Mental health cases stress police, emergency workers; patients end up in justice system

Mental health cases tax police, emergency workers

BURLINGTON, Vt. — Police found him sitting on the floor of his old apartment near a bucket of urine, still dressed in his hospital gown.

The apartment had been condemned for the squalor — food on the floor, flies — and his smoking in bed. But the mentally ill man, just released from the hospital, had managed to get back in. For the second time in four days, he was taken by ambulance to the hospital.

Three firefighters, a battalion chief, the police chief, two police officers, a code enforcement person and a housing official responded, and finally, an ambulance crew — at a cost of thousands of dollars, Police Chief Michael Schirling said.

Police and emergency responders around the nation have long struggled to deal with people who have mental illness, and some say the situation is only getting worse. A poor economy and cuts to institutional programs threaten to overwhelm personnel trained to deal with crime and vehicle accidents, not mental crises.

“The problem seems to be accelerating in scope and severity of late,” the police chief said. “More folks in need of mental health services, more significant issues occurring on the street as a result, and fewer available services for folks in acute crisis or those who are service-resistant.”

On the same day they removed the mental patient from the condemned apartment, police searched the other end of Burlington for a homeless man who’d been yelling at kids in a residential neighborhood. Parents wouldn’t let their children out alone. Some called 911.

The man has paranoid schizophrenia and other mental illnesses but has refused treatment, so police charged him with disorderly conduct. The chief called it a “workaround,” designed to get him into the mental health system by judicial order.

“It’s a perversion of the system,” he said.

And a clear sign that the mental health system has been gutted, he said.

The Burlington Police Department recently hired a mental health specialist with federal stimulus funding to handle some of these calls, in hopes of reducing the number of people with mental illness who are shuttled unnecessarily into the justice system, Schirling said.

Around the country, as many as 1,300 departments have set up crisis intervention teams, modeled after a pioneering Memphis, Tenn., program created in 1988 after police shot a man with mental illness. The teams get specialized mental health training and work with the community on the responses.

The Memphis Police Department now has 225 crisis intervention team members who volunteered for the training.

After the move nationally to deinstitutionalize the mentally ill 50 years ago, resources were not adequately invested in community services, officials said. Many communities don’t have enough beds in inpatient hospitals or community mental health programs — where people are monitored to make sure they take medication — to respond to people in crisis. The problem is likely to worsen as states slash budgets.

“Cuts to inpatient hospitals and community services are particularly devastating because they increase burdens on law enforcement and leave police officers and other first responders with few options when they respond to people with serious mental illness who are in crisis,” said Ron Honberg, director of legal affairs for the National Alliance on Mental Illness.

By the end of 2011, state mental health budgets are expected to be slashed by 21.8 percent, on top of what has already been trimmed, according to the National Association of State Mental Health Program Directors.

In June, the association initially forecast reductions of 10 percent to 30 percent in 10 states this year, 10 percent in 18 other states, and undetermined cuts in 13 more. Those cuts are likely to be more severe, the association now says.

Burlington’s Schirling doesn’t track how much time his department spends on mental health-related calls but says it’s certainly daily. National police organizations contacted by The Associated Press don’t keep a tally, either. One gauge is that 4.2 million emergency room visits nationally in 2006 were for mental disorders, according to the latest numbers from the Centers for Disease Control and Prevention.

“Of the top 20 people who are getting service from us on a day-to-day basis, the majority of those people have an underlying thread of a mental health problem,” Schirling said.

The HowardCenter, a nonprofit organization that serves 837 adults with serious and persistent mental illness in Vermont’s Chittenden County, does a good job with its clients, Schirling said, but its community homes are often full and many people resist treatment.

Case managers have an average of 50 clients. “It’s hard to do a lot of preventive work with those caseloads,” said Todd Centybear, the HowardCenter’s executive director.

It’s not clear-cut that more community programs would reduce the number of emergency-room visits because some people refuse treatment, said Michael Hartman, Vermont’s mental health commissioner. Medication also doesn’t work on everyone and substance abuse is often intertwined with mental illness. And some people who are perceived as strange, talking or yelling to themselves aren’t necessarily dangerous, he said.

The best approach, Hartman says, sometimes is having police work with mental health agencies and local hospitals.

In Des Moines, Iowa, police have dramatically reduced the number of mental-health related arrests by relying on a team of nurses and social workers to assist with crisis calls.

Of the average of 2,000 mental health crisis calls that come in a year, only 3 percent end up in arrests, compared with the majority of them that did before, said Kelly Drain, a senior police officer with the Des Moines Mobile Crisis Response Team.

The team tries to get them services or needed medical help.

“So it’s helped as far as people going to jail. It’s helped with unnecessary hospitalization. It’s helped with saving police time on these calls,” she said.

In Burlington, the man whose apartment was condemned was released twice from the hospital. After his third emergency-room visit, he was sent to the state’s psychiatric hospital.

Burlington police hope the newly hired “outreach interventionist” will be able to handle some of the calls and develop a relationship with those who are frequently called about. By checking in and referring them to services, the specialist should be able to mitigate problems and help the subjects avoid the criminal justice system, Schirling said.

“Because they’re completely falling through the cracks,” he said. “They’re not cracks, they’re chasms.”