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Officers get enhanced training in mental health, substance abuse issues

Spokesman-Review (Spokane, WA) - 6/7/2015

June 07--When Jen Wagner told her story, her last encounter with law enforcement was fresh in her mind.

The 26-year-old college student is a patient at the Spokane Regional Health District methadone clinic, which helps people with addictions to heroin or other opioids get their lives back on track.

In early April, she was pulled over by a state trooper because she swerved while trying to grab a pacifier for her daughter from the back seat, she said. The trooper asked if she was on any drugs, and she explained she was on a prescribed dose of methadone. He got verbally aggressive and threatened to call CPS, she said, her voice shaking as she related the story.

Spokane police Officer Michele Kernkamp, who works patrol on the North Side, was visiting the clinic that April morning to hear stories like Wagner's. She listened intently as patients shared stories about how methadone treatment has changed their lives. More than once, she shook her head and said "Wow" or "I had no idea."

"What it comes down to is we're naïve," the officer said to Wagner after hearing her story. "We have no idea what methadone is."

Kernkamp is one of 13 Spokane police officers working to replace that naïveté with knowledge. They volunteered to go through more than 60 hours of training to help them better respond to crisis situations and work with people who have mental illnesses or struggle with substance abuse.

About half a dozen mental health providers joined the officers for the same training.

Officers say a better understanding of mental illness and local services helps them build rapport, act more compassionately and defuse tense situations.

It's called enhanced crisis intervention team training, or enhanced CIT, and is a step up from a 40-hour crisis training that nearly all Spokane officers have now received.

"CIT is undergraduate and enhanced CIT is graduate school," said Matt Layton, a WSU professor of psychiatry who serves as the methadone clinic's medical director and taught a session at the enhanced CIT training this year.

Substance abuse, mental illness often overlap

People like Wagner, who struggle with substance abuse, have a mental illness or both, prompt an increasingly large percentage of police calls. It's hard to quantify mental health-related calls since officers don't check a box on their reports indicating whether someone has a mental health condition, but Spokane patrol Officer Shane Phillips estimates a quarter to a fifth of his calls involve someone dealing with a mental illness or substance abuse issue.

More than 60 percent of local jail inmates had some type of mental illness, according to a 2006 Bureau of Justice Statistics study. Mania, major depression and psychotic problems like hallucinations were the most common symptoms.

Though substance abuse is not a mental illness like depression or schizophrenia, it's common for people with severe mental illnesses to self-medicate with recreational drugs, and the two categories often overlap, especially in encounters with police. Someone who's high on methamphetamine may behave similarly to someone who's having a psychotic break or hallucinations because of a mental illness, and officers often use similar tactics to de-escalate those situations.

In extreme cases like the May 6 shooting of former Army medic Craig Burton by Spokane police, an officer may be called to deal with someone who's armed, suicidal and behaving violently. But many more mundane calls go better when officers have a basic understanding of mental health, substance abuse and local resources.

Spokane police officers volunteered to attend enhanced CIT training and were selected based on aptitude.

Capt. Keith Cummings, who helps organize the training, said the department deliberately included patrol officers from different shifts. The goal is to have someone with the enhanced crisis skill set on duty at all times.

Police and mental health providers spent three days attending classroom training, which included a review of common mental illnesses and symptoms and instruction in communication skills.

Class was organized around the idea that people are experts in their own experience. For officers, that means trying to partner with people in crisis and explaining options instead of telling them what to do.

Officer Christopher Bode told the class about a time he'd been called to deal with a man whose mother had just died of cancer. She was given six months to live but died two weeks later, and her son was adamant that he didn't want other people touching her body to take it out of the house.

"He was in a rage most of the four hours that we were there," Bode said. Though the man was punching holes in the wall and yelling, Bode said officers decided the best approach was to try to talk him down.

"We just really did not want to get in a fight with him," he said. Instead, they talked -- a long process that Bode said got scary at times.

Eventually, the officers figured out that the son didn't want other people touching his mother's body and were able to work out a compromise where he carried her body out to the gurney himself.

A few weeks later, Bode got a call about a man who was causing a disturbance at a gas station. He responded and found the same man, so he walked over and said, "Do you remember me? I was there when your mom passed away."

The man remembered and calmed down. He thanked Bode for his response.

"Showing compassion ... did solve the problem," Bode said.

Using communication strategies focused on compassion doesn't mean police won't arrest people or take them to the hospital. But approaching encounters from a position of empathy lowers tension and sometimes allows people in crisis to talk themselves into a good solution instead of feeling forced.

"We can do all the things that we need to do. If we do them with this spirit, it's less likely to cause somebody to want to throw a punch at us," said Keith Bryant, an instructor for the enhanced CIT class who works at Frontier Behavioral Health.

After class sessions, officers were sent out in the field for 24 hours of immersion in mental health services. That includes a shift at Providence Sacred Heart Medical Center's psychiatric triage unit, a group discussion at the health district's methadone clinic, and time with Excelsior Youth Center and Frontier Behavioral Health's crisis response team.

Phillips, the Spokane patrol officer, said the experience gave him a better understanding of why mental health providers work the way they do, including the laws and regulations they're required to follow.

"Some of the best training we got wasn't necessarily formal training," he said.

Phillips and Kernkamp said they learned more about the services available to people in crisis through their immersion experiences.

"We only go to incidents when people call and need help," Kernkamp said. "Going out and actually seeing what these facilities have to offer is tremendous."

Police: de facto social service providers

The push to train police on mental illness around the country reflects a reality that in many places, law enforcement has become a de facto social services provider.

Officers who volunteer to undergo enhanced CIT have chosen to embrace, or at least accept, that role.

"We deal with a lot more social issues than we do crime sometimes," Phillips said. "I'm skilled at dealing with guns, dope and warrants. Now we're getting a lot of calls for mental health."

That dates back to a nationwide push in the 1980s to de-institutionalize mental health care after multiple scandals showed abysmal conditions at inpatient mental hospitals.

The idea was to move people with severe mental illnesses back into the community and provide outpatient services to support them. But funding for outpatient services didn't materialize, and many people with severe mental illness were suddenly left with nowhere to go.

"At this point, people began to notice a dramatic increase in crisis events that involved police and the mentally ill," said Randolph Dupont, a criminology professor at the University of Memphis who helped create the CIT training model for police.

The training Spokane officers get on mental health grew out of a 1987 incident in Memphis, where police shot and killed 27-year-old Joseph Robinson, a mentally ill man who was armed with a knife and threatening suicide. The shooting provoked community outrage and led to a conversation among Memphis law enforcement, academics and mental health advocates about how to train officers better.

Among the questions raised by police interactions with mentally ill people was, "Are they ready to deal with individuals who don't understand traditional compliance?" Dupont said.

The Memphis model, as it's now called, has become the dominant mental health training model for law enforcement in the U.S.

In Spokane, crisis training began in 2002, spearheaded by Cummings and Jan Dobbs, the chief operating officer at Frontier Behavioral Health. By about 2005, one-third of patrol officers were trained, Cummings said, but numbers later went down as budget issues made training inconsistent.

But over the past three years, police have intensified their efforts to train officers. The city's 2012 settlement with the family of Otto Zehm, a mentally ill man who died following a confrontation with Spokane officers in 2006, required all officers to receive CIT training.

Establishing a CIT program was also a recommendation of the city's Use of Force Commission in 2012.

To reach the goal of complete training, the department offered nine CIT sessions in 2014. Now, all officers other than new recruits have completed the 40-hour session that includes information on mental illness, developmental disabilities and local resources.

Staci Cornwell, the crisis services director at Frontier Behavioral Health, helps coordinate CIT training.

Each session includes a one-hour panel of people with mental illnesses and their family members talking about their lives. Cornwell said it's often the most well-reviewed part of the training.

Other exercises try to help officers step into the shoes of people who live with mental illnesses.

For the week they're being trained, officers are put on a "medication" schedule and given a pill box full of less-than-tasty candy, along with instructions for taking their pills. Daily check-ins during training show who's able to stick with the schedule. By the second day, Cornwell said, only about half the officers are compliant.

"They'll share stories about their medications, about why they're not taking them," she said. Those reasons are the same ones she hears from clients: everything from trying to avoid stigma while out with friends to not wanting to take something after brushing teeth.

In another exercise, officers have to interview a witness while other people are whispering in their ears to simulate auditory hallucinations. Sgt. Dan Waters said he thinks back to that session when he's in the field and runs into someone who seems to be ignoring his instructions.

"You might be thinking, 'You need to pay attention to me!'" he said. But having a better knowledge of psychosis and hallucination means he doesn't assume people are deliberately not complying, he said.

Some want training to be mandatory

As CIT has spread around the country, the training component has been adopted by thousands of police departments. Like police body cameras, training on mental health has been a seemingly simple idea that police leadership, reform advocates and policymakers can all get behind.

Keeping CIT training voluntary is an important part of the model, said Maj. Sam Cochran, the retired police officer who ran the original Memphis program. It creates a team of officers who are passionate about and specialized in mental health.

But not everyone agrees. Sue Rahr, who leads Washington'sCriminal Justice Training Commission, said responding to mental health emergencies has become an integral part of what it means to be a cop, so training shouldn't be optional.

"If someone says, 'I'm not good at shooting a gun' we don't put them on a different assignment," she said. "Every cop does need to be capable of being CIT."

A bill signed by Washington Gov. Jay Inslee on April 24 requires eight hours of crisis training for all police officers as part of the basic law enforcement academy starting in 2017, though it does not set aside funding for that purpose.

Spokane didn't have a choice about training all its officers after the Zehm settlement, and Cummings, who organizes the training for Spokane police, agrees with Rahr that giving all officers a basic set of crisis skills is important.

The Spokane Police Department's enhanced training preserves the Memphis intention of a specialized crisis team.

Though trainers volunteer their time for CIT, holding a session still isn't cheap because departments often pay overtime to cover shifts for officers who are attending. Cummings couldn't give an estimate for the Spokane Police Department's cost for enhanced CIT training.

Sheriff Ozzie Knezovich said he'd like to offer more crisis training to his deputies but estimated it would cost $216,000 to hold a training session.

He said the need for crisis training reflects larger neglect of the mental health system.

"When are we as a nation and a state going to take mental health seriously and fund it correctly? It isn't just a law enforcement problem," he said.

Spokane's enhanced CIT officers had a final day of class May 19 after completing their shifts in the field with mental health care providers.

Cummings said those officers are part of an ongoing effort to strengthen connections between mental health care providers and police in Spokane.

"We're there on many different levels. Can we improve? Absolutely. And the E-CIT program, I think, is a great vehicle to do that," Cummings said.

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