Crisis training takes some cues from Memphis

From the Portland Tribune, September 11 2008

In Memphis, as in Portland, change started with a death.

In Portland, two years ago, the death of 42-year-old schizophrenic James Chasse Jr. at the hands of Portland police prompted public outcry for change in the way officers here deal with people suffering mental illness.

In Memphis, Tenn., a similar death 20 years ago — of a 27-year-old schizophrenic man who was shot by police after he brandished a knife — was the beginning not only of change for the Memphis police department, but for police throughout the country.

The outcry from the Memphis mental health community led the Memphis police department, in partnership with local mental health activists, to form the nation’s first Crisis Intervention Training program. It’s a program similar to one that, after Chasse’s death, Portland police have turned to as their primary response to the local call for change.

But the evolving Portland program is significantly different from the one in Memphis — for the better, according to some, and for the worse, according to others. The critics say the police don’t have adequate backup in their new efforts to help the mentally ill.

Crisis Intervention Training is based on 40 hours of classroom work designed to teach police officers to recognize the signs of mental illness in people they are dealing with, and then to use social worker techniques to defuse situations that might otherwise lead to use of force.

By the end of 2008, Portland will be the largest city in the country to have required all its street officers to be trained in crisis intervention.

Nevertheless, many experts say that Portland’s program, as currently configured, never will achieve the success that Memphis has had.

Memphis effort multipronged

According to Memphis officials, crisis intervention training is only one part of their overall solution, which includes a designated place for police to take people with uncontrolled mental illness, and a partnership between police and local mental health advocacy organizations.

“I believe the Memphis model is the gold standard,” says Bradley Cobb, executive director of the Memphis chapter of the National Alliance on Mental Illness. “I believe it is a lifesaver.”

A 2000 analysis of three cities and how their police responded to incidents involving people with mental illness showed that Memphis police rarely ended up arresting subjects with mental illness — only about two out of every 100 they dealt with on the street.

In some cities, as many as 20 percent or 30 percent of people with mental illness are taken to jail. In Memphis, a city comparable in size to Portland, almost all are directed into mental health care rather than the criminal justice system — an outcome mental health and police officials agree is preferable.

Departments in Memphis and Portland do not track police use of force involving people with mental illness. But Memphis police say they’ve got a pretty good idea that their use of force dropped when they instituted crisis intervention.

According to Sam Cochran, who has coordinated the crisis intervention program for Memphis police since its inception, in the first three years after the program was instituted, injuries suffered by police officers during crisis events dropped by more than 80 percent.

“If you’re seeing where officers are not getting hurt, you can pretty much conclude that (citizens) are not getting hurt,” Cochran says.

But the program being developed in Portland differs from the Memphis model in three significant ways.

All Portland street cops trained

In Memphis, not all officers are trained in crisis intervention, and that is intentional. In fact, Cobb says, after early successes, the Memphis chief of police told him he wanted to train all of the city’s officers, and Cobb says he told the chief that wouldn’t be a good idea.

Cobb says that — similar to a police agency’s special tactics team — not all officers are qualified to routinely deal with people suffering mental illness.

“It’s more than just training,” Cobb says. “You can get training anywhere. It depends on the officer. It really has to come from the heart.”

In Memphis, police officers volunteer to be trained in crisis intervention, and then are screened, so only those selected get to wear the crisis intervention badge and are in charge on calls involving people showing signs of uncontrolled mental illness.

Before Chasse’s death, about 250 Portland police had received crisis intervention training, following the Memphis model. Now, Portland is training all its street level officers. And that’s a good idea, says Jason Renaud, a longtime Portland mental health activist and former executive director of the Multnomah County chapter of the National Alliance on Mental Illness.

“They’re wrong,” Renaud says of Memphis. “I’m convinced James Chasse proves that. The people who took crisis intervention in the past (in Portland) were looking for promotions, or were people already sensitized to the issue (of mental illness) and knew it was useful. It’s the folks who think it’s not useful training who benefit the most from it.”

Training helps alliance form

Another difference between crisis intervention training in Memphis and in Portland is the training itself. In Memphis, mental health advocates take part in the classes, from describing their own experiences with police to role-playing.

Cobb says that approach has forced the mental health community and police officers into what has become a strong alliance. “They (mental health activists) feel they have ownership in this program because they help do it,” Cobb says.

Portland is training more than 500 officers. But Liesbeth Gerritsen, a crisis counselor hired by the city to coordinate its crisis intervention training, said that while the city once used mental health advocates in its training, it was unable to find enough advocates to continue participating.

Instead she uses a videotape of interviews with local advocates.

Still, even with an entire street level force trained in crisis intervention, Portland’s police are at a disadvantage in dealing with the mentally ill because of the city’s lack of a dedicated mental health triage facility, according to Cobb and Cochran.

Portland police don’t have a place to take people once they have them in custody — something Cochran, in charge of Memphis’ program for 20 years, calls “a tragedy.”

“You’re undermining crisis intervention training,” he says.

In Memphis, crisis intervention officers are trained to take subjects they suspect of having out-of-control mental illness to a special center set up at the University of Tennessee medical center. The officers are able to drop the subjects off there and leave within minutes, and by agreement with the city, no drop-offs are refused.

In Portland, police officers’ choices are usually jail or one of the local hospital’s overcrowded emergency departments, where the officers cannot leave until physicians have signed off on a transfer.

That process often takes hours, according to police officials. That makes dropping them off at jail a much more appealing alternative, even if officers know people won’t get the help they need.
Assessment center lacking

Multnomah County officials have plans for a mental health crisis and assessment center to be located in Northeast Portland, but details and funding have not yet been worked out. The facility, if funded, could be years away from opening.

Portland police get calls about people whose primary problem appears to be mental illness about 360 times a year, according to bureau statistics.

But Gerritsen says the collapse of the Multnomah County mental health system, from the near bankruptcy of Cascadia Behavioral Healthcare, the county’s primary provider of mental health services, to inadequate state funding for psychiatric services for the poor, means there are more Portlanders with untreated mental illness than ever.

Add in the lack of an assessment center, and that means there probably will be another James Chasse event in Portland — despite improved policing.

Still, the new system appears to be working so far. Renaud says he hasn’t heard a complaint about police abusing someone with mental illness in at least six months — and those complaints used to come in regularly, he says.

“Portland has done a terrific job at getting prepared for the next experience,” Renaud says. “Perhaps the next experience has already happened and the crisis intervention training intervened and no one was hurt or killed.”

Some plans turned into action

In the wake of James Chasse Jr.’s death, Mayor Tom Potter launched a Mental Health and Public Safety Initiative, involving regular meetings by a wide variety of mental health providers, county and city officials, and advocates, that produced a 10-page action plan involving 14 separate recommendations.

Two years later, some have become reality and some haven’t.

Based on one recommendation, the Portland Police Bureau and the Multnomah County Sheriff’s Office have trained officers and law enforcement deputies with special Crisis Intervention Training classes. To address another recommendation, the county has increased its funding for Project Respond, a nonprofit group that specializes in crisis intervention with the mentally ill.

However, the Multnomah County Board of Commissioners did not fund mental health screening nurses for the jail booking area, and local jurisdictions have not produced funding for a new mental health coordination and oversight body.

The county is making progress toward setting up a 16-bed mental health crisis and assessment center, so police don’t have to take the mentally ill to jail.

Multnomah County Circuit Court Judge Julie Frantz and county Community Health Services Director Joanne Fuller chair the committee that was supposed to oversee the implementation of the initiative’s recommendations. The committee has shifted its focus to setting up a “mental health court” intended to divert the mentally ill from the criminal justice system.