to Seattle to "start a new life," though he didn't have a job or apartment waiting for him. He was experiencing psychotic delusions, a symptom of his severe bipolar disorder, said his mother, Jerri Clark. He didn't put any gas into the car because he believed the engine would run solely off of his "energy."

When the car inevitably puttered to a stop, Calvin fell asleep until a law enforcement officer woke him. The officer thought Calvin was drunk or high because of his odd behavior. Calvin was brought to a nearby hospital—not for a mental health exam, but for a toxicology screening.

This was Calvin's first significant interaction with the police. The misinterpretation of his psychosis would set him on a path to arrests and time spent in jail, where his illness would get markedly worse. This, paired with difficulty finding consistent treatment, ultimately resulted in his death by suicide in 2019.

Calvin's case is one of countless examples of how police are inept at managing the health and lives of severely mentally ill people, despite the fact that they are often the first responders to mental health crises. Last year, the mental health nonprofit Treatment Advocacy Center found that one in three people taken to hospital emergency rooms in psychiatric crises are brought there by the police. Law enforcement drove 5,424,212 miles transporting people with serious mental illness—a distance greater than circling the earth 217 times.

Police are not qualified for this responsibility. A survey by the Police Executive Research Forum found that officers received an average of eight hours dedicated to "Crisis Intervention Training" (CIT)—a mental health training program with promising but mixed results, according to research. New recruits spend nearly 60 hours learning how to use guns.

Police also don't have a great track record of de-escalating situations with mentally ill people, who are 16 times more likely to be killed by police officers. One in four people killed by police in 2015 had a serious mental illness, a Washington Post investigation found. And when mental illness intersects with racial prejudices, it’s a sinister combination. “It’s often said that the criminal justice system is the mental health system for Black men," said Gregg Bloche, a health policy expert and a professor of law at Georgetown University.

A rallying cry emerging from the recent nationwide protests against police brutality is to “defund the police,” or, use money dedicated to police departments to pay for other social welfare initiatives. Mental health programs are a top candidate—CIT, preventative mental health services, more psychiatric beds, and, importantly, alternative response teams to respond to 911 mental health calls.

Some law enforcement officers around the country agree that they're spending disproportionate amounts of their time and money on mental health, when it's not their place to do so. "Philosophically, using law enforcement authority to arrest someone as a means to seek mental healthcare is just simply wrong," said Dave Mahoney, the sheriff of Madison, Wisconsin.

"Once an individual with mental illness is caught up in the criminal justice system, it's a trap."

When Calvin was brought to the hospital, he soon became confused, agitated, and combative. He was taken to an involuntary treatment facility in eastern Washington for a 14-day-hold. Meanwhile, the county court held his DUI arraignment and issued a bench warrant for his arrest because he wasn’t there. Jerri tried to get the arraignment moved, but was told it wasn't possible.

“My son was released from the hospital, still incredibly fragile, and within 24 hours was deep in psychosis again,” she said. “He encountered police in this state of psychosis and they looked him up and saw there was a warrant for his arrest and took him to jail."

Calvin spent six weeks in jail—unmedicated, hallucinating, and getting sicker. “He was out of his mind," Jerri said. "He thought everyone in there was a vampire and they were trying to suck his blood. He called me a witch. He thought everyone was trying to cut off his arms and legs.”

During much of his time in jail, he was confined to a suicide vest. Three months later, his toxicology report would come back clean.

"Once an individual with mental illness is caught up in the criminal justice system, it's a trap," Jerri said. "It's like this funnel that no matter what you do, no matter what interventions you try, no matter how much you understand about the illness as a medical condition, the system will ultimately funnel you to jail. There was no way there was ever going to be a safe route out of this trap.”

The past weeks' examination of police budgets has, among other things, brought the law enforcement's role in mental health further into focus. The police are our de facto first responders for the mentally ill, when too often this ends up criminalizing mental health issues, making people sicker, or killing them.

In the first six months of 2015, on average, the police shot and killed someone having a mental health crisis every 36 hours, the Washington Post found. In more recent years, people with mental illness continue to die in their interactions with police.

In San Mateo County in California, in February 2019, Ramzi Saad, who had schizophrenia and bipolar disorder, died from cardiac arrest after police handcuffed him, pushed him to the ground, and tased him. The police had been called because he was “acting erratically” at his mother's house. In June 2019 in West Milwaukee, a 22-year-old with schizophrenia and bipolar disorder was killed in the shower after being tased by police officers. The family received $2.5 million in damages; the officers were placed on administrative duty for two months but have resumed duty, according to local news reports.


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In August 2019, a 69-year-old man, Wallace Wilder, was killed by Pickens County sheriff’s officials in Alabama. The police were originally called to do a wellness check; Wilder had bipolar disorder and schizophrenia. The neighbors said that after using mace and a taser, the police “dragged him outside of his apartment. Wilder then fled back inside and locked the door. Police then went into his home and shot him,” per a local news report.

Mental health crises calls are increasing, and it's up to police to answer them. In New York, emergency distress calls have nearly doubled from 2009 to 2018—increasing from 97,132 to 179,569, according to a report from Jumaane Williams, New York City's Public Advocate. A disproportionate number of these calls come from Black and Latinx neighborhoods.

"This is the only medical illness that we use criminal justice to respond to,” said John Snook, the executive director of the Treatment Advocacy Center. “Someone has a heart attack, a stroke—we don't send the police to help them. Law enforcement aren't trained to be mental health professionals. They don't know what to do. Even if they know exactly what to do from a law enforcement standpoint, it's a medical illness and that's just not what they're there for.”

When police enter tense situations, mentally ill people may not be able to respond to their directions, and can get agitated if they feel like they’re being cornered. "Police's lack of understanding of the cognitive deficits that go with psychiatric illness will make it more likely that the police will respond with deadly force," Bloche said.

“Given the prevalence of mental illness in police shootings," a 2015 Treatment Advocacy report concluded, "Reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric diseases may represent the single most immediate, practical strategy for reducing fatal police shootings in the United States."

In 2015, Keith Kutz got a call from his neighbor saying his son, Travis, was breaking into the front window of his house in Bangor, Pennsylvania.

Travis started to show troubling mental health symptoms at the end of high school. He first developed a temper. Then he began to converse with the television, hear voices, and see people that weren't there. At the time of the break-in, Travis was experiencing delusions that nano-robots had been put under his skin to control him.

Keith had previously had Travis involuntarily committed, but because of the Pennsylvania’s Mental Health Procedures Act, Travis was able to sign himself out as soon as the next day. Keith hoped that pressing charges against his son could finally get him some lasting help. “I was wrong,” he said.

Travis was arrested for burglary while taking Powerade, ice cream, and a can of ravioli. A judge found Travis incompetent to stand trial, and ordered that he be moved to a psychiatric hospital. But since there weren't any openings, Travis stayed in jail—for 554 days.

Even when people survive their initial interaction with police, once they end up in the criminal justice system, a grim reality faces them. This is where the incarceration of the mentally ill confronts the failures of our mental healthcare system.

In the 1960s, there was a push to “deinstitutionalize” people with mental illness—meaning closing down the state-run psychiatric hospitals and asylums that many believed were infringing on quality of life and mistreating patients. The problem is that those long-term facilities and treatment centers were never replaced with anything. Then, in 1981, Ronald Reagan blocked grants that allowed states to provide mental health care, and combined that with more federal cuts of around 30 percent.

When mental healthcare options dry up, mentally ill people end up in jail.

Research from the Cummings Graduate Institute for Behavioral Health Studies found that from 2005 to 2010, the number of state psychiatric beds decreased by about 14 percent nationwide. Some states, like New Mexico and Minnesota, closed more than 50 percent of their beds; 13 states closed 25 percent or more. There were also $5 billion in state cuts to mental health services from 2009 to 2012, in the immediate aftermath of the financial crisis. (In contrast, police spending has increased over the past 40 years, and been far more resistant to cuts than mental health programs.)

When mental healthcare options dry up, mentally ill people end up in jail. In 2015, The Sentencing Project, a Washington D.C.-based research and advocacy center, compared states' rates of incarceration to how much mental healthcare access they had. They found that states with less access to mental healthcare have more adults in the criminal justice system. Six out of 10 states with the least access to care have the highest rates of incarceration.

Bureau of Justice statistics from 2011 to 2012 found that half of people in prison and two-thirds of people in jail had current “serious psychological distress” or a history of mental health problems. In 2015, people with severe mental illness took up at least 1 in 5 of America’s prison and jail beds. An investigation by the Marshall Project in 2018 found that 30 percent of California state prisoners had a serious mental illness that required consistent treatment; in New York, it was 20 percent, and in Texas, 21 percent.

“I don’t think you’ll find much debate in the literature that, since deinstitutionalization was implemented across the US, beginning in the 1960s, the complementary, necessary funding of community mental health systems to care for people with severe mental illness has been insufficient,” said Michael Rogers, a forensic psychiatrist and staff psychiatrist at San Quentin State Prison in California.

Private hospitals and community centers can provide some care, but mostly for people with health insurance or those who seek out treatment voluntarily. For the uninsured or severely ill who are resistant to treatment, there are few other places for them to go.

If a person is deemed mentally incompetent, they often have to wait in jail for an opening at a state psychiatric facility. Most of the state bed-wait lists are filled with inmates who need to be evaluated before they can stand trial. The wait is around 30 days in most states, but can stretch up to six months or a year, as in Travis's case.

While waiting in jail, mentally ill people's conditions deteriorate, by not having access to the right environments, treatments or medication. In 2016, 24-year-old Jamycheal Mitchell was accused of stealing a Mountain Dew, Snickers bar and Zebra Cake from a 7-Eleven—worth around $5. He died in jail while waiting for space to open up at a mental health facility. He had been diagnosed with schizophrenia and had stopped taking his medication at the time of his arrest. In 2010, in Texas, 33-year-old Amy Lynn Cowling died in Gregg County Jail after withdrawal seizures from stopping her medication suddenly. She had bipolar disorder and was in treatment for opioid addiction.

25-year-old Eric Dykes, who had bipolar disorder, died by suicide in Hays County Jail in 2011, in a cell that was not suicide-resistant—the staff at the jail had ignored him saying that he was thinking about suicide.

Only 27 percent of the county jails responding to a 2016 Treatment Advocacy Center survey reported that they hired full or part time non-police employees, like nurses, social workers, and psychiatrists. Only 42 percent said they offered pharmacy services, meaning many inmates go without their medication. And less than 25 percent said that they offered any support for mentally ill people once they were released from jail.

The longer a person has untreated psychosis, the worse their outcomes are, Snook said. “At the end of the day, this is common sense stuff that you don’t need to be a brilliant psychiatrist with 20 years of experience to tell you. Good outcomes depend on being able to access treatment consistently."

When Keith asked if he could visit Travis in jail, someone at the prison told him that it wasn't likely that Travis would even recognize who he was—that’s how much his condition had worsened.

Jerri said that when she visited Calvin in jail, it was her "biggest nightmare" come true. "It was my life entering a terrible horror movie,” she said. “The place was dirty. It was stark, it was mean. And my little boy was in there because he needed a doctor and there wasn’t one.”

On July 31, 2017, Dwayne Jeune’s mother called 911 asking for help because her son was behaving erratically. Four NYPD officers responded to the call in Brooklyn. The one officer who hadn't received Crisis Intervention Training shot at Jeune five times, killing him. (The other officers attempted to use a taser; police claimed Jeune was holding a knife.)

CIT was developed after a police officer shot a mentally ill man in Memphis in 1988. It's a 40-hour training that seeks to make police encounters with mental ill people more safe, and lead people to treatment instead of prison or jail—though it was designed to be flexible so departments could implement it as they needed.

That three out of the four officers who approached Jeune had CIT is unusual. In 2015, City Hall promised CIT for all NYPD police officers, but in 2019, only 11,970 of 36,753 uniformed cops received the training. Nationally, the University of Memphis CIT Center reported there were 2,700 CIT programs in 2019, accounting for about 15 to 17 percent of total police agencies.

Advocates who call for defunding the police to create alternative mental health response teams can find themselves at odds with those saying that reforms within police departments should be attempted first. Research on CIT shows it's an important start, but from the outset, CIT was intended to be paired with collaborations with the mental health community, not insulated within the police department.

“One of the biggest issues is the idea that we are somehow going to train our way out of this crisis,” Snook said. “What we hear from law enforcement all the time is we want the training, we want to be as skilled as possible. But the reality is it's a tragic situation that they don't have control of and we can't rely on training alone.”

A study from this year in the Journal of the American Academy of Psychiatry and the Law Online said that there's so much variability within CIT that it makes it hard to ascertain how effective the program is overall. Police officers who use CIT do show reductions in mental health stigma, and a self-perceived reduction in use of force. One survey found that CIT-trained officers reported they’d be less likely to escalate to using force in a “hypothetical mental health crisis encounter.”

But other studies haven’t found any different between CIT-trained officers and those who hadn’t received training. CIT programs have been around for 20 years, and yet the number of people killed by the police has remained steady. Other factors may be at play, the authors of the study noted, like the effects of race, increased militarization of policing, and gun ownership patterns.

Rogers researched CIT during his fellowship in forensic psychiatry at University of California San Francisco. He agreed that while some individual case reports showed positive results, overall, he was "not able to find consistent, significant evidence that the implementation had made a difference in the 'fatality' statistics."

“One of the biggest issues is the idea that we are somehow going to train our way out of this crisis."

Since the findings around CIT are mixed, there are concerns about whether that money or time could better be spent elsewhere, or that more focus should be placed on well-rounded mental health approaches.

“Police officers and their equipment are expensive," Rogers said. "Communities and governments need to understand if their money is being well-spent to keep them safe, and whether there might be more efficient or more just ways to reallocate funds."

Bloche thinks that ideally, you’d have first responders skilled in triage, who have public safety training and also medical or mental health training, and who can analyze what’s happening and refer a person to the appropriate place. “Just like in an emergency room, the doctor or the nurse who first treats you is not both a hand surgeon and the cardiac specialist," Bloche said. "Rather, you have a person that gets emergency medicine which becomes a specialty in itself.”

While "defund the police" has become a contentious slogan politically, many within law enforcement don't think they should be given the sole responsibility of responding to mental health crises. A statement from the International Association of Chiefs of Police in June, pushing back against any funding decreases to police, clearly stated that police were being asked to do jobs that they weren’t trained for.

“Police are often the only ones left to call to situations where a social worker or mental health professional would have been more appropriate and safer for all involved,” the statement said. “Although police agencies are working to train officers in crisis intervention or mental health first aid, this does not take the place of proper medical treatment.”

“Being mentally ill is not a crime," said Thor Eells, the executive director of the National Tactical Officers Association and a retired commander from the Colorado Springs Police Department. "Suicide is not a crime. So you have law enforcement that has been thrust into a non-criminal scenario."

Mahoney, the sheriff of Madison, Wisconsin, said he's painfully aware of what happens when severely mental ill people get imprisoned. "Because they are in crisis, oftentimes they can't be housed with other individuals in my jail," he said. "Right now I don't have a medical unit, so where are they housed? They're housed in solitary confinement. Now you have an exacerbation of their existing conditions because you've taken them into custody in crisis and you locked them in a six by nine foot solitary confinement cell in hopes of protecting them. In fact, all you're doing is making the condition worse.”

Mental health initiatives try to keep mentally ill people out of jail by deploying non-police response teams. There are already successful examples of such teams cropping up on a small scale around the country. They are made up of healthcare professionals and social workers who respond to mental health 911 calls not with guns, but with medical expertise. Multiple studies show that these kinds of programs can reduce jail days and emergency room visits and decrease inpatient hospital stays when they also provide housing and healthcare support.

Cahoots, in Eugene, Oregon, has been lauded as an alternative response to mental health calls since 1989. In 2017, they managed 17 percent of the 96,115 calls for service made to Eugene police, the Wall Street Journal reported. The people who work at Cahoots aren’t cops—they’re trained medical and crisis workers. In Eugene, Cahoots is linked with the 911 system, and can respond to crises without police. As of 2018, they had 39 employees and cost $800,000 a year.

In Dallas, where there are 1,500 mental health calls per month, some 911 calls involving mental health emergencies bring social workers to the scene. Since the program, RIGHT Care, was implemented the number of psych patients at the emergency room rose 30 percent—suggesting that people were getting medical treatment instead of being put into jails.

A program called the Targeted Adult Service Coordination program in Lincoln, Nebraska, provides officers a hotline to call when they need a trained professional to help them with a mental health crisis. The counselors are often able to prevent people from ending up in emergency mental holds—around 82 percent of the time.

Jason Winsky founded the Tucson Police Department Mental Health Support Team. They are a dedicated team of non-uniformed officers driving unmarked cars who are highly trained in mental health crises. They’re also responsible for the training of everyone in the police department—as of last year 65 percent of the department had received the full 40-hour CIT.

Winsky said that about 40 percent of the calls they get are from people they already know. Having a dedicated team means they can develop a relationship with that person, know their health history and family. When 911 calls in, the computer alerts the dispatcher if the call is regarding someone they already know, and they’ll send out the people familiar with that person.

“Being mentally ill is not a crime. Suicide is not a crime. So you have law enforcement that has been thrust into a non-criminal scenario."

Some law enforcement officers have even tried to tackle the problem on their own. At the National Tactical Officers Association, Eells said they have created a new center of excellence called the mental illness response alternatives center for law enforcement, or MIRACLE. They are providing classes for officers who want to learn how better to respond to mental health calls in the field, with the goal of reducing use of force and incarceration rates.

About six years ago, Darron Hall, the sheriff of Nashville, investigated the top reasons why someone with mental illness was brought to his jail. The majority of people had warrants, like Calvin did. “Usually it was a warrant for something we asked them to do that we never should have asked,” he said: failure to report to probation, failure to go to court, or failure to be booked on charges.

If someone has a warrant, the officer has to arrest them, no matter what kind of mental health training they have. This year, Hall and his colleagues opened a facility for people with mental illness to go, instead of rebooking them on criminal charges. Low-level, misdemeanor charges would then be suspended and never make it into a person's record, as long as they complete a recommended course of treatment. “It’s our way of, over the next several years, flushing out our system,” Hall said.

But these initiatives are few and far between, and there is still the issue of funding. In Tucson, they have two master’s level trained social workers that ride out with officers. ‘I could use 20 more of those clinicians,” Winsky said. “The two that we have are through the generosity of a behavioral health provider in Tucson. The problem is, who is going to fund that?”

Hall got the money from his own budget. “We were in the process of building a new booking room and jail downtown. We took that money to build a jail and built two separate standalone buildings. One of those would be a processing booking room, and right beside it would be our behavioral care center.”

Other cities have also pulled from police budgets, or are calling to do so now. In 2019 in Durham, North Carolina, the City Council decided against hiring 18 new police officers and instead planned to create a “community safety and wellness task force." Last week, San Francisco’s Mayor, London Breed, announced that in place of police officers, trained, unarmed professionals will respond to noncriminal calls, including mental health, and also homeless and neighbor disputes. In Los Angeles the mayor proposed allocating $150 million of the Police Department’s nearly $2 billion operating budget to health and job programs. An open letter signed by current and former staff of Bill De Blasio called for $1 billion dollars of the police budget to be directed to other essential social services.

Hall said it just didn't make sense to him to keep spending money on more jail space and more officers if that didn’t solve the root of the problem. “If you have a hundred beds in your county jail, and 30 of those are diagnosed mentally ill—take the 30 beds away and take 30 percent of the budget away from Sheriffs,” he said. "It's about reallocating the money that historically has gone to arresting the person and moving the money to the healthcare field."

Keith thinks that a local newspaper article in The Morning Call, highlighting how long Travis had been waiting, helped Travis be released after more than 18 months in jail. Shortly after it was published, they finally got a call about an open hospital bed.

Travis improved with treatment, and with help from a community mental health team, found a place to live on his own. But once the support from that team ended, he stopped taking his medication. He became delusional again, his behavior sometimes so erratic and violent that Keith and his family had to call police three to four more times. Keith said he would call 911 because there was no one else to call. Today, Travis has been back in a private hospital for over a month.

In 2019, after surviving his jail time, another arrest, and homelessness, Calvin had finally made it into treatment and to his dream of living in Seattle on his own. But because he was feeling well, he stopped taking his medication. Jerri said that she suspects he became overwhelmed by delusions and mania again right before he died.

Jerri and Keith both agree that their children's time in jail made things worse. Law enforcement misunderstood what their children needed to get better, what their symptoms meant, and what environments they needed to be in. Combined with a dearth of mental healthcare in their communities, it made their situations impossible to control.

Calvin died by suicide in March 2019 at age 23. “The multiple periods of homelessness, incarceration, and all of that trauma, I believe led to his death from suicide,” Jerri said. “That first encounter with police that led down that path of ridiculous incarceration made him so much sicker.”

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