Social work and police reform

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    Why did police shoot a mental health therapist?

    While the rest of us were living an average afternoon in mid-summer 2016, law enforcement officers were called in to respond to an incident on a Miami city street.  A young man held an unknown object in his hand while another man spoke to him. From the 911 call, the man was described as being suicidal and armed. The police arrived on the scene and despite several requests, the man would not drop the object. With guns drawn, the police surrounded the man and his counterpart, Charles Kinsey, a mental health therapist, who was trying to de-escalate the situation. The allegedly suicidal man that Charles Kinsey was speaking to was a 27-year old patient with autism. The patient had absconded from Charles Kinsey’s group home and was holding a toy that he used to remain calm.

    These are the details of the events that resulted in Charles Kinsey being shot in the leg while attempting to de-escalate the situation as he lay on the ground next to his patient. One of the officers seemed to haphazardly shoot his gun hitting Charles Kinsey. This incident was recorded by an onlooker.

    Although, both Charles Kinsey and his patient survived the ordeal, this occurrence raises many questions. What were the police thinking? What happened to the officer after this event? And the crucial, underlying question: what are the police doing to change the way they negotiate in mental health crises?

    The police response to public incidents of acute mental illness

    “Emotional awareness and mental health have historically not been major factors in [police] hiring practices, but are crucial elements to ensuring that staff have the capacity to deal with essential elements of their job – properly dealing with and responding to individuals, complainants, and suspects.” Faisal Khan, Senior Legal Counsel and Hospitals and Health Systems Practice Lead at Nixon Gwilt Law.

    In a study of all arrests in the U.S. made in 2016, it was found that 31.3% were of people with a mental health diagnosis, and a further 27.7% of people with a diagnosed substance abuse disorder. Considering the 2 groups, 22.5% had a joint diagnosis of both a substance abuse disorder and a mental illness.  From this combined group, 21.5% were arrested at least twice in 2016 making them “frequent flyers” in the criminal justice system.

    Police officers who respond to  911 crisis calls need to quickly assess if what they are witnessing is an actual crime or a mental health crisis, before determining the next steps. Law enforcement officers are expected to conduct an assessment that leads to, in psychological terms, a differential diagnosis. For example: is a delusional episode due to schizophrenia or drug use? Is the person experiencing a panic attack or asthma? Are they even in a mental state where they are aware that they are being detained? And most importantly, is the person a danger to themselves or others?

    Police officers who are unable to correctly identify what the person is experiencing are seriously compromised in being able to carry out their duties.  For the person being handcuffed, a police officer incorrectly identifying their situation can result in the difference between them making it through the day alive and uninjured, or not. A 2016 study published in the American Journal of Preventative Medicine estimated that 20% to 50% of fatal encounters with law enforcement involved an individual with a mental illness.

    The thin blue line and a change in response by law enforcement

    Sometimes, there exists only a thin blue line that separates a mental health crisis and a crime committed in a stressful situation. There has been a procedural shift in some U.S. states away from the police being the sole responders to all crisis situations –  to the involvement of mental health professionals for non-violent crises. Large metropolitan cities have incorporated training protocols or special departments to address these situations. Following are 3 different examples of these programs and protocols.

    Mental Evaluation Unit (MEU)

    Over 40 years ago, the Los Angeles Police Department (LAPD) established a Mental Evaluation Unit (MEU)  with the mission “to reduce the potential for violence during police contacts that involve people who suffer from mental health disorders and to simultaneously assess the mental health services available to assist.”

    The MEU currently has 63 officers who deploy in 12 teams, called System-wide Mental Assessment Response Team (SMART) units, across the city per day, waiting for requests to help respond to calls involving people in mental health crises. These teams are made of a police officer and a mental health professional (psychologist, psychiatric nurse, social worker, or other clinician).

    Crisis Intervention Response Team (CIRT)

    Created in 2008, the Houston Police Department developed their Crisis Intervention Response Team (CIRT) which partners police officers trained in crisis intervention masters-level licensed professional clinicians, typically licensed social workers and psychologists. When responding to a situation that is deemed appropriate for CIRT, the officer and clinician together attend roll-call before heading out in a patrol car. In 2019, CIRT over 5,000 emergency situations.

    Crisis Assistance Helping Out On The Street (CAHOOTS)

    In 1989, the White Bird Clinic in Eugene, Oregon developed a program where the response does not have a law enforcement office involved at all – CAHOOTS (Crisis Assistance Helping Out On The Streets). This is a free 24/7 community-based public safety system for residents in the Eugene-Springfield area.  CAHOOTS  uses a mental health first response model to address crisis situations for people struggling with acute mental illness, homelessness, and addiction. The program mobilizes 2-person teams consisting of a medical professional (e.g. a nurse, paramedic, or EMT) and an experienced crisis worker who has substantial training in the mental health field.

    The CAHOOTS teams deal with a wide range of mental health-related crises, including conflict resolution, welfare checks, substance abuse, suicide threats, and more. They rely on trauma-informed de-escalation and harm reduction techniques. CAHOOTS staff are not law enforcement officers and do not carry weapons; their training and experience are the tools they use to ensure a non-violent resolution of crisis situations.

    Programs like CAHOOTS, Los Angeles’ MEU, and Houston’s CIRT have proven to be more effective compared to the punitive model of policing that has created or added to a negative stereotype of law enforcement over the last few decades. The White Bird Clinic reported in 2017, the CAHOOTS teams answered on average 1 out of every 5 of the Eugene Police Department’s overall call volume. Houston’s Mental Health Division reported CIRT responded to 13% of the city’s 40,000 calls. In 2014, Los Angeles’s SMART units saved over 6,000 hours of patrol time.

    Ryan Skyles, of the Eugene Police Crime Analysis Unit noted, “There has been significant visibility and discussion, even nationwide, of the CAHOOTS program in recent months, highlighting the important role this program has in our community by offering critical crisis intervention services. CAHOOTS is a valued partner within the city of Eugene and provides a needed service within the community.”

    Social work joins law enforcement

    In 2016, researchers put forward the following argument:

    We therefore, argue that if social workers (with specialized knowledge in non-criminal interventions areas such as mental health) partner with police officers, will be able to help reduce the high incidences of fatalities that occur due to the poor interventions strategies usually adopted by police.

    In all crisis intervention programs, the mental health professionals have completed graduate school and are licensed to work as social workers, nurses, counselors, etc. Crisis intervention training programs are specialized programs that these professionals generally complete, in addition to their general training and licensing requirements. Crisis workers need to have a genuine passion for mental health and the capacity to carry the workload that comes with being in the field under high stress situations.

    Further to traditional post-graduate studies, mental health professionals have additional law enforcement training. Crisis workers typically train alongside police officers in the classroom and in training scenarios.  These scenarios prepare the crisis worker for situations that may present themselves in real life, and highlight the responsibilities of their role in the agency.  Training sessions cover a variety of areas including de-escalation training, working with the homeless, and responding to the elderly.

    Working in crisis intervention, social workers and other mental health professionals provide an alternative path of intervention to a crisis caused by mental illness. A crisis, like a psychotic episode or suicide attempt, can be the only sign many of us, including the police, witness. Yet this acute or momentary problem may be just a tiny part of a larger universal problem.

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official guidebook for determining mental illness published by the American Psychiatric Association, contains diagnosis codes for being impoverished or disenfranchised due to the mental anguish an individual experiences due to their perceived station in life. The codes below match the circumstances that are easily identified in people living in poverty.

    • 2 (Z59.6) Low Income
    • 2 (Z59.7) Insufficient Social Insurance or Welfare Support
    • 9 (Z59.9) Unspecified Housing or Economic Problem

    Marked stress due to loss of income builds up and under enough pressure, panic can push an individual into a state of crisis. Being disenfranchised can be compared to living on a deserted island and not knowing when or if help will arrive. The person has generally done everything they can do to resolve the situation: they have made the fires, created the shelter, yet nothing changes and they continue to live from one day to the next looking for hope.

    For some people, this desperate situation fueled by multiple stressors can lead to a crisis where the police are called. Not all police officers are trained in identifying someone in crisis or have experience in the situations they are confronted  with.  Having a crisis worker involved can make an considerable difference in the outcome of the situation by both identifying the underlying cause of the crisis, and by connecting the person to essential community resources.

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