Evaluation Trumps Incarceration in L.A. Police Dept. Mental Health Efforts

LOS ANGELES — In the Los Angeles Police Department manual, the section addressing contact with persons who have a mental illness says the goal is to provide a humane, cooperative, compassionate and effective law enforcement response, reduce the potential for violence, and assess services available to the person involved.

That’s easier said than done when an officer encounters a person who’s irrational, disconnected from reality, and threatening himself or someone else — maybe even the officer.

Calls for help from families, friends, and observers come at the rate of approximately 25,000 a year to the LAPD. More than 14,000 of those are verified crisis calls. The Mental Evaluation Unit engages and links those in crisis to services that can help them, saving millions of dollars for the city and county and thousands of precious officer patrol hours for the department itself.

Interest in the Los Angeles unit and demand for the MEU’s expertise — locally, nationally and internationally — have increased recently. The MEU, established in the mid-1980s, has trained nearly 1,000 officers of its own and almost 130 outside agencies worldwide. It has fulfilled requests from nearly 60 agencies and departments in California, as well as in Texas, Virginia, New York, Canada, Ireland and Australia.

The focus on law enforcement’s connection to mental health treatment has come under the spotlight as communities and law enforcement nationwide seek a better way to manage this fragile population. When it goes wrong, it makes news.

“Nationwide, police have shot and killed 124 people this year who … were in the throes of mental or emotional crisis,” according to a Washington Post analysis last month.

“More often, the police officers were called by relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically, reports show.

“More than half the killings involved police agencies that have not provided their officers with state-of-the-art training to deal with the mentally ill,” the story said.

 

Not a Crime

 

Mental health experts estimate that one in five people will suffer a mental disorder in a given year.

A 2013 California HealthCare Foundation report found that one in six California adults has a mental health need. Approximately one in 20 has a serious mental illness, such as schizophrenia, bipolar disorder or major depressive disorder. (California HealthCare Foundation publishes California Healthline.)

In L.A., which has 10 million people in the county and four million in the city proper, LAPD Detective Charles Dempsey estimates the MEU serves a potential population of two million people at a time. Dempsey is officer in charge of the unit, its administration and training, and was formerly a licensed psychiatric nurse.

The MEU is supported by the L.A. County Department of Mental Health and is recognized as the largest of its type in the world. “We don’t seek out the notoriety,” Dempsey said. “Yet, there’s not another law enforcement entity that dedicates so many people solely to mental health response. We’re managing mental illness. Remember it’s not a crime to be mentally ill.”

“The LAPD has a multilayered approach, which is necessary for a more comprehensive response to connect individuals with mental illness to the most appropriate services needed,” said Nicola Smith-Kea, policy analyst for the Law Enforcement Program of the Council of State Governments Justice Center.

“The department represents a specialized policing response or SPR model, which is collaborative and encouraged for a more effective response,” she said. “Their program is consistently successful when dealing with individuals in mental health crisis, and they have data that supports the work they do.”

 

A Rich History

 

“We are now more robust and engaged than ever,” said Dempsey, recounting the unit’s humble beginning in the 1940s. “Even back then there was awareness of police responsibility during a mental health crisis.”

In 2003, LAPD piloted Crisis Intervention Team training, assessed and discontinued it, then offered an Introduction to Mental Health Training in 2006 for 800 officers. Late last year, the department introduced its Mental Health Intervention Training, a 36-hour curriculum for first-responder officers likely to encounter people in mental health crises, including those who are violent or high risk.

Overall goals for the unit are to:

  • Prevent unnecessary incarceration and/or hospitalization of mentally ill individuals;
  • Provide alternate care in the least restrictive environment through a coordinated and comprehensive system-wide approach;
  • Prevent the duplication of mental health services; and
  • Facilitate the speedy return of police patrol units to patrol activities.

The LAPD was one of the first departments to employ the concept of a co-responder officer/clinician team, established in 1994 and known as the Systemwide Mental Assessment Team or SMART. With 61 officers and 31 LACDMH clinicians, at minimum four teams per watch work in the field at one time, when dispatched by the MEU’s triage desk.

From an information access and sharing perspective, the officer-clinician partnership is a match made in heaven. Privacy laws prevent police from seeing medical records, and clinicians from seeing criminal records, but the two joining forces can share each other’s information — ultimately expediting treatment, Dempsey said. Clinicians can also access private insurance information.

 

More Help for the Mentally Ill

 


Those clinicians include licensed clinical social workers, mental health registered nurses, psychologists and family therapists, said Dempsey. They’re all qualified to write an application for involuntary civil commitment for psychiatric treatment under the Lanterman-Petris-Short Act of the 1960s — also known as the California Mental Health Act.

Typically, patrol officers are limited to taking consumers to county emergency departments, he said, and that creates a backlog. The county purchases crisis beds from contract providers — private mental health facilities — so MEU teams can circumvent the ED.

As another way around inefficient ED visits, LACDMH operates four mental health urgent care centers. The focus is on recovery and linkage to services, a process that must be completed within 23 hours and 59 minutes. After 24 hours, the person must be transferred to a psychiatric hospital bed.

“Anyone can walk into these,” said Kathleen Piché, LACDMH public affairs director. “For example, maybe they can’t get a doctor’s appointment and they need a medication refill to prevent a relapse.” Three more centers are slated within the next fiscal year that began July 1, she said.

 

Heading Crisis Off at the Pass

 

“We know how to identify those people who need help,” said Captain Kelly Mulldorfer, who commands the department’s Crisis Response Support Section of which the MEU is a part. “They tax resources because there are very few services available for crisis and it’s difficult to find them. Emergency rooms are not the best place, and when there’s no bed for them, people decompensate so quickly when waiting in the hall and not getting treatment.”

It all presents a challenging dilemma, she said. “So many people need a place to be treated. Finding them, identifying them is not the issue. What to do with them is.”

Mulldorfer is quick to dispel a common misconception. “Only 19% of those we deal with in the MEU are homeless,” she said. “The lion’s share have homes and families they’re living with.”

As with physical health, prevention should be the priority, Mulldorfer said. “Get more service providers on the pre-crisis side of the coin. Have places to go before people get into crisis and need police response, because that response may lead to custody,” she said.

The county’s efforts to manage its mentally-ill population have noticeably ramped up. That’s due especially to the commitment of District Attorney Jackie Lacey, said Mark Gale, criminal justice chair for NAMI’s Los Angeles County Council.

Both NAMI and the Autism Society of Los Angeles provide blocks of instruction for the Mental Health Intervention Training, said Dempsey. In an about-face, the mental evaluation unit trains NAMI volunteers who instruct in the countywide effort to train police officers and deputies.

Lacey spearheaded the county’s Diversion and Alternative Sentencing Program in 2014, and “she got everybody rowing the boat in the same direction,” Gale said.

The MEU has been engaged in diversion since its inception, Dempsey said. “We believe that if you look at the Sequential Intercept Model, the most effective intercept point is Intercept Number One or pre-booking diversion.”

The L.A. County Sheriff’s Department will also begin mental health training in August, Gale said. “I applaud the county, especially for being solutions-oriented, which is something you rarely hear from an advocate. Training is how you change culture from the inside out. We as society have failed by not taking responsibility for those who are at risk.”

Gale said positive momentum for the mentally ill was aided by the passage of a new state law in 2013 — the Investment in Mental Health Wellness Act — that provided funding for new resources.

Both the MEU’s Dempsey and NAMI’s Gale are encouraged by bills in the state Legislature that support additional behavioral health training for state peace officers — SB 29 and SB 11, by state Sen. Jim Beall (D-Campbell).

“The state needs to approve appropriate funding for any type of training, or it will not be mandatory,” Dempsey said.

Related Topics

Insight Mental Health