Diffusing crisis

     A fatal showdown between a mental patient and police left the Memphis (Tennessee) Police Department dealing with the aftermath of the patient's death, as well as increased public demand for a different approach. Unfortunately, the incident wasn't singular, either to the Memphis PD or law enforcement in general. Police regularly confront mental patients, and the results are often violent and tragic.

     A gunman who recently killed a Los Angeles SWAT officer had a history of mental illness.

     A mentally ill San Francisco man died during a confrontation with police.

     A bipolar Texas resident, armed with a knife, died after being shot by police answering the call.

     The death of North Carolina police officer Terry Lanier is typical of police fatalities resulting from encounters with deranged individuals. Lanier had a promising law enforcement career ahead of him when he was killed responding to the call of a mentally disturbed man carrying a butcher knife. With only his basic law enforcement training to guide him and no outside support, Lanier intended to talk the man into putting down his weapon. He made the fatal mistake of getting too close and instead of surrendering, the man turned and slashed the officer's throat. Sadly, the young officer bled to death before help arrived. His assailant was eventually deemed not fit to stand trial.

     It was a tragedy for everyone involved. Lanier's back-up, arriving a split-second too late to intercede, found himself forced to shoot the man (who survived), but he has since lived with the memory of seeing a friend and fellow officer lose his life.

Past and present problems

     Like the vast majority of officers, Lanier didn't want an out-of-control situation to escalate even further and become a shooting. He sought a peaceful resolution to the encounter and it didn't work. The few hours of specialty training he underwent while in the police academy didn't begin to cover the nuances of dealing with those who are mentally challenged. There were no mental health specialists involved in the incident. And even though Terry Lanier died nearly 30 years ago, many departments have done very little to change their approach to handling those who suffer from mental illness.

     And that's ironic because in today's world, police officers are even more likely to encounter the mentally ill than they were when Lanier died. There's a good reason for this: Reform of the country's mental health system has changed the way those with mental disorders are confined, housed and viewed in the context of the law. This has had strong and sometimes disastrous repercussions.

     The impetus for the change had good intentions. Alarmed at the state of mental facilities, which often kept patients in brutal, inhumane conditions, and concerned about the relative ease with which individuals were kept in confinement, well-intended advocates pushed to reform the system. As a result, warehousing the mentally ill became a thing of the past. Across the country, many mental institutions, especially long-term residential care facilities, closed.

     The mentally ill were given a stronger voice in their treatment and the burden of proof in a commitment became more challenging. Today, it is much more difficult to simply commit someone and "throw away the key" than it was in the past. But in protecting the rights of the mentally disabled and breaking down the chain of sub-standard mental institutions, lawmakers inadvertently created a system that fails to protect patients who cannot make sound judgments on their own.

     As a result, these initiatives increased the numbers of homeless wandering the nation's streets. Police have known for years that many homeless suffer from mental problems, as well as substance abuse. They are mental patients with no place to go, and no one to help them get there. And families in many cases no longer have the legal authority to get their afflicted loved ones help without their cooperation.

     Also among the untended fallout from this legislation was the subsequent wide-spread criminalization of mental illness. Since commitment to a mental institution has become more difficult, law enforcement too often remains a last resort. Much too frequently, responding officers have little training beyond their academy days, leading to both public relations disasters and rapid escalation into new levels of violence.

     Families of the mentally ill are many times frustrated at the inefficiency of the system — and they are put off at what they perceive as an often heavy-handed approach. That makes many loathe to call police, even when problems escalate beyond control. Responding officers, on the other hand, often find themselves face-to-face with situations for which their training has not properly prepared them. Just as often they are faced with few options and little in the way of resources. As a result the margin for error is unacceptably great — too much force, and a family ends up grieving for a member whose real crime was an inability to think rationally; too little and responding officers put their own lives and the lives of others in the community in serious jeopardy.

     Obviously, more training helps officers work through to the best approach. But the Memphis PD went several steps further than simply providing extra training. Recognizing the need for compassionate and positive handling of the mentally ill, the Memphis PD took the initiative and created a program that today is used successfully in dozens of agencies across the country.

     The program builds a team of officers available to respond to calls that partner with families, mental health providers and individuals who are diagnosed with mental diseases. The Crisis Intervention Team, or CIT, preserves the individual's dignity, insures greater safety for both responding officers and the mentally ill person — called consumers — and reassures families.

Addressing the issue

     Maj. Sam Cochran of the Memphis PD coordinates the city's CIT, which grew out of a concern that family members of mentally disturbed individuals had when summoning police help.

     "They felt the officers were in crises as much as they were," Cochran says.

     The seed that nourished CIT was planted in the late 1980s. At the time officers were receiving approximately 8.5 hours of training on handling these potentially explosive situations. Then in 1987, the department responded to an emergency call where a mental patient, armed with a very large knife, was cutting himself and threatening both family members and neighbors. In the ensuing encounter with police, the individual was shot and killed. A public outcry ensued.

     "Many felt the Memphis Police Department could have handled it better," Cochran admits.

     From this encounter grew a task force composed of the National Alliance on Mental Illness (NAMI), specialists from the University of Tennessee and Memphis State University's medical schools, officers, families and those afflicted with mental illness (also called consumers).

     "The task force explored the option of a mobile crisis team," Cochran says. That idea did not meet with favor and the reasons were obvious. Tried in other places, these teams are formed with permanent members and have a lengthy — as much as one to two hours — response time. Any officer who has answered a violent call involving an out-of-control mental patient knows it's all about rapid response. Instead, it was decided to train officers department-wide, partnering with other resources in the community, and ensuring that CIT members are ready, available and working around the clock.

     Implemented in 1988, the selection process was narrowed to include officers, who not only showed an interest in the program, but were suited to the demands of CIT. Successful candidates needed to possess good judgment skills and, says Cochran, some also had family members with mental issues, giving them special, irreplaceable insight.

The nuts and bolts

     Cochran likes to emphasize that CIT isn't simply a law enforcement initiative.

     "A lot of people misunderstand the word 'team.' They think of a team of law enforcement officers, when it's really a team in the context of community partnerships," he says.

     Crucial to CIT's model are family members, the consumers, the mental health community and, finally, law enforcement, all working on the same page. Cochran is a huge advocate of this approach, and says that one of the biggest mistakes communities can make when considering CIT is to look at it as only a training program. CIT has a lot of heart, and that, says Cochran, is one of the reasons it works.

     The Memphis police major doesn't simply talk the talk when it comes to the people the program is designed to serve. He also champions them and deplores the stigma that often attaches to a diagnosis of mental illness.

     "I believe stigma, as it relates to mental illness issues, permeates our communities and our culture," Cochran says.

     The 40-hour CIT course is "the platform that creates a foundation by which a structure is designed to fight 'stigma' and to reflect a model program that is not just a 'training' program," he says.

     Cochran says CIT is an opportunity to improve the entire system and, indeed, communities that have signed onto the CIT concept have seen more success working with incidents that, in other circumstances, could have led to heartbreaking results.

     CIT succeeds because it respects the dignity of the mentally ill. It works to divert these individuals from the criminal justice system and into more appropriate surroundings, whenever possible. And it takes a reasonable, caring approach. Families know that their loved ones are not being handled as if they were disabled. Instead, their lives, health and well-being have value and that value is consistently recognized by those in the system.

     "CIT is about saving lives," Cochran says. "One life — what's that worth? The urgency of this mission demands attention, not delays. Family members, consumers and crisis responders face traumatizing realities daily."

     Like diabetes, heart disease or cancer, mental illness is a physical ailment, not something the sufferer brings on him or herself. But unlike those who are burdened with those afflictions, the public's attitude toward the mentally ill is cloaked in ugliness and invective. They are called crazy, loony, out-of-their-minds, nuts and many things worse. And that is the perception Cochran, his officers and other members of the CIT partnership are working to change.

     As for the stigma of mental illness, Cochran says he doesn't like it. "I believe that within the context of how this word relates to issues of mental illnesses that the most appropriate word is 'prejudice.' But our culture does not like the use of that word."

     Still, he says, like the word or not, "It's all about prejudice."

Benefits of CIT

     CIT has saved lives. Period. The MPD says the program's benefits have been significant, immediate and verifiable. According to the MPD, CIT has led to:

  • Immediate crisis response.
  • A decrease in the number of arrests and use of force.
  • Identification of consumers who are not being fully served.
  • Better training and education in the art of verbal de-escalation techniques.
  • Fewer officer injuries in crisis situations.
  • Good public relations — the community recognizes the department's willingness to resolve these issues without resorting to violent methodology.
  • Fewer arrests in these cases.
  • A decrease in jail health care issue liabilities.
  • Savings to the taxpayer.

     "NAMI (Memphis) credits CIT with saving lives and preventing injuries, both for consumers and officers," Cochran wrote in an opinion piece on the department's Web site. "Officer injury data has decreased by seven-fold since the program's inception. University of Tennessee studies have shown that the CIT program has resulted in a decrease in arrests rates for the mentally ill.

     "Most importantly, CIT officers give consumers a sense of dignity. This dignity generates a new respect and outlook on the police and the mental health systems."

But dignity, first and foremost

     The time for change to the nation's attitude toward those afflicted with mental illness has come. All human beings deserve to be treated with dignity and respect. That law enforcement can provide a gateway for change speaks volumes about how this profession has grown and matured over the years.

     Today, many criminal justice agencies are reaping the benefits of a CIT partnership. For those who've not yet taken that step and would like to know more about it, Cochran is happy to share. He can be reached at Sam.Cochran@memphistn.gov.

     A 12-year veteran of police work, Carole Moore has served in patrol, forensics, crime prevention, criminal investigations and has extensive training in many law enforcement disciplines. She welcomes comments at carolemoore@ec.rr.com.

A historical concern

     Mental illness often has a genetic basis, so it is not uncommon to find certain illnesses running in families. And, since the presence of mental illness often conjures up stigma, sufferers find themselves treated like lepers, their disease relegated to the shadows, a secret they must keep hidden. That is how mental illness has been traditionally been treated, although there are a few historical exceptions.

     History indicates the ancient Egyptians believed the mentally ill possessed special religious or spiritual connections. A facility near present-day Saqqara, Egypt, is thought to have been an early treatment center.

     In medieval times, it is said Muslims established mental hospitals where their mentally ill population was cared for with a compassion extraordinary for the times. A number of important pioneers in the early study of psychiatric disorders were also Islamic. While Europeans feared the mentally ill, enlightened Arabs were trying to understand their neurological roots.

     Treatment for psychiatric diseases during the Middle Ages was generally brutal. The mentally ill were often regarded as demonic and thrown into filthy, barbaric institutions to languish and die. It wasn't until the 19th century that mental illness began to receive sympathetic treatment in this country.

     Dorothea Dix (1802-1887) was an activist who took up the cause of inhumane treatment of the insane. In a report she wrote following her investigation of Pennsylvania's system, where indigent individuals were treated worse than animals, she said, " Insane Persons (are) confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience."

     Dix's compassionate attitude toward the mentally ill led to the establishment of mental institutions across the country, but confinement to an institution was often at the whim of a family member. It was not unusual for someone to deteriorate in one for decades.

     Treatments for mental illness were often experimental and cruel. Physicians have tried approaches ranging from convulsive shock therapy to frontal lobotomies, but most of these approaches have been largely ineffective. It wasn't until the use of medication to treat mental illness came into large-spread use that many of the afflicted were able to lead lives with any semblance of normalcy.

     The National Alliance on Mental Illness estimates 10 million Americans suffer from bipolar disorder, evenly split between men and women. Formerly known as manic depression, both adults and children have the disease, and it often leads to substance abuse, depression and suicide.

     Schizophrenia affects 2 million individuals, and it's estimated that with 15 million sufferers major depression is the most prevalent mental illness of them all. Other mental disorders, ranging from Post Traumatic Stress Disorder (PTSD) to Tourette's Syndrome afflict countless others.