CRIMINALIZATIONCRIMINALIZATIONOF MENTAL ILLNESS OF MENTAL ILLNESS

ANDANDTHE LAW ENFORCEMENT ROLETHE LAW ENFORCEMENT ROLE

Risdon N. Slate, Ph.D.2010 FBI National Academy Utah ChapterFall Training – St. George, Utah

Free AssociationFree Association

•Mentally Ill

PsychoPsycho

Jason in Jason in Friday the Friday the ThirteenthThirteenth

Jason on Arsenio Hall ShowJason on Arsenio Hall Show

Crisis in Mandarin ChineseCrisis in Mandarin Chinese

Crises Often Drive CJ PolicyCrises Often Drive CJ Policy

•Crisis Intervention Team Training•Eugene Gregory and Alan Singletary•Andrew Goldstein•Aaron Wynn•Brad H.• Seung-Hui Cho

Recipe for FailureRecipe for Failure

•Not offering adequate treatment

•Providing no follow-up on re-entry into the community

California’s Lanterman-Petris-California’s Lanterman-Petris-Short Act Short Act

•Prompts Abramson to coin the phrase “Criminalization of Mental Illness”

•WHY?

•Magna Carta of the mentally ill (Abramson).

Each of the following cited for Each of the following cited for contributing to the criminalization contributing to the criminalization

of mental illnessof mental illness

•CJ Process viewed by LE as more expeditious than MH Process

•Deinstitutionalization

•Inadequate community support service

•Lack access to intermediate & long-term care

DeinstitutionalizationDeinstitutionalization

Patients in State Mental Patients in State Mental HospitalsHospitals

20th Century 21st Century

• Beginning roughly 150,000

• 1955 peak = 559,000

• 1960 – 1980 = < 100,000

• Beginning = _______

• Estimated today = _______

. . . The grim statistics - jails and . . . The grim statistics - jails and prisons have become the new prisons have become the new

“psychiatric hospitals”“psychiatric hospitals”

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Nu

mb

er

of

Pe

op

le

Hospitals Jails & Prisons Homeless

Harcourt, 2006 Texas Law ReviewHarcourt, 2006 Texas Law Review

•Penrose finds as prison populations decrease mental hospital populations increase; as prison populations increase mental hospital populations decrease.

•Today more persons with mental illnesses in prisons and jails than in psychiatric hospitals.

•Transinstitutionalization has take place

Factors Associated with Factors Associated with Deinstitutionalization Deinstitutionalization

MovementMovement•Inhumane conditions and abuses in state

hospitals

•Discovery of Thorazine

•The anti-psychiatry movement

2 Cases Set the 2 Cases Set the Deinstitutionalization Deinstitutionalization

Movement in Motion in the Movement in Motion in the 1970s1970s

•Wyatt v. Stickney (1972)

•O’Connor v. Donaldson (1975)

Founders of the Anti-Founders of the Anti-Psychiatry MovementPsychiatry Movement

•Michael Foucault

•R.D. Laing

•Thomas Szasz

•Work of Szasz & the anti-psychiatry

movement has made it easier to put a

person in jail than to secure treatment for

them.

L. Ron Hubbard (Scientology L. Ron Hubbard (Scientology Founder)Founder)

“There is not one institutional psychiatrist alive who could not be arraigned and convicted of extortion, mayhem, and murder” (Rissmiller & Rissmiller).

ScientologyScientology

•Religious Views

•Prominent Members

•Views on Formal Education

•Views on Psychiatry

Community Mental Health Community Mental Health CentersCenters

• JFK appropriated $3 billion in 1963 for CMHCs

•Never allocated

• JFK assassinated

•Viet Nam War

•NIMBY (Gilligan)

States’ Ways to Shift Costs for States’ Ways to Shift Costs for the Care of PWMI to the the Care of PWMI to the

Federal GovernmentFederal Government• Disability insurance

• Housing assistance

• Medicaid

• Moving persons with mental illnesses from state hospitals to nursing homes

• How Shift Costs to County & Local Govt. ?

Managed Psychiatric or Managed Psychiatric or Behavioral HealthCareBehavioral HealthCare

•Has actually resulted in payment of commissions for denial of hospital admissions

•May result in cost shifting instead of saving

•Limited choices, pre-certification, cut corners

National Alliance on Mental National Alliance on Mental Illness (NAMI) Grading the Illness (NAMI) Grading the

States ReportStates Report

•Average Grade for the Public Adult Mental Health Care Systems in the U.S. = D

____UTAH= ?

Medicaid vs. MedicareMedicaid vs. Medicare

Preferred Drug Preferred Drug Lists/Restricted Lists/Restricted

FormulariesFormularies

Hospitals do not have to Hospitals do not have to provide mental health provide mental health

treatment to those unable to treatment to those unable to pay.pay.

•Markowitz found a predominance of private psychiatric hospital beds in cities to be significantly associated with increases in both arrest and crime rates, suggesting that when the mental health system is privatized police have fewer referral options to mental health treatment and are more likely to make an arrest.

““That’s news to us”That’s news to us”

Whose job is it?Whose job is it?

MOUsMOUs

HomelessnessHomelessness

MilitaryMilitary

Daytona Beach Police Chief Daytona Beach Police Chief Michael ChitwoodMichael Chitwood

•Greyhound Therapy

•Banishment

•Cost-shifting

Surgeon General’s ReportSurgeon General’s Report

•The most formidable obstacle to future progress in the arena of mental illness and health is:

________

ViolenceViolence

• Factors linked to violence include: past incidences of violence, substance abuse, lack of treatment, and non-compliance with medication.

• “Laws change for a single reason, in reaction to highly publicized incidences of violence. …[And it] may be necessary to capitalize on the fear of violence”

(D.J. Jaffee, Treatment Advocacy Center)

• Violence & Funding for Mental Health Treatment

• Stigma - Otto Wahl

• One Flew Over The Cuckoo’s Nest

• Negative media portrayals of persons with mental illnesses have reportedly contributed to roughly half of all citizens perceiving persons with mental illnesses as being more violent than persons without mental illnesses.

• Famous persons with mental illnesses

One Flew Over the Cuckoo’s One Flew Over the Cuckoo’s NestNest

AnosognosiaAnosognosia

•Xavier Amador

•Effects

3 Largest Inpatient Psychiatric 3 Largest Inpatient Psychiatric FacilitiesFacilities

People with mental illnesses People with mental illnesses are incarcerated longerare incarcerated longer

• Riker’s Island (NYC)• Average length of incarceration

• All inmates = 42 days• Inmates with SMI = 215 days

• Pennsylvania Prisons• Inmates with SMI three times more

likely to serve maximum sentences.

Source: www.consensusproject.org

Prevalence of Mental Prevalence of Mental IllnessIllness

•Ditton Study

•James & Glaze

•Percentage of PWMI with a substance abuse disorder

THE LAW THE LAW ENFORCEMENT ENFORCEMENT

RESPONSERESPONSETO PERSONS TO PERSONS

WITH WITH MENTAL ILLNESSES MENTAL ILLNESSES

IN CRISESIN CRISES

Seth GreenbergSeth Greenberg

•“Mental illness is not a … choice; it is a medical disease.”

VPH vs. SBCVPH vs. SBC

CITCIT

•Memphis PD

Gary CordnerGary Cordner

•PWMI more likely to be injured by police and _______ times more likely to be killed by police.

PricePrice

•Police have been found to have more empathetic views than the general public toward pwmi in crises.

Ruiz & MillerRuiz & Miller

•Two most common misperceptions held by the police toward pwmi

Experts advise police not to Experts advise police not to resolve encounters with pwmi resolve encounters with pwmi

in crises quicklyin crises quickly

•However, most police agencies do not have such specialized training or a formalized policy for such interactions.

•Greenberg, in a study of 28 police training academies, found the average amount of training was _____hours.

Law Enforcement Relationship Law Enforcement Relationship with Mental Health Personnelwith Mental Health Personnel

•Fairly Negative Working Relationship•LE often views arrest and cj process as a

more expedient option than referral to the mh system.

•Mercy Bookings•“The system that can’t say no.”•MOU

No MercyNo Mercy

Mental Health Providers Refuse Mental Health Providers Refuse TreatmentTreatment

•Substance Abuse

•History of Violence

•Frequent Hospitalizations

•Inability to Pay for Services

Police RolePolice Role

•Prefer to Be Crime Fighters over Service Providers

Types of Police Responses to Types of Police Responses to PWMIPWMI

•Mental Health-Based Specialized Mental Health Response

•Police-Based Specialized Mental Health Response

•Police-Based Specialized Police Response (CIT)

Police-Based Diversion Police-Based Diversion ProgramsPrograms

•Are generally pre-booking in nature.

Mobile Crisis TeamMobile Crisis Team

•= a mental health based specialized mental health response

Lamb & his colleaguesLamb & his colleagues

•Like joining MH & LE

•CSOs Birmingham, AL = example of police-based mental health response.

•CSOs do not have arrest powers

• Arrest rates in police encounters with pwmi are lower when specialized police responses are used; in fact, they found ____ times more likely pwmi to be arrested when encountering non-CIT officers (Steadman et al.). [although one Ohio study found an increased arrest rate]

• Majority of Memphis PD officers perceived CIT as effective in reducing time spent on MH crisis calls (Borum et al.).

Reduce Police Turnaround Reduce Police Turnaround Time & Likelihood of arrest Time & Likelihood of arrest while improving linkages to while improving linkages to

the CJ systemthe CJ system

•Single point of entry to the mh system

•Streamlined intake process

•No refusal policy

CITCIT• First & Foremost, the goal is Officer Safety

• Steadman estimates _____to ____CIT programs in U.S. (Bastardizing)

• Reuland – CIT most popular of specialized programs

• Steadman et al. Memphis PD CIT (most well known).

• Greenberg Memphis CIT (most often replicated).

• Sellers et al. Memphis CIT (most effective in resolving mh crises).

CIT continuedCIT continued• Identified as the best of the 3 specialized responses for

reducing arrest rates of pwmi

• Reduces injuries to pwmi and police

• Reduction in jail suicides

• Fewer shootings of pwmi by police

• Fewer deaths for pwmi and police

• Increases access to mental health services

• Officers perform general police duties when not responding to crises with pwmi (Reuland)

• Inexpensive to implement

PWMI in CrisesPWMI in Crises

•Can typically recall their interactions with police.

•Therefore, disrespect and/or abuse by police toward them can severely diminish their cooperation with police in the future.

Typical CIT Training Typical CIT Training Components Components

• Signs & Symptoms of Mental Illness

• Types of Psychotropic Medications

• De-escalation Techniques

• Interaction with Consumers of MH Services (IOOV)

• Memphis PD CIT training includes 8 Hrs. of interaction with consumers of MH Services (Cochran selectivity in choosing participants; Borum & Thompson ___to ___% of sworn force).

Stephen R. Covey, author of the Seven Stephen R. Covey, author of the Seven Habits of Highly Effective People,Habits of Highly Effective People,

“Seek first to understand, then to be understood.”

Ten Commandments’ of De-Ten Commandments’ of De-Escalation: Escalation:

• The Art of De-Escalation http://www.neoucom.edu/CJCCOE/cit.html•  “It is the wise officer who can, at times, conceal his or her combat-

ready status.”• 1) Your safety comes first• 2) Keep therapeutic spacing• 3) Speak in tones that fit the situation• 4) When appropriate use non-threatening posture• 5) Personalize the conversation (i.e. use first names)• 6) Ask how you can help• 7) Don’t be afraid to set firm yet calm limits• 8) Never validate hallucinations• 9) Don’t internalize people’s negative comments• 10) Never forget schizophrenia, bipolar disorder, and major

depression are organic and genetic disorders. The person did nothing to inherit them. So, there by the grace of God, go I.

Comptom, Michael. T. & Kotwicki, Raymond J. (2007) Comptom, Michael. T. & Kotwicki, Raymond J. (2007) “Responding to individuals with mental illnesses. “Responding to individuals with mental illnesses. Sudbury, Massachusetts: Jones and Bartlett Publishers.Sudbury, Massachusetts: Jones and Bartlett Publishers.

  •Law enforcement responses to emotional

people in volatile situations cannot rely on convincing people by making a rational proposal to think differently. Rather, negotiators need to create a stable and respectful environment within which emotional individuals can take solace and rest. Arguing with a paranoid or aggressive person is futile. 

Tips From Fred Frese, Ph.D.Tips From Fred Frese, Ph.D.

• Remain as calm and respectful as possible.• Talk to others.• Separate the persons present and talk with them

individually to determine why one is saying that the other has a mental illness.

• Whether seeing a psychiatrist?• Case manager?• Ever in a mental health facility?• Whether person is taking or has been prescribed

medication?• Ask if the person has any strange or unusual beliefs?• Psychiatric treatment, medications, beliefs and history.

• At some point, the negotiator may want to ask what the person is hearing or seeing; in doing so, remember to be respectful of what the person is experiencing.

• Heightened Sensitivity• Persons with schizophrenia typically exhibit a heightened

sensitivity to stimuli in their environment. Person may be easily startled by sudden noises, or being overly reactive to sudden changes in lighting or quick movements by persons or objects in his or her surroundings.

• Thus, when an officer first encounters a person with mental illness, the environment should be altered to reduce stimulation. Turn down radios, and flashing lights and sirens should be minimized.

Full Metal JacketFull Metal Jacket

Rain ManRain Man

Training VideoTraining Video

Most People Who Are Mentally Most People Who Are Mentally Ill Are Not Violent Ill Are Not Violent

Thought and/or Mood Thought and/or Mood DisordersDisorders

•Psychosis = a general term for a state of mind in which thinking becomes irrational and/or disturbed. It refers primarily to delusions and hallucinations. 

•Hallucination

•Delusion

Command HallucinationsCommand Hallucinations

Tony Rolon’s interaction with Tony Rolon’s interaction with “Arnold”“Arnold”

•Who was in the attic?

•Delusion or Hallucination?

Patricia DeeganPatricia Deegan

•Hearing Disturbing Voices

HIPAAHIPAA

Medical Security ProgramMedical Security Program

Sam CochranSam Cochran

•Specialized Training VS. Services

TreatmentTreatment•Cuts drug use in half

•Reduces crime by 80%

•Reduces arrests by 64%

Linda Rosenberg, President & CEO

National Council for Community Behavioral Healthcare

Opportunity - Annual Costs Per Person – Linda Rosenberg

Lord KelvinLord Kelvin

•When you can measure what you are speaking about, and express it in numbers, then you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.”

Jail/Hospital costs per person

Program # of

Partici-pants

PRIOR to involvement

DURING involvement

(plus program cost)

Cost savings

per person

Thresholds Jail

Program (Cook

County, IL)

30 (two years)

$53, 897 $35,024 $18,873

Project Link

(Monroe County,

NY)

44 (one year)

$73,878 $34,360 $39,518

Source: Criminal Justice Mental Health Consensus Project

Cost Savings

Three County Data (Annualized)

12 Months

Prior to Enrollment

Since Enrollment

Days Homeless 205,992 63,764

Days Incarcerated

60,438 9,287

Days Hospitalized

10,906 2,435

Source – National GAINS Center

California’s AB 2034 Program

2007 RAND STUDY 2007 RAND STUDY Ridgely et al.Ridgely et al.Allegheny County, PA

Total Cost Savings of $9,584.00per participant for a½ Million Dollar Savings Over 2 Years

COLLABORATION (MOUs)COLLABORATION (MOUs)

•Mental Health Courts•Intensive Case Management•Assertive Community Treatment•Re-entry•Establishing Best Practices•Influencing Policy

Crisis in Mandarin ChineseCrisis in Mandarin Chinese

“A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.”

-- Hippocrates