Where the Police Are Part of Mental-Health Care

“We had absolutely no training 20 years ago in the police academy on how to deal with mental-health disturbances,” recalls Stevens.

Back then, Bandoske adds, police responded to mental-health emergencies the way they would to any other call: They used the tough guy command voice they’re taught to handle criminals. “Police are notorious for the A personality type. They walk into a situation. They gain control of it. It’s their call now. They’re in charge,” he says.

And more often than not, the officers ended up taking people like Mason with serious mental-health issues to jail. “They would be arresting them for just minor misdemeanor offenses such as trespassing or criminal mischief or just disturbing the peace type calls,” says Stevens.

The other option was to take the person to a hospital emergency room. But in San Antonio, the police were waiting an average of 12 to 14 hours in the hospital until the person could to be triaged; that often made jail seem like a much more appealing option. 

“You can book somebody in the jail in 20, 30, 45 minutes tops, especially if you have a partner to help share the paperwork load, and then you’re back out on the streets,” says Bandoske.

The police were arresting the same people over and over again; many not only had a serious mental illness but were also addicted to drugs or alcohol and were often homeless. And whether they went to the jail or the ER, it was expensive for everyone—the jails, the hospitals and the police department that had to pay for overtime while cops waited at the hospital. And it meant that fewer police were available to work the streets.

San Antonio’s response was to require all officers to take a 40-hour course called Crisis Intervention Training, to learn how to handle mental-health crises like the one with Mason. The course includes visits from families of people with mental illness, who come in to tell their stories. And while some officers, like Bandoske and Stevens, specialize in mental health, all learn de-escalation techniques and how best to interact with someone in a state of psychosis.

The effort to train police to handle mental-health emergencies is gaining steam across the country. Fifteen percent of police departments nationwide offer the program.

But even with strong programs, there’s only so much that training alone can do; there’s still the problem of where to take patients like Mason, other than jail or an emergency department.

San Antonio tackled that problem, too.

“I’ll be honest with you. When it first came out, I was very skeptical. I thought, well this is ridiculous. If somebody’s breaking the law, if they’re public intoxication, they should go to jail,” says Bandoske.

People who commit a felony still go to jail, regardless of their mental status. And those who need extensive medical care are still taken to the hospital.

But for patients like Mason, San Antonio built another option: the Restoration Center—a totally separate facility with a 16-bed psych unit, a medical clinic and a “sobering room” where police can drop off people who are intoxicated.

The Restoration Center was built with cops in mind to allow them to drop off their charges as quickly as possible. There’s a work station for paperwork, free coffee and a nurse available to provide medical clearance for people who are arrested, even those without a mental illness, to save the police a trip to the ER whenever possible. The center is saving the police department at least $600,000 a year in overtime pay.

Restoration Center nurse Catherine Riojas checks Mason in immediately after Bandoske and Stevens arrive with him at the center.

Mason seems more settled now, as she collects all of his property—cigarettes, jewelry and a folded piece of construction paper with a poem. She gives Mason a physical and helps him get settled in the 48-hour inpatient psychiatric unit.

And then, about 15 minutes from the time the police walked through the door of the center, they’re heading out again, ready to get back on the street.

“OK Mason, good luck. OK buddy? Hope you feel better,” Stevens calls to him, and waves. 

This post appears courtesy of Kaiser Health News.

Presented by

Jenny Gold writes for Kaiser Health News. Her work has also appeared on NPR and in the Washington Post.

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