Trainings improve, but obstacles remain for mentally ill

From Street Roots, September 19 2008

If anything has become clear in the two years following the beating death of James Chasse by the hands of Portland police, it is that police officers need to know what to do when responding to a situation involving someone with a mental illness.

Soon after Chasse’s death, Mayor Tom Potter convened the Mental Health Task Force. On the task force’s recommendations, Project Respond, an information referral program for people with mental illnesses, received $290,000 in additional funding to strengthen the ties between law enforcement and mental health providers to deal with individuals suffering from mental illnesses.

“Police officers are the default interveners for people with severe mental illness,” says Jason Renaud, a long-time mental health advocate and volunteer with the Mental Health Association of Portland. “They need to know what to do.”

“It takes a long time for the police to figure out a situation with someone’s that mentally ill,” says Greg Borders, Clinical Director of Crisis and Intake Services at Cascadia Behavioral Healthcare.

One of the Task Force’s recommendations was to make a training called Crisis Intervention Training mandatory for all patrol officers and their sergeants. Officers receive 40 hours of training about mental illnesses, their signs and symptoms, and how to interact with someone expressing those symptoms. Borders says that the training has helped the police to have a better understanding of how to work with individuals with a mental illness.

“There was a lot of energy after James Chasse died to increase capacity,” says Lynnae Berg, assistant chief of operations for the Portland Police Bureau.

“We really wanted to get away from the idea of us and them,” says Leisbeth Gerritson, the Portland Police’s CIT coordinator.

The program started in 1995, but was voluntary, and only a fraction of Portland’s police officers took it. Officers Christopher Humphreys and Kyle Nice, the two Portland officers who approached Chasse, did not have CIT training at the time of the incident, according to Gerritson.

As of August 2008, 554 officers have received the training, and all 612 officers will have received the training by December 2008.

With the CIT training, any officer has the knowledge to properly respond to a situation involving someone experiencing a mental health crisis.

“I think the police have been greatly educated by Project Respond over the years,” says Renaud. “How many other James Chasse’s have they intervened with and de-escalated? It’s in the thousands.”

Project Respond also funds an outreach program called Intensive Services, operated by Cascadia Behavioral Healthcare.

Partnering with law enforcement, the Intensive Services program provides outreach to homeless and housed individuals suffering from the most severe mental illnesses, including schizophrenia, thought disorders, and mental illnesses with psychotic features. The program is the only one to originate from Potter’s Task Force.

The program targets those who run afoul of law enforcement and who are “frequent users of the criminal justice system,” Borders says. “There are a lot of mentally ill folks who, because of their mental illness, come into frequent contact with the police.”

Those contacts can involve something as simple as public urination, but also petty crimes such as theft and shoplifting. But there are also times when the person is presenting a danger to himself and others.

The outreach workers work with mentally ill individuals in an effort to engage them with services that can help them receive benefits, housing, medication, and solutions other than long waits in the emergency room or short stints in the psychiatric ward.

Between the time the Intensive Services project began on April 1, 2007 and June 30, 2008, 80 individuals were served, including 35 individuals experiencing homelessness. Eight of those people were placed into housing, and three were placed into permanent housing.

On Sept. 3, City Council voted to continue funding the Intensive Services program and contracting with Cascadia.

But it raises questions as to why the city is continuing to contract with Cascadia, the state’s largest, and now discredited, mental health provider.

In April of this year, Cascadia went through a financial implosion when its bank, Capital Pacific, collected on a $2 million credit line, threatening the mental health provider with bankruptcy.

A $2.5 million loan from Multnomah County and the state’s Department of Human Services is keeping Cascadia’s doors open. Currently, other providers such as LifeWorks and Central City Concern are taking over some of Cascadia’s operations, and Multnomah County is working to create a viable future for Cascadia.

“I think our partners at the city and the county actually believe that Cascadia does excellent clinical work,” Borders says, and cites instead fiscal and administrative failings for Cascadia’s now tarnished reputation.

Having the funding and training to respond to someone in a mental health crisis, however, is not remotely close to a real solution to Portland and Multnomah County’s mental health woes.

“The answer isn’t Project Respond,” Renaud says.

State and county cuts in mental health care and Cascadia’s now wobbly existence lead Renaud to say that “the mental health system is far worse off today than it was two years ago.”

“Every other social safety net is gone, or underfunded,” Berg says. “More and more, officers are the ones who are having to respond to people in mental health crisis.”

Berg says what is needed is a mental health system more preventive in nature, allowing for intervention at an earlier point in a person’s mental illness. If people can be helped and medicated at an earlier point, Berg says, they would not enter a crisis.

“One of the biggest problems we see is that there is just a backlog,” Borders says. “We just need more of everything.”

“The sub-acute center is the big missing piece,” Renaud says, referring to an emergency psychiatric center that would be equipped to treat and house individuals experiencing a mental health crisis until they stabilized.

Creating such a facility was the number one recommendation of Potter’s Task Force, which released its recommendations in January 2007.

There was a time when such a center did exist — the Crisis Triage Center — but it was closed by the county in 2003 because of poor management. Had it existed two years ago, it could have been where police could have taken James Chasse for treatment.

Lately, there have been murmurs of such a center opening. The county is partnering with Central City Concern to build a facility that would provide mental health assessments, treatment, and evaluations at the current location of the David P. Hooper Detoxification Center in east Portland.

Funding from the county and the Portland Development Commission is set aside for the building of the center, but the money for operational costs — an estimated $3 million a year — has not yet been found.

“There’s no reason to think that it will be any time soon,” Renaud says.