Mentally Ill Lives Matter

Question: Why do people call police to handle someone with mental illness? Answer: Because calling the mental health system is almost always useless.

The day after Christmas, allegedly mentally ill Quintonio LeGrier came after Chicago police with a bat and was shot by one. So was Bettie Jones. A report on justifiable homicides by the Treatment Advocacy Center found that "At least half the people shot and killed by police each year are believed to have mental health problems."

To address the issue, legislators in Washington, New York and multiple cities have supported providing police training on better ways to handle the mentally ill. As someone with a mentally ill relative, I know it may be useful, but police Crisis Intervention Training is not the best way to solve the problem. The police step in when one condition has been met: the mental health system failed. Police are not the problem. The mental health system is. It only accepts the highest functioning into their programs and turns the most seriously ill over to criminal justice. As Police Chief (Ret.) Michael Biasotti, former President of the New York State Association of Chiefs of Police explained to Congress

We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. ... [M]ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.

As a result of advocacy by some in the mental health industry, almost all new investments in mental health go to the highest functioning individuals or irrelevant programs like 'public education,' not treatment programs for the seriously ill. As Pete Earley wrote in the Washington Post the day before Mr. Legrier was shot, states are closing psychiatric hospitals that serve the most seriously ill. Programs willing to serve the most seriously ill, like New York's world-famous Fountain House are forced to raise their own funds due to lack of public funding. Until legislators force the mental health system to accept, rather than shun the most seriously ill, police training is at best a Band-Aid.

No officer wants to pull his gun. It is a sign that something has gone terribly wrong. Professionals in law enforcement are advocating for improved care for the seriously ill, but the mental health "advocates" stand in their way. Too many mental health programs want to continue to receive their public funds, but don't want an obligation to use them for the seriously ill. They are fine with shifting responsibility for the most seriously ill to police and sheriffs. Too many advocates continue to spout platitudes like, 'the mentally ill are no more violent than others,' which disingenuously hides the reality that some of the most seriously ill, when allowed to go untreated, are more violent than others. Hence, the calls to police.

To force the mental health system to accept the most seriously ill, criminal justice leaders propose greater use of Assisted Outpatient Treatment (AOT), called "Laura's Law" in California and "Kendra's Law" in New York. AOT is only for a small group of the most seriously ill who because of refusing treatment, already accumulated multiple episodes of hospitalization, incarceration or threats of serious violent behavior. Many are so ill they don't know they are ill and therefore won't accept treatment. These are the people most likely to come into contact with police. Off treatment they spiral out of control and police are forced to intervene. AOT prevents the spiral by allowing judges to compel them to accept treatment while they continue to live free in the community. Los Angeles found it reduces incarceration 78% and thereby cut cost to taxpayers 40%. Similar results around the nation, led the Department of Justice, National Sheriff's Association, International Association of Chiefs of Police, Mental Illness Policy Org., the Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Healthcare Research and Quality (AHRQ) and others to call for greater use of AOT. But parts of the mental health industry doth protest. They want to limit their programs only to those well enough to volunteer.

As a result of efforts by Representatives Tim Murphy (R. PA), the only psychologist in Congress, and Eddie Bernice Johnson (D. TX), a former chief psychiatric nurse, the just-passed federal budget includes $15 million for states to expand AOT programs. They also proposed the bipartisan Helping Families in Mental Health Crisis Act (HR 2646) along with 172 cosponsors from both parties. It would provide more funds for AOT and create an Assistant Secretary of Mental Health who would be required to focus local spending of federal dollars more on those with serious mental illness. Speaker Paul Ryan has indicated support for the bill, but predictably, opposition to HR2646 comes from those within the mental health industry who want to preserve the status-quo.

Police are not the problem. Nor can they be the only solution. To reduce police shootings of people with serious mental illness requires legislators to require existing mental health programs accept those with serious mental illness, not just those without.

##

A version of this of this originally appeared in the San Diego Union Tribune on December 5, 2015 and was written by DJ Jaffe and Theresa Bish.