The stories make the news with increasing frequency: A frightened person screaming for help when nobody else sees danger. Suicidal or scared people climbing onto freeway overpasses or bridges, either contemplating taking a leap or just contemplating. A confused, bewildered person walking around naked in an airport.

Where do they usually end up? In jail. And that is the worst possible, least compassionate place to put a person suffering from mental illness.

For mental health advocates and professionals, it’s a painful reality that’s difficult to accept. We all want to believe that we live in a civilized society.

But in Nashville and several other communities around the country, law enforcement and the mental health community are working together to improve the situation. In fact, Nashville, (and Tennessee too), have led the nation for quite some time in finding humane ways to keep the peace without putting a distressed person with a mental disorder through further trauma.

“There is nothing the criminal justice system can meaningfully do to make a positive impact on Mr. Walters or someone in his situation,” said Metro Public Defender Dawn Deaner, who defended William Walters, then 46, when he climbed atop an Interstate 65 freeway sign in Nashville last year. “That’s not what the criminal justice system is for. That’s what hospitals are for. That’s what treatment centers are for. We shouldn’t have dealt with his case.” 1

Deaner made her comments in an interview with The Tennessean, which reported in January 2016 on the problem of throwing nonviolent people with mental illness into jail. Now, a year later, Nashville’s new jail is being built with something that never has been done before anywhere in the US. The jail will include a separate wing with a 64-room behavioral health center. People with mental illnesses who commit misdemeanor crimes will be treated there and then released into the community mental health care system.

In a WKRN-TV report, Davidson County Sheriff Daron Hall said about 30 percent of the inmates at the jail he oversees have a mental illness. He believes that getting them into treatment instead of locking them up will save taxpayers millions of dollars over the long run. The new jail is set to open next year.2

Just Yelling in the Wrong Place Can Land You in Jail

In other communities around the nation, scenarios are even worse, at times unthinkable. In some areas, officers can arrest someone simply for making a “scene” and jail them on absolutely no charges at all. Laws vary from state to state, but they can do this under the provision (true or false) that a person is “suicidal,” or that criminal charges could be pending.

Taken into custody for something as simple as yelling in a public place, arrestees are often held in solitary confinement, which is known to worsen symptoms in many mentally ill people.3 There have even been cases reported where mental health professionals have deemed an inmate being held on no charges as not suicidal, but the jail kept them there for 48 hours or even longer (in many states, it’s 72 hours).4

While such reports may sound extreme, and appear to clearly cross the line of violating a person’s civil rights, some law enforcement officials argue that it’s a way to teach someone a lesson while also sparing them a criminal record. But it’s a practice that is inhumane, intolerable, and leaves municipalities open to massive liability.

The relationship between mental health professionals and law enforcement has long been strained. But things are slowly getting better, thanks to a nationwide program that, again, found its beginnings in Tennessee — this time in Memphis. That program, known as CIT, or Crisis Intervention Training, has gone global.

“Early on in the task force meetings that eventually led to the development of the CIT model in Memphis, it became abundantly clear that law enforcement and mental health providers were extremely frustrated with and did not trust each other,” according to a 2012 paper published in the peer-reviewed medical journal Best Practices Mental Health.5 “Providers felt that police officers lacked understanding of mental illness and would often exacerbate crisis situations. Police officers were frustrated that hospitals often would not provide care for people that they transported who were clearly symptomatic and likely to continue to come to police.

“Family members involved in these meetings expressed frustration with both the police and mental health providers. As each group gained an understanding of the others, they were able to work together to develop a solution in the form of the CIT model.”

Voluntary Mental Illness Training for Cops

CIT training is largely voluntary, although some municipalities require all officers to have it. The model varies widely from jurisdiction to jurisdiction based on the resources available. Some cities train enough officers in CIT so whenever they get a mental health-related call, only a CIT-trained officer gets dispatched. But that can be problematic, because in many places, dispatch centers operate independently of law enforcement agencies, which creates a disconnect.

Officers attend CIT training for a full 40-hour week. They learn about various mental illnesses, how to defuse a mentally ill person who is under duress, and even get to meet people who have recovered from mental illness. They also rehearse various scenarios where an officer may encounter someone with a mental illness who is having a crisis.

“CIT gives officers more tools to do their job safely and effectively,” the National Alliance on Mental Illness reported on its website.6 “It helps keep people with mental illness out of jail, and get them into treatment, where they are more likely to get on the road to recovery.”

Often, people know that they have a mental illness, but for whatever reason — stigma, the side effects of some medications — do not seek help. Like any illness, you don’t realize how much you are suffering until you feel better. Seeking treatment in a psychiatric hospital is scary, largely because of how Hollywood has depicted them and because of perceptions put forth by people who unfortunately may have had a bad experience or didn’t get better.

But people with mental illness can be proud in knowing that Tennessee has been a pioneer in compassionate mental health care for many years, from the new jail being built in Nashville, to the CIT program, to the creation of more and more “mental health courts,” which also aim to keep people out of jail. Tennessee seems to be ahead of the curve for the kind of mental health care that the rest of the country is trying to emulate.


Sources
1. Meyer, H. (2016, Jan. 25). Mental illness stretches Nashville justice system. The Tennessean. Retrieved March 12, 2017, from http://www.tennessean.com/story/news/local/2016/01/25/mental-illness-stretches-nashville-justice-system/78407052/
2. Sherman, N. (2017, Jan. 4). Nashville to build first-of-its-kind health center for mentally ill arrestees. WKRN. Retrieved March 12, 2017, from http://wkrn.com/2017/01/04/nashville-builds-first-of-its-kind-health-center-for-mentally-ill-arrestees/
3. Felthous, A. Does “Isolation” cause jail suicides? (1997; 25, 3). Journal of the American Academy of Psychiatry Law. Retrieved March 12, 2017, from http://jaapl.org/content/jaapl/25/3/285.full.pdf
4. FindLaw. How long may police hold suspects before charges must be filed? Retrieved March 12, 2017, from http://criminal.findlaw.com/criminal-rights/how-long-may-police-hold-suspects-before-charges-must-be-filed.html
5. Watson, A. et al. 2012 Dec; 8(2): 71. The crisis intervention team model of police response to mental health crises: A primer for mental health practitioners. Journal Best Practices Mental Health. Retrieved March 12, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769782/
6. NAMI. What is CIT? Retrieved March 12, 2017, from http://www.nami.org/Law-Enforcement-and-Mental-Health/What-Is-CIT

Written by David Heitz