San Diego Experts Discuss Police Interactions With Mentally Ill People

Our top story is that in all of the controversy surrounding the shooting death of Fridoon Rawshan Nehad by a police officer, one fact is disputed all agreed that he was mentally ill. Statistics in San Diego County, show that calls involving psychiatric emergencies have skyrocketed in. Up 67% countywide in the last five years. In the news conference yesterday, District Attorney Bonnie Dumanis said that an estimated 40% of people shot by the police in the United States, are mentally ill. Why are these interactions increasing so dramatically ? Why do some and so tragically? Joining me is Dr. Mark Marvin , he is Director, Community Research Foundation's Psychiatric Emergency Response Team , known as part. Welcome to the program. Thank you so much. Theresa Bish is here , and she had a family member who suffered from severe mental illness. Welcome Theresa Bish Thank you morning. Market, how do law enforcement agencies use the psychiatric response team? In San Diego County, we are thankful to have a wonderful collaboration amongst the clinicians and Director, Community Research Foundation's Psychiatric Emergency Response Team , and our law enforcement partners which comprise of the officers in the county, and the sheriff department. Also, a collaboration with the local agencies and behavioral health services, as well as our consumers and family members in the mental health system. It allows us to deliver what we consider a best practice and state-of-the-art services. Do you a company police officers on calls? Yes. Currently as of this fiscal year, we have expanded from 23 teams to 33 teams. They ride with the sheriff deputy or police officer, on typical calls. Some of the units are designated. They do not respond to criminal type calls. Most of the teams are out there responding to all calls. However, when a psychiatric matter comes the attention of dispatch, the dispatchers in the county are trained to authorize a pert unit to dispatch a pert unit to the scene. Was at the scene, the officer Deputy takes the lead and assesses for safety. Backing up, along the way the pert clinician, will try to at this records to see if the person is in the system. This gives us a heads up. Because one of the hallmarks of this program is -- one of the slogans I like to put out there often, is that it is all about the relationship. What that means is to build trust -- Nunnelee for the consumers, but also for the family members. We may have many contacts with the family members this help us, when we make contact with the person in the community who is struggling with this process. This will lot of to know best what works. The officer Deputy on the scene, will access safety, and then the pert person will get out and do what? What you do? Basically, it is mental health out in the field. It is taking and assessment and talking, listening, problem-solving -- we run the gamut. A lot of our contacts me just be talking about resources, trying to help convince that person that perhaps going to patient therapist, psychiatrists would be a good idea. What is prevention all about? What kind of issues are you struggling with at home? Other calls involve a very serious psychiatric interaction. Someone in fact may be at a point where they are danger to themselves or someone else. Perhaps, disabled. It is up to the clinician to determine that level of risk. What we want to do is prevent unnecessary hospitalization or incarceration. Theresa Bish, let me bring you into the conversation. We have all seen this video that was released yesterday of the shooting death of Fridoon Rawshan Nehad. I would like to get your reaction to it in light of your experience with the mentally ill. Of course, like most viewers, it is gut wrenching. It is a tragedy for everybody involved. My experience, while I was on the mental health board, and was cheering in 2010 and 2011, are critical incident committee looked at shootings involving officers of the mentally ill. Fridoon Rawshan Nehad would have met the criteria for Laura's law , have implemented it earlier. Midas what Laura's law is. It is known as assisted outpatient treatment. It would mean to him, that we could have stepped in sooner and been proactive. He would not have lost his housing. He would have had more case management, as an outpatient. He possibly, would be alive today, and the fiscal savings is enormous. It also cuts down on emergency contacts. Additionally, while I was on the critical incident committee, I heard many of the same comments by law enforcement, that I heard in 1990, while studying forensic services for mentally ill. That is that the mental health officials have not done enough for this population. The hard to treat. Instead, it -- too much has been put on law enforcement to deal with. Historically. The family has said that they are very concerned about the brothers safety. His mother went on to say that recently, she had put out a restraining order against him, in order for him not to have an address, so that he could go to a treatment facility. He would qualify for that treatment facility. Is that really the only way that families can get treatment for their loved ones? Historically, today, yes. When somebody is not compliant, or they do not recognize that they have a problem, we have to wait for a crisis to intervene. We know that approximately 3000 involuntary holds are called for in this county annually. As a family member, I had to also file for a restraining order on my older brother. This is a last resort scenario. It is horrible to have to do that. You do not want to, but when the person degrades to such a state, you are looking for every mechanism possible to get that person into treatment. Mark, in your experience, do police officers feel particularly threatened by people who are behaving erratically, for not obeying orders? Part of our training is to reduce the stigma of mental illness. Unfortunately, in our society in general, it seems that most people's idea of mental illness is not based in what really occurs. It may come from some sort -- may be something they saw as a kid at the drive-in. The bottom line for law enforcement, is that nationally, about 25% of the calls coming into dispatch, involve a psychiatric crisis. You had mentioned, that the stats are growing. 67% increase. Even more staggering, the central omission in San Diego Police Department, has seen a 102 increase in services. For training of law enforcement officers, including detention deputies, the first thing is to reduce the stigma. When you say reduce stigma, does that mean do not be afraid right off the bat, of somebody who appears to be acting in a way that is erratic or could indicate mental illness? Right. It is to not have the goal of turning the officer into a clinician. Basically, it is adding to their toolbox. We do trainings that involve the use of force continuum, but most of this is listening and conversation. It is a presence that builds trust. The cousin it is not just the one contact that this officers going to have. Officers in detention deputies, may have additional contact with the family. It sets the tone for the officer's relationship and for all law enforcement. We want to build on that to give them a basic understanding, that somebody may not be responding, because they are hearing voices that we are not hearing. Maybe their beliefs are not based in reality. How to approach and how not to approach is a huge part of our training with the scenarios. I also want to say that it is great that Theresa Bish is here. One of the biggest part of our training days one the most favorable result as we bring in consumers and family members to talk about the reality. It is really touching. It gives the officers a different perspective. Teresa, when a police officer pick someone up, whom they suspect is mentally ill, what happens to them? Typically, they will be hospitalized or incarcerated. Went they commit a crime, they are taken to county jail. They are treated in County Jail for mental illness, and sometimes drug or alcohol as well. Again, this is the most costly and least effective, and most restrictive type of service that is provided to the mentally ill. This is versus treating them on an outpatient basis with some case management. There is recognition nationally that mental illness is a growing problem. It is not just exclusive to our County, but nationally. I'm sure your listeners pay attention to the news. There is legislation pending to expand federal funding for things such as assisted outpatient treatment. It cuts costs so effectively and is a better means of treating somebody. Specifically, there is a bill sponsored by Representative. 10 Murphy, HR 2646, and asking Susan Davis to cosponsor. Is called helping families and mental health crisis act. It will go a long way to providing the needed help, as far as resources go, for County as well Mark, you mentioned in the San Diego district, with dispatch, these calls have gone up more than 100% over the last five years. Why? It is systemic. As Treacher meant mentioned, a lot of the services, a case management program -- outpatient services are really crucial for success. I have to say, in the last fiscal year, we had over 17,000 contacts in San Diego. Of that number, 11,000 of those involved trying to cultivate and initiation of people into resources, into outpatient services. We find unfortunately, that was a patient is released from the hospital, they often end up going back to the streets. Do you have any idea, Teresa, why the number of these calls have increased so dramatically? I do not think that our County mental health officials have been taking the responsibility seriously enough in taking care of, and creating a safety net, for those most seriously inflicted. They are legally charged by the state, with providing services for the severely mentally ill. Historically, this has not been a population that has been looked after by the Board of Supervisors and mental health officials. We have mental health services act money that has flowed into our County, that are there, that could be utilized for this hard to treat, and coffee population. Instead they are being either held, pending utilization elsewhere, or at some future time for other needs, within the mental health services department. Will Laura's law change some of that? I believe it will. They have only appropriated to $.9 million to date for that program. With the rollout. We know from Nevada County statistics, as well as Los Angeles County, the phenomenal and overwhelming savings that Laura's law provides. For example, Nevada County saw emergency contacts reduced by almost 50%. Incarceration and hospitalization at 50%. It is overwhelming. We can a tricky late that down to the taxpayers savings, so that we are not treating somebody in jail. That is at a high dollar annual amount. As an outpatient with existing services that are refunded. I am interested, Mark, you said you do not train officers to be clinicians. Right now, I am afraid that I have to wrap it up. I have been speaking with Dr. Mark Marvin, Director, Community Research Foundation's Psychiatric Emergency Response Team . Also, Theresa Bish . Thank you so much for coming in and speaking with us today. Thank you Maureen.