City Life

Police respond to mental illness crisis

Here's how one police department is changing...

On a frigid winter morning inside the City-County Building, Roberta Stellick, the Madison Police Department’s designated mental health officer for the east district, gets a call on her cell phone. She ducks out of the weekly staff meeting to take it and returns looking concerned. “Everything OK?” asks her captain Kristen Roman, a 26-year veteran of the force. Stellick mentions a first name, and officer Andy Naylor of the central district nods in recognition. There’s a homeless woman in danger of losing her bed at the only women’s shelter in town because she refuses to shower, a symptom of her mental illness. But there’s an upside. “If they kick her out, given how cold it’s supposed to be tonight, that might be our grounds to get her back on ‘51,’” says Stellick.

Fifty-one is shorthand for Chapter 51, one of the places where the mental health community and law enforcement intersect. It allows our government to step in if we’re a danger to ourselves or others. This plays out most commonly in emergency detention, referred to as ED, a 72-hour involuntary hospitalization often followed by court-ordered medication or other interventions. It’s a complex, critical, civil liberties decision that’s not left solely to the police. By law since 2006, crisis responders from Journey Mental Health Center—a private, nonprofit agency that gets some funding from Dane County—must agree to the need in each case. If MPD says a citizen should be committed but Journey says he shouldn’t, he isn’t—and vice versa.

“There’s a high bar you have to meet to get somebody committed. There has to be evidence of a treatable mental illness, as well as imminent dangerousness,” Journey crisis worker Sarah Henrickson says later, over coffee. “There are some people that could have a much better quality of life if we could get them connected to treatment. At the same time, I think there’s wisdom in having a pretty high threshold for suspending someone’s civil rights and forcing them into treatment.”

Team members routinely consider that wisdom, and they have plenty of on-the-job experience to back it up. Formed by Roman and Madison Police Chief Mike Koval in February 2015, this five-member team marks the first time MPD has had a full-time mental health officer designated in each district.

They’re not first responders to every mental health situation in Madison. They don’t swoop in, as you might imagine from television, talking potential victims off ledges or negotiating with someone erratically brandishing a weapon. All MPD officers train in crisis response, de-escalation and the needs and nuances of mental illness. For this team, it’s more a big-picture, upriver thing; they’re logging vital information and connecting moving dots. They’re building trust with caseworkers and crisis responders, affected family members, other cops in and out of the department and the struggling citizens themselves. They’re attending meetings and trainings and making home visits. They’re strategizing and educating, writing and distributing memos to patrol officers. And the whole team is fielding phone calls and emails on 10 to 20 cases a day, says Naylor.

Officially, MPD clocks an estimated 3,000 mental health related calls each year, about 17 percent of the total; anecdotally, says Roman, it feels much higher. But these aren’t life-or-death situations, or at least not in the way you think. “Even the dangerousness that we ED on often, it’s not the kind of things that make the news,” says Stellick. “I’d say nine times out of 10, it’s suicidal, not homicidal.”

While the vast majority of those suffering from mental illness are never violent (probably the most prevalent, frustrating stereotype out there), cops get called when nobody knows what else to do, and the offending behavior can easily result in tickets or even jail time. That’s what this group hopes to avoid by serving as a resource and ultimately a connector to mental health services instead. Throughout the hourlong weekly staff meeting, Stellick won’t be the only one interrupted with calls on her personal cell phone from professionals at area mental health agencies. It’s a big part of the job.

Fostering Teamwork
Although MPD’s Mental Health Liaison Officer Program is 12 years old and counts among its ranks 20 mental health liaison officers (who voluntarily fold this work into their regular patrol duties), it’s been only a year since Koval pulled five officers from his force and assigned one to each district to focus full-time on citizens with mental health struggles. His actions were compelled by Roman’s longtime efforts, including her successful securing of a Bureau of Justice Assistance Project grant. (Although MPD receives no direct funding from this grant, the department provides technical peer-to-peer assistance to other agencies and gets reimbursed for its expenses for doing so.)

Stellick, Naylor and officer Joanna Hollenback work the east, central and south districts respectively, flanked by officer Carlin Becker in the north and officer Eugene Woehrle in the west. Each earned the job through a competitive interview process, and each was already an MPD mental health officer. Creating this team was an unprecedented move, and unpopular at the time. No captain wants to be down an officer in his district. But now, says Koval, those same leaders would “fight tooth and nail” if he were to put things back the way they were.

Becker is out sick on this particular day but Woehrle is handling some mental health training with a suburban department, a common duty for this group. Five officers can’t do everything, nor are they expected to—the more they can share what they know, the stronger the force is as a whole. Their most notable impact so far seems to be on relieving patrol officers of the time-consuming emergency detention process, a huge resource-suck that could take six to eight hours of a patrol officer’s shift. It could take even longer if they have to transport the patient 90 miles to the Winnebago Mental Health Institute (the much closer Mendota Mental Health Institute stopped taking Chapter 51 patients in 2014, a move for which the City of Madison unsuccessfully sued the State of Wisconsin this year).

The homeless woman refusing to shower—we’ll call her Mary—will be the team’s third emergency detention in 24 hours. Stellick spent her entire shift yesterday at the hospital processing an emergency detention for a girl who’d attempted suicide. Across town, there was another case at a nursing home. “I feel like we did do a lot in 2015,” Hollenback says, and the statistics bear that out. In 2014, department-wide, MPD performed 110 emergency detentions; last year, these five officers alone did 73.

But processing emergency detentions isn’t the end goal, not for this team or for the agencies they work with every day.

“We want to be as proactive as we possibly can,” says Naylor, “in order to prevent crisis situations from happening.”

Hollenback nods emphatically. “We understand that jail isn’t appropriate the vast majority of the time, so we try to do everything we can in order to avoid that as an end result,” she says, mentioning another name, let’s say Tina, who sold her living room furniture to pay public nuisance citations. She can’t afford another ticket and she’s not yet connected with adequate services, and so Hollenback drives Tina to her mental health appointments herself.

It’s not that there aren’t a lot of resources in Madison, the officers say; it’s that there aren’t enough officers, and everybody’s spread too thin. “I think we’re in a really fortunate position in this role,” says Hollenback, “to be able to advocate for a lot of consumers in our community.”

Each officer has a dozen stories like Mary’s and Tina’s. Naylor started keeping a spreadsheet last year, a database of names of those with mental illness with whom he’s made contact or read about in police reports. He checks it when he interacts with folks, or when other officers call or email to ask about so-and-so—the Marys and Tinas of Madison. It’s how he tracks who might be most vulnerable, who’s off medication, whose delusions translate to a lot of 911 calls to report threats that aren’t there. Whose mothers or sisters or uncles are worried. What worked last time, what didn’t. As of this meeting, the spreadsheet is up to 385 names.

That sounds high to Stellick and Hollenback, but Naylor has the central district, where a larger percentage of homeless people congregate (and an estimated 46 percent of all single homeless individuals suffer from mental illness). For them, on a daily basis, it’s more like 60 names. People whom all five officers know by their faces, their struggles, their complex, cyclical stories. By virtue of the job, they don’t get to see how their efforts might be paying off. But there’s one clear thing that marks a win, says Stellick, and the others chuckle in wry agreement.

“It’s when we don’t hear that name anymore,” she says.

Forming a Circle of Trust
Success could never be measured in this way for those with mental illness—the “names” themselves. For “consumers,” as they’re known in mental health-speak, police interactions are complicated at best. At worst, they can be terrifying and threatening.

“I think it was a little aggressive behavior, with handcuffs and dragging me to the ground and pepper spraying me when I was having a nervous breakdown at 23 years old,” says John—not his real name—from his place in a large circle of chairs, where 22 MPD recruits in full uniform sit, listening.

No one in this group pepper sprayed John; he’s talking about a police interaction decades ago, one of many he’s endured throughout his 40 years of mental health treatment. But for him, a uniform is a uniform. He does not disclose the specificities of his illness, just that when he feels scared or threatened, he becomes violent. Often, interjects his caseworker (who is sitting next to him and who is unnamed, to protect John’s privacy), John just needs five or 10 extra minutes to “pull it together.” When he’s manic he has disorganized thoughts, which make him process information more slowly. “He’s had a lot of not-positive interactions over the years with police,” says the case worker, adding that this training is as much for MPD’s benefit as it is for John’s. It’s a calm, quiet, compassionate experience in a room full of uniformed officers.

All MPD recruits receive 40 hours of Crisis Intervention Team training. On this particular day at the Police Training Center on Femrite Drive, Lindsay Wallace, executive director of the National Alliance on Mental Illness—better known as NAMI—of Dane County, has just wrapped up a presentation. “In talking with families and consumers, there is a lot of distrust with the police because they’re witnessing their kids being pushed to the ground and put in handcuffs and arrested,” says Wallace. But she’s seen the opposite from the five MPD mental health officers. “I’ve gotten to witness them interact with people. They have so much love and compassion and understanding.”

Roman and the five mental health officers are dressed in plain clothes at the back of the room. After Wallace’s talk, the recruits push all of the tables to the edges of the room and create a circle of chairs to help the consumers feel more comfortable. There’s John and his social worker. There’s a woman named April whose developmental disability complicates her mental illness. There’s a mother, Sue, whose clinical depression descended after years of caring for her son, who has schizo-affective disorder. And there’s Wallace herself, who lives with bipolar II disorder, along with a handful of other diagnoses. Each takes a turn sharing the intimate details of their life experiences, including their positive and negative police interactions.

April’s had both. She was traumatized during an emergency detention when, despite her pleas, officers didn’t make arrangements for her service dog while she was hospitalized. But on another occasion, April says two officers stood up for her against a case worker she says was attempting to ED her over the phone, without meeting her. “The worst thing you can do is treat somebody with disrespect,” she says.

One recruit raises his hand and asks what he can do to make emergency detentions feel better for the consumer. “Ask them, is there anything that you need from me?’” says April. “I would probably be like, ‘Wow, you really want to know what I have to say?’ Just that humanization.” Sue tells the recruits to be compassionate to the consumer’s family members. “Tell them about NAMI. Tell them there’s help, there’s hope,” she says. John’s caseworker advises that they work proactively. “Put yourself out there. Get to know the individuals,” he says. “If you’re able to make the connection and build a relationship when somebody is doing well, that goes so much further if they’re not.”

From the back of the room, Hollenback tells the recruits that every one of them is trained and equipped to effectively handle these cases, and Woehrle reminds them: “Don’t forget about all of your professional communications skills and your empathy and compassion.” This reinforcement from the veteran officers goes a long way, says Wallace, after the consumers are applauded and thanked and the circle breaks.

“They bring a lot more credibility to officers than me coming in as a mental health advocate,” she says. “Because, you know, I’m an outsider. And the police culture is just so different.”

Building Bridges
The relationship between city police and area social services agencies is hardly new. But there was a time “when if a police officer showed up at the mental health clinic, they were the enemy,” says Ronald Diamond, a University of Wisconsin–Madison professor of psychiatry and former medical director of Journey (then called the Mental Health Center of Dane County).

Diamond had a front-row seat to former police chief David Couper’s efforts to repair that relationship and prioritize mental health efforts. In 1975, Couper was the first to designate an MPD liaison between police and mental health: an officer named Michael Puls, who also held a master’s degree in social work. Dane County crisis workers often met officers in the field. Crisis workers participated in ride-alongs with police, and those same officers visited mental health agencies to gain awareness. “At the time it was highly innovative and considered quite new,” says Diamond. “A tremendous amount of collaborative—on the street, in the middle of State Street, in people’s apartment—kind of stuff, a 24-7 kind of thing [happened]. It was a very heady, very exciting time.”

But over time, Roman says, those resources and funding for the mobile field response tapered off and dwindled. When she got her start at MPD in 1990, it was at the tail end of Couper’s reign. Over the years, MPD’s social services liaison officer evolved into a sergeant’s position, one she eventually held. When keeping track of all the individuals with mental health needs became “like a needle in a haystack” for one person, the mental health liaison officer program was formed in 2004, with Roman as its coordinator. These officers weren’t paid extra and it wasn’t full-time, but it helped. They were able to follow up, do some outreach, gather bulletins, create safety plans and build relationships. Today, having these five designated officers formalizes what those who came before them have done, and it’s “what should be done,” says Diamond.

In February 2016, Henrickson, of Journey, got her own cubicle just outside Roman’s office—another unprecedented move for MPD. She’ll remain a Journey employee but work three days each week out of MPD’s Central District office, where “she’ll be able to put some of the puzzle pieces together because she’ll have the biggest picture,” says Roman. She can respond out in the field with patrol officers. And she can bridge the sometimes disparate mental health and law enforcement islands because she speaks the language of each and has access to information from both. Henrickson, like the rest of her colleagues in the crisis unit, has been working closely with MPD for quite a while—but with the changes this year, her position and the five dedicated officers among them, it feels new, and hopeful.

To have five full-time people focused on mental health has been a huge help for how the crisis team works with police, says Henrickson. “Everybody in my unit knows exactly who they are—and has, I would say, a good, trusting relationship,” she says.

While the jails are still inundated with those suffering from mental illness—Dane County houses between 700 and 800 inmates each day, 40 percent of whom have a diagnosable mental illness—the hope is efforts like this will drive that number down.

“Why would we arrest a person who has mental illness?” says Henrickson, who also serves as Journey’s law enforcement liaison to all of Dane County, including the UW–Madison Police Department and municipalities such as Fitchburg, Sun Prairie, Verona and Middleton, who’ve each shown an increased interest in what MPD is doing. “They’re starting to develop, on a much smaller scale, their own mental health liaison officer programs,” she says.

Measuring Success
Police are not mental health professionals—although MPD’s Stellick has a master’s degree in counseling psychology and prior experience as a caseworker—nor are they expected to be. Untreated substance abuse, developmental disabilities, homelessness, poverty—these issues compound already complex cases. If crisis workers can perform nuanced assessments case by case, and patrol officers overall can develop a more innate awareness of mental illness, maybe those jail numbers can drop and this population can get the help it needs. That’s the idea, anyway.

The success of programs like this can be hard to measure, beyond anecdotes like not hearing a struggling citizen’s name anymore. That’s one of the next steps, says Roman, and researchers at the UW–Madison sociology department have agreed to take it on. Measuring outcomes and the “impact this team is having,” says Roman, will help make the program accountable and sustainable. But the total impact may never be revealed, because how do you effectively measure the absence of something?

Diamond recalls a particular case about 15 years ago when his patient’s behavior had sparked “35 or 40 police calls” from concerned residents. Roman held an hourlong community intervention with Diamond in which they addressed concerns and educated those present. And the calls just stopped, says Diamond. Nobody was arrested. It didn’t make the news. But police stopped hearing that name.

“This is one of those quiet things that, when it works well, will only be known to a relatively small number of people,” says Diamond. “But it is exactly where the mental health and police should be, and should be going.”

Resources

NAMI of Dane County offers resources for mental health consumers and their affected family members, including help lines and peer support groups, 608-249-7188

National Suicide Prevention Lifeline
24-hour crisis line,
800-273-8255

Parental Stress Center, Inc.
Parent Stress Line,
8 a.m.-10 p.m. daily,
608-241-2221

For additional resources, visit namidanecounty.org/resource-guide/list-of-resources/help-lines-and-peer-support-groups/


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