Pressure Mounts on How Police Handle Mental-Health Crises

Published July 20, 2020 on Capitol Weekly.

 

Calls to ‘defund’ police gain traction, as protesters — and public officials — contend that money would be better spent if clinicians, social workers responded to mental-health 911 calls. Police say many such programs already exist, and that they need more staff and funding.  (First of two parts. Part 2 can be seen here.)

On the afternoon of May 8, 2017, the family of 32-year-old Mikel McIntyre called 911 for help in dealing with his increasingly erratic and threatening behavior. The former high school and college athlete, who lived in Antioch and had briefly played baseball in the minor leagues, had been showing signs of serious mental illness, and his mother was concerned. She hoped a visit with family in Sacramento might help.

The first call, shortly after 3 p.m., indicated a possible mental-health crisis: McIntyre had locked himself in a vehicle and was being “slightly combative,” but the firefighters who responded decided he was not a threat. When family members called again to say McIntyre was becoming increasingly volatile, Sacramento County sheriff’s deputies responded at 3:32 p.m., and they determined McIntyre’s behavior did not meet the criteria for him to be detained on a 72-hour mental-health hold, as a danger to himself or others. The deputies suggested he leave the house, which he did.

McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder.

Later that same day, at 6:47 p.m., McIntyre was observed hitting and choking his mother in her car outside a Ross store in Rancho Cordova, near a busy intersection at Zinfandel Drive and Highway 50. Several witnesses called 911, and deputies again responded.

This time, the confrontation rapidly escalated.

McIntyre walked across the parking lot, ignoring deputies.  There was a scuffle, and a deputy fell while attempting to detain McIntyre, who threw a large rock, hitting the deputy in the head. Dazed and bleeding from a head wound, the deputy fired two shots, but missed, as McIntyre fled on foot toward the Zinfandel Drive onramp to westbound Highway 50, then on the freeway shoulder. Officers from several agencies quickly swarmed the area.

At one point, McIntyre threw another, smaller rock from the piles of river rock near the freeway, that hit a sheriff’s deputy and a canine.  According to a highly critical Sacramento County Inspector General’s report on the incident, three deputies fired a total of 28 rounds at McIntyre as he fled the scene, running alongside the busy freeway during rush hour. He was hit by seven bullets in his torso and limbs, six of them in his back.

Several rounds were found embedded in the roadway, and Inspector General Rick Braziel, a former Sacramento police chief who consults for law enforcement agencies throughout the U.S., said vehicles were passing on the freeway as shots were being fired.

“There are instances where the number of rounds fired at McIntyre were excessive, unnecessary and put the community at risk,” Braziel concluded in the detailed, 27-page report. The report infuriated Sacramento County Sheriff Scott Jones, who barred him from further investigation and issued a statement describing the findings of Braziel, a highly regarded former police chief, as “a lay opinion.” The county board of supervisors took no action to prevent Braziel’s precipitous firing, despite intense public pressure and demonstrations.

McIntyre was not armed and Braziel concluded “escape was unlikely,” and that officers had options other than lethal force to detain him.

“There were adequate resources on the ground with three officers on foot, six officers driving marked vehicles, and a canine, for a total of nine law enforcement officers, to isolate and contain McIntyre without firing additional shots,” Braziel wrote. There was also a sheriff’s helicopter and a CHP aircraft hovering over the scene.

The graphic videos of the pursuit are difficult to watch. They show McIntyre, who was Black, running alongside the freeway, pursued by multiple police vehicles and officers. The canine, which bit him, and several officers can be seen descending on McIntyre as he drops to the ground.  He was transported to UCD Medical Center, where he died shortly afterward.  In a detailed, May 28 Sacramento Bee account following release of the sheriff’s report and videos, a sheriff’s photo of the aftermath at the scene shows a pool of blood where McIntyre’s body had been, a pair of sneakers nearby.

“He did nothing but run for his life,” his mother Brigette McIntyre told reporters. “His death was senseless.” Sacramento District Attorney Anne Marie Schubert ruled the shooting justified.

McIntyre’s family sued, and the county settled for $1.725 million earlier this year, while not admitting fault. Despite a new state law requiring law enforcement agencies to release reports and videos of incidents that result in death or serious injury, Jones had refused to release the McIntyre reports or video, saying the case occurred before the law became effective in January 2019. The CHP released a redacted video, but the sheriff’s video was only released by Jones this past May, after the Sacramento Bee and the Los Angeles Times went to court, and more than three years after McIntyre’s death.

One in four
According to a 2015 study, “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters,” by the nationally recognized Treatment Advocacy Center, “the risk of being killed during a police incident” is 16 times greater for people with untreated mental illness. “By all accounts – official and unofficial – a minimum of 1 in 4 fatal police encounters ends the life of an individual with severe mental illness.”

“We would never send a social worker to a bank robbery. Why would we send a police officer to a mental-health emergency?” — Maggie Meritt

The McIntyre case – and many like it, frequently involving the deaths of Black men at the hands of police — have become flashpoints in growing calls for major changes in police use of force and in the way law enforcement responds to mental-health crises. Black Lives Matter protesters and civil-liberties groups, including the American Civil Liberties Union, are calling for “defunding” the police, slashing police budgets to fund more social services and redirecting mental-health calls to social workers and clinicians better qualified to help.

“We would never send a social worker to a bank robbery,” says Maggie Merritt, executive director of the nonprofit Steinberg Institute in Sacramento, which was founded by former state Senate Leader Darrell Steinberg, now Sacramento’s mayor, to advocate for improved mental-health policy and programs. “Why would we send a police officer to a mental-health emergency?”

But Merritt and other mental-health policy experts caution against removing police officers entirely from the equation.

“There is a need for somebody in the process of responding to a call to do a threat analysis and public-safety assessment,” says Randall Hagar, legislative advocate for the California Psychiatric Association. “There is no doubt that we need a lot more clinicians on the street responding to crises that are derived from a person’s mental illness, but sometimes a clinician needs backup” by law enforcement, especially in incidents where a weapon is involved. “There always has to be a determination of whether a public-safety issue is involved.”

Hagar and others want more training for police and 911 dispatchers on how to respond to mental-health crises, perhaps with a clinician involved in screening the calls. A former president of the Sacramento chapter of the National Alliance on Mental Illness (NAMI), which advocates for families, Hagar said he once surveyed his members and found that more than half had experienced “some sort of law enforcement in the last year, and those were not always happy situations.”

Many law enforcement and mental-health professionals argue that existing programs already use clinicians and counselors who work with officers to respond to mental-health calls, often de-escalating potentially volatile situations. They emphasize that follow-up contact is essential to avoid future crises, and that the presence of mental-health professionals frees up officers to focus on violent, serious crimes, saving limited public funds by preventing incarceration, hospitalization and homelessness.

In reality, the 5150 statute is widely regarded as ineffective and outdated.

“Officers didn’t sign up to be social workers, or to determine people’s mental-health status,” says veteran San Diego police officer Brian Marvel, president of the influential Peace Officers Research Association of California (PORAC). For many years, Marvel worked as an officer in the San Diego Police Department’s Psychiatric Emergency Response Team (PERT), in which officers are paired with mental-health professionals to respond to and follow up on mental-health emergencies. “I’ve long been an advocate of sending mental-health calls to others first – let the people who are skilled in this area handle these calls,” he said.

“I don’t think we have to re-invent the wheel in California,” he adds. “It’s a matter of evaluating what the best program would be. But it’s really incumbent on elected officials to be sure it’s adequately funded. Elected officials have set up law enforcement to fail, because they’ve failed to properly fund services for homelessness and mental health.”

Officers are required to respond to so-called “5150” calls, a reference to the state Welfare and Institutions Code that sets criteria for detaining someone for 72 hours who is deemed “a danger to self or others.” In reality, the statute, which is widely regarded as ineffective and outdated, too often means an individual who is detained under a 5150 goes to an already overburdened hospital emergency room. There, an officer must stay with the patient, who frequently is released without treatment, medication, or a referral to overwhelmed mental-health programs and largely nonexistent housing. It’s an expensive, time-consuming and frustrating process for all concerned.

The SMART unit also has 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“I’m very limited in what I can do in a 5150,” says Marvel. But when clinicians are involved in the response at the outset, as in San Diego’s PERT program, “that literally opens up all of the services available in the county.”

The Los Angeles Police Department, which has 9,000 sworn officers and 3,000 civilian employees,  has long had a mental-health unit that pairs officers in civilian clothes (a uniform of tan khaki’s and a black polo with the LAPD insignia, designed in consultation with NAMI) and clinicians – social workers and psychologists – to respond to mental-health calls.

Headed for the past five years by Lt. Brian Bixler, who was a youth pastor before he became a cop, the SMART (Systemwide Mental Assessment Response Team) unit currently includes 68 officers and 18 supervisors, also sworn officers, some with advanced degrees in social work and psychology, and 60 clinicians, whose salaries are paid through the county’s Department of Mental Health with some funding from the state Mental Health Services Act.

“We run it like a patrol division,” Bixler said, “with four shifts” around the clock. Like San Diego’s PERT program, they also partner with community programs that provide mental-health treatment and suicide prevention.

Depending on the time of the call and its location, regular patrol officers may be the first responders to a mental-health call, Bixler said, with SMART teams either joining them at the scene or following up soon afterward. Bixler has long believed “there’s gotta be a better way” for police to respond to mental-health crises, and current calls for major change “may be the impetus to do that.”

“I’m asked if we want more police officers (in the SMART program),” he adds, “and I say I’d rather have more clinicians [who can intervene] before someone gets to the point where they call 911. My whole goal is to work us out of a job.”

Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs.

In Sacramento County, the Division of Behavioral Services has a Community Support Team – which includes licensed mental-health clinicians and peer-support specialists (lay counselors with personal experience) — who provide phone and community-based assistance, connecting people with mental-health and housing programs. Using state Mental Health Services Act funds, the county also has six Mobile Crisis Support Teams, consisting of licensed mental-health clinicians who work with local law enforcement to respond to calls and help de-escalate mental-health emergencies.

Mobile crisis teams expand
The Mobile Crisis teams, which the county is expanding to 11 teams, each include a senior mental health counselor paired with an officer or deputy, as well as a “peer navigator” (a lay counselor with personal experience) who helps to ensure connections with ongoing services.  As in other agencies throughout the state, staffing and funding are inadequate, and mental-health clinicians are spread thin in a large county with multiple police and fire agencies asking for help.

There are other, similar programs around the country, in which police collaborate with mental-health professionals on crisis calls. Some local agencies send mental-health and other “non-criminal” calls directly to community mental-health programs, with police backup if necessary.

Many point to the 30-year-old CAHOOTS (Crisis Assistance Helping Out on the Streets) program in Eugene, Ore., a collaboration between the police department and a 50-year-old community program, the White Bird Clinic, in which non-emergency and 911 calls that do not involve an extreme threat of violence or bodily harm are routed to a medical-crisis team (usually a nurse or EMT and a mental-health professional) trained in de-escalating mental-health crises and connecting individuals with services.

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment.

As a result of national protests, the CAHOOTS program is getting a lot of press in recent weeks. According to a “Media Guide” on the White Bird Clinic website, CAHOOTS teams responded to 24,000 calls in 2019, about 20 percent of total non-emergency and 911 calls, and only 150 required police backup. The program is estimated to save the city about $8.5 million annually in public safety costs, plus some $14 million in ambulance trips and ER costs.

The coronavirus epidemic in many ways has served to shine a bright light on the historic lack of coordination between police and mental-health professionals, with growing national demands for changes in how police respond, particularly to calls involving people of color.

“When we have a loud response from a diverse community, there is this opportunity for looking at different ways of doing things,” says Jennifer Reiman, a licensed clinical social worker who is Sacramento County’s Mental Health Program Coordinator for the Community Support Team and Mobile Crisis programs. “Providing a spectrum of response is really important.”

Myriad proposals have been made in cities and counties throughout California and the U.S. in the wake of massive national protests against historic police mistreatment – and many deaths – of Black citizens, especially Black men and boys who are arrested and incarcerated at numbers far disproportionate to their numbers in the general population.

Some proposed changes involve nomenclature as well as pandemic-driven cuts and redirecting police spending. The Davis City Council is considering a proposal to rename the Police Department, calling it the Department of Public Safety. In Minneapolis, where the gruesome death of George Floyd under a policeman’s knee spurred national protests, the City Council has proposed the creation of a Department of Public Safety and Violence Prevention.

“We must reduce our reliance just on caging people.” — Supervisor Sheila Kuehl

New York’s City Council recently voted to shift $1 billion from policing to education and social services in the coming year. In Los Angeles, the City Council cut the LAPD budget by $150 million, ostensibly redirecting more funds to social services. The LA County Board of Supervisors proposed cuts of $162 million to the 2020-21 Sheriff’s budget, also with an eye to redirecting services from incarceration to treatment.

And LA Supervisors are revisiting plans to close the dangerous, cramped Men’s Central Jail, to focus more on diverting the huge percentage of mentally-ill inmates in the system into treatment and diversion programs. LA County’s jail system, overseen by the Sheriff’s Department, is often referred to as the largest mental-health facility in the world.

“We must reduce our reliance just on caging people,” said Supervisor Sheila Kuehl, a former state legislator, public-interest attorney and law professor. The once-controversial proposed closure of the 57-year-old Men’s Central Jail is no longer a “revolutionary concept,” she added, but rather “simply logical, fiscally prudent and another opportunity for community healing.”

In Sacramento, Mayor Steinberg, who has long advocated for more funding and resources for mentally ill Californians and their families, last month proposed hiring an Inspector General to provide oversight and investigation of Sacramento police, as well as a plan for “triaging” 911 calls from individuals and families in mental-health crises. The plan would shift police funding to create a new unit comprised of mental-health professionals who would respond to calls involving mental-health emergencies, homelessness and other “non-criminal,” non-violent issues.

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in.” — Bridgett Dean

“We’ve been hearing calls for ‘de-funding’ the police,” Steinberg said in a press release, “but I think it’s more productive to talk about the function of the police and let the money follow the function.”

Sacramento Police Chief Daniel Hahn recently hired a licensed clinical social worker, Bridgette Dean, to oversee a Mental Health Unit in the Police Department. Dean, who has worked in law enforcement for the past decade, filled a similar role in the Roseville Police Department when Hahn was chief there. She is one of the few – possibly the only — social-services administrators in Northern California with direct authority over police officers whose primary focus is on mental-health calls.

Dean heads a team of five officers with intensive training in how to deal with mental-health crises, as well as a homeless outreach team. They work with patrol officers to assess mental-health emergencies and help people in crisis get services. “We’re not going in to do an enforcement model,” she said, “We want to close the gap, get the services they need.” She stresses the importance of training for officers and dispatchers, who are “trained and experienced in listening to key words to understand that it’s a mental-health call.”

“We are the 24/7 crisis call line,” she said. “You call, we come, regardless of the level of crisis the individual may be in. If it’s a priority call – ‘I’m going to kill myself’—we go right now. If it’s not an emergency crisis on the patrol side, they will refer the call to the mental-health unit for follow-up.”

‘Major Issues’ at state level
Collaboration is the key to the success of programs like Dean’s, and state support.

“We have some major issues we have to resolve at the state level,” she said, including reforms in an outdated, ineffective system created with the closures of state mental hospitals in the 1960s and 70s, which resulted in strict legal protections for the rights of the mentally ill. But those changes assumed that a robust system of “community care” would replace the hospitals – which never happened, leaving thousands of mentally ill Californians homeless and untreated, shuttling among hospital emergency rooms, jails and prisons, at tremendous public expense and incalculable human suffering.

“The structure we have in place is so antiquated,” Dean said, referring to the 1967 Lanterman Petris Short Act that drastically altered California’s system of mental-health care and has never been substantively changed or updated. And the ambitious proposals currently advanced throughout the country to reorganize and/or defund the police often fail to recognize the reality of services on the ground.

“All of this is good talk. . .until we realize we have 50 detox beds in Sacramento city and county,” and extremely limited numbers of beds for psychiatric patients in crisis, much less for those needing long-term care. “When we talk about the need to get somebody off the streets, we’re not able to do that because of the lack of beds.”

TOMORROW: Solutions emerge in national push for major changes in how police respond to mental-health crises (Second of two parts)
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Editor’s Note: Sigrid Bathen is a longtime Sacramento journalist and former Sacramento Bee reporter who has covered mental-health and related issues for several publications for more than 40 years. She has taught journalism and communications at Sacramento State since 1988. She has written for Capitol Weekly since 2005, on a variety of subjects, including education and health care. To see two of Bathen’s recent pieces in Capitol Weekly on mental health issues, click here and here.