How did we get to the point where mental health care has become a
police issue? Over the last 28 years I have watched the government's
response to mental illness shift from being a state issue - to being a police
issue whereby too often when a person is having a mental health crisis, the police
are called and sometimes the person in crisis enters the criminal justice
system as a result. It has put our police and criminal justice system in a bad position and subjected our efforts to
significant criticism and scorn. In turn, the narrative in 2020 has become, "the
police are the problem."
In an article published on-line by Dr. Roy W. Menninger (History of the Mental Health Care System in Kansas), asylums began in the 19th Century with good intentions by volunteers; not the government. As time went on asylums became "human warehouses." Beginning in the 1950's there became a growing focus on deinstitutionalization as the conditions in many of the state hospitals were facing increasing scrutiny of their conditions and treatment of patients.
Menninger writes "Albert Deutsch published Shameof the States (1948), reflecting the horrors of state hospitals, primarily Byberry in Philadelphia: patients flung into misery and seemingly forgotten. But it was intended as a call for reform, not censure or closure. Further exposure of state hospital conditions in the movie of MJ Ward’s novel,“The Snake Pit,” (1949) starring Olivia de Havilland; on the cover of Time magazine." At the height of the use of state hospitals, Menninger reports Kansas had approximately 5,000 beds.
The development and use of antipsychotic drugs also grew and the focus became "community based" mental health - that is, moving the patients from the institutions and back to their hometowns and closer to their families. Menninger goes further saying, "Deinstitutionalization was the true ‘shame of the states.’ One-third became homeless; many transferred to other institutions lacking treatment capabilities: nursing homes, boarding houses, etc. and especially jails. In short, it was transinstitutionalization, not deinstitutionalization."
As I worked the streets, the increase of those in a mental health crisis was significant. Some of the mental illness was organic, some was from meth and other illegal drugs, and some was a combination of both. The more I worked to address repeat calls for service, the more I saw a significant percentage were driven by those in crisis and drug addiction. I began to work closer with social workers to obtain civil commitments with the goal of helping the individual in crisis and resolving on-going calls. While we increased our communication with our social workers, we still operated out of silos. As different social workers and supervisors came and went, we would undergo the time-consuming process of building relationships, understanding and work to solve problems.
I had been gently pushing for social workers to be embedded in the police department since we were the first responders for those in crisis. We also had the database for those threatening suicide, attempting suicide, and those who were homeless and a danger to themselves and others. I wanted social workers to have access to our database and respond and address those in crisis using their knowledge and systems in order to effectively stabilize the individual. Despite a lot of conversations, we were unable to get the right people's attention to fund these positions.
Everything came to a head in 2013 or 2014 when an officer shot a suicidal male who was in a meth-induced psychosis and came at the officer with a butcher knife. Fortunately the male lived, but what we found when we completed a review of the incident showed significant gaps in our systems that needed addressing. If my memory serves me correctly, the male had been the subject of four police calls for threatening suicide. Each time officers responded they were able to get the male in for an evaluation without any problems. After the evaluation, the male was always released by a doctor as he agreed to attend a voluntary treatment program at a later date. On the fifth suicide incident in a 10 day period, the male was shot by a police officer. We found the paperwork completed by the treating physician had not yet made its way to the social workers for follow up.
It was clear to me that we needed to expedite our response. I approached several county commissioners and shared the details of what we found. I requested that they fund an embedded social worker to review all suicide and mental illness calls daily so we could
respond more nimbly and quickly to someone in crisis needing immediate help. The commissioners bought into the idea and funded the first embedded social worker program in the state of Minnesota.
In Wichita we collaborated to create ICT-1, which has shown significant success; you can read more about it here. We continue to build on the need for an integrated response to mental health in our community in an effort to move mental health crisis response away from only being a police issue. In my next post I will write more about how we are evolving and making lives safer by collaborating with our community partners on this critical issue.