No Good Deed: Improving Mental Health Crisis Response to Law Enforcement
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Presented by: Dan Abreu, MS CRS LMHC CMHS National GAINS Center
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No Good Deed: Improving Mental Health Crisis Response to Law Enforcement
- 1. No Good Deed: Improving Mental Health Crisis Response to Law Enforcement 1 st Crisis Intervention Team International Conference June 2, 2010 San Antonio Dan Abreu, MS CRS LMHC CMHS National GAINS Center
- 10. And Now!
- 11. And Now!
- 16. Who Are We Talking About? Repeated Cycles INCARCERATION ARREST Private Home Group Residence Shelter Street S.A. Residential Treatment Mental Health Inpatient COMMUNITY
- 17. “ Treatment-Resistant” Clients Or “ Client-Resistant” Services
- 18. 9 Patients -2700 ER visits 3 million dollars 8 of 9 substance abuse problems 7 of 9 mental health problems Austin American Statesman, 2009
- 19. Institutional Circuit Cost: July 05 -- June 07 System Days Per Diem Total Cost Shelter 160 *68 10,880 Jail 96 *129 12,384 Detox 8 **1,000 8,000 Prison 408 *79 32,232 Hospital Inpatient 15 *657 9,855 Parole 60 **7 420 Unaccounted 43 - - Total 730 $73,771 Annualized Cost $36,886
- 20. Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental Disorders Detainees with severe mental disorder plus either alcohol or drug abuse/dependence = 72% = 72% Adapted from: Abram, K.M. and Teplin, L.A. “Co-Occurring Disorders Among Mentally Ill Jail Detainees: Implications for Public Policy.” American Psychologist , 46(10):1036-1045, 1991 and Teplin, L.A. “Personal Communication.” Males Females Disorder Alcohol Abuse/ Dependence Drug Abuse/ Dependence Alcohol Abuse/ Dependence Drug Abuse/ Dependence Schizophrenia 59% 42% 56% 60% Major Depression 56% 26% 37% 57% Mania 33% 24% 39% 64% Any Severe Disorder 58% 33% 40% 60%
- 21. Trauma History Interview Data (n=978) Percent Experiencing Lifetime Percent Experiencing in Last 12 Months 1 Witness of Violence 65.4% 31.7% Sexual Abuse 55.2% 31.7% Physical Abuse 90.2% 65.2% Any Trauma 94.0% 64.7% Any Abuse 92.9% 61.1% 1 – For Those Respondents Experiencing Trauma in Lifetime
- 24. % Clients by Presenting Medical Conditions California Fuse Study, 2008 # of Conditions Alameda Los Angeles S’mento Santa Cruz Tulare Total One Condition 13% 50% 32% 15% 46% 32% Two Conditions 34% 27% 34% 34% 29% 32% Three Conditions 34% 19% 31% 28% 19% 26% Four or Five Conditions 18% 3% 2% 22% 6% 10%
- 25. ED and Inpatient Visits Aggregated Across Programs (N = 598) California FUSE Study, 2008 Pre Post Difference Visits 4,799 3,380 1,419 30% decrease* ED Charges $8,531,971 $7,066,670 $1,465,301 17% decrease* Inpatient Admissions 959 822 137 14% decrease* Cumulative Inpatient Days 4,299 4,200 99 2% decrease Inpatient Admission Charges $35,799,433 $33,081,671 $2,717,762 8% decrease
- 29. Intensity of Force N=36
- 34. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Stabilization Units
- 36. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services - Transition Local Law Enforcement Jail Releases Other Crisis Stabilization Units Service Linkage : ICM/ACT EBP’s Peer Bridging Medical f/u Trauma Specific Services Jail linkage Other Assistance: Medication Access Benefits Housing Information Sharing
- 37. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Respone
- 41. Street Encounters with Homeless 2006 – 271 2007 – 271 2008 - 150
- 42. Homeless Subjects as “Suspects” 2006 – 499 2007 – 401 2008 – 252
- 43. Calls for Service Involving Emotionally Disturbed Persons 2006 – 299 calls 2007 – 279 calls 2008 – 281 calls Westchester Co. NY
- 44. Resisting Arrest Charge for Emotionally Disturbed Persons: 2006 – 6 arrest 2007 – 1 arrest 2008 – 1 arrest Westchester Co. NY
- 45. Mental Health Outreach Contacts and Referrals 2006 – 60 2007 – 126 2008 - 225 Westchester Co., NY
- 48. Common Action Steps Broome Cat’gus Dutchess Erie Madison Putnam Rockl’d Task Force X X X X X X Crisis/911 Integration X X 911 database X Data analysis X X LE/ER Imp. X X X X Increase ER Response X X X X Info sharing X X X X X Xsystem train X X X X X LE training X X X X X Consumers X X X X High users X X Veterans X X Jails X
Notes de l'éditeur
- Cross-Systems Mapping & Taking Action for Change 10/07 Trainer Note: Return to this graphic to note that people with mental illness and co-occurring substance use disorders frequently cycle in and out of the criminal justice system It is not necessary to review the content, but use this as a segue to the next slide
- Cross-Systems Mapping & Taking Action for Change 10/07 Dan you may want to insert the references for the above here in the notes; eg Skeem, 200? After Memphis CIT was implemented: injuries to individuals with mental illnesses caused by police decreased by nearly 40 percent. The rate of TACT (similar to SWAT) calls in Memphis decreased by 50 percent In 1999, the Albuquerque Police Department reported: Officers arrested, transported to jail, or protective custody fewer than 10 percent of those people with mental illnesses they contacted. Injuries were reduced to 1 percent of calls The decrease in use of SWAT was reported at 58 percent. Miami Dade CIT reports reduction in wrongful death lawsuits Las Vegas Use of Force Study (Skeem) Race: White 74%; Black; 19%; Hispanic 7% Sex: Male 61% Age: Mean = 36 With Mental Disorder: 64% Bi-polar 28% Depression: 20% Schizophrenia: 19%
- Cross-Systems Mapping & Taking Action for Change 10/07 CIT Call Profile (N=655) 295 (45%) suicide threats/attempts Suicide Plans/Methods knives 106 (36%) overdose 45 (15%) firearms 35 (12%) 98 (15%) family disturbance
- Cross-Systems Mapping & Taking Action for Change 10/07 Call Resolution 485 (74%) Hospitalization 344 (71%) Involuntary 25 (18%) Onsite resolution 6 (4%) Arrest Conclusions As event violence increased, use of force increased Use of force used in 36 incidents (6%) Use of force used in only 30 of 189 (15%) serious to extreme incidents Severity of force related to severity of threat
- Cross-Systems Mapping & Taking Action for Change 10/07 Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)
- Cross-Systems Mapping & Taking Action for Change 10/07 Essential Elements of a Specialized Response: (Consensus Project) Call Taker and Dispatcher Protocols On-Scene Assessment of Signs and Symptoms of Mental Illness, and Subsequent Disposition On-Scene Stabilization and De-Escalation Transportation and Custodial Transfer Specialized Crisis Response Sites/Treatment Supports and Services Specialized Training Organizational Support Confidentiality and Information Exchange Collaborative Planning and Implementation Programs Evaluation and Sustainability
- Cross-Systems Mapping & Taking Action for Change 10/07 Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)
- Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)