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The first class of Wake cops train to recognize mental illness when they see it. But then what?

Jail, or treatment? 

The first class of Wake cops train to recognize mental illness when they see it. But then what?

You're a cop. You're called to a "scene," which turns out to be a parking lot where a young man, naked, is screaming and fighting off an older man--his father--who is trying to get him into his car. Is this a crime in progress? Soon to be compounded by resisting arrest when the cop tries his hand? Or is it mental illness on sad display? The latter, according to the dad, who said his son suffers from schizophrenia and bipolar disorder and was, at the time, off his medication and hearing a voice tell him "religious things" about baring his body, his soul, and such. But the cop was inexperienced and had never seen such a thing. He arrested the son for public indecency, which landed him in jail and then a magistrate's office instead of the mental health facility he needed.

This was in Wake County about three years ago, and if it had a bad beginning, maybe it helped bring about a good end. Because after a few missed calls and false starts, the Raleigh and Cary police departments and the Wake Sheriff's Office have teamed up to create a new CIT--a Crisis Intervention Team--which is a fancy way of saying that our cops are going to be trained to distinguish between a criminal-in-the-act and a person, not a criminal, in the throes of a psychiatric disease or addiction.

The difference isn't always obvious, Cary Lt. Chris Hoina said at a meeting of Wake County's National Alliance for the Mentally Ill (NAMI) chapter last week, and cops aren't being stripped of their authority to use force, even lethal force, if they reasonably think that it's necessary to protect themselves or others.

That said, though, Hoina, the Cary P.D. training coordinator, is a true believer that what's called "the Memphis Model" will help front-line officers get more of these tough calls right with fewer casualties--and fewer lawsuits. "Anyone who sees mental health and law enforcement and the relationship we used to have," Hoina said, "and where we could go, has got to be charged [up]."

The Memphis model emphasizes training the cops themselves, as opposed to having social workers on the force (or allied with the force), though obviously the two approaches are not mutually exclusive. But forced to choose, says Wake-NAMI member Iris Kapil, she'll go with Memphis. The research supports its effectiveness, she says, and the reason is obvious: The cops will be there anyway.

That's for sure. According to Hoina, Wake cops are called on to transport people with mental illnesses 4,000 times a year. The mentally ill are twice as likely as others to be arrested for the same activity, he added, and if they end up in jail, they stay five times as long as the "general population."

That's money out of the taxpayers' wallets, not to mention the growing number of lawsuits against police departments for mishandling--or allegedly mishandling--people who weren't bad guys, only sick guys. That's what happened in Memphis 16 years ago. Someone was killed who shouldn't have been, the NAMI folks there said it was the last straw, a lawsuit was filed, and the Memphis police invited the CIT.

Three years ago, Kapil read about Memphis, started e-mailing people like Hoina (who jokes that her message was so "noble," cops at first found it confusing--maybe you have to know how earnest Iris Kapil is to get that one), and the upshot is that a half-dozen Wake, Raleigh and Cary cops have been trained in Memphis so far and a class of 30 more cops are in the first CIT class here at Wake Tech.

Moreover, with a grant from the Governor's Crime Commission, Wake Tech is setting up shop as a statewide training venue.

There's no mystery to the training. It's 40 hours of listening to the experts and visiting sites like Dorothea Dix Hospital and The Healing Place--40 hours, in short, that aren't about how the world is riddled with crime and gangs, but rather is about how much mental illness and substance abuse there is and how scary it can look sometimes--and about techniques for de-escalating the situation when somebody's going nuts in front of you for no apparent reason.

I've seen a few of these in my time. Years ago, a friend of mine who was both an alcoholic and a former Green Beret decided he wasn't leaving when a cop told him--with good reason--to vacate the premises of a summer art show. It took three cops in all and about 20 minutes of sustained wrestling in the dirt to cuff my very strong, passively resistant friend, who really meant no harm, though I couldn't blame the cops for not knowing that.

But that just underscores Hoina's point: Why not try 20 minutes of talking and friendly body language before going at it, and maybe getting somebody hurt?

As Hoina, a couple of young Raleigh cops and the NAMI folks were talking around the table, it was impossible not to think about the case my Indy colleague Peter Eichenberger's been writing about, which saw Batrone Jamal Hedgepeth die in Raleigh after police pepper-sprayed him in the course of making an arrest on a failure-to-appear charge. Hedgepeth's mother says he was bipolar. He was resisting. (See "Arrest ignored pepper spray warnings," May 25, indyweek.com/durham/2005-05-25/triangles.html).

I have no doubt it was in everyone's mind. No one brought it up. However it comes out, it's a shame. Whether the CIT training would've changed the outcome isn't clear. But it will change outcomes, there's no doubt of that.

A footnote: So the CIT training works, the cop talks down the screaming man, now what? Old story, he takes him to Dix. New story, Dix is closing, the nearest psychiatric hospital is in Butner, an hour away, but Wake County has a new 16-bed Crisis Assessment Center near WakeMed. It's 24/7, and that's where the cop is supposed to go. But it's only for short-term treatment. What if the patient needs more?

Chris Wassmuth, the social worker put in charge of the CIT by Wake Human Services, says the center will try to hook the patient up with "appropriate services" in the community. But that raises the whole specter of the state's mental health "reform" program and its failure to supply the new community-based facilities it promised.

Nothing will kill the CIT approach quicker, Hoina warns, than if a cop takes somebody to a center and is either turned away or finds the same troubled person back on the street hours later, unhelped. Then, he says, the cop will take him to the jail--just like he used to.

Well, by complete coincidence, I'd been at a county-run meeting in Durham a few days before and heard a woman who lives with depression talk about going to the Durham crisis center. The woman, who asked that I not use her name (she works; her colleagues don't know about her illness), knew she was about to experience a crisis--a crash. She presented herself on a Friday afternoon, asking to be admitted for preventive treatment over the weekend so she could gather herself in time for work on Monday. She was sent home.

This, too, sounded like mental health "reform" at work. Durham County no longer runs its own mental health services; instead, it contracts them out to for-profit companies, one of which runs the crisis center. That company apparently did not think, if it admitted the woman, that it would be reimbursed by the county for its costs, or else it was maxed-out, staff-wise, for the weekend.

Bad decision. The woman did crash, and she ended up hospitalized for six days at UNC, which cost her work time, plus a $1,000 co-pay, plus the toll every such crash exacts from a person's long-term health, which is the biggest cost of all.

Durham County, now merely the "LME" (local managing entity) in the state's mess, is looking into the woman's complaint.

Wake County isn't Durham, and every county's response to the state's abandonment of mental health is different. But all suffer from the same lack of local facilities to a greater or lesser degree. That's why, Wake-NAMI's Ann Akland says, the new head of the state Division of Mental Health told her group recently that the reforms were "in shambles."

Wake-NAMI will be out in force at the Wake County commissioners' budget hearings Monday, June 6, at 2 p.m. in the courthouse and again at 7 p.m. at the Wake Commons Building off Poole Road. Those interested in mental-health funding issues and the questions surrounding a new county psychiatric hospital are urged to attend.

Contact Bob Geary at rjgeary@mac.com.

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